RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00052
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20060412

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Combat Engineer, medically separated for “chronic pain, left shoulder” with a disability rating of 10%.  

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 - 20051128	VARD - 20061114	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Shoulder	5099-5003	10%	Left Shoulder Impingement	5024	10%	20061017	
Lower Extremity Pain, Secondary To Exertional Myalgias Related To Thrombocytosis	5099-5021	EPTS	Right Lower Extremity Peripheral Vascular Disease, Claimed As Claudication	7114	20%	20061002	
			Left Lower Extremity… Claudication	7199-7114	NSC	20061002	
Chronic Low Back Pain	5243	EPTS	Lumbar Strain	5237	10%	20061017	
Essential Thrombocytosis, Requiring Continuous Medication To Control	7799-7705	EPTS	Thrombocytopenia	7705	NSC	20061002	
Migraine Headaches, Not Prostrating	8100	EPTS	Migraines	8100	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70% 	

ANALYSIS SUMMARY:  

Chronic Left Shoulder Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left shoulder condition began in November 2003 after lifting weights.  Physical therapy improved symptoms somewhat, but continued pain prevented him from performing duties of his military occupational specialty.  The 7 April 2005 MEB NARSUM examination, 12 months prior to separation, noted CI complaints of pain primarily on the posterior aspect of his shoulder exacerbated by overhead activities or heavy lifting.  Physical examination showed no edema, erythema, obvious deformities or atrophy.  Active shoulder range of motion (ROM) was 170 degrees (normal 180) forward flexion and 165 degrees (normal 180) abduction, with mildly increased symptoms at the upper limits of flexion and abduction.  Motor strength was 4+/5 for the teres minor and infraspinatus, and 4/5 for supraspinatus and subscapularis.  Hawkins and Neer testing was positive (for impingement).  

At the 17 October 2006 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported recurring left shoulder pain and weakness, stiffness, swelling, giving way, lack of endurance and locking with the pain level up to 8/10.  Physical examination showed flexion of 150 degrees and abduction of 120 degrees, both with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the left shoulder condition 10%, coded 5024 (tenosynovitis), based on the C&P evaluation 6 months after separation, citing painful or limited motion of a major joint.  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.  However, members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating 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 there was insufficient cause to recommend a change in the PEB adjudication for the chronic left shoulder pain condition.  

Contended PEB Conditions:  Lower Extremity Pain, Chronic Low Back Pain, Essential Thrombocytosis and Migraine Headaches.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Low back pain, essential thrombocytosis and migraine headaches conditions were profiled and implicated in the commander’s statement and judged to fail retention standards by the MEB.  There was performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation.  However, the PEB correctly concluded that these conditions existed prior to entering active duty based on the NARSUM, CI sworn testimony, and statements by counsel, and there was also no evidence that any of the conditions were exacerbated while on active duty.  After due deliberation, the panel concluded 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 chronic left shoulder condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended lower extremity pain, chronic low back pain, essential thrombocytosis and migraine headaches 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.  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 20161207, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180003347, 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