RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	BRANCH OF SERVICE:   Army 
CASE NUMBER:  PD1201280	SEPARATION DATE:  20021108
BOARD DATE:  20130430      

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, SGT/E-5, (63B/Wheeled Mechanic) medically separated for left shoulder pain.  The CI injured the left shoulder in January 2000 when a vehicle transmission fell onto his left shoulder and again in April 2001 while playing football.  He underwent surgery in October 2001 however he could not be fully rehabilitated and the CI was unable to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  Moderate sensorineural hearing loss, nasal obstruction, status post rhinoplasty and right ankle crush injury, identified in the rating chart below, were also identified and forwarded by the MEB.  The Physical Evaluation Board (PEB) adjudicated the left shoulder condition as unfitting, rated 20%, with application of the US Army Physical Disability Agency (USAPDA) pain policy.  The remaining conditions were determined to be not unfitting.  The CI made no appeals, and was medically separated with a 20% disability rating.  

CI CONTENTION:  “My left shoulder condition is severe and continues in its severity.  Getting cortisone shots on my left foot, pain on whole foot and ankle.  Back problems and rectal bleeding.  Migraines/sleeping disorder.”   

SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.”  The service ratings for unfitting conditions will be reviewed in all cases.  Only the left shoulder condition (left shoulder pain and instability, anterior capsular shrinkage, status post arthroscopy) as requested for consideration meet the criteria prescribed in DoDI 6040.44 for Board purview; and, is addressed below.  The other requested conditions (left foot, back pain, rectal bleeding, migraines and sleep disorder) are not within the Board’s purview.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the respective Service Board for Correction of Military Records.

RATING COMPARISON:  

Service IPEB – Dated 20020718 | VA (7 Mos. Pre-Separation) – All Effective Date 20021109
Condition | Code | Rating | Condition | Code | Rating | Exam
Left Shoulder Pain | 5099-5003 | 20% | L shoulder s/p surgery | 5201 | 20% | 20020419
Right Ankle | Not Unfitting | Right Foot posttraumatic strain | 5284 | 10% | 20020419
Hearing Loss | Not Unfitting | Tinnitus | 6260 | 10% | 20020430
Nasal Obstruction | Not Unfitting | NO VA ENTRY |
↓No Additional MEB/PEB Entries↓ | Lumbar strain | 5292 | 10% | 20020419
| Left Ankle chronic strain | 5271 | 10% | 20020419
| 0% X 5 / Not Service-Connected x 7 |
Combined:  20% | Combined:  50%

ANALYSIS SUMMARY:  The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force.  While the DES considers all of the service member's medical conditions, compensation can only be offered for those medical conditions that cut short a service member’s career, and then only to the degree of severity present at the time of final disposition.  The DES has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service connected by the VA but not determined to be unfitting by the PEB.  However the Department of Veteran Affairs (DVA), operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the veteran’s disability rating should his degree of impairment vary over time.  The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on severity at the time of separation.  

Left Shoulder Condition.  The right hand dominant CI experienced difficulties with left shoulder instability with recurrent dislocations beginning in 2000.  Magnetic resonance image (MRI) scan of the left shoulder on 10 August 2001 showed a small intersubstance tear of the supraspinatus tendon consistent with a partial tear.  Left shoulder X-rays 17 October 2001 showed no evidence of arthritic, inflammatory or traumatic changes, peritendinitis or calcified bodies, and the glenohumeral and acromioclavicular joints were unremarkable.  The CI underwent arthroscopic examination, debridement of the supraspinatus tendon, and capsular shrinkage on 18 October 2001.  Physical therapy (12 December 2001) and orthopedic (18 December 2001) examinations approximately two months after surgery recorded left shoulder flexion of 110 and 115 degrees respectively and abduction of 120 and 90 degrees respectively, limited by pain.  Orthopedic examination on 22 January 2002 noted constant aching in the left shoulder, pain with lifting or overhead activity, inability to do pushups or function in his MOS as a mechanic. Motion was limited by pain to shoulder level.  Because his pathology was poorly defined, he had not responded to surgery or conservative treatment, and further surgery did not offer a substantial chance of bringing him to retention standards, the case was referred to MEB.  The narrative summary reported decrease motion and strength due to pain and noted the CI was not receiving any active treatment.  There were no further episodes of dislocation reported following surgery.  The VA general Compensation and Pension (C&P) examination and the bone and joint C&P examination in April 2002 reported elevation of the arm to approximately shoulder level with pain limiting motion.  The 26 April 2002 neurology C&P examination noted that despite the complaint of weakness there was normal bulk and tone of the upper arm muscles and that the musculature was quite well developed.  A bone scan in May 2002 of the upper extremity was normal.  

The Board directs attention to its rating recommendation based on the above evidence.  At the time of enlistment medical examination 30 April 1992 the CI indicated he was right handed and VA C&P examination 19 April 2002 records the CI is right handed.  The PEB rated the left shoulder 20% with application of the USAPDA pain policy.  The VA adjudicated a 20% rating based on limitation of motion.  Following initial recovery from surgery, the range of motion of the left shoulder was limited to about shoulder level by report of pain.  Although there were examinations with more limitation and the CI reported weakness due to pain, the absence of muscle atrophy with quite well developed musculature at the time of the neurology examination six months after surgery indicated active use of the left arm.  All members agreed the preponderance of evidence supports a 20% rating under limitation of motion (5201).  No further problems with dislocation was reported after surgery and a higher rating is not supported under 5202 (other impairments of the humerus).  Furthermore, the left shoulder would be considered the minor joint in this case and the rating would be unchanged if this code were utilized.  There was no impairment of clavicle or scapula to warrant consideration under code 5203.  Although the PEB adjudicated using the USAPDA pain policy, a higher rating was not supported under the VASRD.  Although the Board concluded a rating higher than that adjudicated by the PEB was not warranted, it noted that the 20% rating derived from application of VASRD guidelines was most appropriately coded 5201.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% coded 5201 for the left shoulder pain condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB reliance on the USAPDA pain policy for rating the left shoulder condition was operant in this case; the condition was adjudicated independently of that policy by the Board.  In the matter of the left shoulder condition, the Board unanimously recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

UNFITTING CONDITION | VASRD CODE | RATING
Left Shoulder Pain | 5201 | 20%
RATING | 20%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120611, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for AR20130010841 (PD201201280)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability description without modification of the combined rating or recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA