RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-01179
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040604

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E6, Construction Equipment Repairer, medically separated for “left shoulder injury” with a disability rating of 10%.  

CI CONTENTION:  “Continued issue with shoulder and knees, also had a claim for sinus problems I developed after Iraq.  Had to take pain medicine for shoulder.”  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 - 20040415	VARD - 20050224	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Injury	5099-5003	10%	Left Shoulder Impingement with Partial Rotator Cuff Tear	5201	20%	20050202	
Bilateral Infrapatellar Tendinitis	Not Unfitting	Patellofemoral Pain Syndrome, Left Knee	5099-5024	10%	20050202	
		Patellofemoral Pain Syndrome, Right Knee	5099-5024	10%	20050202	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Left Shoulder Injury.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI initially injured his left shoulder while lifting tires overhead while deployed in August 2003.  He felt something pop in his left shoulder while tightening a torque wrench in October 2003 and then injured his shoulder further while bench pressing for physical training in November 2003.  X-rays demonstrated a left Grade 1 AC (acromioclavicular) separation.  X-rays dated 19 November 2003 revealed left shoulder impingement and a magnetic resonance arthrogram (MRA) dated 3 December 2003 demonstrated no evidence of labral injury and mild undersurface irregularity of the supraspinatus tendon.  The CI subsequently had a subacromial injection and underwent physical therapy.  However on 21 January 2004, the CI underwent a left shoulder examination under anesthesia for left shoulder impingement with a partial-thickness rotator cuff tear.  An arthroscopic subacromial decompression and partial thickness rotator cuff tear debridement were then performed.  

The 24 March 2004 MEB NARSUM evaluation, 2 months prior to separation, noted complaints of severe shoulder pain with an inability to lift anything over his head or to pull anything at waist level.  The CI also stated that he was unable to carry a rucksack, shoot a weapon or lift anything heavy above his waist level.  Shoulder dislocations were not reported.  Physical examination showed left shoulder range of motion (ROM) at 120 degrees flexion (normal 180) and 120 degrees abduction (normal 180).  He had 4+/5 external rotation strength and negative apprehension (a possible torn labrum or anterior instability) and posterior load shift tests (instability).  Subscapularis liftoff (to determine subscapularis muscle rupture) was normal and Neer’s and Hawkin’s tests (to determine subacromial impingement) were +/-.  He also had a negative O’Brien’s test (test for glenohumeral joint labral tear).  
 
At the 2 February 2005 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported left shoulder pain at 3-4/10 (10 being the worst pain).  He reported his pain could approach 7/10 approximately once per week lasting several hours.  He denied any dislocation or subluxation of his shoulder.  He denied any functional impairment during flare-ups or any residual impairments during repetitive use.  Physical examination showed left shoulder ROM with 160 degrees flexion with pain and 90 degrees abduction with pain.  His muscle strength was “good,” and his sensation and reflexes were intact.  X-rays of the shoulders on 2 February 2002 were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5099-5003 code (arthritis, degenerative), citing painful/loss of motion.  The VA assigned a 20% rating using the 5201 code (limitation of arm motion) for limitation of motion.   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 above this level, albeit to 120 degrees noted at the NARSUM for flexion and abduction.  Members discussed whether those measurements which the PEB noted were passive rather than active, albeit active and passive measurements were the same at the NARSUM, would be in compliance with the shoulder level, which is approximately 90 degrees.  Based on the surgical procedures and the CI reports of being unable to lift over his head or pull anything at the waist level, the shoulder level appeared to be the CI’s functional limit.  While the VA examination was 7 months after separation, members noted whereas flexion was 160 degrees with pain, abduction was 90 degrees with pain, thereby additionally supporting a 20% rating, based on the abduction limitation.  Therefore, panel members determined that a 20% rating is not inappropriate using code 5201.  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 injury condition, coded 5201.  

Contended PEB Condition:  Bilateral Infrapatellar Tendinitis.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left shoulder injury condition, the panel unanimously recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  In the matter of the contended bilateral 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	
Left Shoulder Injury	5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018489, 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