RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20020115 

 
NAME:  XXXXXXXXXXXX 
CASE NUMBER:  PD1200873 
BOARD DATE:  20130122   
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty PFC/E-3 (77F/Petroleum Supply Specialist), medically 
separated  for  left  shoulder  impingement  syndrome.    CI  suffered  a  fall  to  the  right  upper 
extremity  in  October  of  2000,  suffering  from  residual  loss  of  motion  in  left  elbow  and 
impingement  signs  at  the  left  shoulder.    The  left  shoulder  impingement  syndrome  condition 
could  not  be  adequately  rehabilitated  to  meet  the  physical  requirements  of  his  Military 
Occupational  Specialty  or  satisfy  physical  fitness  standards.    He  was  issued  a  permanent  U3 
profile  and  referred  for  a  Medical  Evaluation  Board  (MEB).    Left  elbow  flexion  contracture 
without pain condition, identified in the rating chart below, was also identified and forwarded 
by the MEB.  The Physical Evaluation Board (PEB) adjudicated the left shoulder impingement 
syndrome condition as unfitting, rated 10%, with application of the Veterans Affairs Schedule 
for Rating Disabilities (VASRD) and cited application of 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:  “They should have been increased due to the severity.”   
 
 
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.  The unfitting condition of left shoulder 
impingement  syndrome  and  the  not  unfitting  condition  of  left  elbow  flexion  contracture 
without pain as requested for consideration meet the criteria prescribed in DoDI 6040.44 for 
Board purview and are addressed below.  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 IPEB – Dated 20011206 
Condition 
Left 
Impingement Syndrome 

Shoulder 

Code 
5299-5003 

Rating 
10% 

Left 
Elbow 
Contracture …  

Flexion 

Not Unfitting 

↓No Additional MEB/PEB Entries↓ 

of 

the 

Left 

VA (STRs) – All Effective Date 20020116 
Condition 
Code 
Impingement 
5299-5203 
Shoulder 
Left  Elbow  Contracture  with 
Traumatic Arthritis 
Left  Ulnar  Nerve 
Impairment 
Associated  with  Left  Elbow 
Contracture  with 
Traumatic 
Arthritis 
Not Service-Connected x 1 

5010-5213 

8516 

Rating 
*10% 
0% 
*10% 

10% 

Exam 
STR  

STR 

STR 

STR 

Combined:  20% 

Combined:  10% 
*Per  VARD  dated  20070612  ratings  changed  from  10%  to  20%  for  code  5299-5203.  Code  5010-5213  changed  0%  to  10% 
effective 20020116 and then inc. to 20% and Left ulnar nerve impairment added@10%, effective 22 Dec 2005 for combined 
40%.  20090610 VARD  inc. 5010-5213 to 50% (unfavorable ankylosis -5205) and 8516 inc. to 20% eff.11/3/2006.  
ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application 
regarding the significant impairment with which his service-aggravated condition continues to 
burden him.  It is a fact, however, that 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.  This role and authority is granted 
by Congress to the Department of Veteran Affairs (DVA).  The DVA, operating under a different 
set  of  laws  (Title  38,  United  States  Code),  is  empowered  to  compensate  service-connected 
conditions  and  to  periodically  re-evaluate  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  its  recommendations;  and,  DoDI  6040.44 
defines a 12-month interval for special consideration to post-separation evidence.  The Board’s 
authority as defined in DoDI 6044.40, however, resides in evaluating the fairness of DES fitness 
determinations  and  rating  decisions  for  disability  at  the  time  of  separation.    Post-separation 
evidence therefore is probative only to the extent that it reasonably reflects the disability and 
fitness implications at the time of separation.   
 
Left Shoulder Impingement Syndrome Condition.  At the MEB exam, the CI reported pain in the 
left  shoulder.    The  MEB  physical  exam  noted  the  CI  was  right  hand  dominant.    There  was 
tenderness  to  palpation  of  the  anterior  shoulder  joint,  but  not  the  acromioclavicular  joint.  
There were signs of impingement.  There was no joint laxity or dislocation.  The left shoulder 
goniometric range-of-motion (ROM) evaluation demonstrated flexion to 170 degrees (normal 
180  degrees)  and  abduction  to  170  degrees  (normal  180  degrees)  with  symmetric  internal 
rotation and decreased external rotation of 30 degrees (opposite side 50 degrees).  Magnetic 
resonance  imaging  was  consistent  with  impingement  syndrome.    Treatment  notes  indicated 
painful motion.  At the first VA Compensation and Pension (C&P) exam, about 12 months after 
separation, the left shoulder condition was not addressed.  The next VA exam that addressed 
the left shoulder was in 2006, over 4 years post-separation.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  coded  the  left  shoulder  condition  5299-5003  rated  at  10%  based  on  the  USAPDA  pain 
policy  rated  as  slight/constant.    The  VA  coded  the  left  shoulder  condition  as  5299-5203  (as 
analogous  to  clavicle  or  scapula  impairment)  rated  at  10%  based  on  the  service  treatment 
records.  Coding IAW VASRD rules only and applying VASRD §4.59 (Painful motion), also would 
result in a 10% rating for the shoulder condition.  After due deliberation, considering all of the 
evidence  and  mindful  of  VASRD  §4.3  (Resolution  of  reasonable  doubt),  the  Board  concluded 
that there was insufficient cause to recommend a change in the PEB’s 10% adjudication for the 
left shoulder impingement syndrome.   
 
Contended PEB Conditions.  The contended condition adjudicated as not unfitting by the PEB 
was left elbow flexion contracture without pain.  The Board’s first charge with respect to these 
conditions  is  an  assessment  of  the  appropriateness  of  the  PEB’s  fitness  adjudications.    The 
Board’s  threshold  for  countering  fitness  determinations  is  higher  than  the  VASRD  §4.3 
(Resolution of reasonable doubt) standard used for its rating recommendations, but remains 
adherent  to  the  DoDI  6040.44  “fair  and  equitable”  standard.    The  MEB  indicated  the  CI 
underwent left elbow surgery 7 months prior to separation.  At the MEB exam, the examiner 
stated  the  CI  had  “…  a  flexion  contracture  at  the  left  elbow,  which  is  non  painful  and  no 
functionally limiting.”  ROM was 30 degrees-130 degrees indicating inability to straighten out 

the  elbow  (lacking  30  degrees  of  a  straightened  arm  at  0  degrees).    The  examiner’s 
recommendations  stated  “This  patient  is  severely  limited  and  is  unable  to  perform  basic 
soldierly duties and is medically unacceptable .…. This applies to both the left elbow and left 
shoulder.  Therefore, the case is referred to the Physical Evaluation Board for disposition.”  The 
left elbow condition was profiled along with the left shoulder which listed the profiled medical 
condition  as  “left  shoulder  impingement  and  pain,  left  elbow  flexion  contracture.”    The 
commander did not specify duty limitations to either specific condition (elbow or shoulder).   
At the VA C&P exam conducted about 12 months after separation, the CI reported decreased 
ROM, constant pain, and weakness in his left elbow.  The exam noted the elbow ROMs “flexion 
130⁰,  lacks  40⁰  of  full  extension”  pronation  was  90⁰  (normal  80⁰)  and  supination  was  80⁰ 
(normal 85⁰)”.  The examiner stated “Pain starts with any flexion or extension.  No pain with 
pronation or supination.”  Normal sensation and muscle strength were noted.  X-ray of the left 
elbow  showed  moderate  arthritis  of  the  left  elbow.    The  diagnosis  was  post  traumatic  left 
elbow arthritis.  
 
The  Board directs  attention to  its  recommendation based  on  the  above  evidence.    The  MEB 
adjudged  the  left  elbow  condition  did  not  meet  retention  standards.    The  PEB  adjudged  the 
elbow condition was not unfitting.  The VA post-separation exam (12 months after separation) 
indicated similar ROMs, but with pain.  Service treatment notes about 4 to 6 months prior to 
separation indicate that the CI was unhappy with the outcome of his elbow surgery, was taking 
prescription pain medications and wearing a brace for the elbow, with pain and weakness in 
the  preponderance  of  the  notes.    Although  the  exam  portion  of  the  narrative  summary 
specified  painless  flexion  contracture  with  no  functional  limitation,  the  recommendation 
section  indication  severe  impact  to  duty  performance  was  attributable  to  the  shoulder  and 
elbow together.  There was no justifiable separation of profile limitation to either the shoulder 
or elbow alone as they overlapped.  The CI demonstrated lack of flexion, lack of extension of 
the elbow.   
 
After due deliberation, the Board agreed that the preponderance of the evidence with regard 
to  the  functional  impairment  of  the  left  elbow  condition  favors  its  recommendation  as  an 
additionally unfitting condition for disability rating.  The Board majority agreed that given the 
limitation  of  flexion, extension, and  multiple treatment  notes  indicating  painful  motion  (IAW 
§4.59),  the  elbow  is  appropriately  coded  5010-5207  (trauma  with  forearm,  limitation  of 
extension) and meets the VASRD §4.71a criteria for a 10% 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 left shoulder condition 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  and  IAW  VASRD  §4.71a,  the  Board  unanimously 
recommends  no  change  in  the PEB  adjudication.    In  the  matter  of  the contended  left elbow 
condition, the Board unanimously agrees that it was unfitting; and by a vote of 2:1 recommends 
a  disability  rating  of  10%,  coded  5010-5207  IAW  VASRD  §4.71a.    The  dissenting  voter  (who 
recommended a 0% rating under code 5003) did not elect to submit a minority opinion.  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 
Left Shoulder Impingement Syndrome  
Left Elbow Flexion Contracture  

 

VASRD CODE  RATING 
5299-5003 
5010-5207 
COMBINED 

10% 
10% 
20% 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120606, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXXXX, DAF 
           Director 
           Physical Disability Board of Review 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXX, AR20130002545 (PD201200873) 
 
 
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 
 
 
 
 

     XXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)