RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03560
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080408

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Infantryman, medically separated for “right shoulder and left ankle pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  No specific contention was made.  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 - 20080508	VARD - 20080616	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder and Left Ankle Pain	5099-5003	10%	S/P Right Shoulder Surgery	5201	20%	20080429	
		10%	S/P Left Ankle Arthroscopy	5299-5271	0%	20080429	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Left Ankle Pain.  According to the STR and MEB NARSUM, the CI underwent left ankle arthroscopic surgery on 2 April 2007 with debridement of a medial talar osteochondral lesion.  The 14 August 2007 orthopedic clinic examination, 8 months prior to separation, noted persistent ankle pain.  Physical examination demonstrated a markedly stiff and antalgic gait.  The physician noted the CI’s gait was identical prior to surgery.  During the 9 October 2007 orthopedic clinic examination, 6 months prior to separation, the CI reported continued pain and stiffness that was not improving with physical therapy.  Physical examination showed a markedly antalgic gait with minimal swelling, but no instability.  Dorsiflexion was limited to 5 degrees (normal 20).  Plantar flexion measurements were not provided.  Range of motion (ROM) was painful.  

The 8 November 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of pain when walking or putting pressure on the left foot.  Physical examination showed point tenderness on the dorsal aspect of the left foot, but there was no edema or erythema noted.  The CI’s “gait was altered somewhat, but not significantly, as he walked in the hall without his cane though he did stagger somewhat to his right when he was favoring his left foot.”  The left ankle ROM evaluation showed, after repetition, dorsiflexion of 12 degrees and plantar flexion of 12 degrees (normal 45).  The panel noted the examiner recorded the left ankle ROM measurements under the right ankle column and vice versa.  The examiner noted pain as soon as the CI started to move his left ankle.  

At the 29 April 2008 C&P examination, 3 weeks after separation, the examiner recorded 6/10 left ankle pain.  The CI denied give-way, but indicated he was not able to run or stand too long.  The physical examination omitted a focused examination of the left ankle, but the CI’s gait was noted to be normal and left ankle X-rays showed no significant joint or bony abnormality.  There were no ambulatory aids.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, analogously coded 5099-5003, citing minor functional loss caused by pain.  The VA rated the left ankle condition 0%, analogously coded 5299-5271 (limitation motion of ankle), based on the C&P examination, citing a non-compensable evaluation based on constant pain and inability to run or stand for too long.  The VA also noted that, “we will be scheduling a VA examination in the near future for your left ankle to determine current severity.”  

The panel considered the examinations in evidence proximate to separation and agreed the NARSUM examination held more probative value because it was the most complete examination.  The VA C&P examination was incomplete and omitted a focal examination and ROM study of the CI’s left ankle.  The panel agreed the NARSUM examination was consistent with the “marked” limitation of motion required for the maximum 20% rating under this code.  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 left ankle condition, coded 5271.  

Right Shoulder Pain.  According to the STR and MEB NARSUM, the left-handed CI underwent right shoulder surgery (Mumford procedure) in August 2006.  The 25 October 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported chronic shoulder pain.  Physical examination showed right shoulder pain with extension and abduction.  

During the MEB NARSUM examination, the CI complained of limitation of motion and pain.  Physical examination showed point tenderness at the midclavicular location.  Upper extremity strength, reflexes and sensation were normal.  The ROM evaluation, after repetition, showed flexion of 106 degrees (normal 180) and abduction of 122 degrees (normal 180); limitations were due to pain and the CI had pain at the midclavicular point as soon as he lifted his arm.  

At the C&P examination, 3 weeks after separation, the examiner recorded 6/10 right non-dominant shoulder pain and noted the CI avoided using his right arm.  The ROM evaluation, after repetition, showed 70 degrees of flexion and abduction.  

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 minor functional loss caused by pain.  The VA rated the right shoulder condition 20%, coded 5201 (limitation of arm motion), based on the C&P examination, citing limitation of arm motion at shoulder level.  The panel assigned more probative value to the MEB NARSUM as it was the most detailed and complete.  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 MEB NARSUM examination 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 the 5202 (humerus, other impairment of) or 5203 (clavicle or scapula, impairment of) 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.  

BOARD FINDINGS:  In the matter of the left ankle condition, the panel recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.  In the matter of the right 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 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	
Left Ankle Pain	5271	20%	
Right Shoulder Pain	5201	10%	
COMBINED	30%	

AR20190007837, 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