RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2017-04171
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070702

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Vehicle Maintenance Supervisor, medically separated for “chronic neck pain” and “left non-dominant shoulder pain,” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION: The CI requested review of all conditions and explained why his lupus condition should have been found unfit by the 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 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 - 20070327	VARD - 20070522	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5299-5237	10%	Cervical Spondylosis with Disc Disease	5242	10%	20070518	
Left Non-Dominant Shoulder Pain	5099-5003	0%	Type II Superior Labral Abnormality with Impingement	5299-5020	10%	20070518	
Discoid Lupus Erythematosus	Not Unfitting	Systemic Lupus Erythematous (SLE) with Discoid Lupus	7809-7806	30%	20070518	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 60%	
	
ANALYSIS SUMMARY:

Chronic Neck Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s neck condition began sometime after he injured his left shoulder in 1997. On

20 May 2005 the CI complained of neck pain after a coughing spell. An MRI dated 24 July 2005 showed a mild right foraminal narrowing at C-5-C6 with moderate foraminal narrowing at C6-C7.

The 8 August 2006 MEB NARSUM examination, 11 months prior to separation, noted complaints of neck pain 1-2 times per week with radicular symptoms to his left upper extremity. Physical examination showed tenderness in the mid to lower cervical spine and left paravertebral muscles, with motor and sensation normal in the extremities. Gait along with heel and toe walking were intact. At the 8 November 2006 physical therapy (PT) evaluation, 8 months prior to separation, forward flexion was at 40 degrees (normal 45) with combined range of motion (ROM) of 240 degrees (normal 340). There was mild kyphosis and gait was without deficits. Pain, tenderness and increased spasms at the upper trapezius and levator scapula muscles on the left were noted. X-rays of the cervical spine on 14 March 2007 showed straightening with osteophytosis (arthritic changes) in the anterior vertebral endplates at C6 and degenerative disc disease at the C6-C7 disc space.

At the 18 May 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported neck stiffness and recurrent pain. Physical examination showed the cervical spine was straight, nontender, and with any crepitus (grinding sensation). Motor strength was normal in the upper extremities and sensation was intact. Flexion was noted at 40 degrees with pain at 40 degrees and the combined ROM was at 250 degrees. With repetitive motion the CI had stiffness and pain, but no weakness or fatigability.  Gait was normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic neck condition 10%, analogously coded 5299-5237 (cervical strain), citing combined ROM passive 268 degrees, motor and sensation intact, and tenderness to the cervical spine. The VA also rated the cervical spondylosis with disc disease condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion to 40 degrees.

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 40 degrees) as reported at the PT and VA examinations. 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 intervertebral disc syndrome (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 chronic neck condition.

Left Non-Dominant Shoulder Pain. According to the STR and MEB NARSUM, the CI’s left shoulder condition began in 1997 during the Basic Non-Commissioned Officers Course when he was breaking track on an armored vehicle and sustained a left shoulder injury. Conservative treatment was carried out, but he underwent a surgical SLAP (superior labrum, anterior to posterior) repair on 9 December 2005 for a rotator cuff injury and also had a subacromial repair. Some improvement was reported, but in August 2006, he sustained a second injury while performing chest compresses causing recurrent mechanical symptoms. X-rays of the left shoulder revealed moderate AC (acromioclavicular) joint DJD (degenerative joint disease).

The 8 August 2006 MEB NARSUM examination, 11 months prior to separation, noted complaints of painful mechanical symptoms, pain with overhead activity, and diffuse shoulder pain with radiation of pain to the left elbow. Physical examination showed positive Hawkin’s and Neer’s impingement tests and O’Brien’s test (to determine a glenohumeral joint labral tear). Tenderness over the greater tuberosity of the humerus and the AC interval was present. Cross arm testing was positive, but apprehension and jerk testing were negative. No supraspinatus, infraspinatus, or deltoid atrophy was noted, and extremity motor strength was normal.

At an 11 November 2006 PT examination, 8 months before separation, left shoulder flexion was 140 degrees (normal 180) and abduction was 130 degrees (normal 180), while at the 11 December 2006 PT examination, 7 months before separation, left shoulder flexion was 130 degrees and abduction 120 degrees with pain. Pain was also reported in the left scapula and upper trapezius. Posture of the left shoulder was lower than the right and mild scoliosis and kyphosis of the spine were present.

A magnetic resonance arthrogram performed on 29 November 2006 revealed moderate osteoarthritis of the AC joint, a recurrent SLAP tear, and moderate chondromalacia of the glenohumeral articulation as well as a subacromial bursal effusion. No further surgery was recommended. During the 7 March 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, physical examination revealed left shoulder pain with abduction around 100 degrees and pain with inversion.

At the 18 May 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported problems with abduction and forward flexion. Restrictions included limited motion and inability to do overhead work, but there were no paresthesias. Physical examination showed no swelling or redness, modest AC joint crepitus, but no tenderness. Some impingement tests were negative; however, pain was noted with resisted abduction, a form of impingement. Neer’s and Obrien’s tests were negative. Forward flexion was noted at 135 degrees with pain at 125 degrees and abduction was 125 degrees with pain at 120 degrees.

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 arthritis of one major joint. The VA also rated the type II superior labral abnormality with impingent left shoulder condition 10%, analogously coded 5299-5020 (synovitis), based on the C&P examination, citing limitation of motion.

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 examinations in evidence demonstrated motion above this level. Although there was insufficient limitation of motion to support a rating under the 5201 code, 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 to justify a rating under the 5202 code (humerus, other impairment); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating 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 10% for the left shoulder condition, coded 5299-5003.

Contended PEB Condition: Discoid Lupus Erythematosus. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was profiled and implicated in the commander’s statement, but did not fail retention standards. The PEB did note that the profile did not limit any of the CI’s functional activities and was not commented upon by the commander as hindering the CI’s performance. The case file contained no evidence that the discoid lupus independently, or combined, rendered the CI unfit for his assigned duties. The undated MEB NARSUM addendum examination indicated the CI’s condition began in 1996 when he was seen for a rash on his left shoulder and treated with topical ointments without improvement. He was referred to dermatology, and in June 1997 underwent a skin biopsy that showed results consistent with lupus erythematosus. The CI was diagnosed as having discoid lupus and started on Plaquenil (hydroxychloroquine, an anti- rheumatic drug). In November 2001, the CI was noted to have a malar rash and discoid photosensitivity. Despite the fact that the CI was initially diagnosed with discoid lupus in 1997, he continued to function for almost 10 years with medication and sun protection. It was not until

4 April 2007 that the diagnosis of SLE was recorded, although laboratory tests were positive as early as June 2004. However, the CI did not have any renal, central nervous system, or hematologic manifestations proximate to separation. There was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the chronic neck condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication. In the matter of the left shoulder condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71. In the matter of the contended discoid lupus condition, the panel recommends no change from the PEB determination 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	
Chronic Neck Pain	5299-5237	10%	
Left Shoulder Pain	5099-5003	10%	
	COMBINED	20%	

The following documentary evidence was considered:

PD-2017-04171

AR20190012056, XXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified to 20% 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 and to the counsel you listed on your application; [name and address].