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AF | PDBR | CY2013 | PD-2013-01810
Original file (PD-2013-01810.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-01810
BRANCH OF SERVICE: Army  BOARD DATE: 20150121
SEPARATION DATE: 20050815


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Automated Logistical Specialist) medically separated for a left shoulder condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty; however, his profile indicated he could take a modified physical therapy (PT) test. He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The “persistent left shoulder pain” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated “chronic pain, left shoulder, status post arthroscopic surgery” as unfitting, rated 10%, citing the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: “1. Anxiety 2. right lower femoral 3. Thoracolumbar 4. Bilateral Feet) 5. Status post repair of labral tear (shoulder) 6. PTSD (Pending).”


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


RATING COMPARISON :

IPEB – Dated 20050601
 VA* - (~3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Pain, Left Shoulder 5009-5003 10% Degenerative Changes, Left Shoulder, Status Post Repair of Labral Tear 5203 10% 20050504
Scar, Left Shoulder 7805 0% 20050504
Other x 0 (Not In Scope)
 Other x 4 (Not in Scope)
RATING: 10%
 RATING: 40%
* Derived from VA Rating Decision (VA RD ) dated 200 50913 (most proximate to date of separation ( DOS ) ) .


ANALYSIS SUMMARY:

Chronic Pain, Left Shoulder Condition. At a clinic visit in October 2003, the CI reported a 10-year history of left shoulder “popping and pain” that began after a motor vehicle accident, but symptoms became worse in 2003. Evaluation discovered left shoulder instability which was arthroscopically corrected in December 2003. Although there was no further instability, shoulder pain persisted despite PT. Follow-up imaging studies were unremarkable, and further surgery was not recommended. Examination by PT on 25 April 2005 showed mild left shoulder weakness in all ranges-of-motion (ROM), but muscle atrophy was absent. The narrative summary (NARSUM) on 9 May 2005 (3 months prior to separation) identified the CI as right handed. He reported an inability to lift heavy items or perform overhead work. He could not run, do push-ups or sit-ups, and no longer participated in martial arts or swimming. Physical examination of the left shoulder showed well-healed arthroscopy scars.

The VA Compensation and Pension (C&P) examiner 3 months before separation identified the CI as right handed. He complained of constant left shoulder pain that was worse with activity or overhead movement. He experienced difficulty driving and lifting items greater than 20 pounds. He was receiving no treatment. Examination of the left shoulder showed a normal appearance. After repetitive motion, there was no additional limitation. Painful motion and tenderness were not mentioned. Shoulder X-rays were normal. The examiner characterized the left shoulder condition as “left shoulder pain, discomfort and instability,” however the CI did not complain of instability or dislocations, nor were findings of instability described on examination. At an orthopedic follow-up evaluation on 10 November 2005 (3 months after separation), the CI denied ever having a left shoulder dislocation.

The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Shoulder ROM
(Degrees)		 MEB PT ~4 Mo s . Pre-Sep VA C&P ~3 Mo s . Pre-Sep
Flexion (180 Normal) 180 180
Abduction (180) 180 180
Comments +Crepitus, painful motion
§4.71a Rating 10%* 10 % **
invalid font number 31502 *IAW painful motion (VASRD §4.59) invalid font number 31502
invalid font number 31502          **Conceding §4.40 (functional loss) or §4.59

The Board directed attention to its rating recommendation based on the above evidence. The PEB assigned a 10% rating under an analogous code 5003 (degenerative arthritis), while the VA rated the condition at 10% using the code 5203 (clavicle or scapula, impairment of). The VASRD §4.71a threshold for compensable ROM impairment is “at shoulder level” (90 degrees from the side), but all ROM in evidence showed normal ROM. However, sufficient evidence of painful motion was present to support a 10% rating. Board members agreed that rating under the 5202 code (other impairment of humerus) was not supported since there was no history of humeral malunion with deformity or of recurrent dislocations. The Board also concluded there was no non-union with loose movement of the clavicle or scapula to warrant the next higher 20% rating under the 5203 code. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the 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 left shoulder pain was operant in this case and the condition was adjudicated independently of that policy by this Board. In the matter of the chronic pain, 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131024 w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record





                                   
XXXXXXXXXXXXXXX
President
DoD 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 XXXXXXXXXXXXXXX, AR20150009846 (PD201301810)


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

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