RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01285
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20081222

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

CI CONTENTION:  “Over 10 years later and still have significant pain from back, knee and shoulder injuries.”  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 - 20081024	VARD - 20090205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rt Shoulder Pain	5099-5003	10%	Status Post Capsular Shift with Acromioclavicular Arthritis	5010-5203	10%	20080923	
Rt Knee Instability and Pain	Not Unfitting	Residuals of a Torn Rt ACL	5299-5257	10%	20080923	
Pain from Neck to Low Back with Multiple Small Disc Protrusions	Not Unfitting	DDD, Lower Back	5242	10%	20080923	
		Neck Pain	5237	NSC	20080923	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right shoulder surgery in May 2008 for instability with HAGL (humeral avulsion glenohumeral ligament) lesion.  The 26 August 2008 orthopedics examination, 4 months prior to separation, noted complaints of some pain in the anterior portion of the right shoulder at the site of the surgical incision.  Physical examination showed good range of motion (ROM) with no pain posteriorly or superiorly.  The 10 September 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of pain in the right shoulder.  Physical examination showed forward flexion of 165 degrees (normal 180) and abduction of 184 degrees (normal 180) with pain on internal rotation.  

At the 23 September 2008 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported 3-6/10 pain and catching with lifting or use above his head.  Physical examination showed normal flexion and abduction.  Motor strength was 5/5 and there was no mention of painful motion, functional impairment due to pain, pain on repetitive use, fatigue, weakness, lack of endurance or incoordination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the right shoulder condition 10%, coded 5010-5203 (clavicle or scapula, impairment) citing malunion or nonunion of the clavicle or scapula.  

The VASRD §4.71a threshold for rating 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.  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); 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 right shoulder condition.  

Contended PEB Conditions:  Right Knee Instability and Pain; Pain from Neck to Low Back with Multiple Small Disc Protrusions.  With regard to the right knee condition, the panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The knee condition was profiled and mentioned in the commander’s statement as “able to do only the walk or bike tests.”  The MEB judged the condition to not fail retention standards.  

At the 2 November 2007 orthopedic evaluation, 13 months prior to separation, the CI reported a constantly painful knee with laxity.  The examiner noted remarkable laxity.  The examiner believed that the graft would have to be redone for the CI to have a stable well-functioning knee.  During a physical therapy evaluation on 20 August 2007 the CI was being fitted for a new ACL support brace and was not planning on doing any “truly” athletic activities but was continuing as a volunteer firefighter.  

At the NARSUM orthopedic examination on 10 September 2008 the knee had trace laxity, flexion of 128 degrees (normal 140) and extension of 4 degrees  (normal 0) with 3/10 pain.  At the 23 September 2008 C&P examination, 3 months before separation, the CI reported pain and popping and that his knee gave out on him with pain varying from 0- 8/10.  ROM of the right knee showed extension of 0 degrees and flexion of 140 degrees.  Repetitive ROM (completed 10 times) was negative for pathology.  Ligament tests showed the anterior drawer was 2+ with no endpoint.  Medial collateral ligament was bilaterally positive.  Pivot shift was 2+.  Lachman was 3+ with no endpoint.  Posterior drawer was negative.  Meniscal signs were negative.  Though it is clear that the CI had ongoing issues with his knee, he was able to do most activities including volunteer firefighter duties.  The panel concluded there was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation and thus there is not a preponderance of evidence to overturn the finding that the right knee was not unfitting.  

With regard to the contended neck and low back pain, once again the panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Neither of the conditions were 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 determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right shoulder pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right knee instability, the panel agrees it cannot recommend it for additional disability rating.  In the matter of the contended pain from the neck to the low back with multiple small disc protrusions, 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.  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 20170224, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180008653, 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