RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03280
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090716

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, mental health specialist, medically separated for “left shoulder pain” with a disability rating of 20%.  

CI CONTENTION:  In addition to his left shoulder, anxiety disorder, neck and hypertension, the CI requested review of additional conditions 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 - 20090616	VARD - 20100426	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain	5003	20%	Residuals of left Cuff Injury	5201	30%	20100426	
Anxiety Disorder	Not Unfitting	Generalized Anxiety Disorder	9400	30%	20100412	
Neck Pain	Not Unfitting	Degenerative Changes of the Cervical Spine	5242	10%	20100426	
Hypertension	Not Unfitting	Hypertension	7101	0%	20100426	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Left Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the right-handed CI underwent left shoulder arthroscopy with debridement of a posterior labral tear and decompression of a “spinoglenoid notch cyst" in December 2005.  He underwent a second arthroscopic procedure with subacromial decompression and repair of a longitudinal split in the left rotator cuff.  A post-surgical MRI in May 2008 showed a fissure of the posterior glenoid with reactive bone bruise, degeneration of the thickened superior glenohumeral ligament, aplasia of the middle glenohumeral ligament, partial rupture of the supraspinatus tendon, bone bruise and acromioclavicular effusion.  A CT scan showed poor bone in the posterior glenoid.  He underwent a third surgery on 18 December 2008 with arthroscopic debridement of the left labrum and open resection of the left distal clavicle.  He initially did well after this surgery, but his left shoulder pain returned and he was placed on a permanent profile.

The 13 April 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation and 4 months after surgery, showed decreased left shoulder range of motion (ROM) and referred to the physical therapy (PT) ROM evaluation.  At the 15 April 2009 PT goniometric ROM study, flexion was 120 degrees (normal 180) and abduction was 110 degrees (normal 180) with pain.  There was no change in ROM after repetition.  

During the 28 April 2009 MEB NARSUM examination, the CI complained of constant 4/10 left shoulder pain aggravated by lifting the hand.  Physical examination showed the left acromioclavicular joint was tender and left shoulder abduction strength testing was limited by pain with give-way noted.  Neer and Hawkins tests (rotator cuff/tendon impingement signs) were positive.  The examiner stated that “left shoulder ROM [was] consistent with the ROM measured by PT on 15 April 2009.”  

At the 26 April 2010 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported constant left shoulder pain, aggravated by certain movements, and limited ROM.  The CI denied a history of dislocations.  Physical examination showed normal left shoulder strength with pain against resistance, but no muscle atrophy.  There was tenderness, but no swelling or effusion.  The ROM study showed flexion of 30 degrees and abduction of 35 degrees.  There was no additional limitation with repetition.  The examiner noted no objective evidence of pain, but the CI complained of pain at the end of ROM with all maneuvers.  The examiner also noted “an accurate assessment of ROM is not obtainable due to pain.”  X-rays showed absence of the distal left clavicle.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 20%, analogously coded 5003 (degenerative arthritis), citing “functional loss due to factors such as pain, including pain on repeated use and painful motion, fatigability, incoordination, weakness with repetitive use and flare-ups.”  The VA rated the left shoulder condition 30%, coded 5201 (limitation of arm motion), based on the C&P examination, citing limitation of arm motion to 25 degrees from the side with application of “higher of two evaluations” regulation.  

The panel first considered the disparate examinations and agreed the 3-month pre-separation PT ROM study held more probative rating value than the 9-month post-separation VA examination because of its proximity to separation and because the VA examiner could not get accurate measurements because of shoulder pain.  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 limited to this level.  The highest 30% rating for a non-dominant arm requires motion limited to “25 degrees from side,” but examinations did not reflect this degree of limitation.  There was no fibrous union or nonunion of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available 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.  

Contended PEB Conditions:  Anxiety Disorder, Neck Pain and Hypertension.  The panel’s main charge is to assess the fairness of the PEB determinations that the contended conditions were not unfitting.  None of the conditions were profiled or judged to fail retention standards.  The commander’s statement implicated a mental health condition, noting the CI was unable to complete an 8-hour duty day, had occasional difficulties with reduced reliability and productivity and had difficulty establishing and/or maintaining effective work relationships.  However an extensive mental health interview reviewed the CI’s diagnosis, treatment, medications and fitness for duty.  The psychiatrist (who the CI had worked with in clinic) determined the CI met retention standards, and that no mental health profile or limitations were required.  There was no performance-based evidence from the record that any of the conditions 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 left shoulder condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended anxiety disorder, neck pain, and hypertension conditions, 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.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

AR20180015326, 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.

A copy of this decision has been provided to the counsel you listed on your application, Disabled American Veterans, National Service Office,.

				       

Enclosure