RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03534
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091019

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “low back pain (LBP)” and “right dominant shoulder pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  “After 11 years since my injuries occurred on my airborne jump, I still rely on daily medications to function somewhat normally with my chronic pain, PTSD, nightmares and lost ROM in my back and shoulder.”  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 Medical Evaluation Board (MEB), but determined by the Physical Evaluation Board (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 - 20090716	VARD - 20100503	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP	5237	10%	Low Back Strain and Lumbar DDD	5243	10%	20091002	
Right Shoulder Pain	5099-5003	10%	Right Shoulder Strain with Degenerative Changes Status Post Labrum Tear Repair	5010-5201	20%	20091002	
Right Ulnar Nerve Compression	Not Unfitting	Ulnar Nerve Dysfunction, Right	8561	10%	20091021	
Sleep Disorder due to Chronic Pain	Not Unfitting	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

LBP.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), 
the CI’s low back condition began in November 2006 after hitting a tree during an airborne operation.  An MRI from 7 December 2006 revealed a small L5-S1 central disc protrusion that did not appear to cause significant nerve root compression.  Another MRI on 7 July 2008 revealed mild lower lumbar degenerative disk disease (DDD) without significant disk herniation or spinal stenosis.  

The 18 December 2008 MEB consultation, 10 months prior to separation, noted the CI received physical and chiropractic treatment, pain management, but LBP persisted.  Physical examination showed the ability to heel and toe walk, and bilateral motor strength, straight leg raise testing (for radiculopathy), reflexes, and sensation were normal.  During the 6 May 2009 MEB physical therapy (PT) examination, 5 months prior to separation, repetitive goniometric-measured thoracolumbar flexion was 50 degrees (normal 90) with a combined range of motion (ROM) of 200 degrees (normal 240) with painful motion.  There was no additional ROM loss following repetitive use.  At the 5 June 2009 MEB NARSUM examination, 4 months prior to separation, the CI reported chronic LBP.  The examiner referenced the findings from aforementioned MEB consultation and MEB PT ROM examination.  

At the 25 September 2009 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported LBP that radiated to the buttocks and down the back of the legs.  Physical examination showed a normal gait and posture with spinal tenderness and guarding but no muscle spasms.  Thoracolumbar flexion was 75 degrees and combined ROM was 160 degrees with painful motion.  There was no ROM loss following repetitive use.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5237 (lumbar spine strain), citing the “pathology does not support forward flexion limited to 50 degrees, rated for combined ROM of 200 degrees;….”  The VA also rated the low back condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)), based on the C&P examination, citing limitation of flexion or combined ROM. 
The panel placed greater probative value on the VA ROM examination which examination was more detailed, compliant with VASRD rating guidelines, most proximate to separation, and most reflective of the CI’s impairment at the time of separation.

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) and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the  VA examination proximate to separation.  
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 IVDS with incapacitating episodes which would provide for a higher rating under that formula.  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 low back condition.  

Right (Dominant) Shoulder Pain.  According to the STR and MEB NARSUM, the CI’s right shoulder condition began on November 2006 when the CI hit the aforementioned tree becoming entangled in the parachute static line which dislocated his right shoulder.  He sustained a superior labral anterior to posterior (SLAP) tear (located in the shoulder socket area).  The CI underwent right shoulder arthroscopy and Bankart repair on 1 February 2007 and was able to deploy to Afghanistan (June 2007 to April 2008).  He experienced difficulty over a period of time while deployed from wearing his battle gear.  A right shoulder MRI on 19 September 2008 showed likely postoperative changes at the superior labrum with no evidence of significant residual or recurrent SLAP tear.  There were mild hypertrophic changes (degeneration) at the acromioclavicular joint.  

At the 24 November 2008 MEB orthopedic examination, 11 months prior to separation, the CI reported persistent right shoulder pain despite surgery.  He completed 8 months of aggressive rehabilitation and regained a significant amount of ROM and strength.  The examiner referenced an upcoming MEB PT examination which would measure right shoulder ROM. This examination was conducted 6 May 2009 and recorded goniometric-measured, repetitive, right shoulder flexion to 125 degrees (normal 180) and abduction was 180 degrees (normal 180).  Painful motion was elicited.  During the 5 June 2009 MEB NARSUM examination, 4 months prior to separation, the CI noted complaints of chronic right shoulder pain following surgery.  The examiner referenced the aforementioned MEB PT ROM examination.

At the 2 October 2009 VA C&P examination, less than one month before separation, the CI reported pain, instability, stiffness, weakness, decreased ROM, tenderness, swelling, and guarding of movement.  Physical examination revealed right shoulder flexion to 70 degrees and abduction was 180 degrees with painful motion.  There was no ROM loss following repetitive use.
 
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 (degenerative arthritis), citing limitation of flexion to 125 degrees and abduction to 180.  The VA rated the right shoulder condition 20%, analogously coded 5010-5201 (arthritis due to trauma - arm, limitation of motion) based on the C&P examination, citing limitation of motion at approximate shoulder level.

The panel placed greater probative value on the VA ROM examination which was more detailed, compliant with VASRD rating guidelines, most proximate to separation, and most reflective of the CI’s impairment at the time of separation.  The panel noted that 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).  The VA ROM examination, one month prior to separation, recorded flexion to 70 degrees which the panel agreed supports a 20% rating at approximately shoulder level.  There was no fibrous union or nonunion of the humerus (5202), nor nonunion or malunion of the clavicle or scapula (5203) to support a higher rating.   After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the right shoulder condition, coded 5010-5201.

Contended PEB Conditions:  Sleep Disorder due to Chronic Pain, Insomnia Type, and Right Ulnar Nerve Compression.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The contended conditions were not profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that any of the contended 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 low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the right shoulder condition, the panel recommends a disability rating of 20%, coded 5010-5201 IAW VASRD §4.71A.  In the matter of the contended sleep disorder due to chronic pain, insomnia type, and right ulnar nerve compression 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.  

The panel recommends 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Low Back Pain	5237	10%	
Right Shoulder	5010-5201	20%	
COMBINED	30%	

AR20190006879, 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), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

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