RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	   CASE:  PD-2014-02059
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Motor Transport Operator) medically separated for chronic right shoulder pain.  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 a Medical Evaluation Board (MEB).  The “chronic right shoulder pain, postoperative” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic pain, right shoulder, postoperative” as unfitting, rated 10%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.  

CI CONTENTION:  “Please consider all conditions.”

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 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:  

IPEB - Dated 20061221	VA* - (~1 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Shoulder, Post-Operative	5099-5003	10%	Status Post Surgeries for Right Shoulder with Residuals	5201-5019	10%	20070122	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 7	
RATING:  10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20070524 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Chronic Pain, Right Shoulder, Post-Operative.  The CI first injured his dominant right shoulder in mid-2003 and had surgery on 4 November 2003 to improve the shoulder stability.  Despite rehabilitation, he continued to have symptoms and underwent a second operation on 6 May 2004.  He was an activated member of the Army Guard and released from active service.  He was cleared for full duty by orthopedics in January 2005.  He then reenlisted on 26 April 2005.  Shortly after reenlistment, he again had shoulder pain and was treated in physical therapy (initial visit was on 04 June 2005).  He again underwent rehabilitation and was able to deploy.  While deployed, his symptoms recurred and he was evacuated out of theater 5 months later.  He was again treated with physical therapy (PT).  On 5 June 2006, a month after redeployment, he was noted to have some muscle atrophy of the shoulder and decreased strength, but full range-of-motion (ROM).  At the 17 August 2006 PT visit, his ROM remained full and his motor function had improved and was normal.  At the MEB examination on 1 November 2006, the CI reported the prior surgery and ongoing shoulder pain.  The MEB physical exam noted full ROM and strength, but tenderness to palpation.  The narrative summary (NARSUM) was dated 27 November 2006, 3 months prior to separation, and recorded that the CI reinjured his right shoulder while lifting heavy equipment.  He continued to have pain despite aggressive rehabilitation and was not thought to be a surgical candidate.  The motor function and the ROM were normal.  A Speed test (done to assess for inflammation of a tendon for the biceps muscle) was positive.  At the VA Compensation and Pension (C&P) examination performed on 22 January 2007, a month before separation, the CI reported continued pain, but that he could perform the activities of daily living.  He had normal strength and painful, but full, ROM.  The shoulder was tender to palpation.  Instability was not documented.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Shoulder ROM
(Degrees)	MEB ~3 Mo. Pre-Sep	VA C&P ~1 Mo. Pre-Sep	
Flexion (180 Normal)	180	180	
Abduction (180)	180	180	
Comments	Speed test positive	Painful motion	
§4.71a Rating	10% (4.59)	10% (4.59)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the right shoulder condition at 10%, citing the pain policy and painful motion, respectively.  The PEB coded the shoulder 5099-5003, analogous to degenerative arthritis, and the VA coded it 5201-5019, limitation of motion of the arm and bursitis.  The Board considered these and other codes available for the shoulder and found no route to a rating higher than the 10% adjudicated by the PEB.  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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the right shoulder condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the chronic pain 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 20140508, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160004365 (PD201402059)

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