RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-03931
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050321

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Heavy Construction Equipment Operator, medically separated for “left shoulder impingement” with a disability rating of 0%.

CI CONTENTION: Shoulder condition has worsened. Review of all conditions requested. 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 - 20050228	VARD - 20041124	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Impingement Syndrome	5009-5003	0%	Left Shoulder Degenerative Joint Disease	5201	20%	20040804	
Mild Osteoarthritis of Right Knee	Not Unfitting	Patellofemoral Pain Syndrome, Right Knee	5257	0%	20040804	
High Frequency Sensorineural Hearing Loss with Tinnitus	Not Unfitting	Hearing Loss	6100	NSC	20040804	
		Tinnitus	6260	NSC	20040804	
Mixed Headaches	Not Unfitting	No VA Placement	
Hyperlipidemia	Not Unfitting	No VA Placement	
Hypertension	Not Unfitting	No VA Placement	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Left Shoulder Impingement Syndrome (Ambidextrous). According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left shoulder was injured in May 2003 while loading a duffel bag onto a truck, and reinjured in July 2003 while lifting another duffel bag. Follow-up treatment was conservative. MRI of the left shoulder on 23 July 2004 showed mild hypertrophic degenerative changes in the left acromioclavicular (AC) joint and subcoracoid bursitis. The CI was diagnosed with a frozen shoulder and education on the importance of rehabilitation to improve shoulder ROM was emphasized.

At the 4 August 2004 VA Compensation and Pension (C&P) examination, 8 months before separation, the CI reported left anterior shoulder pain aggravated by elevation of the shoulder above the head level and by heavy maneuvering. Physical examination (PE) showed forward flexion and abduction at 90 degrees (normal 180) each, with noted expression of extreme pain during movement. The examiner suggested that additional loss of motion would occur with repetition if the left shoulder became more painful or with heavy use. External rotation of the left shoulder against resistance was somewhat painful. No crepitus was present. Impingement testing was negative, but tenderness was present over the AC joint and insertion of the rotator cuff area. At the orthopedic examination on 4 October 2004 the CI reported improvement with PT. Shoulder range of motion (ROM) was 160 degrees each for forward flexion and abduction. Testing for impingement was positive.

During the 6 December 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, PE showed raising the arm was limited to less than 90 degrees. Tenderness and slight diffuse muscle atrophy were present. At the MEB orthopedic examination
2 days later, the CI reported shoulder pain aggravated by overhead activities. Physical examination showed flexion and abduction of 90 degrees. Testing for impingement was positive. There was no tenderness of the shoulder joint, AC joint or deltoid muscle.

The 10 December 2004 MEB NARSUM examination noted complaints of constant, dull pain in the left shoulder rated 4-5/10 and worsened with lifting more than 10 pounds or lifting the arm. The PE showed significant shoulder tenderness was noted with minor pain during impingement tests and testing for AC joint tenderness (painful motion). Left shoulder ROM was measured by physical therapy on the same day and flexion was 110 degrees and abduction was 115 degrees after repetition, with painful motion noted. The left upper extremity was neurovascularly intact. The 12 October 2005 VA C&P examination, 7 months after separation, noted the CI had undergone left shoulder surgery on 5 August 2005, 5 months after separation, for subacromial decompression and bursectomy with improvement in his symptoms.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left shoulder condition 0%, analogously coded 5099-5003 (degenerative arthritis) citing shoulder ROM was at least 110 degrees, limited by pain, noting the CI was ambidextrous. The VA rated the left shoulder degenerative joint condition 20%, coded 5201 (limited motion of arm), based on the August 2004 C&P examination.

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 although some examinations, including the MEB NARSUM examination, noted ROM above this level, many examinations in record noted ROM limited to shoulder level, including the VA, the MEB orthopedic and the MEB Form 2808 examinations, supporting the 20% rating based on functional loss. The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level.” However, examinations did not reflect this degree of limitation. There was no malunion with marked deformity or frequent episodes of recurrent dislocation  of  the  humerus to  justify  a  higher  rating under the  5202  code  (humerus,  other

impairment), and no higher ratings available under the 5203 code (clavicle or scapula, impairment). 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 shoulder impingement syndrome condition, coded 5299-5201.

Contended PEB Conditions: Mild Osteoarthritis of Right Knee, High Frequency Sensorineural Hearing Loss with Tinnitus, Mixed Headaches, Hyperlipidemia, and Hypertension. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The contended mild osteoarthritis of right knee, high frequency sensorineural, hearing loss with tinnitus, mixed headaches, and hypertension conditions were not implicated in the commander’s statement and did not fail retention standards. Only the hearing loss condition was profiled, with limitations of no duty or assignment to noise levels in excess of 85 decibels and a requirement for annual hearing testing. The hyperlipidemia was an asymptomatic laboratory finding, had no impact on fitness and is not a VASRD-ratable condition. 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 impingement condition, the panel recommends a disability rating of 20%, coded 5099-5003 IAW VASRD §4.71. In the matter of the contended mild osteoarthritis of right knee, high frequency sensorineural hearing loss with tinnitus, mixed headaches, hyperlipidemia, 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. The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Left Shoulder Impingement Syndrome	5299-5201	20%	

	PD-2017-03931

AR20190010913, XXXXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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 also been provided to the Department of Veterans Affairs.

	PD-2017-03931