Search Decisions

Decision Text

AF | PDBR | CY2014 | PD-2014-00630
Original file (PD-2014-00630.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-00630
BRANCH OF SERVICE: Army  BOARD DATE: 20150220
DATE OF PLACEMENT ONTO TDRL: 20060519
DATE OF REMOVAL FROM TDRL: 20070815


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-7 (Air Traffic Controller) medically separated for left shoulder and cervical spondylosis. The conditions 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/L2 profile and referred for a Medical Evaluation Board (MEB). The shoulder and neck conditions, characterized as “type 4 SLAP lesion” and “cervical spondylosis with C7-8 radiculopathy,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded a bilateral knee condition for PEB adjudication. The Informal PEB (IPEB) adjudicated “shoulder pain” and “cervical spondylosis” as unfitting, rated 20% and 10%, likely applying the Veterans Affairs Schedule for Rating Disabilities (VASRD) and placed the CI on the Temporary Disability Retired List (TDRL) with a combined 30% disability rating. The additional bilateral knee condition was found not unfitting. The IPEB removing the CI from the TDRL a year later adjudicated “chronic pain left shoulder” and “cervical spondylosis” as unfitting, rated 10% and 10%, with likely application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: “I wish to have my PDBR reviewed for the following listed reasons. (1) This injury causes me pain on a daily basis’s and will be for the rest of my life, as well as requiring me to endure additional surgeries. I will need a shoulder replacement in the near future. (2) This injury cost me my military career. I had no intentions of leaving the military until I had completed my 20 years of service and was able to retire. I wanted to continue to serve my country and I was told by my PBLO that was not an option with my injury. (3) I feel that my original board and follow-up evaluation results were inaccurate. I was originally placed on TDRL and a year later removed. I do not feel that I should have been removed from TDRL, but placed on a permanent retirement status because my injuries continue to worsen.”


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 :
Final Service PEB - 20070723
 VA (16 Mo. Prior to Adjudication Date*) - Effective 20060519
On TDRL - 20060519
 Code Rating Condition Code Rating Exam
Condition
 TDRL Sep.
Chronic Pain Lt Shoulder 5099-5003 20% --- Rotator Cuff Tear, Lt Shoulder S/P Arthroscopy 5299-5201 20% 20060407
5201 --- 10%
Cervical Spondylosis 5299-5242 10% 10% Degenerative Disc Disease Cervical Spine 5242 10% 20060407
Cervical Radiculopathy 5242-8515 10% 20060407
Other x 1
 Other x 9
Combined: 30% → 20%
 Combined: 70%
* VA rating exam proximate to TDRL placement dated 20070822 did not change any ratings.


ANALYSIS SUMMARY:

Left Shoulder Condition. The service treatment record indicated the CI’s injury began with a pop in his non-dominant left shoulder while performing push-ups and was marked by pain with an inability raise his arm on 13 May 2002. Treatment consisted of physical therapy (PT), but pain recurred after holding a baby. An X-ray series of the left shoulder was unremarkable. Persistent pain warranted a magnetic resonance imaging (MRI), which was performed on 15 July 2002 that revealed an acromioclavicular (AC) joint arthrosis (degenerative change with wear and tear) with mild supraspinatus (a muscle contributing to the rotator cuff) tendon irregularity, but no rotator cuff tear. On 15 November 2002, the CI underwent examination under anesthesia, diagnostic arthroscopy and partial synovectomy (removal of a membrane around the joint), and debridement of the superior labrum (cartilage) of the left shoulder. Thereafter, he had persistent left AC-joint type symptoms not responsive to PT. AC-joint arthrosis was confirmed after he had relief with a diagnostic anesthetic injection into the joint. The CI underwent a left shoulder open distal clavicle excision of the AC arthrosis on 31 January 2003. The post-operative course progressed satisfactorily until 8 December 2004 when the CI slipped down steps with his left arm backwards and dislocated his shoulder (glenohumeral dislocation), which mildly impinged on the axillary nerve. The shoulder was manually reduced with improvement of the axillary nerve sensation. Post-reduction films demonstrated normal alignment of the left shoulder joint. However, X-rays performed 3 weeks later showed a low-lying humeral (arm bone) head probably associated with ligamentous laxity. The CI reported his left arm was numb in the biceps area and in the fingers of the left hand. Pain decreased, but the CI still had paresthesias (tingling sensation) of the left hand and numbness of the lateral arm. Ranges-of-motion (ROMs) of the shoulder were flexion 140 degrees, abduction 120 degrees, external rotation (ER) of 55 degrees, and internal rotation (IR) 70 degrees. An MRI dated 31 March 2005 noted findings that suggested a full thickness rotator cuff tear. The CI noted during an orthopedics examination he felt burning in the arm, which “gives out easily,” and the arm hurt and cramped. Concurrent cervical radiculopathy (discussed below) was not relieved with electric stimulation (TENS). The CI subsequently underwent left shoulder surgery on 26 August 2005 consisting of a diagnostic arthroscopy, which demonstrated an intact rotator cuff, a subacromial decompression (to reduce pressure on a muscle), an open biceps tenodesis (move a biceps tendon to the humerus), and an anterior labral (cartilage) repair. Post-operative PT was instituted with pain medication as needed. At the MEB examination on 8 December 2005, the MEB physical examiner noted “left shoulder tenderness to palpation at the AC joint” and limitation of the ROMs with pain. Left upper extremity weakness involving the hand grip strength was noted to be 3/5. The commander’s statement dated 14 December 2005 indicated the CI came to the unit unable to perform his MOS due to the injury of his left shoulder with multiple surgeries; and he was non-deployable. He could not use his left shoulder to do any kind of physical work or full ROM, but could perform all his duties proficiently as a Family Readiness Group Liaison. The narrative summary (NARSUM) dated 5 January 2006 indicated the CI’s left shoulder pain began in July 2002 d uring physical training. Non-surgical treatment with PT , profiling, nonsteroidal anti-inflammatory , and pain medications did not ameliorate the CI’s pain. He then underwent three shoulder surgeries between 2003 and 2005 as noted above. However, s houlder pain persisted in spite of PT , activity modification, and rest along with associated with upper extremity numbness and tingling. Examination of his left shoulder revealed tenderness to palpation (TTP) over his AC joint with some muscle atrophy in his deltoid. The ROM s were: flexion 80 degrees (Normal 180 degrees ) , abduction 80 degrees (Normal 180 degrees ) , adduction 30 degrees , internal rotation to his coccyx (Normal 90 degrees ) , and external rotation about 20 degrees (Normal 90 degrees ) . A permanent U3 profile was issued on 7 February 2006 for “shoulder surgery 3X’s” as well as left cervical spondylosis and nerve damage C6/C7 (discussed below).

At the VA Compensation and Pension (C&P) exam ination dated 7 April 2006, performed a month after TDRL placement and 16 months prior to TDRL removal , the CI reported a significant l eft shoulder injury in July 2002 when d oing push - ups for physical training . Thereafter, he underwent three surgical interventions noted previously. He did poorly following each surg ery eventually requiring a permanent P3 profile . Physical examination revealed no atrophy. There was TTP throughout the superior aspect of the shoulder. ROMs were forward flexion was 0 degrees -110 degrees , abduction 0 degrees -90 degrees , e xtension 0 degrees -30 degrees (Normal 50 degrees ), i nternal rotation 0 degrees -70 degrees , and external rotation 0 degrees -20 degrees . Painful motion was noted in the last 20 degrees in all ROMs except external rotation where the last 10 degrees were painful.

P lacement on TDRL occurred on 19 May 2006 . At a follow-up examination dated 7 August 2006 , the examiner indicated the CI still had left shoulder pain with weakness of the his left triceps on manual muscle testing and good overall ROM of his should er with good cuff function. At an examination dated 27 March 2007, the CI was noted to have left shoulder pain, but no physical examination was carried out. An X-ray series of the left shoulder was normal on 17 May 2007 and the ROMs on that date were flexion 100 degrees and abduction 87 degrees with limitation of motion due to pain/mechanical secondary to contracture. At a TDRL examination on 17 May 2007, the CI reported continued pain since his last surgery at 4-5/10 at rest and 6-7/10 with activities. Shoulder ROMs were limited secondary to pain. Operative sites of the left upper extremity were well healed. Global tenderness without specific anatomic correlation was noted; no muscle atrophy was present. Motor strength was decreased for the entire left upper extremity without an anatomical or dermatomal pattern, but sensation was intact; and there was no evidence of instability. A temporally remote (almost 50 months after final separation ) examination was reviewed; however, it offered very limited or no probative post-separation evidence of any significant value other than indicating some labral fraying, some degeneration of the rotator cuff without any tears, and a fair amount of subacromial bursitis.
The Board directed attention to its rating recommendation based on the above evidence. The PEB assigned a 20% rating using code 5201 (Arm limitation of motion) fo r shoulder pain s tatus post biceps tenodesis and distal clavicle resection (Abduction 85 degrees) and placed the CI on TDRL . The VA assigned a 20% rating using code 5299-5201 based on shoulder abduction of 90 degrees on 15 June 2006 . The CI was removed from TDRL on 15 August 2007 and was assigned a 10% rating usin g code 5099-5003 for chronic left shoulder following distal clavicle resection based on limited ROM secondary to pain without atrophy and was rated slight/constant . There was no change to the VA’s original 20% rating on the left shoulder condition (from the predischarge examination ) based on the Board’s review of the VA rating decision closest to the CI’s removal from the TDRL . The Board discussed the TDRL placement rating and found it to be reasonable at 20% ; however, at the time of TDRL removal , the Board considered a 20% rating for the shoulder condition based on flexion of 100 degrees and abduction of 87 degrees . Code 5201 states: “ Midway between side and shoulder level” for a 20% rating. While 90 degrees would be the midway between the side and shoulder level referred to in the VASRD, it is not precise as to which ROM or whether any ROM can be used to meet the “midway” point. Certainly, the flexion measurement exceeded 90 degrees and the motion was limited by pain, but the abduction was 87 degrees , which is less than the “midway” point and the 20% rating is in concert with the PEB TDRL placement measurement and rating as well as the VA rating proximate to TDRL placement. Because the CI is right - handed, there is no route to a higher rating since the residuals of the injury are confined to the non-dominant extremity. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the left shoulder condition on TDRL placement and removal.

Cervical Spine Condition . A cervical spine series dated 12 January 2005 (performed after the CI fell down stairs and had numbness in the lateral shoulder and intermittent left hand radicular symptoms) was normal ; and an examination dated 24 June 2005 was normal as well . A PT evaluation on 12 July 2005 noted the CI had numbness of the left 4th and 5th digits and referred to a prior electro-diagnostic study documenting C7-8 radiculopathy. An MRI dated 5   August 2005 demonstrated straightening of the usual cervical lordosis and mild uncovertebral hypertrophy (bone spur ring ) at C4-5 and more so at C5-6 with no evidence of a herniated disc or stenosis . Orthopedic evaluation noted continued weakness and pain in the distribution of the C7-C8 nerves. Repeat electro-diagnostic studies performed on 21 August 2006 revealed chronic C6 radiculopathy of the left upper extremity and borderline left ulnar nerve cubital tunnel changes, which was probably a subset of the radiculopathy. The CI had an epidural injection at the C6-7 interspace for pain in his neck that radiated into his left hand on 2 October 2006. However, t he cervical epidural did not help much. At the MEB examination dated 8 December 2005, the CI reported “seen by ortho for nerve damage, left shoulder, and neck.” The MEB physical examination of the cervical spine noted [p]araspinal tenderness to palpation; [n]o limitation of movement; and [p]ain elicited by flexion, lateral flexion to the right and rotation to the right.” The MEB NARSUM dated 5   January 2006 note d the CI had chronic neck pain since 1998 when he sustained an injury to his neck while performing helicopter sling-loading o perations when he was caught in t he back of his Kevlar [helmet] . He had intermittent neck pain until December 2004 when he sustained a fall. Subsequently, he had con stant and dull neck pain with radiation down his left upper extremity with numbness and tingling down his arm . Treatment consisted of rest, activity modification, anti- i nflammatories. C7 and C8 radiculopathy was reported , but the MRI and his symptoms d id not match ; therefore, he was not a surgical candidate. The left upper extremity had numbness on the ulnar border and the palm of his hand. Neurological evaluation was unremarkable. The commanders’ statement (see above) did not address the cervical spine condition. In a note dated 7 August 2006, the examiner was suspicious that the CI had both a radicular pain complaint coming from his neck and also bilateral carpal tunnel [syndrome] that required follow-up , but is outside the scope of review .

At the VA C&P examination, performed 16 months prior to separation, the CI reported a cervical spine injury in 1998 with continual pain accompanied by a left upper extremity radiculopathy. No overt deformity of the cervical spine was noted, but there was TTP throughout the cervical vertebrae and accompanying spinal accessory muscles bilaterally. Strength was rated at 4/5 involving the left upper extremity. ROMs for flexion, extension, and left and right lateral flexion were all 45 degrees ; l eft and right rotations were 0 degrees -80 degrees ; and p ainful motion was noted.
The TDRL addendum dated 17 May 2007 noted normal cervical spine X -rays. The CI’s chronic shoulder and neck pain, which require d daily narcotic use and significantly limit ed his activit i es and preclude d return to active duty . An MRI dated 11 July 2007 noted generalized narrowing of the spinal canal throughout the cervical spine and l eft removal foram en (spinal nerve opening) stenosis (narrowing) was suspected at C6-7. In a follow-up visit on 7 August 2007, the CI’s motor strength remained good and conservative treatment with muscle relaxant and pain medications at night was recommended.

The 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.

Cervical ROM
(Degrees) 		MEB ~ 19 Mo. Pre-Sep
VA C&P ~ 16 Mo. Pre-Sep
TDRL ~ 3 Mo. Post-Sep
Flex (45 Normal) ( 20/20/20 ) 20 45 ( 45/45/45 ) 45
Extension (45) ( 15/20/20 ) 20 45 ( 35/35/35 ) 35
R Lat Flexion (45) ( 20/25/25 ) 25 45 ( 35/35/35 ) 35
L Lat Flexion (45) ( 20/20/20 ) 20 45 ( 35/37/33 ) 35
R Rotation (80) ( 45/40/40 ) 40 80 ( 60/60/60 ) 60
L Rotation (80) ( 40/45/45 ) 45 80 ( 75/75/75 ) 75
Combined (340) 170 340 285
Comment Limited by pain Painful motion Limitation due to pain ; guarding
§4.71a Rating 20 % 10 % VA 10 % ; 10% radiculopathy

The Board directed attention to its rating recommendation based on the above evidence. The IPEB assigned a rating of 10% using code 5299-5242 (degenerative arthritis) for cervical spondylosis, without significant neurologic abnormality, cervical ROM limited by pain with localized tenderness for TDRL placement and the same rating and code on TDRL removal based on ROMs of 17 May 2007. The VA assigned a 10% rating using code 5242 for cervical spine degenerative disc disease with left upper extremity radiculopathy, which was retained proximal to TDRL removal. Based on the ROMs in the record the Board was unable to find a route to a higher rating. The MEB referred cervical spondylosis with C7-8 radiculopathy; however, the PEB noted cervical spondylosis “without significant neurologic abnormality.” The Board considered whether an additional rating could be recommended under a peripheral nerve code, as conferred by the VA, for the associated cervical radiculopathy at separation. Firm Board precedence requires a functional impairment linked to fitness to support a recommendation for addition of a peripheral nerve rating to disability in spine cases. The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a. The sensory component in this case has no functional implications; and, the motor impairment was either intermittent or relatively minor and cannot be linked to significant functional consequence relative to the conditions within the scope of review. There is thus no evidence of a separately ratable functional impairment (with fitness implications) from the residual radiculopathy; and, the Board cannot support a recommendation for an additional disability rating on this basis. 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 adjudications for the cervical spine condition at either TDRL placement or TDRL removal.

Contended PEB Condition Bilateral Knee Pain. The Board’s main charge is to assess the fairness of the PEB’s determination that the bilateral knee pain condition was not unfitting. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. The bilateral knee pain condition received a L2 profile, whereas the other conditions in scope received a U3 profile. The bilateral knee pain condition was not implicated in the commander’s statement and was not judged to fail retention standards. At the MEB examination dated 8 December 2005, the CI indicated he had a sprained knee in 2004 (but unclear whether one knee or both knees) and the examiner noted bilateral subpatellar (below the knee cap) TTP without edema or erythema (redness). There was a full ROM of the knees, although there was pain on extension and crepitus (a grinding sensation) to palpation. At the VA C&P examination both the left and right knees were examined; and there was no swelling, no effusion, and no ligament instability of either knee. There was TTP throughout the periphery of the patella (knee cap) and patellar tendon areas bilaterally. The ROM measurement for each knee was 0 degrees-130 degrees with pain noted between 110 degrees and 130 degrees. The aforementioned findings were reviewed by the action officer and considered by the Board. There was no performance based evidence from the record that the condition significantly interfered with satisfactory duty performance. 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 contended bilateral knee pain condition and so no additional disability rating is recommended even if each knee were separately addressed.


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. It appeared that the PEB relied on the VASRD on TDRL placement, but relied on the USAPDA pain policy for rating the chronic pain of the left shoulder on TDRL removal. However, the condition was adjudicated independently of that policy 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 for both TDRL placement and TDRL removal. In the matter of the cervical spine 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 recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
TDRL PERMANENT
Left Shoulder 5201 20% 20%
Cervical Spine 5299-5242 10% 10%
COMBINED 30% 30%




The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131220, 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, AR20150011000 (PD201400630)


1. Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.

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:

         a. Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

         b. Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

         c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

         d. Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

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

Similar Decisions

  • AF | PDBR | CY2009 | PD2009-00253

    Original file (PD2009-00253.docx) Auto-classification: Denied

    Pain rating: Bilateral knees - slight/constant. The PEB noted cervical range of motion limited by pain, with localized tenderness. X-rays showed normal spine.

  • AF | PDBR | CY2013 | PD-2013-01319

    Original file (PD-2013-01319.rtf) Auto-classification: Approved

    Chronic neck pain continued and she was referred for a MEB.At the MEB examination (3 months prior to separation), the CI reported“spasms in her neck and flares in her neck pain,” with “herniated discs in my neck which are irreparable.”She reported that “load bearing equipment and Kevlar headgear worsen her neck pain.”The Report of Medical History (DD Form 2807) for the MEB reported the presence of herniated discs with “no surgery.”The MEB physical exam noted surgical scars on the right palm...

  • AF | PDBR | CY2010 | PD2010-00975

    Original file (PD2010-00975.docx) Auto-classification: Denied

    The ratings assigned to unfitting conditions is based on the severity of the condition at the time of separation, and then at the time of removal from TDRL, and not based on possible future changes. In the matter of the left and right shoulder conditions, the Board unanimously recommends no change in the rating at the time of initial placement on the TDRL and a permanent rating after removal from the TDRL of 10% each, coded 5304 IAW VASRD §4.71a. After careful consideration of your...

  • AF | PDBR | CY2014 | PD-2014-01884

    Original file (PD-2014-01884.rtf) Auto-classification: Approved

    The TDRL’s re-evaluation IPEB adjudicated the right wrist, right knee and left shoulder as a single unfitting condition, rated at 20%. However, the PEB combined the condition of the right hand with the right knee and left shoulder and rated the conditions under the pain policy. In the matter of the left rotator cuff and left shoulder pain condition and IAW VASRD §4.71a, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.59 at both TDRL placement and...

  • AF | PDBR | CY2010 | PD2010-01210

    Original file (PD2010-01210.docx) Auto-classification: Approved

    The C&P examination just prior to the TDRL examination also supports a 20% rating. At the time of placement on the TDRL, PTSD was adjudicated as an unfitting condition rated 10% by the PEB. If the Board does not agree with the PEB and concludes that the PTSD condition remained unfitting for military service, the Board must determinate the most appropriate fit with VASRD 4.130 criteria at the conclusion of the TDRL interval for its permanent rating recommendation.

  • AF | PDBR | CY2009 | PD2009-00136

    Original file (PD2009-00136.docx) Auto-classification: Denied

    A Board majority determined the Commander’s letter which stated the CI’s knee, neck, shoulder, and hand conditions prevented him from performing the duties of his rating and the required physical fitness test was sufficient evidence to determine both cervical spondylosis and C6 radiculopathy were unfitting at the time of separation. This Board member determined there was insufficient evidence to consider either Cervical Spondylosis with C5-C6 Left Foraminal Stenosis and Arthritis or...

  • AF | PDBR | CY2011 | PD2011-00415

    Original file (PD2011-00415.docx) Auto-classification: Approved

    A January 2004 clinic encounter during a flare of LBP and the April 2004 orthopedic NARSUM indicated normal or near normal motion without muscle spasm while the March 2004 MEB examination recorded significantly reduced ROM. Other PEB Conditions . The Board does not have the authority under DoDI 6040.44 to render fitness or rating recommendations for any conditions not considered by the DES.

  • AF | PDBR | CY2014 | PD-2014-01304

    Original file (PD-2014-01304.rtf) Auto-classification: Approved

    The Informal PEB adjudicated “chronic low back pain without neurologic abnormality, chronic left non-dominant shoulder pain, and chronic neck pain” as unfitting, rated 10%, 20% and 0% respectively, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) for the left shoulder and back conditions and referencing application of the US Army Physical Disability Agency (USAPDA) pain policy for the neck condition. Prior to TDRL Placement) - Effective 20031216On TDRL -...

  • AF | PDBR | CY2009 | PD2009-00403

    Original file (PD2009-00403.docx) Auto-classification: Denied

    The VA rated his shoulder as a separate condition as described below. Right Shoulder Pain/Impingement: The VA examination on 20081105 documented Pain to palpation of the right shoulder, painful motion of right shoulder, and crepitation in right shoulder.

  • AF | PDBR | CY2011 | PD2011-00346

    Original file (PD2011-00346.docx) Auto-classification: Approved

    The CI was then medically separated with a 0% disability rating. Right Shoulder Pain . In the matter of the neck and right shoulder condition, for a separation rating after TDRL, the Board unanimously recommends that it be rated as two separate unfitting conditions with rating, by a vote of 2:1, as follows: a cervical spine condition coded 5290 and rated 10%; and, a right shoulder condition coded 5099-5003 and rated 10%; both IAW VASRD §4.71a.