RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00513
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071002

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “synovitis, left (non-dominant) shoulder” with a disability rating of 0%.  

CI CONTENTION:  He is unemployable and has shoulder, back, PTSD, knees, sleep, and tinnitus issues.  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 - 20070823	VARD - 20080423	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Synovitis, Left Shoulder 	5020	0%	Synovitis, Acromioclavicular Joint	5020-5201	20%	20080924	
Lumbago	Not Unfitting 	Thoracic/Lumbar Sprain	5237	10%	20080924	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Synovitis, Left Shoulder. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right hand dominant CI’s left shoulder condition began in December 2006 during a unit football game.  Initial X-ray studies were unremarkable and the CI was treated for a muscle strain and underwent two months of physical therapy (PT).  On 16 March 2007, an MRI revealed degenerative joint disease at the left acromioclavicular (AC) shoulder joint.  Despite continued conservative therapy including local steroid injections, his left shoulder pain continued.  He was permanently profiled and sent for MEB.  

On 21 June 2007 at the PT evaluation 4 months prior to separation, the CI’s left shoulder range of motion (ROM) was documented as painful, noting flexion to 150 degrees (normal 180) and abduction to 125 degrees (normal 180).  During the July 2007 MEB examination (recorded on DD Forms 2807 and 2808), 3 months prior to separation, the CI’s physical examination (PE) revealed swelling and tenderness at the left AC joint.   “Range of motion reduced primarily in abduction.”  At the 11 July 2007 MEB NARSUM examination, 3 months prior to separation, the CI’s chief complaint remained as left shoulder pain.  His PE was unchanged from the MEB examination.  His pain was rated as “moderate” and “frequent”.  A follow-up PT evaluation performed on 11 December 2007, 2 months after separation, noted 155 degrees of flexion and 145 degrees of abduction of the left shoulder with painful motion present.  On 3 January 2008, 3 months after separation, the CI underwent a surgical repair for a left-sided (new injury) collar bone fracture.  Four days after this surgery and 3 months after separation, the CI underwent a VA Compensation and Pension (C&P) evaluation whereby he reported generalized left shoulder tenderness with severely limited ROM due to the recent collar bone surgery.  The PE revealed forward flexion to 15 degrees and abduction to 70 degrees.  Both directional movements were painful.  The examiner detailed that repetitive motion was not undertaken due to the CI’s recent surgery.  At the 28 January 2008 VA orthopedic examination, 4 months after separation, the CI’s left shoulder ROM was reported as forward flexion to 180 degrees and abduction to 90 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 0%, coded 5020 (synovitis), citing persistent painful ROM.  The VA rated the left shoulder condition 20%, coded 5020-5201 (synovitis- arm limitation of motion), based upon the C&P examination, citing limitation of arm motion midway between side and shoulder level for a limitation of arm motion at shoulder level.  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, with the exception of the C&P examination completed 4 days following left-sided collar bone surgery, demonstrated motion at or above this level.  Prior to the CI’s post separation collar bone surgery, there was insufficient limitation of motion to support a rating under the 5201 code.  Panel members deliberated and agreed that ROM deficits seen after the collar bone surgery demonstrated motion above this level.  Although there was insufficient limitation of motion to support a rating under the 5201 code, panel 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 collar bone 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 recommends a disability rating of 10% for the left shoulder condition, coded 5020.  

Contended PEB Condition:  Lumbago.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Records indicated that the CI’s initial onset of back pain occurred spontaneously upon wakening on 20 February 2007.  There was only one other STR entry dated 2 weeks later that revealed low back tenderness with full ROM.  The MEB NARSUM examination physical findings performed on 11 July 2007 were unchanged from the above referenced STR encounter.  The spine specialty C&P examination conducted on 24 September 2008, 13 months after separation, revealed decreased and painful ROM of the low back.  The panel concluded that the greater probative value should be apportioned to the pre-separation examinations which indicated minimal pathology and full ROM.  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 there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left shoulder condition, the panel recommends a disability rating of 10%, coded 5020 IAW VASRD §4.71a.  In the matter of the contended lumbago condition, the panel 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 the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT  RATING	
Synovitis, Left (Non-Dominant) Shoulder	5020	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004688, 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