RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01675
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090604

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Watercraft Operator, medically separated for “right dominant shoulder arthropathy,” with a disability rating of 20%.

CI CONTENTION:  “Please consider all conditions.”  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 - 20090419	VARD - 20150429	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Dominant Shoulder Arthropathy	5299-5202	20%	Right Shoulder Limitation of Motion Associated with Rotator Cuff Syndrome	5201	20%	20150403	
			Right Shoulder Dislocation Associated with Rotator Cuff Syndrome	5202	20%	20150403	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Dominant Shoulder Arthropathy.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI injured his right shoulder while bull riding in January 2006.  Diagnostic imaging (MRI) studies on 13 February 2006 showed a greater tuberosity (proximal humerus prominence where rotator cuff muscles attach) nondisplaced fracture, rotator cuff edema, infraspinatus partial tear, and inferior glenohumeral ligament injury.  The radiologist opined that adhesive capsulitis (immobility of glenohumeral joint connective tissue capsule) could have a similar magnetic resonance (MR) appearance.  The CI underwent right shoulder manipulation under anesthesia for adhesive capsulitis on 28 March 2006.  The MEB forwarded “right shoulder instability,” “right shoulder arthropathy,” for PEB adjudication.  On 10 February 2009, physical therapy (PT) measured repetitive (X3) active range of motion (ROM) for the MEB.  The goniometer measured right shoulder ROM values were flexion of 107/108/106 (180 normal) and abduction of 120/120/119 (180) degrees.  The MEB NARSUM examination on 12 March 2009, 4 months prior to separation, noted complaints of right shoulder pain rated at 3-4/10 scale, increasing to 8-10/10 scale when aggravated by repetitive abduction and external rotation of the arm.  The pain was relieved by medication (Percocet).  The CI reported a subluxation (incomplete dislocation) of the humerus on 25 August 2008 while doing the push-up event for PT.  He related the humerus spontaneously reduced (restored to correct alignment) and shoulder X-rays showed minimal asymmetric widening of the right acromioclavicular (AC) joint compared to the left.  The CI complained that he could not perform abduction or external rotation against force without reproducing the “sensation of subluxation” and pain.  The physical examination showed moderate atrophy of the deltoid and musculature surrounding the AC joint region.  All intrinsic shoulder muscles had 4/5 strength and sensation and deep tendon reflexes (DTRs) were normal.  There was evidence of right shoulder pathology, impingement, and instability with the Yergason’s (assesses long head of biceps tendon), cross arm (assesses AC joint), and posterior apprehension relocation (assesses anterior and posterior shoulder instability) tests being positive.  The sulcus (assesses glenohumeral joint inferior instability) test was negative.  The examiner repeated the right shoulder ROM with a goniometer and documented “… was consistent with the formal PT testing enclosed.”  There was pain throughout all ROM with mechanical limitations and firm endpoints. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right dominant shoulder arthropathy condition 20% coded 5299-5202 (humerus, other impairment of) citing infrequent episodes of recurrent dislocation of scapulohumeral joint.  The VA rated the right dominant shoulder arthropathy condition 20% coded 5201 (arm, limitation of motion of) and 5202 (humerus, other impairment of) based on the C&P examination 6 years after separation citing recurrent dislocation of the scapulohumeral joint with infrequent episodes and guarding of movement at shoulder level and limitation of the arm at shoulder level.  The Board assigned little probative value to the C&P examination because it occurred 6 years after separation  The Board agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  Based on the PT for MEB and NARSUM examinations, there was no compensable limitation of motion for consideration under 5201 (at shoulder level [90 degrees] is minimum 20% rating).  There was no evidence of scapulohumeral ankylosis to support a rating under 5200 and no evidence of nonunion or malunion of the clavicle or scapula to support a rating under 5203.  While the CI endorsed that abduction or external rotation against force reproduced the “sensation of subluxation,” there was no evidence of recurrent dislocations, loss of humeral head, nonunion, fibrous union, or malunion of the humerus, to support a rating under 5202.  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:  In the matter of the right dominant shoulder arthropathy 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 20140414, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR2016001 0640 (PD20101675)

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