RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01610
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20041020

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, C41 Enhanced Operator/Maintainer, medically separated for “chronic right shoulder pain secondary to rotator cuff tendinitis” and “chronic right knee pain secondary to chondromalacia,” each rated 0%, with a combined disability rating of 0%.

CI CONTENTION:  “Review all medical 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 - 20040927	VARD - 20050627	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5024	0%	Rotator Cuff Impingement Syndrome, Right Shoulder	5299-5203	10%	20050331	
Chronic Right Knee Pain	5099-5003	0%	Right Knee Condition	5014	NSC	20050331	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Chronic Right Shoulder Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-handed CI’s right shoulder condition was initially treated in July 2003 without evidence of injury or trauma.  MRI studies showed underdevelopment of the bony structure of the shoulder with a possible cartilage injury.  The 26 March 2004 orthopedics examination noted normal right shoulder strength.  Range of motion (ROM) was “elevation” [flexion] to 180 degrees (normal 180).  During the 6 April 2004 primary care evaluation showed “full” ROM with painful motion.  A 28 June 2004 orthopedics evaluation showed a positive anterior/posterior instability test.  ROM was flexion to 170 degrees.  
According to the 20 August 2004 MEB NARSUM evaluation, 2 months prior to separation, the CI complained of right shoulder pain that prevented heavy lifting.  Physical examination showed positive signs for instability, but signs of impingement were absent.  Bilateral ROM was flexion to 170 degrees.  He was diagnosed with rotator cuff tendonitis.  A physical therapy examination also performed on 20 August 2004 revealed flexion of 180 degrees and abduction to 180 degrees (normal); painful motion was not addressed.

At the 31 March 2005 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported ongoing shoulder pain.  The neurological examination was normal.  Flexion was 165 degrees and abduction was 108 degrees both measured after exercise. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 5024 code (tenosynovitis), citing painful motion.  The VA assigned a 10% rating, analogously coded 5299-5203 (clavicle or scapula, impairment), based on the C&P examination 5 months after separation, citing slight limitation of motion.  Although there was no limitation of motion of the shoulder to support a rating under diagnostic code 5201 (arm, limitation of motion), panel members agreed that a 10% rating under code 5024 was justified with application of VASRD §4.59, §4.40 and §4.45 (painful motion and functional loss) and radiographic evidence of the right shoulder pathology.  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 5024.

Chronic Right Knee Pain.  According to the MEB NARSUM, the CI’s right knee condition began in 2002 with gradual onset.  The pain was aggravated by activity.  There was no surgical indication mentioned.  The 20 August 2004 MEB NARSUM physical examination, 2 months prior to separation, showed no effusion or crepitus.  Extension and flexion were 0-130 degrees (normal 0-140) with pain noted at the endpoint of flexion.  The examiner noted pain with loading of the patellar joint.  The knee was stable and without signs of meniscal irritation.  There was no evidence of patellar subluxation.

At the C&P evaluation physical examination essentially mirrored the MEB NARSUM examination.  There was no effusion or tenderness.  The right knee was stable and meniscus testing was negative.  Repetitive extension to flexion was 0-131 degrees; painful motion was not addressed.  X-rays were normal.  The examiner determined there was insufficient evidence to render a diagnosis.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing normal X-rays, no instability or loss of joint motion.  The VA did not service-connect the right knee condition, coded 5014 (osteomalacia), based on the C&P examination 5 months after separation, citing no permanent residual or chronic disability subject to service connection.

The panel majority agreed there was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under those codes.  There was no fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  No additional functional limitation was evidenced by the examinations.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded there was insufficient cause to recommend a change in the PEB adjudication for the chronic right knee condition.

BOARD FINDINGS:  In the matter of the right shoulder condition, the panel unanimously recommends a disability rating of 10%, coded 5024 IAW VASRD §4.71a.  In the matter of the chronic right knee condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommends a right knee modification to 10%, but elected not to submit a minority opinion.  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 Right Shoulder Pain	5024	10%	
Chronic Right Knee Pain	5099-5003	0%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161019, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180002557, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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