RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02472
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Petroleum Supply) medically separated for a right shoulder condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The “osteoarthritis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “osteoarthritis right acromioclavicular joint, with range of motion (ROM) limited to pain” as unfitting, rated 0%.  The CI made no appeals and was medically separated.  

CI CONTENTION:  “The Army gave me 0% after getting out of service the VA gave me 20% for my right shoulder…” The applicant’s complete submission, with attachments, 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 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 20061108	VA* - (~3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis	5003	0%	Degenerative Joint Disease, Right Shoulder	5201	20%	20070306	
Conditions x 0 (Not In Scope)	Other x 1 	
RATING:  0%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20070508 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Osteoarthritis Condition.  The CI is right hand dominant.  The Service treatment record (STR) revealed that the CI injured his right shoulder during a wrestling maneuver in March 2006 which resulted in pain and swelling.  X-rays noted degenerative joint disease (DJD) of the right acromial clavicular (AC) joint without fracture or dislocation.  Conservative treatment modalities of medication, rest, restricted activities, and injections did not relieve his symptoms.  Surgical correction was considered and offered, but the CI declined.  He was permanently profiled in August 2006 with the diagnosis of right shoulder AC joint arthritis and referred to an MEB.  No STR entries documented instability, subluxation, or any positive neurovascular findings.  At the narrative summary (NARSUM) dated 31 October 2006 (1 month prior to separation) the CI endorsed constant 5-6/10 right shoulder pain with normal activities and worsening symptoms with overhead lifting or lifting greater than 20 pounds.  The physical examination (PE) revealed limited and painful motion of the right shoulder.  Upper extremity comparison exams indicated very minimal weakness in the right shoulder.  There was no comment with regards to instability or impingement signs.  His diagnosis was listed as osteoarthritis.  At the VA Compensation and Pension (C&P) examination dated 06 March 2007 (3 months post-separation) the CI reported constant right shoulder pain with almost any movement of his right upper extremity.  Activities of daily living (ADL) were affected with regards to bathing and dressing himself.  He endorsed occasional painful symptoms extending down the right arm to his elbow.  The PE revealed limited and painful motion of the right shoulder.  Slight weakness of the right upper extremity was unchanged.  There was no comment with regards to the presence of spasms or abnormal neurovascular findings.  The examiner noted, “The [CI] reports no limitation due to this condition”.  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 ~1 Mo. Pre-Sep
(20061031) 	VA C&P ~3 Mo. Post-Sep
(20070306) 	
Flexion (180 Normal)	115	0-140	
Abduction (180)	120	0-130	
Comments	painful motion	painful motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the shoulder osteoarthritis condition at 0% coded 5003, (degenerative arthritis) citing ROM limited by pain.  The VA rated the right shoulder at 20% coded 5201 (arm; limitation of motion) citing the same.  The Board first agreed that the persistence of painful motion on both the PEB and VA exams was easily supported under VASRD §4.59 to achieve the minimal compensable 10% rating.  Absent compensable ROM under code 5201 coupled with no clinical evidence of ankylosis or nonunion/malunion of any component of the shoulder girdle; and, no history of recurrent shoulder dislocation; thus, no shoulder joint code under VASRD §4.71a would yield a rating greater than the recommended 10%.  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 right shoulder osteoarthritis 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.  As discussed above, PEB reliance on the AR 635-40 for rating the shoulder was likely operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the osteoarthritis condition, the Board unanimously recommends a disability rating of 10%, coded 5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  
RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

UNFITTING CONDITION	VASRD CODE	RATING	
Right Shoulder Osteoarthritis 	5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140527, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXX, AR20160004501 (PD201402472)

1. 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,
accept the Board's recommendation to modify the individual's disability rating to 10%
without re-characterization of the individual's separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be
corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided
to the individual concerned, counsel (if any), any Members of Congress who have
shown interest, and to the Army Review Boards Agency with a copy of this
memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF:
( ) DoD PDBR
( ) OVA