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AF | PDBR | CY2013 | PD-2013-02743
Original file (PD-2013-02743.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02743
BRANCH OF SERVICE: Army  BOARD DATE: 20150210
SEPARATION DATE: 20061211


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Multi-channel Systems Operator) medically separated for a left shoulder condition (non-dominant). The left shoulder condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). “Left shoulder pain status post distal clavicle excision and labral tear debridement” was forwarded by the MEB to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded two other conditions (proteinuria with history of nephrolithiasis and panic attacks) for PEB adjudication. The Informal PEB adjudicated “left shoulder pain status post distal clavicle excision and labral tear debridement” as unfitting, rated 10%, c iting application of the US Army Physical Disability Agency (USAPDA) pain policy. The remaining conditions were determined to be not unfitting and therefore not rated. The CI appealed to the Formal PEB, but later accepted the IPEB findings and recommendation and was medically separated.


CI CONTENTION: “I am still dealing with shoulder pain and had to have another surgery after separation to relieve more pain.”


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 20060927
 VA* - (~1 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Shoulder Pain
(non-dominant)		 5099-5003 10% Residuals S/P Left Shoulder Surgeries 5201-5024 10% 20061114
Other x 2 (Not In Scope)
 Other x 1
RATING: 10%
 RATING: 10%
* Derived from VA Rating Decision (VA RD ) dated 200 70404 (most proximate to date of separation ( DOS ) ) .


ANALYSIS SUMMARY:

Left Shoulder Pain S/P Distal Clavicle Excision and Labral Tear Debridement. The right hand dominant CI experienced the gradual onset of left shoulder pain without specific injury and was diagnosed with impingement of the shoulder tendons (rotator cuff) at the acromioclavicular joint during shoulder movement (impingement syndrome). He underwent surgery of the left shoulder in February 2004 to enlarge the space for the rotator cuff (subacromial decompression and removal of the end of the clavicle at the acromioclavicular joint). He underwent a second surgery in May 2005 to revise the original procedure. Magnetic resonance imaging with arthrography (injection of contrast into the joint) in August 2005 showed the expected surgical changes but was otherwise normal. Due to persisting left shoulder pain with use, he underwent arthroscopy of the left shoulder in November 2005 showing some fraying of the labrum (the cartilage rim of the shoulder socket) which was debrided. Arthroscopic examination of the shoulder joint showed the rotator cuff to be intact with normal joint surface (no degenerative changes), no loose fragments, and no other significant abnormalities. Physical examination of the shoulder under anesthesia showed a stable shoulder with no laxity and full passive range-of-motion (ROM). Following the third surgical procedure, the left shoulder pain did not improve sufficiently for performance of full military duties. At a follow-up orthopedic examination on 8 May 2006, the orthopedic surgeon noted that the CI had not been to physical therapy or performing the prescribed home exercise program for 2 months. 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 ~ 5 Mo. Pre-Sep
(20060710)
 VA C&P ~ 1 Mo. Pre-Sep
(20061114)
Flexion (180 Normal) 160 180
Abduction (180) 160 160
Comments Pain on motion
No atrophy
+ Impingement tests		 Pain on motion
 No change after repetition
No muscle atrophy
No instability
§4.71a Rating 10% 10%
invalid font number 31502
At the time of the MEB history and physical examination performed on 15 June 2006 (DD Form 2808), there was tenderness at the surgical site and pain with motion. There was no limitation of motion and upper extremity strength was normal (5/5) and equal in both shoulders. At the time of the orthopedic MEB narrative summary performed on 10 July 2006, the CI reported left shoulder pain with lifting, pushing, pulling, and overhead activities. There was no shoulder instability or dislocations. The ROM is recorded in the chart. The CI reported pain with maneuvers that tested for impingement. There was no atrophy of rotator cuff shoulder muscles. At the VA Compensation and Pension (C&P) examination performed on 14 November 2006, a month prior to separation, there was pain with motion. The ROM was similar to the orthopedic MEB examination and is recorded in the chart. There was no muscle atrophy and tests for rotator cuff problems and instability were negative.

The Board directed its attention to its rating recommendation based on the above evidence. The PEB rated the left shoulder pain status post distal clavicle excision and labral tear debridement 10% coded 5099-5003 citing the USAPDA pain policy. The VA rated the left shoulder pain (residuals, status post left shoulder surgeries X3) at 10% coded 5201-5024 (limitation of shoulder motion - tenosynovitis) citing painful motion. The ROM at both the MEB and the prior to separation VA C&P examination did not support a minimum rating for limitation of arm motion (5201). However there was painful motion and functional loss supporting a 10% rating (§4.59 and §4.40). There was no evidence to support consideration of a higher rating under 5203 (impairment of clavicle or scapula) as there was no dislocation or loose movement documented. There was no impairment of the humerus such as dislocations or instability support consideration under diagnostic code 5250 (other impairment of the humerus). 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 adjudication for the left shoulder 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 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 pain status post distal clavicle excision and labral tear debridement 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 20131217, 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, AR20150010433 (PD201302743)


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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