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AF | PDBR | CY2013 | PD-2013-01366
Original file (PD-2013-01366.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX   CASE: PD -20 13 - 0 1366
BRANCH OF SERVICE: Army   BOARD DATE: 201 4 0815
Separation Date: 20050215


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard SGT/E-5 (75B/Personnel Administration Specialist) medically separated for chronic left shoulder pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS). The CI was allowed to take the alternate Army physical fitness test (aerobic portion). He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The MEB shoulder condition, characterized as “chronic left shoulder pain” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB (IPEB) adjudicated “chronic left shoulder pain” as unfitting, rated 10%, referencing the US Army Physical Disability Agency (USAPDA) pain policy. The CI rebutted the IPEB findings and demanded a Formal PEB (FPEB). The IPEB considered the CI’s rebuttal but confirmed its original finding. The CI withdrew his demand for a FPEB and made no further appeals and was medically separated.


CI CONTENTION : The applicant makes no contentions.


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 chronic 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 Board for Correction of Military Records.


 RATING COMPARISON :
invalid font number 31502
Service Recon IPEB – Dated 20050104
 VA - (62 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Left Shoulder Pain 5099-5003 10% Residuals of Remote Left Shoulder Injury; S/P Reconstruction 5201 20% 20100420
Other x 0 (Not in Scope)
 Other x 5 20100420
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VARD) dated 20100614 (most proximate to date of separation [DOS])


ANALYSIS SUMMARY : The Board notes the earliest VA evaluation was over 5 years after the date of separation. DoDI 6040.44 provides for consideration of post-separation VA findings, particularly within 12 months of separation, although the Board’s recommendation is premised on the degree of disability at separation. Therefore the s ervice record evidence was assigned almost exclusive probative value with respect to the Board’s recommendations. Only VA evidence which can be reasonably interpreted to reflect disability at separation is probative to the Board’s recommendations.
Chronic Left Shoulder Pain Condition . There were two 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.

Left Shoulder ROM (Degrees) MEB 4 Mo s . Pre-Sep VA C&P 5 Yrs . Post-Sep
Flexion (180 Normal) 140 95
Abduction (180) 140 70
Comments :
 Right hand dominant		 ROM’s performed 20011004; Pos. reduction in motion; Pos. pain ful motion Pos. painful motion & tenderness to palpation; Pos. apprehension but no instability
§4.71a Rating 10 % 20 %
invalid font number 31502
The CI sus tained a left shoulder injury while doing a litter carry on 19 June 2002 . He was the person at the rear of the litter and felt his left shoulder give. The CI was given a sick slip for left shoulder dislocation, pain and swelling. He was seen by a civilian o rthopedist who documented physical findings of a lack of 5 degrees of full forward flexion , 5 degrees of abduction, a lack of four levels of internal rotation, a positive impingement sign and positive cross arm adduction test . H owever, there was normal strength and normal sensation throughout. The examiner administered a left shoulder cortisone injection at this visit. M agnetic resonance imaging performed showed a slight impingement of the supraspinatus muscle. The CI’s left shoulder condition worsened and he had 3 + instability with a positive apprehension. O n 2 June 2003 , h e underwent a diagnostic arthroscopy of the left shoulder, debridement of anterior glenoid labral tear and an open rotator cuff repair. He was seen by p hysical therapy ( P T) 2 days after surgery and was in significant left shoulder pain throughout the deltoid region and the supraspinatus musculature. The pain was aggravated by any movement and this prevented sle ep. He continued to be followed by civilian PT two to three times per month from 18 June 2002 through to 13 January 2004. The CI continued with left shoulder pain and decreased ROM strength despite aggressive PT and ongoing orthopedic evaluations . The CI was given a permanent U3 Profile for chronic shoulder pain . The MEB n arrative s ummary (NARSUM) exam approximately 4 months prior to separation documented that the CI found it very difficult to fire a rifle or hold it steady , and he was unable to do overhead work. He had significant pain with running and doing sit-ups or push-ups. The examiner rated the pain according to th e American Medical Association pain scale at moderate and occasional. The MEB NARSUM physical exam findings are summarized in the chart above. The c ommander’s s tatement documented that the CI’s position required moderate heavy lifting and his condition interfered with his MOS. The VA Compensation and Pension (C&P) exam completed approximately 5 years after separation documented chronic left shoulder pain, episodes of swelling, limited motion and an inability to do overhead activity. The C&P exam also contained the following statement, “Since the surgery, he has had no further dislocations but he still has chronic pain in his shoulder .” The VA C&P physical exam findings are summarized in the chart above.

The Board directs attenti on to its rating recommendation based on the above evidence . The PEB coded the chronic left shoulder pain condition as 5099 analogous to 5003 (degenerative arthritis) and rated it 10% with application of the USPDA pain policy. The VA coded the residuals of remote left shoulder injury; status/post (s/p) reconstruction condition as 5201 (limitation of arm motion) and rated it 20% citing “…for limitation of arm motion midway between side and shoulder level or for limitation of arm motion at shoulder level.” All exams performed proximate to separation documented pain limited motion without evidence of instability and no exam indicated limited ROM to a compensable level without application of §4.59 painful motion or applicability of any shoulder specific VASRD code. The Board noted that the C&P exam, which was over 5 years after separation, documented that the CI did not have any dislocations after his surgical procedure. VASRD §4.71a specifies for code 5003 that satisfactory evidence of painful motion limitation of motion and specifies a 10% rating for each major joint or group of minor joints affected by limitation of motion. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 reasonable doubt, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic left shoulder pain condition.


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 c hronic l eft s houlder p ain condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the c hronic l eft s houlder p ain 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 re-characterization of the CI's disability and separation determination.


The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 130904 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans ’ Affairs Treatment Record








                                                              
XXXXXXXXXXXXXXXXX
P resident
Physical Disability Board of Review


SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXX, AR20150003021 (PD201301366)


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                                                  XXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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