RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00859
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20081211

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) rotator cuff tendinitis.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “right rotator cuff tendinitis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded three other conditions (cervical degenerative disc disease, hypertension, insomnia) for PEB adjudication.  The Informal PEB adjudicated “right rotator cuff tendinitis” as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.  

CI CONTENTION:  “The applicant makes no specific contention in his application.”

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 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 20080922	VA* - (~2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Rotator Cuff Tendinitis	5099-5003	10%	Impingement Syndrome, Right Shoulder with Right Rotator Cuff Tendonitis and Hypertrophic Degenerative Changes	5299-5010	10%	20081007	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 4 (equals SC, NSC & deferred)	
RATING: 10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20090804 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Right Rotator Cuff Tendinitis.  The narrative summary (NARSUM) and treatment record indicated that the CI was right hand dominant.  He developed right shoulder pain while deployed.  Imaging studies (MRI and MR arthrogram) documented minimal hypertrophic change at the right acromioclavicular (AC) joint with joint edema and mild tendinopathy/tendinitis of the supraspinatus tendon.  There was no evidence of rotator cuff tear, labral tear, or SLAP lesion.  Right shoulder pain did not respond to conservative treatment (physical therapy, medications and injection) and surgery was not indicated.  At the MEB exam performed 5 months before separation, the CI reported continued right shoulder pain and a new flare of pain requiring narcotic pain medications.  The MEB physical exam and physical therapy right shoulder testing documented tenderness with no muscle atrophy or deformity.  There was painful range-of-motion (ROM) of 170 degrees flexion (normal 180) and abduction to 160 degrees (normal 180).  

At the VA Compensation and Pension (C&P) exam performed 2 months before separation, the CI reported similar history and pain complaints.  Exam documented a small bony enlargement of the right AC joint with shoulder tenderness.  There was painful motion of flexion to 155 degrees and abduction to 120 degrees with no increase in pain, weakness, or fatigability with repetition.  The CI was diagnosed with right shoulder impingement syndrome, associated with right shoulder rotator cuff tendonitis.  

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the shoulder at 10%.  The PEB used analogous coding for the criteria of 5003 (arthritis, degenerative [hypertrophic or osteoarthritis]), and the VA for 5010 (arthritis, due to trauma, substantiated by X-ray findings).  There was insufficient evidence of shoulder limitation of motion or loss of shoulder function at shoulder level (90 degrees) for any higher rating.  

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 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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the right shoulder 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, 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 20140221, 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, AR20160002770 (PD201400859)

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