RECORD OF PROCEEDINGS
                     PHYSICAL DISABILITY BOARD OF REVIEW

NAME:       BRANCH OF SERVICE:  Army
CASE NUMBER:  PD1100209                                    SEPARATION  DATE:
 20050714
BOARD DATE:  20120113


SUMMARY OF CASE:  Data extracted  from  the  available  evidence  of  record
reflects that this covered individual (CI) was an active duty SGT/E-5  (88M,
Truck Driver), medically separated for chronic right shoulder pain.  The  CI
injured his  right  shoulder  playing  basketball  in  June  2003.   He  was
eventually diagnosed with a rotator cuff  tear  which  did  not  respond  to
conservative   treatment.    In   October   2003,   he   underwent   surgery
(arthroscopic subacromial decompression and mini open rotator cuff  repair).
 The CI had good recovery initially, but then developed  recurrent  pain  in
the right shoulder due to failure of the rotator cuff repair.   In  November
2004, the CI underwent a second surgery (arthroscopic repair of  a  superior
labrum anterior-posterior tear, a distal one-third clavicle fracture  and  a
middle deltoid  avulsion).   Despite  surgery  and  post-operative  physical
therapy, he did not respond  adequately  to  treatment  and  was  unable  to
perform within his Military Occupational Specialty (MOS) or deploy with  his
unit.  He was  issued  a  permanent  U3  profile  and  underwent  a  Medical
Evaluation Board (MEB).  Right shoulder pain was forwarded to  the  Informal
Physical Evaluation Board (IPEB) as medically unacceptable  IAW  AR  40-501.
No other conditions appeared on  the  MEB’s  submission.   Other  conditions
included in the Disability Evaluation System (DES) packet will be  discussed
below.  The IPEB adjudicated the right shoulder chronic  pain  condition  as
unfitting, rated 0%, with application of the  US  Army  Physical  Disability
Agency (USAPDA) pain policy.  The CI made  no  appeals,  and  was  medically
separated with a 0% disability rating.


CI CONTENTION:  The CI states:  “I was discharged on  July  14,  2005  after
MEB for Right shoulder Reconstruction  surgery  with  a  0%  Rating.  I  was
granted  service  connection  with  disability/severance  pay.   There  were
several things rated at 0% at  time  of  discharge  need  to  be  evaluated.
Currently undergoing physical therapy at the Nashville VA  Hospital  for  my
right shoulder and left knee; left knee surgery in Oct 2010 at Nashville  VA
Hospital. Still continue to have issues with them.”


RATING COMPARISON:

|Service IPEB – Dated 20050503|VA (2 Mo. Pre-Separation) – All Effective|
|                             |Date 20050715                            |
|Condition                    |Code                              |Rating |
|Combined:  0%                |Combined:  20%                           |


ANALYSIS SUMMARY:  The Board acknowledges the  sentiment  expressed  in  the
CI’s  application  regarding  the  significant  impairment  with  which  his
service-incurred condition continues to burden him.   The  Board  wishes  to
clarify that  it  is  subject  to  the  same  laws  for  Service  disability
entitlements as those under which the military DES operates.  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.  That role  and
authority is granted by Congress to  the  Department  of  Veterans’  Affairs
(DVA), operating under a different set of  laws  (Title  38,  United  States
Code).  The VA is empowered to compensate all service  connected  conditions
and to periodically reevaluate said conditions for the purpose of  adjusting
the veteran’s disability rating should his degree of  impairment  vary  over
time.  The Board evaluates VA evidence proximal to  separation  in  arriving
at  its  recommendations,  but  its  authority  resides  in  evaluating  the
fairness of DES fitness decisions and rating determinations  for  disability
at the time of separation.

Chronic Right Shoulder Pain.  There  were  two  goniometric  range-of-motion
(ROM) evaluations in evidence which the Board weighed  in  arriving  at  its
rating recommendation.  These exams are summarized in the chart below.

|Goniometric ROM –|MEB ~ 3 Mo. Pre-Sep|VA C&P ~ 2 Mo.     |
|                 |                   |Pre-Sep            |
|R Shoulder       |                   |                   |
|Flexion (0-180)  |120⁰               |180⁰               |
|Abduction (0-180)|110⁰               |180⁰               |
|Comment          |Painful motion; No |No Deluca; See text|
|                 |instability; mild  |                   |
|                 |crepitation; +pain |                   |
|                 |and weakness with  |                   |
|                 |maneuvers; no      |                   |
|                 |atrophy            |                   |
|§4.71a Rating    |10%*               |0%                 |


            *With application of §4.59

The MEB exam noted limitation of shoulder flexion and abduction,  with  pain
at the terminal limits  of  abduction  and  external  rotation.   Diagnostic
maneuvers (O’Briens and Jobe) also elicited pain as well as  weakness.   The
examiner  additionally  documented  some  mild  crepitation,  but  found  no
evidence of instability.  Conversely, the VA exam documented  no  limitation
of shoulder ROM; it indicated normal ROMs.  There was  no  specific  comment
on  painful  motion;  however,  the  VA  examiner  did  note   flares   with
incapacitation, narcotic medication use, pain  and  difficulty  reaching  in
the history.  But, the  VA  Compensation  and  Pension  (C&P)  exam  further
indicated  that  joint  function  was  not  additionally  limited  by  pain,
fatigue, weakness, lack of endurance,  or  incoordination  after  repetitive
use.  According to the MEB examiner, plain films revealed a resected  distal
clavicle with no evidence of heterotopic ossification, an  indwelling  metal
suture anchor and a planed acromion.  Plain films in  May  2005,  taken  for
the VA C&P exam, noted no osseous abnormality.  The MEB  examiner  concluded
that “given  the  constant,  low-grade  pain  he  is  experiencing  and  the
activity-related pain with reaching and pulling activities he is  unable  to
return to  his  MOS  in  grade.”   The  commander  noted  that  the  CI  was
physically  incapable  of  reasonably  performing  his  MOS  duties  (drive,
perform maintenance,  lift  heavy  equipment)  due  to  the  right  shoulder
reconstruction surgery, and added, “simply stated, he is  totally  incapable
of performing his duties in a combat environment.”  The PEB and the VA  used
different coding for the condition, but this did not bear upon  the  rating.
The PEB coded analogous to degenerative arthritis  and  directly  referenced
the USAPDA pain policy to rate at  0%.   The  VA  coded  analogous  to  arm,
limitation of motion and rated at 0% for normal range of motion.  There  was
operative distal clavicle excision, labrum repair, and surgical evidence  of
deltoid muscle  avulsion  with  no  radiographic  evidence  of  degenerative
arthritis; therefore, coding  options  considered  were  analogous  to  5003
(Arthritis,  degenerative),  5010   (Arthritis,   due   to   trauma),   5019
(Bursitis), 5203  (Clavicle  or  scapula,  impairment  of),  or  5201  (Arm,
limitation of motion of).  Given the clavicle  resection,  coding  analogous
to 5203 was considered predominate.

The Board next considered the probative value of the exams in evidence.   It
is obvious that there is a clear disparity between the  service  examination
and the VA examination, with very  significant  implications  regarding  the
Board's rating recommendation.  The Board  thus  carefully  deliberated  its
probative value assignment to these conflicting evaluations,  and  carefully
reviewed the Service file for corroborating evidence in the 12-month  period
prior to separation.  The exams took place just over one month  apart,  with
the VA exam occurring closer to the time of separation.   The  service  exam
was a detailed and focused right shoulder exam performed  by  the  attending
orthopedic surgeon.  The  C&P  exam  was  not  performed  by  an  orthopedic
specialist, the exam was not detailed or specific, and did not  involve  any
diagnostic maneuvers  specifically  designed  to  elucidate  shoulder  joint
pathology.  Additionally, the completely normal ROMs documented at  the  C&P
exam were not consistent with the  pain-limited  ROMs  that  had  previously
been well documented in the STR.  The Board adjudged,  therefore,  that  the
more comprehensive service MEB exam was of  greater  probative  value.   The
Board noted that the degree of limitation of  shoulder  ROMs  documented  at
the MEB exam would not be  compensable  under  the  shoulder-specific  joint
coding.  However, there was significant evidence of painful motion  on  exam
to justify  application  of  VASRD  §4.59.   Painful  motion  of  the  right
shoulder was also well documented in the service treatment  records.   After
due deliberation, considering all of the evidence and mindful of VASRD  §4.3
(reasonable doubt), the Board recommends a separation rating of 10% for  the
chronic right shoulder pain condition, coded 5299-5203.

Other  Contended  Conditions.   The  CI’s   application   asserts   that   a
compensable rating should be considered for  left  knee  degenerative  joint
disease (DJD).  The CI sought evaluation for left knee pain after an  injury
during  physical  fitness  training  in  1996.   This  condition   was   not
clinically or occupationally significant during  the  MEB  period,  did  not
carry an  attached  profile  and  was  not  implicated  in  the  commander’s
statement.   This  condition  was  reviewed  by  the  action   officer   and
considered by the Board.  There was no  evidence  for  concluding  that  the
left knee condition interfered with duty performance to a degree that  could
be argued as unfitting.  All evidence considered, there  is  not  reasonable
doubt in the  CI’s  favor  supporting  addition  of  left  knee  DJD  as  an
unfitting condition for separation rating.

Remaining Conditions.  Several additional non-acute  conditions  or  medical
complaints were documented  in  the  MEB  history  and  physical  (bilateral
patellofemoral syndrome, bilateral plantar  fasciitis,  cervical  spine  DJD
with radiculopathy, prior nasal surgery, history of  right  thumb  fracture,
history of hand fracture, acid reflux,  hepatitis  B  carrier,  hemorrhoids,
seborrhea, Motrin allergy, chest pain due  to  acid  reflux,  heart  murmur,
elevated blood pressure, history of chest pain/dehydration and the need  for
a  root  canal/crown).   None  of  these   conditions   were   significantly
clinically or occupationally active during  the  MEB  period,  none  carried
attached profiles and none were implicated  in  the  commander’s  statement.
These conditions were reviewed by the action officer and considered  by  the
Board.  It was determined  that  none  could  be  argued  as  unfitting  and
subject to separation rating.   The  condition  of  right  hip  degenerative
joint disease was noted in the VA rating decision  proximal  to  separation,
but was not documented in the  DES  file.   The  Board  does  not  have  the
authority under DoDI 6040.44 to render  fitness  or  rating  recommendations
for any conditions not considered by the DES.  The Board, therefore, has  no
reasonable basis for recommending any additional  unfitting  conditions  for
separation rating.


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 right shoulder condition  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 condition,  the
Board unanimously recommends a rating  of  10%  coded  5299-5203  IAW  VASRD
§4.71a.  In the matter of the left knee pain condition or any other  medical
conditions eligible for Board consideration; the  Board  unanimously  agrees
that it cannot recommend any findings of  unfit  for  additional  rating  at
separation.


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  |
|Chronic Right Shoulder Pain S/P Surgery           |5299-5203   |10%     |
|COMBINED    |10%     |


The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20110328, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans' Affairs Treatment Record


      President
      Physical Disability Board of Review
SFMR-RB


MEMORANDUM FOR Commander, US Army Physical Disability Agency


SUBJECT:  Department of Defense Physical Disability Board of Review
Recommendation



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
                                       Deputy Assistant Secretary
                                           (Army Review Boards)