RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00278
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070408

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Combat Engineer, medically separated for “chronic left shoulder pain,” with a disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  The 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 - 20070308	VARD - 20080425	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	0%	[Surgical Residuals] Left Shoulder	5201	20%	STR	
Depression and Anxiety	Not Unfitting	Depression with Anxiety	9434	0%		
Plantar Fasciitis	Not Unfitting	Plantar Fasciitis, Left Foot	5299-5284	0%		
		Plantar Fasciitis, Right Foot	5299-5284	0%		
COMBINED RATING:  0%	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 injured his left (non-dominant) shoulder in January 2006. He was diagnosed with a labral tear and underwent an arthroscopic surgical repair that April (11 months before separation).  Post-operative STR entries indicated that range of motion (ROM) remained significantly limited by gross observation, although no measurements were provided.  There was STR confirmation of joint stability and the absence of impingement, and there were no entries that documented any additional VASRD-ratable findings.
The 08 February 2007 NARSUM examination, 2 months prior to separation, documented constant pain rated 3/10 at baseline that increased “sharply” with attempts at lifting or “unusual movements,” and that prohibited most general soldiering requirements.  The physical examination recorded some weakness (3/5) due to guarding and did not comment on any subluxation or instability.  Measured ROM was average forward flexion to 100 degrees (normal 180) and average abduction to 80 degrees (normal 180).  Measurements recorded on the MEB’s DD Form 2808 physical examination (same examiner and date as the NARSUM) were very similar and equivalent for rating purposes.

The CI failed to report for a scheduled VA examination, and there was no other probative post-separation evidence in this case.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 0% rating under code 5099-5003 (analogous to degenerative arthritis) cited “pain-limited” ROM suggesting application of Army Regulation 635-40 (B-29, e).  The VA‘s 20% rating, based on the same STR evidence, was under code 5201 (limitation of motion) and cited the applicable criterion of “limitation of arm motion at shoulder level” (90 degrees).  Code 5201 also yields a 20% minor rating for limitation “midway between side and shoulder level” (45 degrees), and requires a limitation to at least 25 degrees for any higher rating.

The only ROM evidence in this case compliant with VASRD §4.46 (accurate measurement) was that from the NARSUM, corroborated in the DD Form 2808.  Members readily agreed that the abduction limited to 80 degrees, as per that evidence, satisfied the above 20% criterion of code 5201.  The same evidence did not support any higher rating under code 5201.  There was no evidence for ankylosis, fracture complications, or subluxation (instability) that would support a higher rating via any other applicable code available under VASRD §4.71a.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a 20% rating for the left shoulder condition under code 5201.

Contended PEB Conditions:  Depression and Anxiety, and Plantar Fasciitis (Bilateral).  The NARSUM referenced a recent mental evaluation for a 2-year history of depression and anxiety under treatment by a civilian provider, but there was no source evidence for the service evaluation.  The NARSUM referenced a chronic history of plantar fasciitis treated with orthotics without further elaboration.  Neither of these conditions were clinically active during the MEB period.  Both were judged to meet retention standards; neither was profiled throughout service; and, neither was implicated in the commander’s performance statement.  

The panel’s main charge was to assess the fairness of the PEB’s determinations that the above conditions were not unfitting.  Members agreed that there was no performance-based evidence indicating that either of the above conditions interfered with duty requirements to an extent that would have prohibited further military service.  

After due deliberation in consideration of the preponderance of the evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determinations for the mental health or plantar fasciitis conditions; thus, neither was eligible for service rating.

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.  In the matter of the contended mental health and plantar fasciitis conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  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 his prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Labral Injury with Surgical Residuals, Left Shoulder	5201	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160430, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170014147, 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