RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00652
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Signal Support Specialist, medically separated for “chronic left shoulder pain” with a disability rating of 0%.   

CI CONTENTION:  “Please 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 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 - 20051024	VARD - 20060501	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	0%	Residuals, Left Shoulder Injury with Episodic Left Sensory Radiculitis and Degenerative Change	5201-5010	10%	20060112	
Migraine	Not Unfitting	Migraine Headaches	8100	0%	20060112	
Medium Hiatal Hernia	Not Unfitting 	Hiatal Hernia	7346	0%	20060112	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left (Non-Dominant) Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left shoulder pain condition began in June 2002 when he was involved in a bicycle accident, separated his left acromioclavicular (AC) joint (confirmed by X-rays), and banged his neck and head.  Despite shoulder immobilization and physical therapy (PT), his pain had not resolved 7 months later.  
During the 21 July 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported constant aching of the left upper extremity.  Physical examination showed a prominent left AC joint with limited left shoulder anterior and posterior range of motion (ROM).  The 8 August 2005 MEB PT ROM study showed flexion to 145 degrees (normal 180); abduction was to 133 degrees (normal 180) and limited by pain.  The 23 September 2005 MEB NARSUM examination, 3 months before separation, noted complaints of persistent left shoulder pain.  Physical examination showed a left tipoff deformity between the clavicle and acromion, AC joint tenderness, and full but painful ROM.  

At the 12 January 2006 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported pain with lifting and an inability to perform push-ups and sit-ups.  Physical examination showed left shoulder flexion to 170 degrees and abduction to 160 with painful motion in both planes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left shoulder pain condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing slight, occasional pain IAW the US Army Physical Disability Agency pain policy. The VA rated the left shoulder condition 10%, coded 5201-5010 (arm limitation of motion-traumatic arthritis), based on the STR or C&P evaluation, citing painful motion.  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 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 recommends a disability rating of 10% for the chronic left shoulder pain condition, coded 5099-5003.  

Contended PEB Conditions:  Migraines and Medium Hiatal Hernia.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The hiatal hernia condition was not profiled.  The migraine headache condition was profiled P2. Neither condition was implicated in the commander’s statement but both were 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 there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic left shoulder pain condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended migraine and hiatal hernia conditions, the panel recommends no change from the PEB determinations as not unfitting.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Shoulder Pain	5099-5003	10%	

AR20190011842, 

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.