RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01637
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081107

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Cannoneer) medically separated for right shoulder condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent U3 profile and referred for an Medical Evaluation Board (MEB).  Right shoulder pain was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated right (dominate) shoulder pain as unfitting, rated 10% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated.

CI CONTENTION:  The CI contends for a higher rating for his right shoulder condition.  His complete submission is at Exhibit A.

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 condition 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 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 IPEB – Dated 20080723	VA* - (2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right (Dominate) Shoulder Pain	5009-5003	10%	Right Shoulder Strain…	5203	10%	20080904	
Other x 0 (Not in Scope)	Other x 5	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 200812107 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Right Shoulder Condition.  The service treatment record (STR) documents that the right hand dominant CI was a prior college baseball center fielder and developed right shoulder pain with throwing activities.  He underwent a right shoulder surgery (arthroscopic thermal capsulorrhaphy with subacromial decompression) before entering military service.  Serial right shoulder X-rays were unremarkable.  A right shoulder magnetic resonance imagining showed postoperative changes, a possible posterior superior labrum partial tear, and no evidence of a rotator cuff tear.  The CI had persistent posterior and lateral right shoulder pain despite activity modification, nonsteroidal anti-inflammatory drugs (NSAIDs), and prolonged physical therapy (PT).  He underwent a right shoulder superior labral tear from anterior to posterior (SLAP) debridement (surgical excision of damaged, devitalized, or contaminated tissue).  Serial postoperative right shoulder range-of-motion (ROM) measurements by orthopedic surgery documented flexion 180 degrees (180 normal) and abduction 180 degrees (180 normal).  The MEB narrative summary (NARSUM) by orthopedic surgery recounted the history and interventions.  The CI did not note any significant improvement from the repeat right shoulder arthroscopy and postoperative physical therapy.  Pain was exacerbated by load bearing, heavy lifting, overhead work, and pushups and relieved by rest.  The focused right shoulder exam documented active ROM was flexion 180 degrees and abduction 180 degrees.  The shoulder was stable to load and shift testing.  Sensation and motor function were normal with 5/5 rotator cuff strength.  The diagnosis listed right shoulder pain that existed prior to service and was service aggravated.

The Compensation and Pension (C&P) exam, 2 months before separation, recounted the history and interventions.  The CI complained of constant, dull, 4-6/10 right shoulder pain which was not relieved by any modality.  He denied dislocation, subluxation (incomplete dislocation), inflammatory arthritis, prosthesis, or use of a corrective/assistive device.  Pain limited occupational activities by preventing lifting greater than 30 pounds, working overhead, throwing, or performing push-ups.  The physical exam revealed a normal posture and gait.  The right shoulder exam demonstrated no ankylosis (joint stiffening or immobility).  Active ROM documented flexion 180 degrees and abduction 180 degrees with 5/10 pain.  All ROM was performed with three repetitions.  There was no change in ROM, weakness, further pain, or increased pain detected during repetitive movements.  Muscle strength was equal bilaterally.  The diagnosis listed right shoulder strain.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition at 10% with code 5099-5003 (Analogy-degenerative arthritis).  The PEB cited right (dominant) shoulder pain, status post right shoulder arthroscopy prior to service, repeat arthroscopy on active duty, preserved ROM, no additional limitations from pain, fatigue, weakness, lack of endurance, or incoordination following repetitive use, minimal compensable rating for painful motion, no neurologic abnormality, and permanently service aggravated.  The VA cited the C&P exam 2 months before separation and rated the right shoulder condition at 10% with code 5203 (Clavicle or scapula, impairment).  The VA rating decision cited right shoulder strain, status post arthroscopy, ROM, painful ROM, no dislocation, subluxation, inflammatory arthritis or prosthesis, and directly related to military service.  The Board agreed there was sufficient evidence of painful motion (§4.59) and functional loss (§4.40) to support a 10% rating.  Based upon the proximate (orthopedic surgery, PT, MEB, and C&P) exams, there was no compensable limitation of motion for consideration under code 5201 (Arm, limitation of motion, at shoulder level [~90 degrees] for a minimum 20% rating).  There was no evidence of scapulohumeral ankylosis to support a rating under 5200, and no evidence of nonunion, malunion, or dislocation of the humerus, clavicle or scapula to support a rating under 5202 or 5203.  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 20140329, 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, AR20160003251 (PD201401637)

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