RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00764
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Radio Repairman, medically separated  for “lumbosacral strain” and “left (non-dominant) shoulder pain,” rated 20% and 0%, respectively, with a combined disability rating of 20%.  

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 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 - 20080513	VARD - 20081125	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbosacral Strain	5237	20%	Lumbar Strain	5237	20%	20080702	
Left Shoulder Pain	5099-5024	0%	Left Shoulder Tendonitis	5201	10%	20080702	
Chronic Bilateral Plantar Dermatitis	Not Unfitting	DJD, Bilateral Feet	5003	10%	20080702	
Adjustment Disorder	Not Unfitting	Adjustment Disorder	9440	10%	20080717	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Lumbosacral Strain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in July 2004 while performing lunges.  An MRI showed mild L4-5 and L5-S1 degenerative disc disease with foraminal narrowing and mild lumbar spine degenerative joint disease (DJD), but the CI was not a surgical candidate.

On 3 March 2008 a nerve condition study of the lower extremities, range of motion (ROM) testing, neurological examination and gait were normal.  The CI was able to heel and toe walk.  Muscle atrophy was absent.  A physical therapy (PT) examination, the next day, showed flexion to 55 degrees (normal 90) and combined ROM of 140 degrees (normal 240) with painful motion.  The 5 March 2008 MEB NARSUM orthopedic examination, 6 months prior to separation, noted complaints of constant back pain, aggravated by almost any activity.  Physical examination revealed spinal tenderness and “limited” flexion; no other ROM measurements were addressed.  The neurological examination and gait were normal.

At the 2 July 2008 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported constant low back pain with radiation down the right leg.  No incapacitation was reported.  Physical examination showed no evidence of radiating pain on movement.  There was spinal tenderness, but spasm was absent.  The provocative testing for nerve root irritation (radiculopathy) was negative.  Spinal flexion was 60 degrees and combined ROM was 155 degrees, with painful motion.  The gait was abnormal due to pain, but was attributed to the left foot and ankle.  At a pain management evaluation on 17 September 2008, 3 weeks after separation the CI reported ongoing back pain with radiation into the right lower extremity.  Physical examination revealed an abnormal gait and spinal tenderness.  Sensation was decreased in the right lower extremity and strength was 4/5 in the bilateral lower extremities.  Flexion and extension were decreased but not quantified.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the low back condition 20%, coded 5237 (lumbosacral strain), citing limited ROM.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion greater than 30 degrees but not greater than 60 degrees, as reported on the PT and VA examinations.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3, the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

Left (Non-Dominant) Shoulder Pain.  According to the STR and MEB NARSUM, the CI’s left shoulder condition began in early 2007 without injury or trauma.  X-rays were normal, but an MRI showed mild tendinosis of the infraspinatus and minimal degenerative changes and hypertrophy of the acromioclavicular joint (ACJ).  The MEB NARSUM orthopedic examination, 6 months prior to separation, noted left shoulder pain aggravated by activity.  Physical examination revealed “full” ROM.  Tests for impingement, ACJ pathology, rotator cuff tears, and internal shoulder pathology were negative.  Motor strength was 5/5.

At the C&P evaluation the CI reported constant left shoulder pain aggravated by physical activity.  Physical examination showed no signs of edema, effusion, weakness, tenderness, redness, heat or subluxation.  Tenderness and guarding of movement were present.  Left shoulder flexion was 160 degrees (normal 180) and abduction was 120 degrees (normal 180), with painful motion.  The neurological examination was normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 0%, analogously coded 5099-5024 (tenosynovitis), citing good stability and full motion.  The VA rated the left shoulder condition 10%, coded 5201 (arm, limitation of motion), based on the C&P examination, citing painful motion.

There was evidence of mild ACJ pathology to support a 10% rating under the 5203 code (clavicle or scapula, impairment).  There was insufficient limitation of motion to support a rating under code 5201 (limitation of shoulder motion), but panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion), as recorded on the VA examination most proximate to separation.  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment).  The panel agreed the pain impairment was a component of both VASRD §4.59 and code 5203, but could only be applied to one rating without pyramiding (§4.14).  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 5203.

Contended PEB Conditions:  Chronic Bilateral Plantar Dermatitis and Adjustment Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The panel noted that IAW DoDI 1332.38, adjustment disorder was not considered to be a physical disability.  The dermatitis was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that either 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 determinations for the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the left shoulder condition, the panel recommends a disability rating of 10%, coded 5099-5024 IAW VASRD §4.71a.  In the matter of the contended dermatitis and adjustment disorder, the panel recommends no change from the PEB determinations as not unfitting.  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; and, the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbosacral Strain	5237	20%	
Left (Non-Dominant) Shoulder Pain	5203	10%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004898, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs. 

Sincerely,					      
Enclosure