RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01923
BRANCH OF SERVICE:  Army	BOARD DATE:  20150303
SEPARATION DATE:  20050608

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Infantryman) medically separated for right shoulder pain.  The shoulder 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).  “Chronic right shoulder pain status post (s/p) superior labrum anterior and posterior (SLAP) repair” 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 pain, right shoulder, following SLAP repair” as unfitting, rated 0%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I had more than one issue pending at that time, and was told they would take care of that.  The board pick one and told me the VA would do the rest.  The back issue was more severe along with the shoulder and right leg.  From this seperation until now, I have been on a downward spiral.  I have tried many jobs and continue to fail at them because of the back and leg issue.  From June 8, 2005 - I have lived in pain on a daily basis.  I continue to seek treatment to find a balance.  This whole event has cause me major mental problems such as daily panic attacks.  I no longer walk striaght an use a cane for support.  As for quality of life, I do what I can to keep weight down and to keep me moving.  It is very difficult to find work, because it hurts to stand, walk, sit, or drive for any lenght of time.  Cannot support any heavy weight with movement.  Cannot work using arms over my head.  This is the the basic's of what I deal with.”

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 20050331	VA* - (~4 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Shoulder, Following SLAP Repair	5099-5003	0%	Chronic Right Shoulder Pain Status Post Labral Repair	5099-5024	10%	20050201	
Other x 0 (Not In Scope)	Other x 9	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20050721 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Shoulder Condition.  In August 2003, the CI first sought treatment for right shoulder pain.  Absent direct injury, the CI related his symptom onset to performance on the obstacle course.  Initially treated as a simple sprain, the CI failed conservative treatment to include local injections.  Subsequent radiographs revealed a labrum tear in the right shoulder.  On 19 April 2004, he underwent an uncomplicated arthroscopic repair of the labrum.  Post-operatively, he did well for approximately 4 months, but painful symptoms returned and he was referred for an MEB.  No service treatment record entries documented shoulder instability, subluxation, or any positive neurovascular findings.  He was permanently profiled in October 2004 with a diagnosis of right shoulder pain.  At the narrative summary (NARSUM) dated 10 February 2005 (4 months prior to separation and 10 months after surgery) the CI endorsed significant pain with any lifting of objects above his shoulder level.  He also reported the inability to carry a rucksack, fire a rifle or perform his primary MOS.  His physical examination (PE) revealed painful and limited motion and tenderness of the right shoulder.  There was no evidence of neurologic deficit or instability of the right upper extremity.  The examiner rated the CI’s pain as ‘constant’ and ‘minimal’.  The commander’s letter implicated the shoulder condition and recommended an extension of military duty.  

At the VA Compensation and Pension (C&P) examination dated 1 February 2005 (4 months prior to separation) the CI endorsed constant right shoulder pain with occasional swelling.  His functional impairment was stated as “difficulty reaching above his head.”  The PE was brief and normal.  The goniometric range-of-motion 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.

Right Shoulder ROM
(Degrees)	
VA C&P ~4 Mo. Pre-Sep
	
MEB ~4 Mo. Pre-Sep
	
Flexion (180 Normal)	180	180	
Abduction (180)	180	121	
Comments	-	painful motion	
§4.71a Rating	0%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  Utilizing the Army pain policy, the PEB rated 0% under the analogous code of 5003 (degenerative arthritis), whereas the VA rated 10% analogously coded under 5024 (tenosynovitis) citing painful motion.  Board members first acknowledged that both the NARSUM and VA examinations were done within 9 days of each other and those findings were different in regards to the VASRD rating impairment.  Although there was a significant decrease in shoulder abduction between the two examinations, all measurements remained non-compensable according to VASRD criteria.  There was no after separation examination and therefore, the Board considered probative value assignment.  The Board also agreed that the MEB was a more detailed, accurate, and clinically intensive examination as compared to the C&P exam.  Therefore, a higher probative value was given to the MEB examination.  The painful motion finding is easily supported under VASRD §4.59 to achieve the minimal compensable 10% rating.  There was no clinical evidence of ankylosis or nonunion/malunion of any component of the shoulder girdle; and, no history of recurrent shoulder dislocation; thus, no shoulder joint code under VASRD §4.71a would yield a rating greater than 10%.  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 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 right shoulder was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the right shoulder condition, the Board unanimously recommends a disability rating of 10%, 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:

CONDITION	VASRD CODE	RATING	
Right Shoulder Condition 	5099-5003	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131022, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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, AR20150011203 (PD201301923)

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 10% 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			

CF: 
(  ) DoD PDBR
(  ) DVA