RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01804
BRANCH OF SERVICE:  Army	BOARD DATE:  20150417
SEPARATION DATE:  20050623

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E-6 (Logistics Supply) medically separated for a left (non-dominant) shoulder condition which 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 U3 profile and referred for a Medical Evaluation Board (MEB).  The condition “left shoulder pain due to partial rotator cuff tear” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded left knee, lumbar, and sinusitis conditions for PEB adjudication, judged to meet retention standards.  The Informal PEB adjudicated the left shoulder condition as unfitting, rated 10%, citing criteria 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 released from active duty in lieu of severance pay to accept Reserve retirement pay at age 60.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

IPEB – Dated 20050503	VA* (7 Wk. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, L Shoulder	5099-5003	10%	Partial Rotator Cuff Tear ... L Shoulder 	5003	10%	20050505	
Other x 3 (Not In Scope)	Other x 5	
RATING:  10%	COMBINED:  30%	
*Derived from VA Rating Decision (VARD) dated 20050803 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY: 

Left Shoulder Condition.  The service treatment record (STR) contains a June 2003 entry during a deployment to Iraq noting an exacerbation of left shoulder pain (no specific injury cited) that had been present intermittently since basic training.  The CI completed the deployment, but there is a post-deployment entry from April 2004 noting continued shoulder pain with a full range-of-motion (ROM).  An orthopedic consultant from May 2004 noted non-specifically decreased ROM and signs of impingement, and subsequent magnetic resonance imaging (MRI) was interpreted as bursitis with the possibility of rotator cuff injury.  The CI elected conservative management, and she did experience transient relief and improved ROM with steroid joint injections.  Long term resolution could not be achieved, however, and a repeat MRI confirmed a partial tear of the rotator cuff.  She declined surgery (optional and reasonable) and was referred for an MEB.  There are no STR entries which provide measured ROM, but none which suggest significant ROM limitation.  There are various exams noting signs of “mild” impingement, but none reflecting instability.

The narrative summary (NARSUM) was conducted on 4 March 2005 (14 weeks prior to separation), and documented “intermittent ... present at least 50% of the time” pain rated 7-10/10 “made worse by heavy lifting or trying to do any overhead work.”  The NARSUM physical exam recorded joint tenderness with no comment regarding impingement or stability; and, measured ROM was 180 degrees (normal) for both forward flexion and abduction, annotating painful motion.

A VA Compensation and Pension examination was conducted on 5 May 2005 (7 weeks prior to separation), and reported constant “pain, stiffness and swelling” without elaboration of severity or limitations, although stating that there was “no functional impairment” from the condition.  The VA physical exam did not detail joint findings, but provided normal ROM measurements (identical to NARSUM), also annotating painful motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating analogous to 5003 (degenerative arthritis) cited the “slight/frequent” criterion of the USAPDA pain policy, but was consistent with VASRD §4.71a criteria for the ROM and ratable findings (conceding painful motion).  The VA also employed code 5003 and cited painful motion to achieve the minimum compensable 10% rating.  There is no ankylosis, instability, fracture, or other ratable feature in evidence which would support a rating greater than 10% under any available code.  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 of the left shoulder 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 was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the left shoulder condition and IAW VASRD §4.71a, 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 20131022, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX, AR20150011069 (PD201301804)

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