RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04296
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Bridge Crewmember, medically separated for “chronic left (non-dominant) shoulder pain and instability” with a disability rating of 20%.  

CI CONTENTION:  “My back, neck, shoulder and PTSD are getting worse by time.”  The CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20091023	VARD - 20091231	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left (Non-dominant) Shoulder Pain and Instability	5201	20%	Left Shoulder Instability with Supraspinatus Tendonitis	5201	20%	20090622	
Nerve Palsy Acquired, of Brachial Plexus, Left	Not Unfitting	Left Hand Condition 	8515	NSC		
Cervicalgia		Cervical Strain	5237	10%		
Back Strain		Thoracolumbar Sprain	5237	10%		
Adjustment Disorder 		No VA Placement at Separation		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Left Shoulder Pain and Instability.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right-hand dominant CI’s left shoulder condition began in February 2007 after wrestling, but the first record in evidence for the shoulder was dated 5 April 2008 while he was deployed.  He noted that his pain began 2 days earlier while “rafting” down the Euphrates River and moving 300-pound ramps.  He re-aggravated his shoulder condition during a physical fitness test on 19 April 2008.  X-rays were normal and range of motion (ROM) was full but painful.  Laxity was present.  On 28 May 2008, he was again noted to have full but painful ROM and slight instability.  On 16 July 2008 the ROM was again full.  Repeat X-rays on 19 September 2008 were also normal as was the ROM.  An MRI on 17 October 2006 noted mild degenerative changes of the acromio-clavicular joint (ACJ, between the collar bone and shoulder).  Thickening of one tendon of the rotator cuff and mild atrophy of one muscle (of uncertain etiology) was also present.  In physical therapy on 4 November 2008 flexion was 170 degrees (normal 180) and abduction 160 degrees (normal 180).  At two subsequent appointments in December 2008 and two in January 2009, the ROM was noted to be full.  An MRI arthrogram on 23 December 2008 showed the prior MRI findings, but did not show labral pathology (the cartilage cushion in the shoulder joint).  In orthopedics on 6 February 2009, flexion was 180 degrees, but abduction was only 100 degrees.  Some motor loss was present and attributed to pain.  Sensation was subjectively decreased over C5.  Signs of instability were present.  

In an orthopedic follow up on 2 March 2009, the ROM was full and subjective signs of instability present although signs of gross instability were absent.  Electrodiagnostic testing on 16 March 2009 showed a resolved brachial plexopathy of C5-7 on the left side.  In physical therapy on 27 March 2009, the CI was noted to have flexion and abduction of 100 degrees, but of the right side.  This was probably a typographical error and the left side was impaired, but it is not certain from the note.  On 8 April 2009, the CI was noted to have full, but very painful, active ROM of the left shoulder with signs of generalized ligamentous laxity not amendable to surgical repair.  X-rays on 21 May 2009 revealed no acute fracture or dislocation.  The 29 September 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of inability to lift weights or do any bridge crew duties.  He could drive with difficulty and had to stop and rest every 3 hours.  Flare-ups occurred with repeated activity.  The physical examination referenced the VA examination below.  

The CI was a participant in the Joint DoD/VA pilot referral program.  At the 22 June 2009 VA Compensation and Pension (C&P) examination, 6 months before separation, the CI reported continued shoulder pain, aggravated by frequent shoulder movement.  The left shoulder ROM study showed flexion of 98 degrees and abduction of 74 degrees, with no further reduction after repetition.  Motion was painful.  All other diagnostic and clinical tests were unremarkable.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 20%, coded 5201 (limitation of arm motion).  The VA rated the left shoulder instability with supraspinatus tendonitis 20%, coded 5201, based on the C&P examination, citing limitation of left arm motion slightly below 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 examinations in evidence demonstrated motion limited to this level.  The highest 30% rating for a non-dominant arm requires motion limited to “25 degrees from side,” but examinations did not reflect this degree of limitation.  There was no fibrous union or nonunion of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available under the 5203 code (clavicle or scapula, impairment of).  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 left shoulder condition.  

Contended PEB Conditions:  Left Brachial Plexus Nerve Palsy, Cervicalgia, Back Strain and Adjustment Disorder.  The panel’s main charge is to assess the fairness of the PEB determinations that the contended conditions were not unfitting.  None of the conditions were profiled or directly implicated in the commander’s statement.  All were judged to meet retention standards.  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 condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended left brachial plexus nerve palsy, cervicalgia, back strain and adjustment disorder, 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.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

AR20190004364, XXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.