RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00294
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070401

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, SATCOM Systems Operator, medically separated for “right (dominant) shoulder pain” and “left great toe arthrodesis,” rated 20% and 0%, respectively, with a combined disability rating of 20%.  

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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20070220	VARD - 20070726	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5099-5010-5201	20%	Right Shoulder… S/P Repair	5010	10%	20070312	
Left Great Toe Arthrodesis	5299-5282	0%	DJD… Left Toe	5010	0%	20070312	
Depression	Not Unfitting	Depression	9434	10%	20070303	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Shoulder.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the right-hand dominant CI underwent right open shoulder surgery in August 2006, 8 months prior to separation, for instability and a torn labrum.  Post-surgical X-rays showed acromioclavicular arthrosis (degenerative changes) and development of a Hill-Sachs type (compression) fracture with post-surgical changes.  

The 16 October 2006 MEB NARSUM examination, 6 months prior to separation, noted complaints of right shoulder pain with overhead lifting or reaching, inability to wear a rucksack and inability to lift or fire his weapon.  The shoulder hurt with walking without any load with a painful arm swing.  Physical examination showed well healed right shoulder surgical scars with no distal neurovascular deficit.  Right shoulder range of motion (ROM) measurements were forward flexion of 120 degrees (normal 180) and abduction to 90 degrees (normal 180).  The 1 January 2007 NARSUM addendum, 3 months prior to separation, documented right shoulder painful ROM with forward flexion of 120 degrees and abduction to 90 degrees.  At the 9 January 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported a painful right shoulder with an acromioclavicular joint that popped and led to shoulder dislocation.  Physical examination showed decreased and painful ROM of the right shoulder (no measurements).  

At the 12 March 2007 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported right shoulder pain with lifting and physical activity.  Physical examination showed the right shoulder with no redness, swelling, or tenderness, and well healed surgical scars.  There was no decreased in strength.  There was painful motion with ROM of forward flexion to 142 degrees (normal 180) and abduction to 124 degrees (normal 180).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 20%, analogously coded 5099-5010-5201 (arthritis due to trauma - arm, limitation of motion), citing 90 degrees of abduction.  The VA rated the right shoulder condition 10% coded 5010 (arthritis due to trauma), based on the C&P examination a month before separation, citing 140 degrees of flexion and 125 degrees of abduction.  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 NARSUM examination demonstrated motion limited to this level.  The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level.”  However, examinations did not reflect this degree of limitation.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available 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 Great Toe.  According to the STR and MEB NARSUM, the CI underwent left great toe surgery (arthrodesis [fusion] of the interphalangeal [IP] joint) in March 2005 for degenerative joint disease (DJD) and contracture of the left great toe (as well similar surgery on the second and third toes).  Note:  The IP joint is the joint within the great toe, while the metatarsal phalangeal joint (MTP) is the joint between the toe and the foot.  

The 16 October 2006 MEB NARSUM examination noted complaints of left great toe fusion with pain increased with walking.  Physical examination showed no motion of the IP joint and painful motion of the MTP joint.  The 1 January 2007 NARSUM addendum, 3 months prior to separation, showed formal ROM measurements with left great toe painful motion and the IP joint fused at 10 degrees of flexion.  At the 9 January 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported left foot problems with the big toe and two little toes not bending correctly, with difficulty walking and standing.  Physical examination showed fusion of the left great toe IP joint.  

At the 12 March 2007 C&P examination the CI reported left great toe IP fusion for contracture and pain after standing for longer than a few minutes and with prolonged ambulation and he was completely unable to run.  Physical examination showed normal posture and gait.  There was painful motion of the left great toe with 10 degrees of MTP flexion and 34 degrees of extension.  There was no movement of the fused IP joint.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left toe condition 0%, analogously coded 5299-5282 (hammer toe), citing limited ROM.  The VA rated the left toe condition 0% coded 5010 (arthritis due to trauma), based on the VA C&P examination 1 month before separation, citing DJD of left great toe post-surgery.  There was no fusion of the left great toe MTP joint and the CI retained painful motion of the great toe.  The panel adjudged that the CI’s disability picture did not more closely approximate severe Hallux rigidus or hallux valgus equivalent to amputation of the great toe for any higher rating than awarded by the PEB.  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 toe condition.  

Contended PEB Condition:  Depression.  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 profiled or judged to fail retention standards.  The commander’s statement mentioned that the CI was seeing a psychologist for depression, and also noted the CI was well motivated and determined with performance limited by physical demands.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  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 right shoulder condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the left toe condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended depression condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20160418, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180005690, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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