RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-05600
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070305

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Cannon Crewmember, medically separated for “sacroiliac joint pain” and “right shoulder pain,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  Review all 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 – 20070124	VARD - 20080314	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Sacroiliac Joint Pain	5236	10%	Low Back Strain	5237	20%	STR	
Right Shoulder Pain	5099-5003	0%	Residuals of Right Shoulder Injury	5201	20%	STR	
Depressive Disorder	Not Unfitting	Depressive Disorder	9433	10%	STR	
Migraine Headaches	Not Unfitting	No VA Placement	
Left Knee Pain	Not Unfitting	Residuals of Left Knee Injury	5099-5024	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Sacroiliac Joint Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI experienced low back sacroiliac (SI) joint pain in June 2005 after a motor vehicle accident.  He also had pain and numbness extending into his left leg, and lumbosacral spine X-rays revealed mild and diffuse degenerative joint disease.  Hip and pelvis X-rays as well as an MRI were normal.  Epidural steroid injections provided short-term relief.  On 30 September 2005, the CI endorsed no further peripheral numbness or tingling, but pain was unrelenting and now in both legs.  The physical examination (PE) was completely normal except for mild low back tenderness.  

A primary care encounter on 6 October 2005 revealed a normal examination with not neurological deficits of the spine or hips.  However, at a follow-up on 14 October 2005, the provider noted lower lumbar tenderness and spinal flexion to 30 degrees (normal 90); motor, reflexes and sensation were intact.  Subsequent clinical encounters in late 2005 and throughout 2006 continued to show decreased range of motion (ROM) of the lower spine.  

The 21 November 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of constant back pain primarily over the right SI joint.  The PE revealed lower lumbar and SI join tenderness, but no surrounding muscle spasm.  Thoracolumbar flexion was to 55 degrees with a combined ROM of 185 degrees (normal 240), after repetition and with limitation due to pain.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the SI joint pain 10%, coded 5236 (SI injury and weakness), citing tenderness and ROM limited by pain.  The VA rated the low back condition 20%, coded 5237 (lumbosacral strain), based on the STR, citing thoracolumbar forward flexion greater than 30 degrees but not greater than 60 degrees.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion as reported on the MEB NARSUM examination.  There was no documentation of intervertebral disc syndrome 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 recommends a disability rating of 20% for the sacroiliac condition, coded 5236.  

Right Shoulder Pain.  According to the STR and MEB NARSUM, the CI underwent arthroscopic surgery to repair a torn labrum and removal of a loose foreign body within the right (non-dominant) shoulder joint in February 2006.  At the 25 October 2006 MEB consult, 4 months prior to separation, the CI reported unremitting right shoulder pain.  On examination, there was mild tenderness to the front aspect of the shoulder, and ROM showed both forward flexion and abduction to 90 degrees (normal 180).  The MEB NARSUM examination, noted complaints of constant shoulder pain which was aggravated with overhead movements.  The PE revealed tenderness to the front aspect of the right shoulder, but intact motor, reflexes and peripheral sensation.  Upon repetition, right shoulder ROM decreased to 95 degrees of flexion and 86 degrees of abduction, both limited by pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, analogously coded 5003 (arthritis, degenerative), citing shoulder motion limited by pain alone.  The VA rated the right shoulder condition 20%, coded 5201 (arm, limitation of motion), based on the STR, citing limitation of arm motion at shoulder level.  Panel members noted that the VASRD §4.71a 20% threshold for rating ROM impairment of the non-dominant arm under code 5201 is “at shoulder level” (approximately 90 degrees from the side), and examinations reflected this degree of limitation.  There was no fibrous union or nonunion of the humerus to justify a higher rating under code 5202 (humerus, other impairment of), and no higher rating available under code 5203 (clavicle or scapula, impairment of).  After due deliberation, considering all the evidence and mindful of VASRD §4.3, the panel recommends a disability rating of 20% for the right shoulder condition, coded 5201.  

Contended PEB Conditions:  Depressive Disorder, Migraine Headaches and Left Knee Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled, and the 31 October 2006 mental health MEB consult determined the depressive disorder met retention standards.  The 25 October 2006 MEB consult found the left knee to meet retention standards with an MRI confirming intact ligaments with no meniscal tears.  The 21 November NARSUM noted the CI had a history of migraines which were aborted with medication and met retention standards.  The commander’s statement referred to a profile for the left knee, left shoulder and back pain; however after a thorough review of the STR, the panel found no such profile.  In fact the right shoulder was profiled and not the left shoulder.  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 SI joint condition, the panel recommends a disability rating of 20%, coded 5236 IAW VASRD §4.71a.  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 contended depressive disorder, migraine headaches and left knee condition, 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.  

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	
Sacroiliac Joint Pain	5236	20%	
Right Shoulder Pain	5201	20%	
COMBINED	40%	

AR20190009392, 

Dear XXXXXXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a permanent 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 permanent 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), 
	A copy of this decision has also been provided to the Department of Veterans Affairs.