RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-04179
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Power Generator Equipment Repairer, medically separated for “right shoulder pain” and “chronic neck pain,” rated 10% each with a combined disability rating of 20%.    

CI CONTENTION:  “Rated condition was worse at time of medical discharge than evaluated.”  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 FPEB – 20070531	VARD - 20080227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain 	5099-5003	10%	Degenerative Joint Disease, Right Shoulder	--	20%	20070830	
Chronic Neck Pain	5241	10%	Degenerative Disc and Joint Disease, Cervical Spine	--	20%	20070830	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  90% 	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right-handed CI underwent right shoulder surgery in May 2005 with subacromial bursectomy, partial coracoacromial ligament excision, debridement and diagnostic glenohumeral joint arthroscopy.  Postoperatively, the CI was diagnosed with right shoulder impingement syndrome.  An MRI dated 16 December 2005 of the right shoulder showed the superior labrum had altered morphology with blunting of the apex that represented a tear or degenerative fraying, and the articular surface of the infraspinatus tendon showed degenerative fray or a partial articular tear.  Range of motion (ROM) testing in September 2006, 10 months prior to separation, showed active flexion of 137 degrees (normal 180) and abduction of 130 degrees (normal 180) with painful motion after three repetitions.  

The 28 February 2007 MEB NARSUM examination, 5 months prior to separation, noted chronic right shoulder pain, but no physical examination was performed.  At the 13 March 2007 physical therapy (PT) MEB ROM examination, 4 months prior to separation, right shoulder ROM testing, following repetitive movement, showed flexion of 142 degrees and abduction of 145 degrees without objective evidence of painful motion.  An MRI dated 15 May 2007 showed an altered signal in the articular surface of the rotator cuff at the junction of the supraspinatus and infraspinatus tendons without evidence of a full thickness tear, and the labrum showed blunted morphology, but no definite tear, which was most compatible with degenerative change.  

The 30 August 2007 VA Compensation and Pension (C&P) examination, 1 month after separation,  was not in evidence in the case file; however, the VA Rating Decision (VARD) provided ROM measurements of flexion to 90 degrees and abduction to 100 degrees with pain.  

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 (arthritis, degenerative), citing application of the U.S. Army Physical Disability Agency pain policy.  The VA rated the right shoulder condition 20%, presumably coded 5201 (arm, limitation of motion) based on the C&P examination, citing a higher evaluation is not warranted unless limitation of arm motion is midway between the side and shoulder level.    

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 VA ROM reflected this degree of limitation.  The VA examination compared to other service examinations was more proximate to separation; therefore, it warrants a higher probative value.  Furthermore, ROM measurements prior to the VA examination were performed while treatment was ongoing; however, imaging most proximate to separation showed an altered signal in the articular surface of the rotator cuff at the junction of the supraspinatus and infraspinatus tendons without evidence of a full thickness tear, and the labrum showed blunted morphology, but no definite tear, which was most compatible with degenerative change.  Therefore, in the absence of treatment along with imaging changes, the VA examination findings have credence and a 20% rating is reasonable.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the right shoulder condition, coded 5201.  

Chronic Neck Pain.  According to the STR and MEB NARSUM, the CI underwent cervical spine surgery with a C4-5 anterior cervical discectomy and fusion on 23 May 2006.  At the 28 August 2006 neurosurgery follow-up the CI had minimal tenderness with mild evidence of paraspinous muscle spasm.  ROM testing of the cervical spine in September 2006, 10 months prior to separation, showed active flexion of 25 degrees (normal 45) and combined ROM of 175 degrees (normal 340) with painful motion after three repetitions.  At the 27 November 2006 neurosurgery 6 month follow-up visit, gait was normal and there was no tenderness or evidence of paraspinous muscle spasm.  An MRI dated 1 December 2006 showed status post C4-C5 anterior cervical discectomy and fusion with no significant abnormalities noted.  Electrodiagnostic studies dated 23 February 2007 of the left upper extremity were normal.  

The MEB NARSUM noted cervical pain, but there was no physical examination performed.  PT ROM testing, performed with an inclinometer on 13 March 2007, 4 months prior to separation, showed cervical flexion of 15 degrees after three repetitions and combined ROM 110.  Abnormal motion was due to pain.  An MRI dated 15 May 2007 showed C4-5 showed minimal degenerative disc changes at C3-4 and C5-6 without disc herniation, stenosis or other abnormality.  At a pain clinic visit on 28 May 2007 the CI had diffuse tenderness over the cervical facets and mild muscle spasm in the cervical spinal muscles.  At a neurosurgery clinic visit on 7 June 2007, 1 month prior to separation, physical examination revealed no acute distress and ROM of the cervical spine was minimally decreased throughout.  Gait was intact.  Neurosurgery follow-up on 29 June 2007 noted the CI was in no acute distress and ambulated normally, but held his neck somewhat stiffly.  There was full ROM in the cervical spine with tenderness over C4-7, but no muscle spasm.  No further surgery was recommended.  The VA C&P examination was not in evidence; however, the VARD indicated flexion was 20 degrees and combined ROM was 150 degrees with pain and tenderness.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5241 (spinal fusion), citing decreased ROM secondary to pain and spasms noted on several evaluations.  The VA rated the neck condition 20%, based on the C&P examination, citing flexion of 20 degrees and combined ROM of 150 degrees.  The panel carefully reviewed all ROM evidence, which waxed and waned over time.  The panel agreed that the preponderance of evidence supported a 20% rating, but no higher for limitation of flexion (greater than 15 degrees but not greater than 30 degrees) or combined ROM not greater than 170 degrees.  There was no evidence of intervertebral disc syndrome, which resulted in incapacitating episodes to warrant consideration of rating under that alternate VASRD formula.  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 neck condition, coded 5241.  

BOARD FINDINGS:  In the matter of the right shoulder condition, the panel recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  In the matter of the neck condition, the panel recommends a disability rating of 20%, coded 5241 IAW VASRD §4.71a.  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	
Right Shoulder Pain	5201	20%	
Chronic Neck Pain	5241	20%	
COMBINED	40%	

The following documentary evidence was considered:

AR20190006863, 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 40% 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.