RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

   BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20050624 

 
NAME:    
CASE NUMBER:  PD1200166 
BOARD DATE:  20121115 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty SPC/E-4 (19D/Cavalry Scout), medically separated for 
moderate/constant chronic pain of the left knee, right and left shoulders, and left femur status 
post  (s/p)  injuries.    The  CI  was  in  a  serious  motorcycle  accident  in  May  2004  and  sustained 
significant injuries to his left knee, left femur, and both shoulders.  Despite two surgeries for a 
fractured  femur,  physical  therapy,  and  medication,  the  CI’s  injuries  could  not  be  adequately 
rehabilitated.  He was unable to meet the physical requirements of his Military Occupational 
Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent U3/L3 profile 
and  referred  for  a  Medical  Evaluation  Board  (MEB).    Although  the  MEB  forwarded  each 
condition as separate medically unacceptable conditions, the Physical Evaluation Board (PEB) 
rated them together as a single unfitting condition of chronic pain.  The MEB forwarded: left 
knee pain, meniscal tear and ACL laxity by orthopedic exam; right shoulder pain, AC separation 
1.0cm; left shoulder pain, supraspinatus tendon tear, Grade II SLAP lesion; pain in the left leg 
s/p  femur  fracture  and  intramedullary  rod  placement;  and  delayed  union  of  the  left  femur 
fracture.  The MEB forwarded no other conditions for PEB adjudication.  The PEB adjudicated 
chronic pain left knee, right and left shoulders, and left femur s/p injuries conditions as a single 
unfitting  condition,  rated  20%,  with  application  of  the  US  Army  Physical  Disability  Agency 
(USAPDA)  pain  policy.    The  CI  made  no  appeals,  and  was  medically  separated  with  a  20% 
disability rating. 
 
 
CI CONTENTION:  “Shoulder pops out of place, L knee injury causes back + L leg pain, L leg is 
shorter than the right because of femur break.  Also see VA rating (PTSD + TBI etc.).”  Remarks:  
“I served for ten years honorably.  I am in school to pay the bills but, I can’t get a job.  People 
don’t like being around me!  Thank you for your consideration!” 
 
 
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 ratings 
for unfitting conditions will be reviewed in all cases.  Therefore the unfitting chronic pain left 
knee, right and left shoulders, and left femur s/p injuries conditions meet the criteria prescribed 
in DoDI 6040.44 for Board purview, and are accordingly addressed below.  The other requested 
conditions  (posttraumatic  stress  disorder  [PTSD]  and  traumatic  brain  injury  [TBI]),  and  any 
other remaining conditions rated by the VA at separation, are not within the Board’s purview.  
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.   
 
 

 

VA (2 Mos. Post-Separation) – All Effective Date 20050625 

Condition 

Left Knee Strain with Instability 
Left Shoulder Strain  
Right Shoulder Strain 
Residuals, Left Femur Fracture 
status post ORIF 
PTSD with Depression NOS and 
Alcohol Abuse 
Right Knee Strain 
Lumbar Strain 

Code 
5257 

5299-5024 
5299-5024 

5252 

9411 

5299-5024 

5237 

Rating 
20% 
10% 
10% 
0%** 

30% 
10% 
10% 

Exam 

20050826 
20050826 
20050826 
20050826 

20050901 
20050826 
20050826 

 

RATING COMPARISON:   
 

Service IPEB – Dated 20050405 
Condition 

Code 

Rating 

Chronic Pain Left Knee, 
Right and Left Shoulders, 
and Left Femur status 
post Injuries 

5099-5003 

20% 

↓No Additional MEB/PEB Entries↓ 

Combined:  20% 

Not Service-Connected x 3 
Combined:  70%*** (Bilateral Factor 4.2) 

its  recommendations;  and,  DoDI  6040.44  defines  a  12-month 

*5260 Left knee strain with limited motion at 10% added effective 20101105 
**Increased to 10% effective 20101105 
***Increased to 90% effective 20101105 with changes noted above and addition of four other conditions 
 
 
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 and his contention that suggests ratings should have conferred for other conditions 
documented at the time of separation.  The Board wishes to clarify that it is subject to the same 
laws  for  disability  entitlements  as  those  under  which  the  Disability  Evaluation  System  (DES) 
operates.  While the DES considers all of the member's medical conditions, compensation can 
only be offered for those medical conditions that cut short a member’s career, and then only to 
the  degree  of  severity  present  at  the  time  of  final  disposition.    However  the  Department  of 
Veterans Affairs (DVA), operating under a different set of laws (Title 38, United States Code), 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  the  degree  of 
impairment vary over time.  The Board utilizes DVA evidence proximal to separation in arriving 
at 
interval  for  special 
consideration to post-separation evidence.  The Board’s authority as defined in DoDI 6040.44, 
however, resides in evaluating the fairness of DES fitness determinations and rating decisions 
for disability at the time of separation and is limited to conditions adjudicated by the PEB as 
either  unfitting  or  not unfitting.   Post-separation  evidence therefore  is probative only to the 
extent  that  it  reasonably  reflects  the  disability  and  fitness  implications  at  the  time  of 
separation. 
 
The  PEB  rated  all  under  the  single  analogous  5003  degenerative  arthritis  code.    This  coding 
approach is countenanced by AR 635-40 (B.24 f.), but IAW DoDI 6040.44 the Board must apply 
only VASRD guidance to its recommendation.  The Board must therefore apply separate codes 
and  ratings  in  its  recommendations  if  compensable  ratings  for  each  joint  are  achieved  IAW 
VASRD §4.71a.  The Board must exercise the prerogative of separate fitness recommendations 
in  this  circumstance,  with  the  caveat  that  its  recommendations  may  not  produce  a  lower 
combined rating than that of the PEB.  If the Board judges that two or more separate ratings are 
warranted  in  such  cases,  however,  it  must  satisfy  the  requirement  that  each  “unbundled” 
condition was unfitting in and of itself.  Since §4.71a criteria are met for separate joint ratings in 
this case, the Board is pursuing separate rating and fitness evaluations as follows.  
 
Left Femur Fracture, Status Post Intramedullary Rod Placement with Delayed Union Condition.  
The  Board  first  considered  if  the  left  femur  condition,  having  been  de-coupled  from  the 
combined  PEB  adjudication,  remained  independently  unfitting  as  established  above.    In 
analyzing the intrinsic impairment for appropriately coding and rating the left femur fracture, 
s/p  intramedullary  rod  placement  with  delayed  union  condition,  the  Board  is  left  with  a 
questionable basis for arguing that this condition was indeed independently unfitting.  While 

   2                                                         PD 1200166 
 

the CI did have a significant injury to his left femur, the restrictions due to this condition that 
render him unfit for continued service cannot be separated out from those restrictions due to 
his  left  knee  pain  condition.    Any  apportionment  of  limitations  to  residuals  of  the  femur 
fracture  as  opposed  to  the  left  knee  condition  would  be  mere  speculation.    After  due 
deliberation,  the  Board  agreed  that  evidence  does  not  support  a  conclusion  that  left  femur 
fracture,  s/p  intramedullary  rod  placement  with  delayed  union,  as  an  isolated  condition 
separate  from  the  left  knee  condition,  would  have  rendered  the  CI  incapable  of  continued 
service within his MOS, and accordingly cannot recommend a separate disability rating for it.  
The Board therefore recommends rating the left femur and left knee conditions together as one 
unfitting condition as discussed below.  
 
Left Knee, Meniscal Tear and Anterior Cruciate Ligament (ACL) Laxity and Left Femur Fracture, 
Status  Post  Intramedullary  Rod  Placement  with  Delayed  Union  Condition.    The  Board  first 
considered  if  the  left  knee  condition,  having  been  de-coupled  from  the  combined  PEB 
adjudication,  remained  independently  unfitting  as  established  above.    The  CI’s  permanent 
profile documented multiple significant limitations that can be attributed only to the left knee 
condition and/or the left femur condition discussed above.  These include the inability to do 3 
to 5 second rushes under direct and indirect fire and no lower body weight training, running, 
biking, ruck marching, marching, and jumping.  These restrictions cannot be attributed to either 
shoulder condition.  The profile does include other restrictions that could be attributed to both 
the left knee and the shoulder conditions including the inability to move with a fighting load at 
least two miles and construct an individual fighting position and no swimming.  All members 
agreed that left knee, meniscal tear, ACL laxity, and left femur fracture, s/p intramedullary rod 
placement with delayed union, as an isolated condition, would have rendered the CI incapable 
of continued service within his MOS, and accordingly merits a separate rating.   
 
There  were  three  goniometric  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.   

 

PT (MEB) ~3 Months 

Pre-Separation 

Ortho ~3 Months 
Pre-Separation 

VA C&P ~2 Months 
Post-Separation 

 
The MEB narrative summary (NARSUM) examination was completed approximately 3 months 
prior  to  separation  and  it  documented  the  multiple  injuries  sustained  during  the  motorcycle 
accident in May 2004.  Orthopedics evaluation after the accident included left knee medial and 
lateral meniscal tears with a possible ACL tear.  A subsequent orthopedic evaluation performed 
in  January  2005  documented  a  positive  anterior  drawer  and  Lachman’s  test  as  well  as  varus 
stress test.  It also noted full active ROM and the absence of tenderness or effusion.  Multiple 
outpatient notes document antalgic gait with the latest in November 2004.  The CI was using a 
cane  for  support.    He  had  previously  used  a  wheelchair  and  then  crutches.    The  record 

   3                                                         PD 1200166 
 

Left Knee ROM 

Flexion (140⁰ Normal) 
Extension (0⁰ Normal) 

Comment 

§4.71a Rating 5260 

5257 

115⁰ 
0⁰ 

90⁰ 
0⁰ 

ROM completed by PT-
source document not 
available.  MEB Examiner 
noted tenderness along 
the medial and lateral 
joint lines and no laxity.  
Uses cane for 
ambulation 

10% Deluca 

Medial joint line 
tenderness, 
minimal effusion, 
mild ACL laxity.  
Assessment: 
acute meniscal 
tear, old 
disruption of ACL. 

10% Deluca 

-- 

10% 

120⁰ 
0⁰ 

Moderate to severe left antalgic gait.  
Weakly positive McMurray sign with pain 
and tenderness in the medial 
compartment, moderate anterior 
cruciate laxity, medial and lateral 
collateral ligaments were stable, no 
change with repetitive motion.  Wears 
left knee stabilizer brace, stopped using 
cane 5 months ago. 

10% Deluca 

20% 

documents use of a cane from as early as November 2004 at least through the time of the MEB 
NARSUM examination.  At the time of the NARSUM, the CI reported a constant severe ache in 
his left knee rated at 4/10 that increases to 7/10 with use.  He also reported that while most of 
his injuries appeared to have been slowly improving, his left knee pain had been getting worse.  
The  examination  findings  are  reported  in  the  chart  above.    Of  note,  the  examiner  noted  no 
laxity.    However,  an  orthopedic  exam  completed  a  day  after  the  ROM  measurements  by 
physical therapy in March 2005 noted the findings in the chart above, including mild ACL laxity.  
This is consistent with previous orthopedic evaluations.  Although the NARSUM examiner did 
not find any joint laxity on examination, she noted the orthopedic evaluation findings in the 
final diagnosis of left knee pain, meniscal tear and ACL laxity by orthopedic exam.  At the MEB 
examination performed in March 2005, the CI reported his left knee was swollen and painful, 
and that both knees would lock and give out, and that he required the use of corrective devices 
of  orthotics  and  a  knee  brace.    The  examiner  noted  the  left  knee  ACL  was  torn  during  the 
motorcycle accident of May 2004 and that surgery was recommended to repair it.  The MEB 
physical exam documented tenderness along the medial and lateral joint lines but no swelling 
or laxity.  The examiner (the same physician who completed the NARSUM) also noted the CI 
walked  into  the  exam  using  a  cane.    The  diagnosis  was  torn  ACL  left  knee.    The  VA 
Compensation  and  Pension  (C&P)  examination was  completed  approximately  2  months  after 
the CI separated from the Army.  At that time, he was wearing a stabilizing knee brace on his 
left  knee  during  most  of  his  waking  hours  and  reported  he  had  stopped  using  the  cane 
approximately 5 months prior.  He was unable to work in the job for which he was qualified in 
law enforcement because of the physical requirements.  The examination findings are reported 
in the chart above.  Of note, the VA examiner noted a moderate ACL laxity as compared to the 
mild laxity noted by orthopedics approximately 6 months prior.  
 
The  CI  sustained  a  left  femur  midshaft  fracture  in  the  motorcycle  accident  and  initially 
underwent an operative reduction with intramedullary nailing.  Approximately 5 months later, 
minimal callus and a 4mm gap at the fracture site were present and a second surgery removed 
the left femoral nail distal interlocking screw.  The MEB NARSUM examination noted constant 
dull  pain  at  the  fracture  site,  rated  at  2/10  with  increasing  pain  to  the  level  of  7/10  with 
exertion.  The C&P examination X-rays taken approximately a year after the second surgery and 
16 months after the initial injury continued to document a visible fracture line indicating the 
fracture was not yet fully healed.  The C&P examination noted full ROM of the left hip with no 
strength deficit. 
 
The  Board  directs  attention  to  its  rating  recommendation  based  on  the  above  evidence.    As 
discussed above the PEB combined multiple conditions and assigned an overall 20% rating IAW 
the USAPDA pain policy.  The VA rated the moderate left knee instability at 20% under 5257 
Knee, other impairment of.  The VA rated the left femur fracture residuals at 0% under 5252 
based  on  the  absence  of  painful  motion.    This  rating  was  increased  to  10%  effective 
5 November  2010  after  two  examinations  documented  daily  hip  pain  without  instability  and 
decreased ROM with painful motion.  While the MEB NARSUM and MEB history and physical 
examinations do not document knee instability, the preponderance of evidence in the service 
treatment  record  (STR)  supports  the  presence  of  this  finding  from  the  accident  through  the 
time of separation.  Additionally, even though the MEB examiner did not find instability in her 
own  examination,  she  noted  its  presence  on  orthopedic  examination.    The  VA  examiner 
determined  the  instability  was  moderate  but  the  military  orthopedic  surgeons  never  noted 
more than mild instability.  This discrepancy in severity could result from either a worsening of 
the condition over time or from a difference in opinion over what would be mild or moderate 
and the Board has no way to determine which reflects the truth.  If the discrepancy resulted 
from  a  worsening  of  the  condition  over  time,  there  would  be  no  way  to  determine  at  what 
period  in  time  the  CI  crossed  the  threshold  from  mild  to  moderate  without  resorting  to 
speculation.  However, the Board acknowledged that the condition, more likely than not, was 
worse at the time of separation than it was on the day of the orthopedic examination discussed 

   4                                                         PD 1200166 
 

above.    Although  completed  more  than  5  years  after  separation,  the  record  does  contain  a 
magnetic resonance imaging (MRI) report from November 2010 that shows an intact ACL with 
any sign of intervening surgery.  Both the Army and VA examinations document pain-limited 
motion at a non-compensable level and this would warrant a minimum 10% under 5260 Leg, 
limitation of flexion.  After reviewing the totality of evidence, the Board determined that the 
record supports a rating greater than 10% for slight instability at the time of separation.  With 
combined effect on the CI’s functional impairment due to the painful motion of the knee along 
with  knee  and  thigh  pain,  the  CI’s  disability  picture  more  nearly  approximates  a  20%  rating.  
After due deliberation, the Board agreed that the preponderance of the evidence with regard 
to  the  functional  impairment  of  these  two  combined  conditions  favors  recommendation  as 
separately unfitting for disability rating.  Considering all of the evidence and mindful of VASRD 
§4.3  (reasonable  doubt)  and  §4.7  (higher  of  two  evaluations),  the  Board  recommends  a 
disability rating of 20% for the left knee, meniscal tear and ACL laxity and left femur fracture, 
s/p intramedullary rod placement with delayed union condition rated as 5260-5252.   
 
Right  Shoulder  Grade  III  Acromioclavicular  (AC)  Joint  Separation  Condition.    The  Board  first 
considered  if  the  right  shoulder  condition,  having  been  de-coupled  from  the  combined  PEB 
adjudication,  remained  independently  unfitting  as  established  above.    The  CI’s  permanent 
profile documented multiple significant limitations that can be attributed only to the shoulders.  
These include the inability to carry and fire individual assigned weapon, perform any push-ups, 
and perform any upper body weight training.  These restrictions cannot be attributed to any 
lower extremity condition.  The profile does include other restrictions that could be attributed 
to both the left knee and the shoulder conditions including the inability to move with a fighting 
load at least two miles and construct an individual fighting position and no swimming.  The right 
shoulder injury, as an isolated injury with normal left shoulder, is significant enough to result in 
the  permanent  U3  profile  as  written.    All  members  agreed  that  right  shoulder  Grade  III 
acromioclavicular  joint  separation,  as  an  isolated  condition,  would  have  rendered  the  CI 
incapable of continued service within his MOS, and accordingly merits a separate rating.   
 
There were two goniometric 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 

MEB ~3 Months Pre-Separation 

VA C&P ~2 Months Post-Separation 

Flexion (0-180⁰) 

Abduction (0-180⁰) 

Internal Rotation (0-90⁰) 
External Rotation (0-90⁰) 

Adduction 

160⁰ 

170⁰ (168) 
80° (77) 
80° (77) 

40° 

170⁰ 
170⁰ 
80° 
80° 

 

Comments 

1.0cm AC separation; AC joint tenderness 

Palpable crepitus in glenohumeral and 
AC joints; ROM was stiff; repetitive 
motion increased pain and stiffness 
but did change ROM. 
10% 

§4.71a Rating 

10% 

 
The MEB NARSUM completed approximately 3 months prior to separation noted a diagnosis of 
right shoulder Grade III AC joint separation at the time of the initial injury.  An MRI performed 
in July 2004 documented AC joint separation of approximately 1.0cm with significant narrowing 
of  the  subacromial  space  due  to  inferior  displacement  of  the  acromion  and  a  small  avulsion 
fracture, most likely from the clavicle.  An MRI from May 2004 documented findings of a rotator 
cuff tear as well as a mild AC joint separation.  The CI did have a history of a right shoulder 

   5                                                         PD 1200166 
 

rotator  cuff  injury  treated  with  physical  therapy  and  steroid  injections,  approximately  18 
months  prior  to  the  motorcycle  accident.    A  second  rotator  cuff  injury  was  documented  in 
January 2004.    However,  all  rotator  cuff  tendons  were  normal  at  the July  2004  MRI.    The  CI 
received physical therapy and steroid injections in his right shoulder after the accident.  The 
Grade III AC joint separation was also noted on his initial orthopedic evaluation at Fort Polk in 
July  2004.    At  the  time  of  the  NARSUM,  the  CI  had  significant  pain  that  never  completely 
resolved.    His  shoulder  pain  would  increase  to  3-4/10  with  use  of  or  sleeping  on  either 
shoulder.  The C&P exam, approximately 2 months after separation, reported the same history 
of the accident in May 2004.  The CI was unable to work in the job for which he was qualified in 
law enforcement because of the physical requirements.  The examination findings are reported 
in the chart above.  Right shoulder X-rays documented posttraumatic osteolysis of the distal 
right clavicle with widening of the AC joint.   
 
The  Board  directs  attention  to  its  rating  recommendation  based  on  the  above  evidence.    As 
discussed above the PEB combined multiple conditions and assigned an overall 20% rating IAW 
the USAPDA pain policy.  The VA rated the right shoulder AC joint separation/sprain, rotator 
cuff tear analogous to tenosynovitis using 5099-5024 and assigned a 10% rating for painful or 
limited motion of that exceeded shoulder level.  While the 10% rating for pain-limited motion 
appears to be at the appropriate disability level, the CI did not have a rotator cuff injury at the 
time of separation.  He did have a rotator cuff injury prior to the motorcycle accident but this 
appears to have resolved by July 2004.  The Grade III AC joint separation is more appropriately 
rated as 5203 with a 10% rating assigned for malunion of the joint.  After due deliberation, the 
Board agreed that the preponderance of the evidence with regard to the functional impairment 
of  right  shoulder  Grade 
its 
recommendation as a separately unfitting condition for disability rating.  Considering all of the 
evidence  and mindful  of  VASRD  §4.3  (reasonable  doubt), the  Board  recommends  a  disability 
rating of 10% for the right shoulder grade IIII acromioclavicular joint separation condition.   
 
Left Shoulder Supraspinatus Tendon Tear, Grade II Superior Labral Anterior to Posterior Tear 
(SLAP) Lesion Condition.  The Board first considered if the left shoulder condition, having been 
de-coupled  from  the  combined  PEB  adjudication,  remained  independently  unfitting  as 
established above.  The CI’s permanent profile documented multiple significant limitations that 
can be attributed only to the shoulders.  These include the inability to carry and fire individual 
assigned weapon, perform any push-ups, and perform any upper body weight training.  These 
restrictions  cannot  be  attributed to  any  lower extremity  condition.    The  profile  does  include 
other restrictions that could be attributed to both the left knee and the shoulder conditions 
including the inability to move with a fighting load at least two miles and construct an individual 
fighting position and no swimming.  The left shoulder injury, as an isolated injury with normal 
right  shoulder,  was  significant  enough  to  result  in  the  permanent  U3  profile  as  written.    All 
members  agreed  that  left  shoulder  supraspinatus  tendon  tear,  Grade  II  SLAP  lesion,  as  an 
isolated condition, would have rendered the CI incapable of continued service within his MOS, 
and accordingly merits a separate rating.   
 
There were two goniometric 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.   
 
 

joint  separation  condition 

 

III  acromioclavicular 

favors 

   6                                                         PD 1200166 
 

 

Left Shoulder ROM 
Flexion (0-180⁰) 

Abduction (0-180⁰) 

Internal Rotation (0-90⁰) 
External Rotation (0-90⁰) 

Adduction 

MEB (PT ROM) ~3 Months Pre-Separation 

VA C&P ~2 Months Post-Separation 

  160⁰ (156) 

135⁰ 

60° (57) 

50° 
40° 

170⁰ 
170⁰ 
80° 
80° 

 

Comments 

Tender anteriorly 

§4.71a Rating 

10% 

Palpable crepitus in glenohumeral and AC 
joints; ROM was stiff; repetitive motion 
increased pain and stiffness but did 
change ROM. 

10% 

 
The MEB NARSUM notes a diagnosis of left shoulder instability with labral tear and rotator cuff 
pathology at the time of the initial injury.  At the time of the NARSUM, the CI had significant 
pain that never completely resolved.  His shoulder pain would increase to 3-4/10 with use of or 
sleeping  on  either  shoulder.    His  left  shoulder would  occasionally  sublux  out  of  joint  and  he 
would have to pop it back in.  When this occurred, his pain level would increase to 6/10 and last 
for 2 or 3 days.  An episode of dislocation documented in the record in May 2004.  An MRI from 
July 2004 documented a nearly complete tear of the supraspinatus tendon with only the very 
posterior fibers appearing to be intact.  Abnormalities of the labrum consistent with a Grade II 
SLAP injury was also present, as was bursitis. 
 
The CI had been receiving physical therapy for left shoulder instability.  The initial orthopedic 
evaluation  at  Fort  Polk  in  July  2004  noted  a  history  of  two  to  three  episodes  of  frank 
subluxation  as  described  above.    That  examination  noted  a  bilaterally  positive  O’Brien’s  test 
and  a  positive  apprehension  test  on  the  left  shoulder.    An  orthopedic  evaluation  from 
November  2004  also  documented  a  positive  left  shoulder  O-Brien’s  test  and  apprehension 
(Crank) test; however, at that time these tests were negative on the right.  A relocation test was 
negative.  This orthopedist noted the diagnoses of left shoulder rotator cuff tear (complete) and 
left  shoulder  sprain  with  anterior  glenoid  labrum  lesion.    Both  shoulder  stiffness  with 
movement  and  a  positive  O’Brien’s  test  are  consistent  with  a  labral  tear  and  the  MRI 
corroborates  these  findings.    While  some  labral  tears  will  heal  spontaneously,  most  require 
operative repair.  The C&P exam, approximately 2 months after separation, reported the same 
history of the accident in May 2004.  The CI was unable to work in the job for which he was 
qualified in law enforcement because of the physical requirements.  The examination findings 
are reported in the chart above.  Left shoulder X-rays were normal, however, neither a SLAP 
tear nor a rotator cuff tear would be seen on a plain X-ray. 
 
The  Board  directs  attention  to  its  rating  recommendation  based  on  the  above  evidence.    As 
discussed above the PEB combined multiple conditions and assigned an overall 20% rating IAW 
the USAPDA pain policy.  The VA rated the left shoulder Grade II SLAP lesion and supraspinatus 
tendon tear (rotator cuff tear) analogous to tenosynovitis using 5099-5024 and assigned a 10% 
rating for painful or limited motion of that exceeded shoulder level.  While there is no specific 
VASRD  code  for  either  labral  tear  or  rotator  cuff  injury,  the  Board  discussed  various  coding 
options and every appropriate option resulted in a 10% disability rating.  After due deliberation, 
the  Board  agreed  that  the  preponderance  of  the  evidence  with  regard  to  the  functional 
impairment of left shoulder supraspinatus tendon tear, Grade II SLAP lesion condition favors its 
recommendation as a separately unfitting condition for disability rating.  Considering all of the 
evidence  and mindful  of  VASRD  §4.3  (reasonable  doubt), the  Board  recommends  a  disability 
rating of 10% for the left shoulder supraspinatus tendon tear, Grade II SLAP lesion condition. 
 

   7                                                         PD 1200166 
 

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 chronic pain was operant in this case and the 
Board adjudicated the conditions independently of that policy.  In the matter of the left knee, 
meniscal  tear  and  ACL  laxity  and  left  femur  fracture,  s/p  intramedullary  rod  placement  with 
delayed union conditions, the Board unanimously agrees that together these conditions were 
separately unfitting; and, unanimously recommends a disability rating of 20%, coded 5260 IAW 
VASRD §4.71a.  In the matter of the right shoulder Grade III acromioclavicular joint separation 
condition,  the  Board  unanimously  agrees  that  it  was  separately  unfitting;  and,  unanimously 
recommends a disability rating of 10%, coded 5203 IAW VASRD §4.71a.  In the matter of the left 
shoulder  supraspinatus  tendon  tear,  Grade  II  SLAP  lesion  condition,  the  Board  unanimously 
agrees  that  it  was  separately  unfitting;  and,  unanimously  recommends  a  disability  rating  of 
10%, coded 5099-5024 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;  and,  that the discharge  with  severance pay  be  recharacterized to  reflect  permanent 
disability retirement, effective as of the date of his prior medical separation:   
 

UNFITTING CONDITION 

Left Knee, Meniscal Tear and ACL Laxity and Left Femur Fracture, 
Status Post Intramedullary Rod Placement with Delayed Union 
Right Shoulder Grade III Acromioclavicular Joint Separation  
Left Shoulder Supraspinatus Tendon Tear, Grade II SLAP Lesion 

5099-5024 
COMBINED (w/Bilateral Factor 1.9) 

VASRD 
CODE 

5260-5252 

5203 

RATING 

20% 
10% 
10% 
40% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120211, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

             
           President 
           Physical Disability Board of Review 

   8                                                         PD 1200166 
 

b.  Providing orders showing that the individual was retired with permanent 

SFMR-RB 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
 
1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the 
enclosed recommendation of the Department of Defense Physical Disability Board of 
Review (DoD PDBR) pertaining to the individual named in the subject line above to 
recharacterize the individual’s separation as a permanent disability retirement with the 
combined disability rating of 40% effective the date of the individual’s original medical 
separation for disability with severance pay.   
 
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: 
 
 
a.  Providing a correction to the individual’s separation document showing that 
the individual was separated by reason of permanent disability retirement effective the 
date of the original medical separation for disability with severance pay. 
 
 
disability effective the date of the original medical separation for disability with 
severance pay. 
 
 
account for recoupment of severance pay, and payment of permanent retired pay at 
40% effective the date of the original medical separation for disability with [severance 
pay. 
 
 
and medical TRICARE retiree options. 
 
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) 

c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will 

d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

   9                                                         PD 1200166