RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2017-00690
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080618

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Mortuary Affairs Specialist, medically separated for “mild left shoulder impingement” with a disability rating of 10%.   

CI CONTENTION:  “Range of motion is worse.  Due to condition of shoulder I get chronic migraines.”  “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 - 20080325	VARD - 20080922	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild Left Shoulder Impingement	5099-5003	10%	Left Shoulder Impingement Syndrome	5201	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Mild Left Shoulder Impingement.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left shoulder condition began in May 2007 when the CI was involved in a rollover motor vehicle accident, one month prior to entering active duty.  The CI reported pain with pushups, overhead reaching, lifting and wearing a rucksack or load-bearing equipment (LBE).  One episode of numbness and tingling from the left shoulder to the left leg was reported along with one episode of swelling and bruising of the left shoulder.  Physical therapy and non-steroidal anti-inflammatory medicines provided some relief.  Radiographic study revealed no bony degenerative changes within the glenohumeral joint, subacromial space or acromioclavicular joint.  The 19 December 2007 physical therapy examination recorded normal range of motion (ROM) with pain.   At the 10 January 2008 examination, 5 months prior to separation, physical examination revealed no swelling, induration, erythema, or deformity.  Supraspinatus muscle tenderness was noted.  ROM was full/normal.  There was no laxity, contractures or crepitus on motion, and no pain with scapular movement.  There was no evidence of dislocation or shoulder instability.  Sensation was intact.  

During the 27 February 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, physical examination revealed left shoulder give way and weakness on extension.   The 11 March 2008 MEB NARSUM examination noted complaints of pain 5/10 with lifting, pushups, overhead reaching, and when wearing LBE and a rucksack.  Physical examination showed full ROM.  Tenderness was noted along the supraspinatus insertion and to a lesser degree, the infraspinatus tendon insertion on the humeral head.  Sulcus sign and a cross arm test were negative as was the anterior load shifts and relocation test.  Pain was elicited during impingement tests.  There was no evidence of scapula winging and muscular atrophy or hypertrophy in the upper extremities.  The CI did not attend the VA Compensation and Pension (C&P) examination.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the mild left shoulder impingement condition 10%, analogously coded 5099-5003 (degenerative arthritis) citing loss of function due to pain.  The VA also rated the left shoulder impingement syndrome condition 10%, coded 5201 (arm, limitation of motion), based on the STRs, citing painful or limited motion of a major joint.  The VASRD §4.71a threshold for rating for ROM impairment (code 5201) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level.  Although there was no 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); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment).   After due deliberation, considering all 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 mild left shoulder impingement condition.  

BOARD FINDINGS:  In the matter of the mild left shoulder impingement condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  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.

AR20190008807,  

Dear XXXXXXXXXXXXX:

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.