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AF | PDBR | CY2012 | PD2012 01659
Original file (PD2012 01659.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201659
BRANCH OF SERVICE: Army  BOARD DATE: 20130327
SEPARATION DATE: 20070310


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (92F/Petroleum Supply Specialist) medically separated for a left shoulder condition. He developed a “snapping” pain in his left scapular and shoulder area in 2005, which was not concisely diagnosed in the record. The condition did not respond adequately to conservative treatment to permit satisfactory performance of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The condition, characterized as “left snapping shoulder,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated the left shoulder condition as unfitting, rated 10%, referencing the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals, and was medically separated with 10% rating.


CI CONTENTION: The application states simply, “I feel as though I should have been awarded a higher rating due to the two years that the Army was treating my injury we were unable to figure out why I had this injury. [sic] However, it was shown to be progressive and life long. ... [The statement proceeds with an elaboration of the progression of his pain and its impact on his quality of life; with the belief that the latter was not factored into his disability rating. He also asserts that he was poorly advised not to contest his rating, stressing a deference to fellow soldiers awaiting medical boards.] . I feel as though I took my time in the Army very seriously, and served to the best of my ability. I also believe that my injury was more severe and life altering than the med board found it to be. I appreciate your time and consideration.”


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 left shoulder 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 Army Board for Correction of Military Records (ABCMR). 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 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, operating under a different set of laws. The Board further acknowledges the CI’s assertion that he was poorly advised when considering an appeal; but, it is noted for the record that the Board has no jurisdiction to investigate or render opinions in reference to such allegations. Redress in excess of the Board’s scope of recommendations must be addressed by the ABMCR or the United States judiciary system.



RATING COMPARISON:

Service IPEB – Dated 20070131
 VA - (17 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Left Shoulder Pain
 5099-5003 10% Left Scapulothoracic Syndrome 5299-5201 20% 20080801
No Additional MEB/PEB Entries
 Other x 1, NSC x 4 20080801
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VARD) dated 20090327 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Chronic Snapping and Pain, Left Shoulder. This right hand dominant CI presented to orthopedic surgery clinic with left shoulder pain and snapping in his scapular that began in July 2005, without specific injury. On 17 July, 2006, computerized tomography (CT) imaging demonstrated no significant shoulder pathology. The CI participated in 9 months of physical therapy and reported limited benefit. Multiple examinations of the left shoulder revealed no evidence of neuromuscular pathology, no objective findings of spasms, and no limitation in range-of-motion (ROM), although pain was noted during ROM testing, and tenderness to palpation around the scapula region. The CI did not experience incapacitating episodes, and he had no limitations on working a normal duty day as noted in the commander’s statement. At the MEB narrative summary (NARSUM) exam, 11 January 2007, 2 months prior to separation, the CI reported pain and snapping of left shoulder, and denied numbness and tingling distally in the extremity. On examination, gait was normal, flexion and abduction was up to 175 degrees equal to the right shoulder. External rotation was 70, cuff strength was normal bilaterally, and there was no objective evidence of left shoulder instability. No generalized ligamentous laxity noted. There was no focal or localized tenderness to palpation. Sensation and motor examinations were normal. Full ROM was recorded about the elbow, wrist, and fingers. At the VA Compensation and Pension (C&P) exam, 1 August 2008, approximately 16 months after separation, the CI reported severe pain on motion, with radiation of pain to upper back and right shoulder and down to the middle of the back. The pain began into the left shoulder blade, but later involved the left shoulder joint. He continued to report snapping and popping of shoulder, and loss of strength in left hand, but no pain or numbness below the elbow, and stated he could not use his left hand at all due to pain and weakness. On examination, gait was normal; flexion was recorded at 170 degrees, abduction of 180. Limitation on forward motion with repetitive use was noted at 140 degrees with pain noted as limiting factor; limitation on abduction with repetitive use was recorded at 90 degrees. Additionally, pain was recorded throughout ROM testing.

The Board directs attention to its rating recommendation based on the above evidence. The PEB chose to rate the condition analogous to 5003 (degenerative arthritis) and granted the minimal compensable rating for pain, 10%. The VA coded the condition under the 5201 code (limitation of motion) and rated the condition at 20. Applicable diagnostic codes include: 5003 (degenerative arthritis) 5201 (limitation of arm motion); 5202, (humerus, other impairment), and 5203 (dislocation of clavicle or scapula). The Board considered the rating under 5003, degenerative arthritis and agreed there was pain on motion supporting the 10%. There is insufficient evidence to support the higher rating of 20%. The Board noted the VA rated the condition under the 5201 for limitation of arm motion and assigned a 20% rating. The Board noted this to be inconsistent with the service treatment records (STRs) which recorded no limitation of motion. After discussion, the Board agreed the probative value of the NARSUM was significant since the findings were more proximal to date of separation than those of the C&P examination. Of note, the CI had full ROM recorded on multiple exams including the NARSUM; therefore, the evidence at the time of separation does not support the use of the 5201 code. The Board considered rating under 5202 and 5203 codes; however, there was no clinical or radiologic evidence supporting ankylosis, loss of the humeral head, nonunion, malunion, fibrous union, or deformity of the humerus. There was further no clinical or radiologic evidence that suggested dislocation of, nonunion of, or malunion of the clavicle or scapula. Hence, no alternative shoulder code is supported in justification of a rating higher than 10% under these codes. There was no evidence of ratable peripheral nerve impairment which would provide for additional or higher rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board concluded there was insufficient evidence to recommend a change from the PEB’s adjudication of the chronic left shoulder conditions.


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, the PEB reliance on the USAPDA pain policy DoDI 1332.39 for rating chronic left 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 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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Chronic Left Shoulder
 5099-5003 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120704, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




                  Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130008747 (PD201201659)

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                                                 

                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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