RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-01840
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050501

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Motor Transport Operator, medically separated for “right shoulder pain” with a disability rating of 10%.    

CI CONTENTION:  “Diagnosis PTSD not Adjustment Disorder; 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 - 20050418	VARD - 20080929	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5099-5003	10%	Residuals of Right Shoulder Injury 	5201	20%	20051212	
Adjustment Disorder	Not Unfitting 	Adjustment Disorder	9440	NSC	NA	
Headaches	Not Unfitting 	Tension Headaches	8199-8100	0%	20051212	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI experienced immediate right (dominant) anterior shoulder pain in June 2004 while assisting a passenger (who slipped) into a truck.  Despite physical therapy (PT), injections and medication, the pain persisted.  Magnetic resonance imaging (MRI) studies on 30 June 2004 showed minimal degenerative changes to the right acromioclavicular (AC) joint and a small effusion within the right glenoid humeral joint.  The CI reportedly fell on 13 September 2004 and sought treatment at the emergency room (ER), where physical examination showed no acute distress, shoulder tenderness, full range of motion (ROM), and normal motor and sensory findings.  Shoulder X-rays were normal and surgery was not indicated.  At an 18 October 2004 orthopedic clinic appointment, ROM was flexion of 150 degrees (normal 180) and abduction of 150 degrees (normal 180); painful motion was not addressed. 

The 16 November 2004 MEB NARSUM examination, 5 months prior to separation, noted CI complaints of right shoulder pain.  Physical examination showed positive signs of sub acromial and AC joint impingement, but was otherwise unremarkable.  Right shoulder flexion was to 145 degrees and abduction to 120 degrees.  

At the 12 December 2005 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported right shoulder pain and stiffness, but no swelling, heat, redness, instability, or giving out.  She experienced increased pain and stiffness when holding her baby longer than 10-15 minutes, but was able to perform all daily activities and had no restrictions.  Physical examination showed tenderness in the posterior deltoid.  Right shoulder ROM demonstrated flexion and abduction to 140 degrees, both with pain.  There was no additional limitation of motion following repetitive use, but the CI had increased pain and fatigue.  Shoulder X-rays showed no significant bone pathology.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing application of the US Army Physical Disability Agency pain policy and ROM above shoulder level, but restricted by pain.  The VA rated the right shoulder condition 20%, coded 5201 (arm, limitation of motion), based on the C&P examination, citing evidence of pain at 90 degrees of flexion with increased pain and fatigue on repetitive use.   Members noted that the VASRD §4.71a threshold for rating for ROM impairment under code 5201 is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level.  However, the panel 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 code 5202 (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under code 5203 (clavicle or scapula, impairment of).  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:  Adjustment Disorder and Headaches.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  

Adjustment Disorder.  Adjustment disorder is not a condition that constitutes a disability IAW DoDI 1332-38.

Headaches. The 5 April 2005 MEB neurology addendum documented that the CI was originally seen by neurology in August 2004 after being treated in the ER for a right-sided headache.  She had no prior history of headaches and was treated with multiple medications with minimal improvement.  An MRI was normal and she did not follow-up with neurology until 6 months later, when she complained of daily headaches that had increased with activity.  She reported two ER visits, with some relief, and the examiner diagnosed headaches, “which are at times prostrating,” and failed retention standards.  The STR showed the CI was treated for headaches in the ER and put on quarters on 6 August 2004 (72 hours) and 9 August 2004 (24 hours).  Additional ER visits on 13 October and 19 October 2004, and 20 January 2005, resulted in no quarters or restrictions.  Treatment records fell silent with regard to care for headaches between January 2005 and the time of separation, and the commander’s statement did not implicate the headaches.  At the C&P examination, the CI reported less frequent headaches, and was not working in order to care full-time for her 3-year-old son.  She did not take any medication, and neurological findings were normal.  The provider diagnosed tension headaches that were sometimes prostrating, but were gradually remitting upon return to civilian life.  

The panel considered the results of the MEB neurology and C&P examinations along with the evidence from treatment records to accurately assess the CI’s overall disability picture (§4.2) at the time of separation.  Panel members noted there were no prostrating headaches occurring on average once every 2 months, or more frequently, over the several months prior to separation to support a rating higher than 0%.  After due deliberation, the panel agreed the preponderance of the evidence with regard to the functional impairment of headaches favors its recommendation as an additionally unfitting condition for disability rating.  It is appropriately coded 8100 and meets the VASRD §4.124a criteria for a 0% rating.  

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 adjustment disorder, the panel recommends no change from the PEB determination.  In the matter of the contended headache condition, the panel agrees it was unfitting and recommends a disability rating of 0%, coded 8100 IAW VASRD §4.124.  There are no other conditions within the panel’s scope of review for consideration. As the proposed new combined disability ratings result in no change to the disability rating previously assigned, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

AR20180015087 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.