RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-01468
BRANCH OF SERVICE:  Army	BOARD DATE:  20140701
Separation Date:  20040430

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (21E/Heavy Equipment Operator) medically separated for right sided snapping scapula syndrome.  The snapping scapula condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  His profile allowed for alternate aerobic events to satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  Snapping scapula syndrome was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated “right sided snapping scapula syndrome” as unfitting, rated 0%, citing language of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Shoulder is hurting more and more no that I am getting older.  Have had to up my dosage of medication since time of injury.”

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 sided snapping scapula condition is addressed below and no additional conditions are 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 20040308	VA - (6.5 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Snapping Scapula Syndrome	5099-5003	0%	Right Shoulder Injury	5201-5019	10%	20041115	
No Additional MEB/PEB Entries	Other x0		
Rating:  0%	Rating:  10%	
Derived from VA Rating Decision (VARD) dated 20050406 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by congress to the Department of Veterans Affairs (DVA), operating under a different set of laws.  The Board considers DVA evidence proximate to separation in arriving at its recommendations and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Right-Sided Snapping Scapula Syndrome Condition:  The CI injured his right shoulder in April 1998 when he fell from a 34 foot tower at Airborne School after his harness broke.  He did not seek medical care until April 2001 when he complained of constant pain under his right scapula radiating to his neck and right shoulder with popping and cracking since the accident.  The examiner documented crepitus with shoulder movement on the right scapula and diagnosed right scapulothoracic crepitus.  A month later, the CI was re-evaluated for worsening right shoulder pain with activity and was diagnosed with snapping scapula and referred to physical therapy (PT).  The CI was seen on a monthly basis for right shoulder chronic pain by both primary care and PT. without any pain resolution.  A right shoulder X-ray performed for “snapping syndrome” with constant aching pain was normal.  The physician ordered a repeat right shoulder X-ray because of pain at the medial scapula border with posterior displacement which was also normal.  A right shoulder CT scan for right shoulder pain and snapping syndrome was normal.  Throughout 2003 and 2004, the CI was followed by orthopedics and primary care for ongoing right shoulder pain and snapping.  The CI underwent steroid injections and he was started on a non-steroidal anti-inflammatory drug for pain control.  An electromyogram was ordered to rule out long thoracic nerve palsy.  However, there is no documentation in the service treatment record.  The MEB narrative summary (NARSUM) exam approximately 8 months prior to separation documented that the CI had chronic right shoulder pain.  The MEB NARSUM physical exam findings are summarized in the chart below.  The CI was given a permanent U3 profile for right shoulder/scapular pain (snapping scapular syndrome).  The orthopedist documented that the right shoulder popped and cracked with motion.  The exam findings are summarized in the chart below.  The commander’s statement indicated that PT could not improve the CI’s injured area and his permanent profile limited him from performing his MOS duties.  An MEB addendum note from the orthopedist documented that the CI was not a surgical candidate.  The VA Compensation and Pension exam documented that the CI had tried and failed a multitude of medications including cortisone injections that failed to provide pain relief.  He reported that he lost time form work on the average of twice per month.  A right shoulder X-ray ordered at this exam was normal.

There were two range-of-motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation as summarized in the chart below.

Right Shoulder ROM (Degrees)	MEB 8.5 Mos. Pre-Sep	VA C&P 6.5 Mos. Post-Sep	
Flexion (180 Normal)	170	110	
Extension	70		
Abduction (180)	80	180	
Comments
Right hand dominant	Tenderness To Palpation with crepitus; Normal strength	Pos. painful motion with flexion only	
§4.71a Rating	10% (PEB 0%)	10%	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB coded the right sided snapping scapula syndrome condition as 5099 analogous to 5003 arthritis, degenerative (hypertrophic or osteoarthritis) and rated at 0% with application of the USAPDA pain policy.  The VA coded the right shoulder injury as 5201 arm, limitation of motion of with 5019 bursitis and rated at 10%.  All exams proximate to separation document pain limited motion with non-compensable ROM measurements.  VASRD §4.71a specifies for 5003 that “satisfactory evidence of painful motion constitutes limitation of motion and specifies application of a 10% rating “for each major joint or group of minor joints affected by limitation of motion.”  The Board considered assigning a rating for bursitis as did the VA; however, this would not result in a rating greater than 10% as bursitis is also rated under code 5003.  The Board also determined that no alternate coding/rating schema would provide a higher rating.  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 right sided snapping scapula syndrome 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 (Army Regulation 635-40) for rating the right sided snapping scapula syndrome condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the right sided snapping scapula syndrome condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 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	
Right Sided Snapping Scapula Syndrome	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130917, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			
XXXXXXXXXXXXXXXXX
President
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 XXXXXXXXXXXXXXXXX, AR20150002600 (PD201301468)

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						     XXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA