RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04292
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060109

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated “left shoulder pain” with a disability rating of 0%.

CI CONTENTION: “I still have issues with my arm and my back. I had back surgery in 2009. I also have PTSD.”  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 – 20051122	VARD – 20060616	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain	5099-5003	0%	Left Shoulder Tendonosis…	5010-5203	10%	20060525	
Low Back Pain	Not Unfitting	Chronic Back Strain, Lumbar	5299-5237	10%	20060525	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Left Shoulder Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s shoulder condition began in July 2001 after lifting a truck tire and her left shoulder “popped.” She went to sick call and was prescribed Motrin (a non-steroidal anti- inflammatory drug (NSAID)) and physical therapy (PT). After PT and four cortisone shots her shoulder condition did not show significant improvement. In March 2004 a note indicated an MRI in January 2004 showed a rotator cuff tear and impingement syndrome. On examination there was painful adduction and internal rotation. A note dated 28 April 2005 indicated forward

elevation (flexion) on the left was 140 degrees (normal 180). An MRI noted tendinitis of the supraspinatus tendon.

On 5 July 2005 the range of motion (ROM) in the front was 45 degrees (presumably flexion) and 80 degrees (presumably abduction) to the side. Treatment consisted of an NSAID. X-rays dated 20 July 2005 showed mild degenerative changes in the acromioclavicular (AC) joint. The glenohumeral joint was within normal limits and there was a type-2 acromion. No calcification was identified. An MRI dated 2 August 2005 showed a partial thickness articular surface tear at the insertion of the supraspinatus [muscle] and a partial intrasubstance tear at the myotendinous junction with an associated moderate tendinosis (inflammation of a tendon). There was also a mild inferolateral tilt of the acromion causing some impingement upon the supraspinatus.

At a sports medicine clinic visit on 12 September 2005, the examiner noted that PT did not provide real relief. On examination forward flexion was to 90 degrees (normal 180) and abduction to 110 degrees (normal 180). A steroid/anesthetic injection was given in the shoulder with  improvement  of  the  ROM,  but  pain  remained  unchanged.    At  a  PT  clinic  visit  on    19 September 2005, flexion was 90 degrees with pain, and abduction was full. Electrodiagnostic studies dated 6 October 2005 of the left upper extremity were normal with no evidence of a left radiculopathy or median nerve neuropathy.

The 21 October 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of constant dull pain of the left anterior shoulder joint with a pain level of 3/10 that worsened with lifting more than 5 pounds or working overhead. Physical examination revealed the left shoulder flexion of 90 degrees limited by pain and abduction; internal and external rotation had full ROMs. There was tenderness over the anterior shoulder joint and left AC joint. Load testing and shift testing were negative. Motor strength in the left upper extremity was normal and deep tendon reflexes were symmetric in the upper extremities. Yergason’s sign (to determine biceps tendon pathology), Speed’s test (to determine a labral tear or bicipital tendonitis), and an apprehension test (to determine a torn labrum or anterior instability) were negative, while Neer’s sign (to determine subacromial impingement) was positive.  Sensation was intact.

At the 25 May 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported left shoulder pain. Physical examination of the left shoulder revealed no signs of edema, effusion, weakness, tenderness, redness, heat, abnormal movement, or guarding. Left shoulder ROM was normal with flexion and abduction, but there was pain, fatigue, and lack of endurance with repetition. X-rays of the left shoulder showed no identifiable abnormality.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the shoulder condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing slight intermittent pain. The VA rated the shoulder condition 10%, analogously coded 5010-5203 (clavicle or scapula, impairment), based on the C&P examination, citing mild degenerative changes in the AC joint, continued painful motion, and diagnosis of tendonosis with impingement.

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 20% rating for the dominant arm requires motion limited to “at shoulder level” and the MEB examination reflected this degree of limitation and was more proximate to separation than the VA examination. Furthermore, it was unclear how the left shoulder ROM for flexion improved to such an extent after separation when for months prior to separation flexion was at the shoulder level. 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 shoulder condition, coded 5099-5003.

Contended PEB Condition: Low Back Pain. 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 not profiled and did not fail retention standards. 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 rating is recommended.

BOARD FINDINGS: In the matter of the left shoulder pain condition, the panel recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a. In the matter of the contended low back pain, 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	
Left Shoulder Pain	5201	20%	

The following documentary evidence was considered:

	PD-2017-04292

AR20190012182, XXXXXXXXXXXXXXXXXXXX

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-2017-04292