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AF | PDBR | CY2013 | PD-2013-02370
Original file (PD-2013-02370.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02370
BRANCH OF SERVICE: Army  BOARD DATE: 20140717
SEPARATION DATE: 20050601


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (11B10/Infantryman) medically separated for fragment wounds, left trapezius area and back. The CI 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 spinal accessory neuropathy with associated weakness, decreased range of motion and impaired use of the left upper extremity” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “fragment wounds, left trapezius area and back…residuals consist primarily of weakness and wasting of the left trapezius, with scapular winging and an electrodiagnostic evidence of denervation of the upper, middle and lower trapezius” as unfitting, rated 30% (complete). After review at the US Army Physical Disability Agency, the case was returned to the PEB for rating clarification. An Informal Reconsideration was completed and the rating was changed to 20% (incomplete, severe), citing criteria of the VA Schedule for Rating Disabilities (VASRD). The CI did not concur and requested a Formal PEB hearing, but later withdrew his request and concurred with the 20% rating and was medically separated.


CI CONTENTION: “Extreme back, knee and neck pain on a daily basis. Inability to do every day common task without immediate pain or pain the next day that at times has left me without the ability to work or function normally.” [sic]


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 fragment wounds to the left trapezius/back area is addressed below. No additional conditions are within the DoDI 6040.44 defined purview of the Board. The contended knee condition was not identified by the PEB and is not within the DoDI 6040.44 defined purview of the Board. Any back pain condition not directly connected to back pain in the area of the trapezius muscle is likewise not in the 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 :

Service Informal Recon PEB – Dated 20050314
 VA - (>4 Years Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Fragment Wounds, Left Trapezius Area and Back 8211 20% Left Shoulder Muscle Injury, Muscle Group I 5301 20% 20100112
20101005
Other x 0 (Not is Scope)
 Other x 8
Rating: 20%
 Combined: 60%
Derived from VA Rating Decision (VA RD ) dated 20 101227 ( most proximate to date of separation ).


ANALYSIS SUMMARY: IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation. The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him but, must emphasize that the Disability Evaluation System 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. The Board considers DVA evidence within 12-months of separation only to the extent that it reasonably reflects the disability at the time of separation.

Fragment Wounds, Left Trapezius Area and Back Condition. The right-handed CI sustained an improvised explosive device (IED) blast injury on 22 September 2004 while deployed to Iraq. Affected areas included the left arm, chest and back (thoracic area). Bilateral chest tubes were inserted to treat collapsed lungs; IED fragment removal and multiple wound debridement were required and skin grafting on his forearm and back was performed. Despite healing of wounds and grafts, difficulty with left shoulder weakness and range-of-motion (ROM) persisted. Electrodiagnostic studies showed evidence of impaired nerve function in the upper, middle and lower parts of the trapezius muscle (a back muscle extending onto the shoulder and neck).

At the narrative summary examination on 27 January 2005 (4 months prior to separation), the CI’s chief complaint was left shoulder weakness, but he also reported pain that was worse after using the arm. He was unable to perform overhead activities. He was taking no medications. Examination revealed obvious wasting of the left upper trapezius muscle. At rest, the scapula (shoulder blade) was protracted (i.e. assumed a more lateral position than normal) and during shoulder flexion and abduction scapular winging (abnormal protrusion) was noted. Moderate weakness of shoulder elevation and of the middle and lower trapezius was present. Shoulder ROM measurements showed flexion of 160 degrees (normal to 180 degrees) with no change after repetitive ROM and abduction was 60 degrees after repetition (initially 70 degrees; normal to 180 degrees). The examiner’s diagnosis was left spinal accessory neuropathy with associated weakness, decreased ROM and impaired use of the left upper extremity.

The Board directs attention to its rating recommendation based on the above evidence. The PEB assigned a 20% rating for severe, incomplete paralysis under the 8211 code (paralysis of eleventh cranial nerve). Board members agreed that “complete” paralysis was not an accurate descriptor of the condition under this code. Therefore, the next higher 30% rating was not supported. The VA’s 20% rating under the 5301 code (Group I muscle injuries) was based on examination evidence over 4 years after separation, which holds no probative value relative to the time of separation. The Board considered if a rating higher than 20% was justified via this coding pathway. However, it was concluded that the “severe" descriptor did not accurately portray the clinical picture and therefore the 30% rating was not supported on this basis. Finally, ROM impairment of the shoulder was considered. Under the 5201 code (arm, limitation of motion) a 30% rating requires limitation of the non-dominant arm to 25 degrees from the side. However, shoulder abduction in this case was greater than this, which justifies a 20% rating. 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 fragment wounds of left trapezius and back 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. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the fragment wounds, left trapezius area and back condition and IAW VASRD §4.124a, 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 20131104, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                 
XXXXXXXXXXXXXXXXX
President
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, AR20150002550 (PD201302370)

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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