RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-06073 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20091231

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Infantryman, medically separated for “arthritis, degenerative, left hip” and “right (dominant) shoulder,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  No specific contention was made.  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 – 20091102	VARD - 20101202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arthritis, Degenerative, Left Hip	5003	10%	Left Hip Trochanteric Bursitis	5242	10%	20100421	
Right (Dominant) Shoulder	5099-5003	10%	Tear of the Supraspinatus Tendon, Right Shoulder	5010	10%	20100421	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 90%	

ANALYSIS SUMMARY:

Left Hip Degenerative Arthritis. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left hip condition began in April 2007 after falling on ice. A primary care clinic examination on 1 July 2009 showed normal left hip motion with pain. An orthopedic examination performed on 4 August 2009 revealed “full” left hip flexion and extension with painful motion. The 5 August 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of chronic left hip pain aggravated by sitting, prolonged walking

or deep knee bending. Physical examination revealed a normal gait. Lower extremity sensation and motor activity were normal. Goniometric-measured left hip flexion was 110 degrees (normal 125), extension was 10 degrees (normal 20) and abduction was 45 degrees (normal). Painful motion was elicited.

At the 21 April 2010 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported bilateral hip pain that limited his activities of daily living. He could not walk greater than a quarter mile or stand more than 20 minutes without increased bilateral hip pain. Physical examination showed a cane-supported limping gait, but no left hip tenderness. Repetitive left hip flexion was 40 degrees, abduction was 15 degrees and external rotation was 25 degrees (normal 45) with painful motion. Extension was not addressed. Left hip X-rays revealed degenerative changes.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left hip condition 10%, coded 5003 (degenerative arthritis), citing limitation of motion of one major joint. The VA also rated the left hip condition 10%, coded 5252 (thigh, limitation of flexion), based on the C&P examination, citing limitation of flexion. Panel members agreed the orthopedic and MEB NARSUM ROM examinations held the most probative value, but neither supported the minimum 10% rating for limited ROM based on codes 5251, 5252 or 5253. However, there was satisfactory evidence of painful motion to support a 10% rating IAW VASRD
§4.59. The panel considered the post-separation VA ROM examination an outlier, as the preponderance of STR ROM evidence did not corroborate the significantly worse ROM values and there was no record of an intervening injury or other development that would explain the dramatic worsening. There was no femur malunion or fracture to support a higher rating under code 5255. 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 hip condition.

Right (Dominant) Shoulder. According to the STR and MEB NARSUM, the CI’s right shoulder condition began in 2004 while kickboxing. The CI was deployed at the time and the shoulder became more problematic while wearing battle gear. During the MEB NARSUM examination, the CI reported increased right shoulder pain when lifting or conducting overhead work. Physical examination revealed “normal” bilateral upper extremity motor strength and sensation. Right shoulder flexion was 160 degrees (normal 180) and abduction was 150 degrees (normal 180). Painful motion was present.

At the VA C&P examination, the CI reported daily right shoulder pain that was aggravated by carrying objects and reaching above shoulder level. Physical examination showed left shoulder flexion to 110 degrees and abduction to 120 degrees.  Painful motion was present.

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, citing limitation of motion of one major joint. The VA also rated the right shoulder condition 10%, coded 5010 (arthritis due to trauma), based on the C&P examination, citing painful motion of a major joint. 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 panel agreed there was no ROM evidence proximate to separation that supported the minimum 20% rating. However, there was satisfactory evidence of painful motion to support a 10% rating IAW VASRD
§4.59. There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment), and no higher rating available under the 5203 code (clavicle or scapula, impairment). After due deliberation, considering all the evidence and mindful of VASRD §4.3, the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder condition.

BOARD FINDINGS: In the matter of the left hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the right 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.

PD-2017-06073 

XXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXX

	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.

PD-2017-06073