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AF | PDBR | CY2013 | PD-2013-02377
Original file (PD-2013-02377.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02377
BRANCH OF SERVICE: Army          BOARD DATE: 20140717
SEPARATION DATE: 20050308


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a mobilized Reserve SGT/E-5 (74D20/Chemical Operations Specialist) medically separated for chronic bilateral shoulder pain with chondromalacia, status post arthroscopic surgery. The bilateral shoulder condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS). He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The bilateral shoulder condition, characterized as “surgery shoulders” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated the bilateral shoulders pain with chondromalacia, status post arthroscopic surgery as a single unfitting condition rated 10% referencing the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: “ I had bi-lalter shoulder surgery and the doctors say my shoulder will not get better. I have had MRI, threphy [ sic ] and rehab done on them by the VA Hospital in Montgomery, Al [ sic ] and the sport medical doctor that did my surgrey at Hughston Clinic in Columbus Ga. Over the years my shoulders are getting worst; I take medication and can not sleep on my shoulders. The doctor new [ sic] this before releasing me from active duty.”


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 bilateral 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 :

Service IPEB – Dated 20050308
 VA - (1 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Bilateral Shoulder Pain with Chondrolmalacia s/p Arthroscopic Surgery 5099-5003 10% Degenerative Osteoarthritis, Left Shoulder 5010-5201 20% 20050419
Degenerative Osteoarthritis, Right Shoulder 5201 20% 20050419
Other x 0 (Not is Scope)
 Other x 3 20050419
Rating: 10%
 Combined: 50%
Derived from VA Rating Decision (VA RD ) dated 200 50601 ( most proximate to date of separation ).


ANALYSIS SUMMARY: 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 proximate to separation in arriving at its recommendations and DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Bilateral Shoulder Condition. The narrative summary (NARSUM) noted the CI sustained injuries to his shoulders in both 1998 and 1999. The CI initially sustained injury to his right shoulder while lifting weights for physical training. The CI underwent arthroscopic debridement of labrum (repairs of the right shoulder) and recovered well. Also, in 1999 the CI injured his left shoulder during training (running an obstacle course) at his civilian occupation (prison guard) and underwent arthroscopic surgery of the left shoulder. Afterwards, the CI successfully rehabilitated and returned to full duty to include all upper body functions, weightlifting, push-ups and was able to mobilize in 2004. While deployed to Kuwait, his unit physical training program included weightlifting for conditioning; during which the CI sustained an acute strain with popping in his right shoulder in mid-February 2004. He was treated with physical therapy (PT) and steroid injections with minimal benefit. A magnetic resonance imaging (MRI) taken on 16 June 2004, demonstrated a right shoulder grade II tear of the supraspinatus and sub-scapularis tendon; and left shoulder grade II tear of supraspinatus tendon with partial tear of inferior labrum. The left shoulder radiographs indicated rotator cuff pathology. The CI was medically evacuated back to the United States and underwent a right shoulder arthroscopic debridement in July 2004. Also in September 2004; the CI had an arthroscopic subacromial decompression and chondroplasty surgery.

His treating physician noted the range-of-motion (ROM) was “good” and opined that mild impingement signs especially with cross body adduction was “probably from glenohumeral
Joint.” There was no indication of neurovascular compromise. The physician diagnosed chondromalacia of both shoulders, stated the CI had reached maximum benefit from treatment and recommended the MEB. There were no other treatment records available for review. The commander’s statement noted the CI was incapable of performing the duties of his MOS due to his physical condition involving his shoulders. His profile restricted push-ups, pull-ups, and lifting above 30 pounds. At the NARSUM examination performed on 11 January 2005, approximately 2 months prior to separation, the CI reported bilateral shoulder pain and limitation. On examination, the CI’s abduction was 110 degrees on the right and 120 degrees on the left. Evidence of muscle atrophy, joint instability, pain or tenderness during manipulation, weakness, or sensory deficit was absent.

At the VA Compensation and Pension (C&P) examination dated 19 April 2005, approximately a month after separation, the CI reported his bilateral shoulder pain on a scale of 0 to 10 was at a level 6. During prolonged extension of his arm or during abduction maneuver his pain increases to a level 10. The pain was described as aching, relieved with Motrin. The physician noted the CI had no periods of incapacitation secondary to his shoulders. On physical examination, the CI noted he gained 40 pounds over previous 6 months and was considerably overweight. His gait was steady and he walked without assistive devices. Small, well-healed, non-painful scars were noted at the surgical sites. Right shoulder ROM recorded abduction at 90 degrees with pain, and 80 degrees without pain. Internal and external rotation to 90 degrees was without pain. The physician recorded no functional loss. Examination of the left shoulder recorded abduction of 70 degrees without pain and 80 degrees with pain. Repetition caused no fatigue, functional loss, pain or weakness. There was no evidence of atrophy. Abduction to 40 degrees caused discomfort.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the bilateral condition as a single unfitting condition at 10% under the analogous code 5299-5003 (degenerative arthritis) for pain slight/constant. The VA coded the condition 5010-5201 (limitation of motion), assigned a 20% rating for each shoulder. Although VASRD §4.71a permits combined ratings of two or more joints under 5003, it allows separate ratings for separately compensable joints. IAW DoDI 6040.44 the Board must follow suit if the PEB combined adjudication is not compliant with the latter stipulation, provided that each ‘unbundled’ condition can be reasonably justified as separately unfitting in order to remain eligible for rating. If the members judge that separately ratable conditions are justified by performance based fitness criteria and indicated IAW VASRD §4.7 (higher of two evaluations), separate ratings are recommended; with the stipulation that the result may not be lower than the overall combined rating from the PEB. The Board’s initial charge in this case was therefore, directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings. The commander’s statement indicated the CI was incapable of performing the duties in his MOS due to “post surgery shoulders”; implicating right and left shoulders. The profile involved restrictions related to right and left shoulders. Treatment records were not available; however, the NARSUM noted the CI underwent steroid injections in each shoulder with transient relief. The VA examiner recorded pain in the right and left shoulders. Thereupon, the Board opined, both shoulders were equally painful, impacted duty performance and adjudged separately unfitting.

The Board then proceeded to the rating of the right shoulder condition. The record documented pain in the right shoulder with decreased ROM, no evidence of instability, or functional loss. There was radiographic evidence of grade II tear in the shoulder and chondromalacia of the right shoulder was diagnosed at the MEB. The Board agreed that the record sufficiently documented pain in the right shoulder and the preponderance of evidence did support a compensable rating under code 5003. The Board agreed that the condition was not compensable under ROM codes 5201 and 5261, or any other applicable VASRD code. The Board next proceeded in rating of the left shoulder condition. A careful review of the records of evidence demonstrated treatment of pain in the left shoulder, at the same frequency of treatment to the right shoulder, there was radiographic evidence of a grade II tear and right shoulder diagnosis of chondromalacia. Pain was recorded at the VA examination and noted at the MEB physical examination. The Board considered rating under 5202 and 5203 codes; however, there was no clinical or radiologic evidence supporting ankylosis, loss of the humeral head, nonunion, malunion, fibrous union, or deformity of the humerus. There was further no clinical or radiologic evidence that suggested dislocation of, nonunion of, or malunion of the clavicle or scapula at the time of separation. The Board was unable to find any additional codes for consideration. After deliberation, the Board concluded the record in evidence supported the minimal compensable rating for both the left and right shoulder pain coded 5003, IAW VASRD §4.59. Thereupon, after due deliberation, 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 pain condition and 10% for the left shoulder pain condition, for the combined rating of 20%.


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 DoDI 1332.39 for rating of bilateral shoulder was operant in this case and the condition was adjudicated independently of that policy/instruction by the Board. In the matter of the bilateral shoulder condition, the Board unanimously determined that each shoulder was separately unfitting, and recommends a disability rating of 10% rating for each shoulder, coded 5099-5003 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, effective as of the date of his prior medical separation:


UNFITTING CONDITION VASRD CODE RATING
Chronic Left Shoulder Pain 5099-5003 10%
Chronic Right Shoulder Pain 5099-5003 10%
COMBINED (W/BLF) 20%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131114, 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, AR20150002548 (PD201302377)
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                                                  XXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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