RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00283
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070928

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E6, 14S Avenger Crewmember, medically separated for “chronic right shoulder pain,” with a disability rating of 10%.

CI CONTENTION:  Right shoulder has changed dramatically and pain has radiated to his left shoulder.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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:  

SERVICE PEB - 20070828	VARD - 20071220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5003	10%	Status Post Right Shoulder Repair with Degenerative Changes (Dominant)	5010-5203	10%	20070927	
			Scar; Status Post Right Shoulder Repair	7804	10%	20070927	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right dominant shoulder pain condition began in November 2003.  The CI was treated conservatively for arthritis but reported persistent pain and had limited range of motion (ROM).  Shoulder imaging in June 2005 showed osteoarthritis of the glenohumeral joint and degenerative changes of rotator cuff tendons.  At on orthopedic evaluation 18 August 2006, the exam showed tenderness to palpation (TTP) and positive impingement signs, without instability.  The CI was diagnosed with arthritis and rotator cuff tendonitis and underwent arthroscopic surgery of the right shoulder 22 August 2006 with debridement and bursectomy (fluid filled sac that reduces friction between bones and adjacent muscles or tendons).  Following the surgery, the CI reported continued shoulder pain and stiffness.  Serial orthopedic exams noted pain and limited ROM, without instability.  Despite treatment, the right shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “right shoulder pain/osteoarthritis” for PEB adjudication.

At an orthopedic follow-up visit on 7 August 2007, a month prior to separation the CI reported constant shoulder pain aggravated by activity.  The exam showed TTP of the shoulder with painful and restricted ROM described as “abduction/flexion …approx. 140 degrees.”  At the MEB NARSUM examination dated 8 August 2007, the CI reported the same shoulder symptoms as at the orthopedic exam.  Physical exam revealed no swelling or discoloration.   There was TTP of the shoulder.  Tests for rotator cuff injury/impingement were positive (Hawkins, Neer’s, and cross body) and a test for joint cartilage damage was negative (SLAP test).  Physical therapy performed ROM testing for the MEB on 17 August 2007 with ROM as indicated in the chart above, with painful motion noted.  Right upper extremity strength, sensation, and reflexes were normal.

At the VA Compensation and Pension (C&P) examination in September 2007, performed a day before separation, the CI reported right shoulder pain and stiffness.  Physical exam showed no swelling or effusion and ROM is recorded in the chart above (after three repetitions), with painful motion noted.  The examiner estimated that the CI would have mild physical impairment with forward flexion limited to 160 degrees during flare-ups and mild physical limitation with repetitive motion due to pain.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under code 5003 (degenerative arthritis) citing “residual pain on motion and some mechanical loss of range of motion.”  The VA also assigned a 10% rating using the analogous code 5010-5203 (clavicle/scapula impairment with traumatic arthritis) based on the VA C&P examination a day before separation, citing status post right shoulder repair with degenerative changes.  Additionally, the VA assigned a 10% rating using the code 7804 (unstable or painful scars).  

The VASRD §4.71a code 5201 (arm limitation of motion) threshold for a rating for ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion above this level.  Although there was insufficient/no limitation of motion to support a rating under 5201, Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment of).  There was no evidence of functional loss sufficient to support a higher rating (based on §4.40 and §4.45) or other shoulder coding under VASRD §4.71a.  The Board does not recommend disability rating for scars unless their presence imposes a direct functional limitation that renders the CI unfit.  Any impact on ROM limitation was considered in the recommended rating of the unfit shoulder joint above.  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 adjudication for the chronic right shoulder pain condition.  

BOARD FINDINGS:  In the matter of the chronic right shoulder pain 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.  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 20131231, 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 XXXXXXXXXXXXXXXXXX, AR20160007253 (PD201400283)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA