RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02502
BRANCH OF SERVICE:  Army 	SEPARATION DATE: 20070220 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aviation Operations, medically separated for “chronic right shoulder pain” and “chronic left groin and testicular pain…” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20061201	VARD - 20070406	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5003	10%	Residuals of Right Shoulder Distal Clavicle Excision and Left Ilioinguinal Nerve Pain	5201-5022	10%	STR	
Chronic Left Groin and Testicular Pain…	8799-8730	0%	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Shoulder.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right shoulder condition began in September 2000 after sustaining an injury performing combative training.  The CI underwent an open right clavicle excision (Mumford procedure) in August 2001.  

The MEB examination in July 2006, 7 months prior to separation full range of motion (ROM) of the right shoulder with pain at the extremes.  The 15 August 2006MEB NARSUM examination, 6 months prior to separation, noted complaints of right shoulder pain located proximal to the distal clavicle down to the shoulder blade.  The pain increased with overhead work, holding the arm in a fixed position for extended periods, carrying and lifting moderate to heavy objects, and weight bearing on the shoulders and upper back.  Physical examination referenced a physical therapy examination which showed full active ROM “with discomfort and tightness at the end range except for internal rotation” at 52 degrees with soft tissue tightness and mechanical limitation.  Anterior shoulder pain and tenderness was demonstrated in abduction, forward flexion, extension, and also internal and external rotation.  There was tenderness to palpation over the acromioclavicular joint as well as diffuse tenderness along the clavicle medial to the sternoclavicular joint.  

At the 9 February 2007 VA Compensation and Pension (C&P) evaluation, performed at time of separation, the CI reported constant burning, aching, sharp right shoulder pain that was elicited by physical activity and relieved with rest.  The pain caused stiffness, lack of endurance and locking.  The CI stated that he could function without medication, however it was difficult to lift above the shoulder.  Physical examination showed the CI was right hand dominant.  The ROM of the right shoulder joint was flexion 160 degrees (normal, 180 degrees), abduction 140 degrees (normal 180 degrees), external rotation 90 degrees (normal 90 degrees) and internal rotation 60 degrees (normal 90 degrees) and all end ROMs exhibited pain.  Repetitive use of the shoulder joint exhibited pain and weakness.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, coded 5003 (degenerative arthritis), citing internal rotation limited to 50 degrees.  The VA rated the right shoulder condition 10% analogously coded 5201-5022 (periostitis), based on the VA C&P examination at time of separation, citing 160 degrees of flexion and 140 degrees of abduction with characteristic pain on motion. 

The VASRD §4.71a (code 5201, arm limitation of motion) threshold for a rating for ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion above this level.  Although there was insufficient limitation of motion to support a rating under 5201, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment of).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder condition.  

Left Groin.  According to the STR and MEB NARSUM, the CI’s groin condition began in late 2000 while performing training without specific injury or trauma.  

At the July 2006MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported chronic groin pain.  Physical examination showed positive cremaster reflex, testes descended with tenderness to palpation of the scrotum as well as the pubic region on mostly the left side.  

The15 August 2006 MEB NARSUM examination, 6 months prior to separation, noted complaints of painful swelling of the left testicle and continued left groin discomfort.  Physical examination was annotated from general surgery clinic examination performed on 21 July 2006 which revealed diffuse tenderness to palpation over the left groin with a well healed scar, normal phallus and testes with no palpable masses in the left groin.  

At the 9 February 2007 VA C&P evaluation, performed at time of separation, the CI reported pain secondary to surgical repair of a hernia.  The CI characterized the pain as constant, occasionally numb and painful to touch.  He also admitted to difficulty with prolonged standing, lifting and running.  The examiner noted the genital examination findings were within normal limits.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left groin condition 0%, analogously coded 8799-8730 (neuralgia), citing no response to ilioinguinal block and pain management.

The panel noted that the PEB rated the left groin condition analogous to neuralgia. The maximum rating for a neuralgia IAW VASRD §4.124 is equal to moderate incomplete paralysis of the nerve.  The rating for moderate incomplete paralysis of the ilioinguinal nerve is 0%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left groin condition.  

BOARD FINDINGS:  In the matter of the right shoulder condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the left groin condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  

The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151029, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013269, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
						      					
Enclosure