RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02108
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050622

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Network Switching Systems Operator/Maintainer, medically separated for “chronic right shoulder pain” and “chronic low back pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  In addition to worsening of his unfitting conditions, the CI requested review of additional conditions, some of them were 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20050315	VARD - 20050628	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5003	10%	DJD AC Joint, Right Shoulder	5203	10%	20050525	
Chronic Low Back Pain	5299-5237	10%	DJD, Thoracolumbar Spine 	5242	10%		
Depressive Disorder	Not Unfitting	Adjustment Disorder 	9440	0%	20050518	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right-hand dominant CI’s right shoulder condition began in July 2004 after a fall while deployed.  An MRI of the right shoulder demonstrated a partial internal tear of the supraspinatus tendon.  There were also degenerative changes of the acromio-clavicular (AC) joint with joint thickening and fluid extending into the sub-acromial bursa.  On 17 December 2004, the CI presented for an orthopedic surgical consultation.  Physical examination revealed flexion of 160 degrees (normal 180) and abduction of 160 degrees (normal 180).  There was a positive Neer impingement sign and Yergason’s test, both indicative of painful shoulder motion.  The orthopedic surgeon noted that the CI had moderate subacromial impingement, but did not recommend surgery. 

During the 26 January 2005 MEB consultation examination, 5 months prior to separation, the CI reported chronic right shoulder pain.  Physical examination revealed no gross abnormalities.  There was some mild tenderness about the AC joint.  Strength and reflexes were normal.  He had a positive Hawkins sign for impingement.  Neer test and cross arm test revealed mild tenderness.  

The 8 February 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of persistent right shoulder pain.  Physical examination showed some mild tenderness about the right AC joint.  The Hawkins test was positive.  Strength and reflexes were normal.  The Neer test showed mild tenderness.  There was normal active ROM, but with pain at the end ranges of flexion and abduction.  

At the 25 May 2005 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported he was unable to perform overhead work.  Physical examination showed normal strength.  ROM testing showed flexion of 103 degrees and abduction of 101 degrees with pain.  Repetitive activity aggravated the right shoulder without alteration in ROM.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the shoulder condition 10%, coded 5003 (arthritis, degenerative), citing major joint with positive radiographs and limited motion.  The VA rated the right shoulder condition 10%, coded 5203 (impairment of the clavicle or scapula), based on the C&P examination, citing painful limited motion of the shoulder.  

The VASRD §4.71a threshold for rating for 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.  However, 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 and no dislocation or nonunion of the clavicle or scapula to justify a higher rating under 5202 (humerus, other impairment of) or 5203 codes.  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 right shoulder condition.  

Chronic Low Back Pain.  According to the STR and MEB NARSUM, the CI’s back condition began in October 2003 after doing sit-ups.  During the 26 January 2005 MEB consultation examination, the CI reported that his back pain was not as bothersome as his shoulder pain.  Physical examination revealed no gross abnormalities of the back.  There was mild tenderness to palpation.  Straight leg raise testing was negative.  ROM showed flexion of 75 degrees (normal 90) and combined ROM of 220 degrees (normal 240) with pain.  The physician reported the CI’s functional status was stable and the prognosis was good.  

The MEB NARSUM physical examination showed mild tenderness.  Strength and reflexes were normal.  Straight leg raise testing was negative.  X-rays showed degenerative joint disease of the thoracolumbar spine.  During the 19 May 2006 physical therapy clinic evaluation, 1 month prior to separation, the CI indicated the TENS unit he was using was therapeutic.  The CI felt that he could continue on his own and didn't need any further physical therapy.  

At the C&P evaluation the CI reported daily low back pain.  The examiner found normal gait and station.  There was very mild scoliosis present, but no spasms, gross muscle atrophy or fasciculations.  Straight leg raise testing was negative.  ROM testing showed flexion of 85 degrees and combined ROM of 175 degrees after repetitive motion.  There was pain with extension and rotation to the right.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5237 (lumbosacral or cervical strain), citing limitation of forward flexion to 75 degrees.  The VA rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing painful limited ROM with intermittent left hip pain and X-ray findings of degenerative joint disease (DJD).  

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees, as reported on the ROM examinations in evidence.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  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 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

Contended PEB Condition:  Depressive Disorder.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition 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 the 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 the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right shoulder condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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 contended depressive disorder, 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 20170328, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008190, 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