Author: JOHN J. D'ORAZIO
Last saved by: WEATHERS, JANICE R SrA USAF AFRBA AFRBA/AFBCMR
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxx		CASE:  PD1201950
BRANCH OF SERVICE:  ARMY		BOARD DATE:  20131106
SEPARATION DATE:  20010927

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Specialist/E-4 (44B10/Metal Worker/Welder) medically separated for chronic right shoulder pain, status post (s/p) excision of soft tissue mass.  In about February 1999, the CI fell on her right outstretched arm during a run in Advanced Individual Training (AIT).  She had persistent right shoulder pain despite various treatments.  CT scan of the right shoulder in February 2000, and subsequent magnetic resonance imaging, revealed a soft tissue mass in the right superior sulcus.  The CI underwent surgery at the Walter Reed Army Medical Center cardiothoracic surgery service in December 2000.  The soft tissue mass pathology returned as low grade spindle cell mass of the brachial plexus.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded the chronic right shoulder pain s/p excision of soft tissue mass right superior sulcus condition to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated the condition as unfitting, rated 0% citing the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in her application.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting right shoulder pain condition is addressed below; no additional conditions are within the Board’s defined DoDI 6040.44 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 Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20010927 | VA - (Exam ~ 4.5 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Right Shoulder Pain s/p Excision Soft Tissue Mass | 5099-5003 | 0% | Painful Right Shoulder s/p Schwannoma Excision | 5203 | 10% | 20020215
No Additional MEB/PEB Entries | Disfiguring Tender Scar of Right Upper Chest | 7800 | 30% | 20020215
| Residual Numbness & Tenderness s/p Surgery | 8003-8717 | 10% | 20020215
| No Other VA Conditions | 20020215
Combined:  0% | Combined:  40%
Derived from VA Rating Decision (VARD) dated 20020626 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

Chronic Right Shoulder Pain, s/p Excision of Soft Tissue Mass:  The CI complained of right shoulder pain over a 14-month period beginning in November 1998.  Her initial four presentations for care noted no trauma or injury until sometime in late January 1999 when she tripped and fell injuring her right shoulder while running during AIT.  She was then evaluated multiple times for right shoulder pain by primary care and orthopedic physicians.  In October 1999, an MEB was initiated for right shoulder pain.  On 25 January 2000 in preparation for the MEB, a chest X-ray was performed and revealed a “Well circumscribed soft tissue mass in the right apex measuring approximately 3.0 cm in diameter.  Findings are suspicious for lymphadenopathy versus neoplasm.”  The CI had an ultrasound guided needle biopsy that showed the mass to be a peripheral nerve sheath tumor.  In June 2000, after multiple consultations, the CI decided to delay surgical excision for the tumor due to her being pregnant.  On December 27, 2000, 9 months prior to separation, the CI underwent an excision of a Schwannoma: a benign nerve sheath tumor.  The MEB history and physical exam accomplished 19 months prior to separation, and prior to the surgical excision, documented full but painful range-of-motion (ROM) of the right shoulder.  The MEB narrative summary prepared 4 months prior to separation documented that the CI complained “only of some minimal right elbow pain in the AM after sleeping.”  The physical exam findings revealed a well healed surgical scar with minimal hypertrophy.  Right shoulder ROM was 170 degrees of forward flexion (180 degrees normal) and 165 degrees of abduction (180 degrees normal) with normal strength, sensory function and reflexes.  At the VA Compensation and Pension (C&P) exam performed 4 months after separation, the CI reported that she continued to have pain in her right upper chest and right shoulder area.  She still had occasional numbness and tingling in the right arm.  The pain affected her ability to lift something heavy with the right arm.  The pertinent physical exam findings were a prominent tender surgical scar located on the right neck extending to the right chest to the right shoulder area.  There was keloid formation and disfigurement but no loss of underlying tissue.  The shoulder joints had “normal” ROM, flexion to 145 degrees, abduction 180 degrees with no abnormal movement, instability or weakness.  There was some tenderness on palpation of the AC joint of the right shoulder and pain on extreme ROM of the right shoulder.  Right arm reflexes, sensation and strength were normal.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB applied the analogous VASRD code 5099-5003, degenerative arthritis, and rated it 0% with specified application of the USAPDA pain policy.  The VA applied code 5203, impairment of the clavicle or scapula, and rated it 10%.  Code 5203 also allows for rating based on impairment of function of contiguous joint, which includes the shoulder.  The CI had a benign nerve sheath tumor, most likely the cause of her pain and not an injury, which was successfully excised.  Rating under 5003, without compensable ROM limitations, does allow for a 10% rating if limitation of motion is objectively confirmed by satisfactory evidence of painful motion IAW §4.59.  After her recuperation, all evidence agrees that she had non-compensable ROM of the right shoulder with adequate documentation of painful motion on the C&P exam.  There was no X-ray evidence of degenerative arthritis with occasional incapacitating episodes that would allow for a 20% rating under 5003.  Additionally, there was no abnormal movement, instability/dislocation or humeral impairment that would allow for application of specific shoulder codes.  The VASRD is consistent in its rating of benign neoplasms; they are rated based on the impairment of the body system where they were located.  By precedent, the Board does not recommend a disability rating for scars unless their presence imposes a direct functional limitation that renders the CI separately unfit.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic right shoulder pain, s/p excision of soft tissue mass 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 chronic right shoulder pain was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic right shoulder pain, s/p excision of soft tissue mass condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

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

UNFITTING CONDITION | VASRD CODE | RATING
Chronic Right Shoulder Pain, s/p Excision of Soft Tissue Mass | 5299-5003 | 10%
COMBINED | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130902, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

xxxxxxxxxxxxxxxxxxxxxxxx, DAF
President
Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for xxxxxxxxxxxxxxxxxxxx, AR20140002048 (PD201201950)

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 rating to 10% without 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						     xxxxxxxxxxxxxxxxxxxxxxxxx
						     Deputy Assistant Secretary
						         (Army Review Boards)

PD1201950