RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01894
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20050518

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cannon Crewmember, medically separated for “chronic neck pain” and “chronic left shoulder pain and instability,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  The CI requested review of a condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 - 20050304	VARD - 20051028	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5237	10%	Status Post Shrapnel Wound of Neck	5299-5237	20%	20050725	
			Scars of Neck	7800	30%	20050725	
Chronic Left Shoulder Pain and Instability	5099-5003	10%	Status Post Shrapnel Wound Left Shoulder with Scar and Status Post Bankart Repair	5299-5202	10%	20050725	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60% 	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent cervical spine surgery with wound exploration, debridement and irrigation of infection in October 2003 for left posterior neck wound after a shrapnel injury following an IED blast.  Post-surgical X-ray studies on 31 October 2003 were normal with no fracture or subluxation.  The 23 November 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of cervical stiffness and pain.  Physical examination showed a well-healed scar over the anterior lateral aspect of the neck.  Muscle strength of the upper extremities was 5/5 and equal bilaterally.  Light touch was intact in all dermatomes.  Range of motion (ROM) by physical therapy (PT), using a goniometer, showed active flexion of 30 degrees (normal 45) and combined ROM of 195 degrees (normal 340).  

At the 25 July 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported chronic neck pain.  Physical examination showed trauma sites of the left lateral neck with numbness distal to the scar of his neck by 3-4 inches.  There was no lymphadenopathy of the neck.  The cervical spine ROM measurements were active flexion of 25 degrees and combined ROM of 175 degrees.  There was mild fatigability, mild loss of ROM but no loss of coordination.  X-ray studies of the cervical spine showed no acute fracture, subluxation or dislocation from C1 to T1.  There was no soft tissue swelling identified.  The intervertebral disc space heights were approximately preserved throughout the cervical spine and no neuro-foraminal stenosis was seen.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5237 (cervical strain), citing limitation of motion.  The VA rated the neck condition 20%, coded 5299-5237, based on the C&P examination, citing evidence of visible or palpable tissue loss and limited forward flexion.  

Although the PEB cited passive cervical flexion to 35 degrees in its rationale, the VASRD rating criteria is based on active ROM.  Therefore, the panel agreed that a 20% rating, but no higher, was justified for limitation of active flexion (greater than 15 degrees but not greater than 30 degrees) as reported on the MEB NARSUM and VA examinations.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the neck condition, coded 5237.  

Chronic Left Shoulder Pain and Instability.  According to the STR and MEB NARSUM, the CI underwent left shoulder surgery in February 2003 for a left scapula fracture and Bankart repair from shrapnel injuries resulting from an IED blast.  The CI was diagnosed with left shoulder instability.  X-ray studies on 12 February 2004 showed normal anatomic alignment with no fracture or subluxation.  The joint spaces were well preserved and the bones and soft tissues were normal.  At the 17 February 2004 PT appointment, 5-days post bankart repair, examination of the left shoulder ROM showed flexion of 80 degrees (normal 180) and abduction of 30 degrees (normal 180).  One week later, the physical therapist indicated the left shoulder flexion was 85 degrees and abduction was 75 degrees.  

The 23 November 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of left shoulder pain and instability.  The goniometric ROM study by PT, after repetitive movement, showed flexion and abduction of 150 degrees.  Muscle strength was 5/5 bilaterally and equal.  There was mild laxity on load and shift testing.  The Hawkins and Neer tests (indicative of painful motion) were negative.  Sulcus and apprehension signs (indicative of instability) were also negative.  The final diagnosis was chronic left shoulder pain and instability.  

At the 25 July 2005 VA C&P evaluation, 2 months after separation, the CI reported chronic left shoulder pain and instability status post shrapnel wound.  Physical examination showed the CI with a trauma site on his left shoulder without tenderness or numbness, but there was tenderness of his left acromioclavicular joint as well as tenderness along the left supraspinatus tendon.  The CI was right-hand dominant.  The CI was able to perform finger opposition with all digits.  Left shoulder ROM following repetitive movement showed flexion of 75 degrees and abduction of 120 degrees.  There was evidence of discomfort, fatigability and crepitus with ROM testing.  X-ray studies showed that the bilateral glenohumeral joints were normally located.    There was an irregularity, likely metallic density, most consistent with a metallic foreign body possibly from prior shrapnel injury at this site.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the left shoulder condition 10%, coded 5299-5202 (other impairment of humerus), based on the C&P examination, citing moderate to severe loss in ROM.  

The VASRD §4.71a threshold for rating ROM impairment of the arm (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 the VA shoulder flexion supported a 20% rating, the panel noted multiple physical therapy ROM measurements and the NARSUM examination did not rise to the 20% threshold.  Panel members placed high probative value on the pre-separation Service examinations proximate to separation which evidenced no ratable limitation of motion 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the left shoulder condition.  

BOARD FINDINGS:  In the matter of the neck condition, the panel recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  In the matter of the left shoulder condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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, that 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	
Chronic Neck Pain	5237	20%	
Chronic Left Shoulder Pain and Instability	5099-5003	10%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20180005876, 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), XXXXXXXXXXXXXXXXXX.

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

Sincerely,					      
Enclosure