RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05068
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080710

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Health Care Specialist, medically separated for “Raynaud’s phenomenon” and “left shoulder pain,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  “Several issues not addressed during time in service.  Recurring problems after service due to connected service conditions.”  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 - 20080411	VARD - 20081126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Raynaud’s Phenomenon	7199-7117	10%	Raynaud’s Syndrome	7117	10%	20081009	
Left Shoulder Pain	5099-5003	10%	Left Shoulder Bicep Tendonitis	5019-5201	20%	20081009	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Raynaud’s Phenomenon.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s Raynaud’s phenomenon began in December 2006 with hand numbness and pain that turned white or blue and then red.  Symptoms continued while deployed, but while home on leave, he sought evaluation for the symptoms and was transferred to the WTU for further medical evaluation.  At an internal medicine (IM) examination on 11 June 2007, the CI reported episodes of morning finger coldness.  A rheumatologist diagnosed Raynaud’s with no other specific autoimmune disorder identified.  The CI was unable to work outdoors and could not wear gloves while working as a mechanic.  At a primary care visit in July 2007, the CI reported fewer symptoms.  At a primary care visit on 14 September 2007, the CI reported an episode occurred while driving the previous week.  At a primary care visit in October 2007, the CI reported a frequency of attacks once or twice a week.  Although he was prescribed medication, he stopped using it because it was as not helpful.

The 21 January 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of bilateral hand numbness and pain which occurred one or two times per week.  Symptoms occurred indoors or out and in any weather.  Physical examination was normal and his hands were warm, pink and dry.  Range of motion (ROM) testing of the bilateral fingers showed full ROM and pulses were intact with good capillary refill.  At a 4 April 2008 primary care visit, 3 months prior to separation, the CI clarified the frequency of his symptoms.  He reported pain and color changes occurring daily during the winter, one or two times per week during the summer and three to four times per week in the fall.  The physical examination noted normal skin.  

At the 9 October 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported bilateral numbness of the second and third fingers with temperature extremes.  He reported coldness, aching and white discoloration of his hands on a weekly basis and whenever exposed to cold temperatures.  Physical examination showed no abnormalities of the bilateral upper extremities or hands.  There was normal strength and sensation throughout.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Raynaud’s phenomenon 10%, analogously coded 7117 (Raynaud’s syndrome), citing current attacks occurring once or twice weekly.  The VA also rated the Raynaud’s phenomenon 10%, coded 7117 based on the C&P examination, citing numbness and tingling at least once a week.  

There was evidence of characteristic attacks occurring one to three times per week to support a 10% rating proximate to separation.  However after the PEB adjudicated the case, the CI reported attacks being more frequent in the fall and daily in the winter, suggesting attacks were temperature dependent.  In late October, the CI reported the frequency of one to two times per week and at the C&P examination, also in October, reported symptoms “on a weekly basis.”  A frequency of one to three times per week was also supported by other visits in the STR in July and September 2007 which implied infrequent attacks.  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 Raynaud’s phenomenon.

Left Shoulder Pain.  According to the STR and MEB NARSUM, the right-handed CI’s left shoulder condition began in 2007 when he experienced a left shoulder pop while performing dips.  Left shoulder X-rays in June 2007 were normal.  At an orthopedic examination on 19 September 2007, the CI reported left shoulder pain and catching with movement, but denied instability.  Physical examination showed biceps tendon tenderness without left shoulder swelling or muscle atrophy.  Left shoulder flexion and abduction were normal without painful motion.  Left arm strength and sensation were normal.  At the initial physical therapy visit on 2 October 2007, left shoulder ROM was normal, but there was painful motion.  An MRI in April 2008 showed a partial tear of the supraspinatus tendon and mild arthritic changes of the acromioclavicular joint 

During the 9 April 2008 MEB physical therapy examination, 3 months prior to separation, the CI reported constant left shoulder pain aggravated by quick movements or lifting greater than 10 pounds.  Repetitive left shoulder ROM showed flexion of 160 degrees (normal 180) and abduction of 165 degrees (normal 180) with painful motion.  There was no additional loss of ROM with repetition.  

At the 9 October 2008 VA C&P examination, 3 months after separation, the CI reported chronic left shoulder pain.  Physical examination showed biceps tendon tenderness.  Repetitive left shoulder ROM showed flexion of 140 degrees and abduction of 85 degrees with painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing painful motion.  The VA rated the left shoulder condition 20%, dual coded 5019-5201 (bursitis causing limitation of motion), based on the C&P examination, citing limitation of motion.

Although there was insufficient limitation of motion to support a rating under the 5201 code noted at examinations prior to separation, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  Panel members agreed that the C&P ROM examination that showed decreased left shoulder abduction was an outlier compared to the preponderance of STR evidence.  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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the left shoulder condition.

BOARD FINDINGS:  In the matter of the Raynaud’s phenomenon and IAW VASRD §4.104, the panel recommends no change in the PEB adjudication.  In the matter of the left shoulder condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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.

AR20190006168, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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.