RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01145
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040820

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Heavy Construction Equipment Operator, medically separated for “chronic right shoulder pain” and “hearing loss,” each rated at 0%, with a combined disability rating of 0%.  

CI CONTENTION:  “Right shoulder shrapnel, right ear hearing impaired and right knee strain/hyperextension.”  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 - 20040614	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5099-5003	0%	
No VA Examination Proximate to Separation in Evidence 
	
Hearing Loss	6100	0%		
Right Knee Pain Injury	Not Unfitting		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a right (dominant) shoulder shrapnel injury on 3 February 2004 while deployed to Iraq.  He had two procedures to irrigate the wound and debride non-viable tissue in the days immediately after the incident.  Right shoulder magnetic resonance imaging in July 2005 showed: mild degenerative changes of the acromioclavicular (AC) joint with sub deltoid/sub acromial bursitis, tendinosis of the distal supraspinatus tendon, and post-traumatic changes adjacent to the proximal shaft humerus limiting evaluation of the biceps tendon.  

At the 20 February 2004 physical therapy evaluation, 5 months prior to separation, physical examination showed shoulder range of motion (ROM) was “normal except internal rotation” and pain was increased with internal and external rotation.  The examiner also noted “compensation” with active ROM suggesting painful motion.  

The 26 May 2004 MEB NARSUM examination, 3 months before separation, noted complaints of right shoulder pain and an inability to perform military specialty tasks.  Physical examination showed popping with right shoulder movements.  The examiner referred to a PT ROM evaluation which was not in evidence.  The PEB recorded 135 degrees of abduction (normal 180) but did not mention forward flexion.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing minimal/occasional pain with likely application of the US Army Physical Disability Agency pain policy.  Although there was insufficient evidence of limitation of motion to support a rating under code 5201, members agreed that a 10% rating is justified for a major joint with radiographic (X-ray) evidence of arthritis and non-compensable ROM under code 5003.  There was no evidence to support consideration of a higher rating under code 5203 (impairment of clavicle or scapula) or code 5202 (other impairment of humerus).  The panel agreed that an additional rating using code 5304 (Muscle Group IV function: stabilization of shoulder against injury in strong movements), would violate VASRD §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right shoulder condition, coded 5099-5003.  

Hearing Loss.  According to the STR and MEB NARSUM, the CI’s hearing loss condition began in February 2004 after an improvised explosive device (IED) explosion while deployed.  During a 20 February 2004 audiology examination, 4 months prior to separation, the CI reported right ear hearing loss and ringing associated with the explosion.  Pure-tone audiogram examination showed mild to moderate right ear hearing loss in all tested frequencies.  The left ear showed normal to mild loss.  Speech discrimination testing was 100% bilaterally.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the hearing loss condition 0%, coded 6100 (evaluation based on Table VII).  Applying the audiogram and speech recognition findings to Tables VI and VII of VASRD §4.85 (evaluation of hearing impairment), the panel agreed that a 0% rating, and no higher is justified, as adjudicated 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 hearing loss condition.  

Contended PEB Condition:  Right Knee Injury.  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 profiled as L2; however, it was not implicated in the commander’s statement nor judged to fail retention standards.  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, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the hearing loss condition and IAW VASRD §4.85, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended right knee 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.  

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	
Chronic Pain, Right Shoulder Shrapnel Injury	5099-5003	10%	
Hearing Loss	6100	0%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161004, w/attachments
Exhibit B.  Service Treatment Record

AR20170018881, 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