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AF | PDBR | CY2014 | PD-2014-01449
Original file (PD-2014-01449.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX        CASE: PD - 2014 -01449
BRANCH OF SERVICE: Army   BOARD DATE: 201 5 051 9
Separation Date: 20070716


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-3 ( Bridge Crewmember ) medically separated for left shoulder pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupationa l Specialty or satisfy physical fitness standards. He was issued a permanent U3 L2 profile and referred for a Medical Evaluation Board (MEB). The shoulder condition, characterized as “left shoulder pain with partial supraspinatus tear , ” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded cervicalgia, lumbago and left knee chrondromalacia for PEB adjudication. The Informal PEB adjudicated “chronic pain left (non-dominant) shoulder pain, with partial supraspinatus tear” as unfitting, rated 10%, referenci ng criteria of the US Army Physical Disability Agency (USAPDA) pain policy. The remaining conditions were determined to be not unfitting. The CI made no appeals and was medically separated.


CI CONTENTION : “Constant pain and joint instability stemming from my injuries forced change in career. Spent several months medicated for PTSD An xiety and (illegible) issues w/continuing counseling/ treatment.”


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.

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RATING COMPARISON :
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Service IPEB – Dated 20070621
 VA – (~6 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Pain Left (Non -Dominant) Shoulder… 5099-5003 10% Impingement Syndrome, Left Shoulder (Non-Dominant) 5201 20% 20080109
Cervicalgia Not Unfitting Cervical Strain… 5237 10% 20080109
Lumbago Not Unfitting Thoracolumbar Strain… 5237 10% 20080109
Left Knee Chrondromalacia… Not Unfitting Patellofemoral Pain Syndrome with Degenerative Arthritis, Left Knee… 5299-5014 0% 20080109
Other x 0
 Other x 5
Rating: 10%
 Combined: 50%
Derived from VA Rating Decision (VARD) dated 20080209 (most proximate to date of separation) .

ANALYSIS SUMMARY :

Chronic Pain Left (Non-Dominant) Shoulder Pain with Partial Supraspinatus Tear . The right - hand dominant CI experienced onset of left shoulder pain with swelling and spasm in October 2006 after being injured while traveling at a high rate of speed in the gun turret of a HUMVEE that stopped suddenly . The m edical provider noted left shoulder pain for 2 months that radiated down to the elbow with tingling in the hand and fingers. There were physical exam (PE) findings of tenderness to palpation of the left shoulder . A medical note dated 15   November 2006 referenced a left shoulder magnetic resonance imaging ( MRI ) which showed tendonopathy and a tear. The CI was referred to p hysical t herapy (PT) for left shoulder pain with numbness to all fingers of the left hand with PE findings of left shoulder flexion limited to 165 degrees and abduction with pain limited to 160 degrees and normal stre ngth. The o rthopedist noted left shoulder PE findings of a decrea s e in active motion, elevation through active forward flexion and elevation though active abduction. The left shoulder MRI demonstrated a tear of the distal supraspinatus (rotator cuff) tendon. The o rthopedist also noted PE findings of an inflamed tend on and shoulder instability . There were no episodes of dislocation noted in the evidence present for review. The MEB n arrative s ummary exam less than 2 month s pri or to s ep a ration documented that the CI had chronic daily discomfort in his left shoulder, had an inability to lift and there was limited left shoulder range-of-motion ( ROM ) . The CI had functional limitations which included an inability to do pushups, sit-ups , run, jump , or do other physical activity nor could he lift more than 10 pounds . The examiner rated the pain according to the American Medical Association pain scale at moderate and constant.

The VA Compensation and Pension (C&P) exam less than 6 months after separation documented that the CI had left shoulder subluxations one to two times a month with p ain. There were two ROM evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation as summarized in the chart below.

Left Shoulder ROM (Degrees)
 PT ~2 Mo s . Pre-Sep MEB ~1.5 Mo s . Pre-Sep VA C&P ~ 6 Mo s . Post-Sep
Flexion (180 Normal)
 86 Noted ROMs from PT 75
Abduction (180)
 86 70
Comments : Right Hand Dominant
 Pos. painful motion Pos. tenderness to palpation ; Pos. apprehension Pos. painful motion & crepitus; decreased strength; Pos. Deluca criteria
§4.71a Rating
 20 % 20% 20 %
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The Board direct ed attenti on to its rating recommendation based on the above evidence . The PEB coded the chronic pain left (non-dominant) shoulder pain with partial supraspinatus tear condition as 5099 analogous to 5003 and rated at 10% with application of the USAPDA pain policy. The VA coded the impingement syndrome, left shoulder (non-dominant) condition as 5201 (limitation of arm motion) and rated at 20% for “midway between side and shoulder level.” The PT exam for the MEB demonstrated that the left shoulder abduction was 86 degrees which meets the 20% rating criteria and most closely fits the “at shoulder level” description. At the C&P exam, nearly 6 months later, there was a slight worsening as evidenced by abduction of 75 degrees and 70 degrees with consideration of the Deluca criteria. That exam was granted a 20% rating as applied by the VA. 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 chronic pain left (non-dominant) shoulder pain with partial supraspinatus tear condition coded 5201.

Contended PEB Conditions. The contended conditions adjudicated as not unfitting by the PEB were cervicalgia, lumbago and left knee chrondromalacia. The Board’s first charge with respect to these conditions is an assessment of the appropriateness of the PEB’s fitness adjudications. 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. Although these three conditions were noted on the profile, all were noted to be profiled at the “2” level. The commander’s s tatement also annotated all three conditions; however, they were noted in a generic, non-specific manner without specific mention of the duty limitations due to any specific condition. None of these conditions were judged to fail retention standards. All s ervice treatment entries were reviewed and considered by the Board. There was no indication from the record that any of these conditions significantly interfered with satisfactory duty performance. After due deliberation , and 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 cervicalgia, lumbago , or left knee chondromalacia contended conditions and therefore, no additional disability ratings can be recommended.


 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 ( 635-40) for rating the chronic pain left (non-dominant) shoulder pain with partial supraspinatus tear condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the chronic pain left (non-dominant) shoulder pain with partial supraspinatus tear c ondition, the Board unanimously recommends a disability rating of 20 %, coded 5201 IAW VASRD §4.71a. In the matter of the cervicalgia, lumbago, and left knee chrondromalacia contended conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting. 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 Pain Left (Non-Dominant) Shoulder Pain with Partial Supraspinatus Tear 5201 2 0%
COMBINED
 2 0%
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The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 140321 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record









                           XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review  








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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 XXXXXXXXXXXXXXXXXXXX , AR20150014198 (PD201401449)
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                                                  XXXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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