RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01381
BRANCH OF SERVICE:  Army	BOARD DATE:  20141216
SEPARATION DATE:  20040723

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a reserve E-8 (Automated Logistical Specialist) medically separated for right shoulder and Hepatitis C conditions.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty but could perform an alternate physical fitness test.  He was issued a permanent P3US profile and referred for a Medical Evaluation Board (MEB).  The right shoulder pain and Hepatitis C conditions, characterized as “right shoulder pain, bursitis and impingement and chronic active hepatitis,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “right shoulder pain, bursitis, and impingement and hepatitis C” as unfitting, rated 10% and 10% respectively, citing criteria of the US Army Physical Disability Agency (USAPDA) pain policy for the shoulder condition.  The CI made no appeals and was medically separated.

CI CONTENTION:  “My left foot conditions have been bad since the 70’s.  I don’t know what other information I can provide since the military Med Board [sic] me back in 2004.  My left foot worsen over the years of my military service.” 

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 and Hepatitis C conditions are addressed below. The contended left foot condition was not implicated by the MEB or PEB and is therefore not within the DoDI 6040.44 defined purview of the Board.  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 20040602	VA - (5 Mos. Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain, Bursitis, and Impingement	5099-5003	10%	Right Shoulder Bursitis and Impingement	5299-5201	0%	20041209	
No PEB entry			Left Shoulder s/p Surgery	5299-5201	10%	20041209	
Hepatitis C, Asymptomatic	7354	10%	Hepatitis C	7354	0%	20041209	
Other x 0 (Not in Scope)	Other x 2	20041209	
Combined:  20%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20050307 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Shoulder Pain, Bursitis, and Impingement Condition.  The right hand dominant CI injured his shoulder in January 2003 following mobilization to active duty and subsequently underwent shoulder surgery on 14 October 2003.  The Board noted that the MEB narrative summary (NARSUM), MEB referral and PEB referred to the injured and unfit shoulder as the right shoulder; however, it is clear from the documents that the CI injured the left shoulder and had surgery on the left shoulder.  The MEB NARSUM on 15 February 2004 noted the shoulder surgery performed on 14 October 2003 and reported persistent shoulder pain aggravated by heavy lifting.  On examination there was “mild limitation of motion” and pain with full external rotation.  The diagnosis was shoulder bursitis with impingement.  The physical therapy range-of-motion (ROM) examination on 29 March 2004, recorded left shoulder flexion of 155 degrees (normal 180 degrees), abduction 170 degrees (normal 180 degrees), extension 65 degrees, adduction 30 degrees, internal rotation 60 degrees (normal 90) and external rotation 45 degrees (normal 90).  The right shoulder ROM was normal.  The PEB cited an 11 May 2004 physical therapy examination, not available in the file, reporting 145 degrees of abduction.  The VA Compensation and Pension (C&P) examination performed on 9 December 2004, 4 months after separation, noted the left shoulder had undergone surgery, not the right shoulder.  On examination, the left shoulder flexed 120 degrees and abducted to 120 degrees before the onset of marked discomfort.  Internal and external rotation was 90 degrees with slight pain.  The right shoulder had a normal ROM.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the shoulder 10% (coded 5099-5003) citing abduction of 145 degrees with application of the USAPDA pain policy.  The VA rated the post-operative residuals of the left shoulder 10% citing painful motion (§4.59) noting the limitation of motion did not attain a minimum rating (coded 5299-5201 limitation of arm motion).  The Board noted the PEB found one shoulder unfitting and that although the PEB listed the right shoulder, it was the left shoulder that was injured and required surgery just prior to referral for MEB.  The examinations noted left shoulder impairment.  The Board therefore based its rating recommendation for the unfitting shoulder condition on the examination results for the left shoulder.  The limitation of motion recorded on the MEB and VA C&P examinations did not show limitation at shoulder level and therefore the limitation of motion did not attain a minimum rating under the VA Schedule for Rating Disabilities (VASRD) diagnostic code 5201 for limitation of arm motion.  There was painful motion and functional loss reported in examinations supportive of a 10% rating based on functional loss (§4.40) and painful motion (§4.59).  There was no ankylosis, dislocations, non-union or malunion to support consideration under the alternate codes for the shoulder.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the unfitting shoulder condition.

Hepatitis C Condition.  The MEB NARSUM reported that the CI was diagnosed with chronic Hepatitis C in January 2004 and deemed non-deployable due to the condition.  He was asymptomatic, had no evidence of nutritional impairment, weight loss or loss of liver function.  The VA C&P examination on 9 December 2004, 4 months after separation, noted the state of nutrition to be good.  The liver was mildly enlarged but there was no enlargement of the spleen or other examination findings of chronic liver disease.  Laboratory testing demonstrated mildly elevated liver enzymes but with normal liver synthetic function (albumin) and a normal blood count.

The Board directed attention to its rating recommendation based on the above evidence.  The VA rated the chronic Hepatitis C condition 0% noting the CI was asymptomatic (coded 7354).  The PEB rated the condition 10% (coded 7354) also noting the CI was asymptomatic.  The next higher rating of 20% requires the presence of multiple symptoms compatible with the condition (fatigue, malaise and anorexia), dietary restrictions, continuous medications or incapacitation episodes of symptoms.  The evidence of the records did not demonstrate symptoms supporting the 20% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the Hepatitis C 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 shoulder pain condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the shoulder pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the Hepatitis C condition and IAW VASRD §4.114, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130916, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

				
XXXXXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAMR-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, AR20150007595 (PD201301381)

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 and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA