RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03297
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090820

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Artillery Mechanic, medically separated for “right shoulder pain” with a disability rating of 10%.  

CI CONTENTION:  He has been deemed unemployable by Social Security and requested review of his neck condition, carpal tunnel syndrome and mental health disorder as well as 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 - 20090514	VARD - 20100408	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5099-5003	10%	S/P Rotator Cuff Repair, Right Shoulder	5024	10%	20100203	
DDD, Cervical Spine	Not Unfitting 	DDD, Cervical Spine	5242	20%	20100203	
Mild Right Carpal Tunnel Syndrome	Not Unfitting	Carpal Tunnel, Right Hand	8515	0%	20100203	
Anger Issues, Resolved	Not Unfitting	PTSD	9411	10%	20100203	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI developed right (dominant) shoulder pain with repetitive heavy lifting during a 2003 deployment to Iraq.  The pain persisted after redeployment, imaging revealed a labral tear (SLAP lesion), and he underwent surgical intervention (arthroscopic SLAP repair) in January 2007.  Follow-up X-rays demonstrated normal alignment and typical post-surgical changes.  

There was documentation in STR clinical entries of grossly normal range of motion (ROM) and no entries that indicated any significant ROM limitation.  Measured ROM from a civilian rehabilitation center in November 2008 was forward flexion to 180 degrees (normal) and abduction to 180 degrees (normal).  There was STR documentation of the absence of instability or impingement, with no contrary evidence and no evidence for other ratable features.  

The 30 March 2009 MEB NARSUM examination, 5 months prior to separation, documented non-specific pain that prohibited heavy lifting and multiple general soldiering requirements.  The physical examination recorded tenderness, no instability, and “full” ROM with painful motion.  The NARSUM referenced goniometric ROM measurements for the MEB by physical therapy completed on 8 April recording forward flexion to 175 degrees and abduction to 180 degrees, specifying painful motion.  

The 3 February 2010 VA Compensation and Pension (C&P) examination, 5 months after separation, documented non-specific pain with no subjective instability.  Functional limitations were not elaborated other than noting that there was no impact on activities of daily living or periods of incapacitation.  The physical examination recorded the absence of tenderness with no signs of inflammation, instability, or weakness.  Measured ROM was forward flexion to 180 degrees and abduction to 170 degrees, specifying painful motion and no degradation with repetition.

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 applicable VASRD §4.71a criterion “satisfactory evidence of painful motion.”  The VA also rated the condition 10%, coded 5024 (tenosynovitis, defaulting to criteria of 5003), referencing the C&P evidence and citing painful motion.

The ROM evidence did not support the minimum compensable rating under code 5201 for limitation of 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).  Therefore, other than supporting the minimum 10% rating under criteria of 5003 via painful motion (VASRD §4.59), the evidence did not justify a higher rating under any other applicable code.  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:  Cervical Degenerative Disc Disease (DDD), Right Carpal Tunnel Syndrome, and Anger Issues.  The CI suffered an insidious onset of neck pain while recovering from his shoulder surgery.  Imaging revealed “mild” multilevel DDD without surgical indications.  This was not associated with significant ROM limitation or neurologic deficits.  The NARSUM stated “[the CI’s] neck pain does not prevent him from performing in a satisfactory manner the duties and responsibilities specific to his 63D MOS.”

In conjunction with the neck pain the CI experienced some radiation down the right arm with intermittent hand paresthesias.  Electrodiagnostic testing (EMG) was interpreted as mild carpal tunnel syndrome.  Neurologic examinations were normal with full 5/5 strength and grip.  The NARSUM stated “these symptoms do not prevent [CI] from performing his MOS duties.”  The CI self-referred to behavioral health in December 2006 stating “he would like to get help with controlling his anger.”  He described longstanding issues with anger management and made no reference to deployment issues or other symptoms.  He was seen by a psychiatrist who deferred an Axis I diagnosis but listed “other interpersonal problem.”  No medication was prescribed, but follow-up was recommended.  There were no follow-up visits in evidence and no psychiatric medications were prescribed while in service.   The CI was evaluated by a MEB psychiatrist who diagnosed “anger issues, resolved” and opined that the condition met retention standards.  Soon after separation, the CI presented to the VA endorsing all diagnostic criteria for post-traumatic stress disorder.  No such symptoms or documentation of Criterion A stressors were captured in the available STR.

The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement, or judged to fail retention standards.  There was no performance-based evidence that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that 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 condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended cervical condition, right carpal tunnel syndrome, and anger issues, 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:

Exhibit A.  DD Form 294, dated 20170405, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180012282, 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