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AF | PDBR | CY2012 | PD2012 01881
Original file (PD2012 01881.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXX       BRANCH OF SERVICE: Army
CASE NUMBER: PD1201881   SEPARATION DATE: 20050412
BOARD DATE: 20130222


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Soldier, SPC/E-4(91W/Combat Medic), medically separated for chronic pain left shoulder. The CI’s shoulder injury resulted from carrying a 70-90 pound aid bag while running, jumping in and out of fox holes, and on and off vehicles during a deployment to Iraq in April 2003. Despite extensive physical therapy and two surgeries, the CI could not be adequately rehabilitated to meet the physical requirements 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 MEB forwarded severe left shoulder pain, status post (s/p) surgery as medically unacceptable IAW AR 40-501. The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated chronic pain left shoulder as unfitting, rated 10%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD) and the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals, and was medically separated with a 10% disability rating.


CI CONTENTION: The CI states: “I have severe decreased range of motion to the point where it renders my left army useless, severe pain, chondrolysis which destroyed all cartilage in my shoulder and bone on bone arthritis. I also have nerve damage which I have been taking medication for many years.” The CI also writes in paragraph 4 of the application that he was misrepresented by his doctor during the MEB process, and that he has been told “there is not a surgeon in the world that can fix my shoulder.” He also states that the VA has sent him to three different surgeons, but they have not been able to help.


SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44 Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The rating for unfitting condition of the left shoulder will be reviewed. 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.


RATING COMPARISON :

Service PEB – Dated 20050211
 VA (9 Mos. Pre-Separation) – All Effective Date 20050413
Condition
 Code Rating Condition Code Rating Exam
Chronic Pain Left Shoulder 5099-5003 10% Left Shoulder Pain 5201 20% 20040713
↓No Additional MEB/PEB Entries↓
 Right Ankle Tendonitis 5099-5024 10% 20040713
Lumbar Strain 5237 10% 20040713
0% X 0 / Not Service-Connected x 2 20040713
Combined: 10%
 Combined: 40%


ANALYSIS SUMMARY: The Disability Evaluation System (DES) 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 (DVA), operating under a different set of laws (Title 38, United States Code). The Board evaluates DVA 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. The Board further acknowledges the CI’s contention for ratings for other conditions documented at the time of separation, and notes that its recommendations in that regard must comply with the same governance.

Chronic Pain Left Shoulder. This right hand dominant CI presented to orthopedic surgery clinic with left shoulder pain in April 2003 that begun with increasing rucksack wear, jumping and running, without specific injury. On 2 September, 2003, magnetic resonance imaging (MRI) demonstrated intact rotator cuff, normal biceps tendon and a tear within the anterior labrum. The CI underwent arthroscopic repair of this tear in November 2003 and reported initial improvement. Postoperatively the CI developed stiffness in the shoulder with restricted range-of-motion (ROM). A second arthroscopic procedure, 5 March 2004, revealed severe scarring within the shoulder joint, and scar removal was undertaken. Examination during surgery revealed no shoulder instability. Postoperatively the CI had persistent shoulder difficulties. At the MEB/narrative summary (NARSUM) exam, dictated on 2 December 2004, 5 months prior to separation, the CI reported pain of left shoulder as worse than prior to initial surgery in respect to pain and motion. The CI denied numbness or tingling distally in the extremity. On examination flexion was 90 degrees and abduction was 100 degrees; there was no muscle atrophy present, no tenderness at the shoulder joint, no weakness, and sensation was intact. Pain was reported on motion. Radiographic studies taken on 2 December 2004 were normal and revealed no evidence of joint arthritis. At the VA Compensation and Pension (C&P) exam, performed on 13 July 2004, approximately 9 months prior to separation, the CI reported pain on motion and limitation of motion that was constant without incapacitation. Physical examination revealed flexion of 90 degrees, abduction of 80, with the notation of no limitation by fatigue, weakness, lack of endurance or incoordination.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated 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 20%. A higher rating of 30% requires a limitation of flexion or abduction to 25 degrees for a nondominant extremity, not supported by the record in evidence. 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% using this code since there were no incapacitating episodes. The Board noted the VA rated the condition under the 5201 for reduced ROM and agreed the ROM was consistent with the findings of the MEB/NARSUM. After discussion, the Board agreed the use of the 5201 code best reflected the shoulder condition at the time of separation and supported the 20% rating under this 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 to support use thereof. 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 (reasonable doubt), the Board concluded there was sufficient evidence to recommend a change from the PEB’s adjudication of the 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, PEB reliance on the USAPDA pain policy for rating left shoulder was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the left shoulder condition, the Board unanimously recommends a disability rating of 20%, coded 5201 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
Left Shoulder Pain 5201 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20121101, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         XXXX
         Physical Disability Board of Review


 SFMR-RB                                                                         


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


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXX AR20130004603 (PD201201881)
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 20% 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                                                  XXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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