RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00230
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E4, Signal Support Systems Specialist, medically separated for “left shoulder tendinopathy with chronic pain…” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  The complete submission is 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 - 20061206	VARD - 20070731	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Tendinopathy…	5099-5003	10%	Left Shoulder Supraspinatus…	5024-5201	20%	20061129	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Shoulder.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s (right hand dominant) left shoulder condition began in May 2006 after heavy lifting.  Radiographic imaging revealed a torn tendon within the left shoulder.  

An Orthopedic evaluation dated 24 August 2006, 4 months prior to separation, documented “constant” left shoulder pain and “worse with lifting”.  The physical examination (PE) revealed global tenderness about the left shoulder coupled with painful and decreased range of motion (ROM); specifically, forward flexion of 110 degrees (normal 180) and abduction of 85 degrees (normal 180).  Surrounding muscle bulk and tone were normal and atrophy was not present.  

The 17 October 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of daily left shoulder pain and the endorsement of the inability to perform sit-ups and or pushups.  His PE revealed left shoulder tenderness and limited abduction to 70 degrees and forward flexion to 150 degrees.  There was no comment with regards to shoulder instability.  His pain scale rating was noted as “moderate” severity and “constant” frequency.    

At the 29 November 2006 VA Compensation and Pension (C&P) evaluation, performed 1 month prior to separation, the CI reported weakness, stiffness and locking with limited ROM of the left shoulder.  He endorsed a constant “aching” pain that was relieved by “itself” and with medication.  He stated that his condition “does not cause incapacitation” and his functional impairment was, “…no heavy lifting, no work above shoulder level, and no physical training”.  The PE revealed decreased and painful motion of the left shoulder; measuring 110 degrees in both forward flexion and abduction.  Pain, fatigue, weakness and lack of endurance was in evidence upon repetitive use, but without additional loss of function.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing the the US Army Physical Disability Agency pain policy.  The VA rated the same condition at 20% dual coded as 5024-5201 (tenosynovitis-arm and limitation of motion), based upon the C&P evaluation 1 month prior to separation, citing limitation of motion at shoulder level. 
  
The VASRD §4.71a threshold for rating for ROM impairment under code 5201 is “at shoulder level” (approximately 90 degrees from the side).  The next higher 30% rating for the non-dominant arm requires motion “limited to 25° from side”.  

Panel members extensively deliberated the 3 most probative examinations in this case during the 4 month period prior to separation and agreed, although noting improved ROMs at the VA examination, such information was most likely not available at the time of the PEB’s determination and that the totality of the service records would support an impairment rating of 20% based strictly upon ROM parameters.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left shoulder condition, coded 5201.  

BOARD FINDINGS:  In the matter of the left shoulder condition, the panel unanimously recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Shoulder…	5201	20%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20160415, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014142, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure