RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-00696
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050529

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Electronic Warfare Intercept Systems Repairer,  medically separated for “chronic bilateral shoulder pain” with a disability rating of 0%.  

CI CONTENTION:  The CI contends that his unfitting bilateral shoulders continue to worsen and negatively impact work activities.  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 based upon a 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 – Dated 20050407	VARD - 20060106 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Shoulder Pain…	5099-5003	0%	Left Shoulder Dislocation	5203	0%	STR	
			Right Shoulder Dislocation	5203	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:   

Chronic Bilateral Shoulder Pain, secondary to Multidirectional Instability.  In April 2000, this CI started complaining of right shoulder pain.  A few years later, in August 2004, he began having problems with the left shoulder.  He was evaluated by Orthopedics, and was diagnosed with bilateral multidirectional instability of the shoulders.  It was determined that he was not a surgical candidate.  He was treated with physical therapy (PT), chiropractic care, and other conservative therapeutic measures.  In spite of all treatment efforts, the shoulder problems persisted and a Medical Evaluation Board (MEB) was initiated.  The MEB narrative summary (NARSUM) was dated 12 January 2005.  At the MEB examination, physical examination (PE) of the shoulders was normal.  There was full range of motion (ROM), without any dislocation.  The NARSUM final diagnosis was: “Bilateral shoulder multidirectional instability, without surgical options.”  The examiner wrote: “I expect the prognosis for the patient to remain at current state.”  The CI was medically separated from service on 29 May 2005.  After separation, he was scheduled for a VA Compensation and Pension (C&P) examination, but he failed to appear for that evaluation.

The Board directed attention to its rating recommendation based on the evidence.  The Army PEB and the VA chose different coding options for the shoulder condition, but both assigned a disability rating of 0%.  The PEB combined the right and left shoulders under a single disability rating coded 5099-5003 (analogous to degenerative arthritis), and assigned a 0% disability rating.   The Board evaluated whether or not it was appropriate for the shoulders to be “bundled” together.  The Board must determine if the PEB’s approach of combining the joints under a single rating was reasonably justified in lieu of separate ratings.  The Board must apply separate ratings in its recommendation if separate compensable ratings are achieved IAW the VASRD.  If the Board judges that two or more separate ratings are warranted, however, it must satisfy the requirement that each ‘unbundled’ condition was separately unfitting.  After due deliberation, the Board agreed that the evidence does not support a conclusion that the right shoulder problem and the left shoulder problem, separately, would have rendered the CI unable to perform his required military duties.  The Board determined that it was appropriate for the right shoulder pain to be bundled with the left shoulder pain, and treated as a single unfitting condition. 
 
At the January 2005 NARSUM examination, 4 months before separation, shoulder ROM was normal.  However, IAW VASRD §4.10 (Functional impairment), §4.40 (Functional loss), §4.45 (The joints), and §4.59 (Painful motion); when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional loss and disability due to pain.  There was no path to a higher rating for the shoulders, since there was insufficient evidence of a seriously disabling bone or joint abnormality which would justify a higher rating.  After due deliberation, the Board determined that a disability rating of 10% for the shoulders was appropriate.  Considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board recommends a 10% disability rating for the chronic bilateral shoulder pain, secondary to multidirectional instability.

BOARD FINDINGS:  In the matter of the chronic bilateral shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003, IAW VASRD §4.10, §4.40, §4.45, and §4.59.  There were no other conditions within the Board’s scope of review for consideration.    The Board, therefore, 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	
Chronic bilateral shoulder pain, due to multidirectional instability 	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140204, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160013049, XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board's recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.

This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,

Enclosure