RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00008
BRANCH OF SERVICE:  Army 	SEPARATION DATE: 20090227  

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Cannon Crewmember, medically separated for “limitation of left (non-dominant) arm” with a disability rating of 20%.

CI CONTENTION:  The CI’s conditions continues to worsen.  The 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 - 20081110	VARD - 20110505	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Limitation of Left (Non-Dominant) Arm	5099-5003
5201	20%	Left Shoulder Dislocation, Status Post Repair	5201	20%	20110225	
			Scars, Bilateral Shoulders (see above)	7804	20%	20110225	
Degenerative Disc Disease of the Lumbosacral Spine…	Not Unfitting	Degenerative Disc Disease, Lumbar Spine	5237	10%	20110225	
Spondylolysis of L5	Not Unfitting					
		Sciatica, Left Lower Extremity	8520	Deferred 	20110225	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Limitation of the Left (non-dominant) Arm.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s condition began on 20 March 2007 after dislocating his shoulder when thrown about in an LMTV (Light Medium Tactical Vehicle) that stopped suddenly.  
Magnetic resonance imaging (MRI) of the left shoulder in August 2007 demonstrated a SLAP (superior labrum anterior posterior) tear not involving the biceps anchor, a posterior labral tear involving the labral ligamentous structures suggesting a reverse Bankart lesion (posterior labral tear), and mild rotator cuff tendinopathy involving the supraspinatus and infraspinatus tendons without full thickness.  The CI underwent non dominant left shoulder surgery in October 2007 for left posterior labral repair and capsular plication (to treat instability).  According to the physical therapy evaluation on 13 December 2007, the CI complained of numbness over his forearm.  There was tenderness but no swelling.  Left shoulder flexion was 115 degrees and abduction was 90 degrees.  An MRI dated 24 June 2008 demonstrated limited evaluation of the labrum due to an artifact with postoperative changes seen in the glenoid.  A healing Hill-Sachs lesion (cortical depression in the posterolateral head of the humerus) was present.  No rotator cuff pathology was identified.  

During the 1 August 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported he had surgery of the left shoulder and had limited active range of motion (ROM) of the left shoulder.  The examiner recorded that the CI had limited ROM and that he “was able to raise anteriorly above his head, laterally to about 145 degrees and he has pain reaching behind his back.”  The 9 September 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of shoulder pain that caused numbness in his left arm and hand.  Previous episodes of shoulder dislocation resolved after surgery.  Left shoulder flexion was 115 degrees (normal 180) and abduction was 90 degrees (normal 180).  External rotation was 75 degrees and internal rotation 95 degrees.  An apprehension test (to check for a possible torn labrum or anterior instability) was negative.  

At the 25 February 2011 VA Compensation and Pension (C&P) evaluation, 24 months after separation, the CI reported he felt his shoulder was unstable and that he had to wear a brace on the left shoulder whenever he was involved in constant activity.  He also reported flare-ups which consisted of an increase in pain that occurred with an increase in activity or cold or moist weather.  Left shoulder flexion was 90 degrees with pain occurring at 90 degrees and abduction was 85 degrees with pain occurring at 85 degrees after repetitive motion.  There was no additional limitation of motion with repetition.  The CI was unable to do external or internal rotation of his left shoulder.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the limitation of the left (non-dominant) arm 20%, coded 5099-5003 (arthritis, degenerative) and 5201 (limitation of motion of arm), citing “persistent pain limits his overhead activities” and flexion of 115 degrees and abduction 90 degrees.  The VA also assigned a 20% rating, coded 5201 code (limitation of motion of arm) for limitation of arm at shoulder level.  

The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion at this level.  The highest 30% rating for a non-dominant arm requires motion limited to “25 degrees from side,” but examinations did not reflect that degree of limitation.  There was no fibrous union or nonunion of the humerus to justify a higher rating under the 5202 code (humerus, other impairment), and no higher ratings available under the 5203 code (clavicle or scapula, impairment).  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 shoulder condition.

Contended PEB Conditions:  Degenerative Disc Disease of the Lumbosacral Spine and Spondylolysis of L5.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not implicated in the commander’s statement.  
However, the contended condition was profiled and was determined by the MEB to fail retention standards, but was adjudicated by the PEB to be not unfitting.  

The CI had a history of insidious onset of low back pain for more than 1 year with left side radiating numbness and tingling through the lateral thigh, lateral lower leg, and lateral foot.  A lumbar spine series 17 April 2008 demonstrated bilateral spondylolysis (of L5 with no evidence of spondylolisthesis and mild hypertrophic changes bilateral facet joints from L3 to L5.  Nerve conduction studies 9 May 2008 were normal without evidence of neuropathy or radiculopathy including the left leg.  An MRI dated 13 May 2008 demonstrated bilateral L4 spondylosis without spondylolisthesis.  Degenerative disc disease at L4-L5 did not affect the exiting nerve roots.  On 21 May 2008 the CI’s symptoms were consistent with biomechanical low back pain and poor lumbopelvic stability along with a possible piriformis syndrome.  No surgical intervention was warranted.  At the MEB NARSUM the CI was reported to have 94 degrees flexion (normal 90), 28 degrees of extension (normal 30) with lateral bending to the right 36 degrees (normal 30) and to the left 8 degrees (normal 30), lateral rotation to the right 22 degrees (normal 30) and to the left 16 degrees (normal 30).  There was mild tenderness to palpation at the spinous processes of lumbosacral vertebra and mild left sided paraspinous muscle tenderness.  No spasm was noted.

There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation, although panel members noted the CI was a cannon crew member limited to carrying 20 pounds, but he also had left shoulder pain; therefore, that limitation could not be attributed fully or even in part to the low back pain without speculation.  However, the record noted the low back pain was intermittent.  The panel members debated fitness and after an extensive discussion concluded the CI’s condition did not meet the preponderance of evidence to determine his condition to have been unfitting.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition; and so, no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the limitation of left arm condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended lumbar spine pain conditions (degenerative disc disease of the lumbosacral spine and spondylolysis of L5), the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151231, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013178, 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