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AF | PDBR | CY2014 | PD-2014-00180
Original file (PD-2014-00180.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2014-00180
BRANCH OF SERVICE: Army  BOARD DATE: 20141204
SEPARATION DATE: 20071018


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Bradley Fighting Vehicle System Mechanic) medically separated for a left shoulder condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The left shoulder condition, characterized as “chronic left shoulder pain with labral tear status post Mumford procedure then superior labrum anterior to posterior (SLAP ) procedure” and “coracoidplasty,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB. The Informal PEB adjudicated chronic left shoulder pain as unfitting, rated at 0% with presumed application of Department of Defense Instruction (DoDI) 1332.39. The CI made no appeals and was medically separated.


CI CONTENTION: “Continuing issue with my left shoulder and with PTSD.”


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 left shoulder condition is addressed below. The contended posttraumatic stress disorder (PTSD) condition was not identified by the MEB or PEB; and, thus not within the DoDI 6040.44 defined purview of the Board. This and any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.


RATING COMPARISON :

Service IPEB – Dated 20070823
 VA* - Based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Chronic Left Shoulder Pain 5099-5003 0% Residual Left Shoulder Arthritis 5201-5010 0% STR
Other x 0 (Not in Scope)
 Other x 4
Combined: 0%
 Combined: 0%
Derived from VA Rating Decision (VARD) dated 200 71227 (most proxima te 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. The Board acknowledges the CI’s contention that suggests a rating should have been conferred for PTSD. The Board wishes to clarify that it is subject to the same laws for service disability entitlements as those under which the Disability Evaluation System (DES) operates. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. However the Department of Veterans Affairs, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically reevaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time.

Left Shoulder Condition. The CI originally injured his left shoulder during a ruck march in basic training in 2002. He received intermittent conservative treatment for exacerbation of left shoulder pain for nearly 4 years. X-ray images revealed degenerative changes about the left shoulder with a labral tear. The STR summarized a history of two separate surgical procedures being performed on the left shoulder; a partial clavicular resection (Mumford procedure) in September 2006 and a repair of a labrum tear (SLAP procedure) in March 2007. A follow-up physical therapy report 5 months after surgery indicated that both his pain and range-of-motion (ROM) were “improving.” At the MEB narrative summary exam on 7 August 2007 (approximately 2 months prior to separation), the CI endorsed a sharp, stabbing 6-8/10 pain in his left shoulder associated with decreased ROM. He reported the inability to perform sit-ups, push-ups, or the duties of his MOS. The physical examination revealed tenderness and painful limited motion. Sensory and strength examinations were normal. The diagnosis was chronic left shoulder pain with past surgical description. His permanent profile listed the same diagnosis and the commander’s statement noted his inability to perform MOS duties due to his physical condition.

The VA examinations were not available for review, but a VARD (proximate to separation) indicated an original at 0% rating was due to “failure to report” for the examination and that the rescheduled exams (approximately 5 months after separation) revealed decreased and painful motion. 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)
 NARSUM ~ 2 Mo. Pre-Sep
(20070807)
 VA C&P ~4 Mo. Post-Sep
(20080206)
 VA C&P ~5 Mo. Post-Sep
(20080308)
Flexion (180 Normal)
 140 140 125
Abduction (180)
 90 90 100
Comments
 P ainful motion P ainful motion P ainful motion
§4.71a Rating
 20% (PEB 0%) 20% 10% (VA 10%)

The Board direct ed attention to its rating recommendation based on the above evidence. The PEB and VA chose different coding options for the shoulder pain condition, but this did not bear on the rating and both were consistent with §4.71a ( Schedule of Ratings, M usculoskeletal S ystem ) . The PEB adjudicat ed the left shoulder at 0% code d 5099-5003, citing degenerative arthritis with loss of joint motion due to pain alone . The VA originally rated the left shoulder at 0% , coded 520 1 -5010 ( arm; limitation of motion -traumatic arthritis) with an increase to 10% subsequent to C&P summary examination s citing painful motion. The left shoulder limited ROM of 90 degrees supports a 20% minimum rating with application of code 5201 . After due deliberation, considering the totality of evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the left shoulder condition code d 5201. Additionally, there was no further clinical or radiological evidence of the left shoulder joint that suggested non-union of, or mal-union of the clavicle or scapula. Hence, no alternative shoulder code is supported in justification of a rating higher than that found in the limited ROM criteria under the 5201 code .


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 DoDI 1332.39 for rating the left shoulder was operant in this case and the condition was adjudicated independently of that instruction by the Board. In the matter of the left shoulder condition, the Board unanimously recommends a disability rating of 20%, coded 5201 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
Left Shoulder Condition 5201 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130229, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record








                          
XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX, AR20150007648 (PD201400180)
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                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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