RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02741
BRANCH OF SERVICE:  Army	BOARD DATE:  20150407
SEPARATION DATE:  20031222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Infantry) medically separated for a right shoulder condition.  The right shoulder condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  The profile allowed for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  “Chronic right shoulder pain” condition 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 right shoulder pain” as unfitting, rate 0% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  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/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 20031003	VA* - (~2 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5099-5003	0%	Right Shoulder Injury with Residuals (Dominant)	5299-5203	10%	20031104	
Other x 0 (Not In Scope)	Other x 6	
RATING:  0%	COMBINED RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20040204 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Right Shoulder Pain.  Treatment records evidence that the CI first noted right shoulder pain after a parachute jump in January 2002.  He did not seek medical care at that time.  On 5 April 2002 he presented with a-week’s history of right shoulder pain when walking and swinging his arm.  The right shoulder examination was normal except for crepitus (grinding with arm movement).  The CI was treated with activity modification and anti-inflammatory medications.  The CI continued to experience right shoulder pain and on 2 August 2002 was referred for physical therapy (PT) with a diagnosis of chronic right shoulder pain.  An orthopedic examination dated 15 October 2002 noted an assessment of questionable SLAP lesion (injury to a ring of cartilage around the shoulder joint); however, X-ray and magnetic resonance imaging arthrogram studies were normal.  PT, activity modification, and pain medications did not relieve the right shoulder pain and the CI was referred to the MEB.  The narrative summary examination demonstrated generalized tenderness of the right shoulder, positive anterior shoulder pain testing (apprehension test), pain with abduction greater than 30 degrees, crepitus with motion (especially anterior motion), and decreased right shoulder strength.  The diagnosis of chronic right shoulder pain was continued.  At the VA Compensation and Pension examination dated 4 November 2003 the CI reported that the right shoulder pain did not interfere with his ordinary lifting, activities of daily living, or service functions.  He was not taking any medications.  The examiner noted that the right shoulder pain was “improved by activity when his attention is focused elsewhere and worsens when he is asked specifically to carry out motions using his right shoulder.”  The right shoulder examination demonstrated full active range-of-motion (ROM) without pain.  The examiner opined that there was no pathology on physical examination to render a diagnosis.

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/NARSUM ~4 Mo. Pre-Sep
	VA C&P ~1 Mo. Pre-Sep
	
Flexion (180 Normal)	180	180	
Abduction (180)	180	180	
Comments	+ apprehension test, crepitus	No painful motion	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the chronic right shoulder pain as unfitting with a 0% disability rating; coded 5099-5003 analogous to degenerative arthritis.  The VA rated the condition at 10% for painful or pain limited motion; coded 5299-5203 analogous to clavicle or scapula, impairment of.  The Board considered whether the evidence supported a higher than 0% rating.  There was no evidence of limitation of shoulder motion to shoulder level (5201- Arm limitation of motion) or radiographic evidence of degenerative arthritis with non-compensable arm limitation of motion to support a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 0% for the chronic right shoulder pain condition was appropriately recommended in this case.

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 chronic right shoulder pain 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 20140606, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150015570 (PD201402741)

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:

Encl						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA