RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02307
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20050606

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Signal Support Systems Specialist, medically separated for “chronic left shoulder pain” with a disability rating of 0%.

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 – 20050210	VARD – 20060110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5201	0%	Left Shoulder Injury	5299-5201	20%	20051205	
			Surgical Scar, Left Shoulder	7805	0%	20051205	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Chronic Left Shoulder Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his left shoulder in February 2003.  Ongoing pain led to arthroscopic surgical intervention in February 2004.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic left shoulder pain status post sub-acromial decompression” for PEB adjudication.  The range of motion (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. 

Left Shoulder ROM
(Degrees)	MEB ~7 Mo. Pre-Sep	VA C&P ~7 Mo. Post-Sep	
Flexion (180 Normal)	180	160	
Abduction (180)	160	160	
Comments	Goniometer utilized; ROM limited by pain 	Pain began 90o  flexion and abduction	
§4.71a Rating	10%	10%	

According to the MEB NARSUM evaluation on 29 November 2004 (7 months prior to separation) the CI complained of left shoulder pain that caused him to be unable to perform duties required of his military specialty such as ruck marching and physical training.  Shoulder dislocations were not reported.  Physical examination revealed no evidence of instability.  The ROM was mildly limited in abduction by pain.  At the VA Compensation and Pension (C&P) examination on 5 December 2005, performed 7 months after separation, the CI reported left shoulder pain that caused mild to moderate limitations of activities of daily living.  His physical examination revealed adhesive capsulitis of the left shoulder with chronic strain.  The ROM was mildly limited in flexion and abduction by pain. 
 
The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the analogous 5201 code (limitation of motion of the arm), citing persistent pain without radiation.  The VA assigned a 20% rating using an analogous 5201 code for limitation of motion midway between side and shoulder level with pain starting at 90 degrees.  The threshold for a 5201 rating for ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion above this level.  However, Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus and no dislocation or nonunion of the clavicle or scapula to justify a higher rating under the 5202 (humerus, other impairment of) or 5203 (clavicle or scapula, impairment of) codes.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left shoulder condition.  

BOARD FINDINGS:  In the matter of the left shoulder condition, the Board unanimously recommends a disability rating of 10% analogously coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration. 

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Shoulder Pain	5099-5003	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140519, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160010927, 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.  1 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,

XXXXXXXXXXXXXXXXXXX
Deputy Assistant Secretarv of the Army

Enclosure