RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-02763
BRANCH OF SERVICE:  Army	 SEPARATION DATE:  20040709

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Automated Logistics) medically separated for a right (dominant) 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 condition “right shoulder pain secondary to failed resection of distal clavicle and debridement of glenoid labrum” was forwarded as the sole submission to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “chronic right shoulder pain ... [elaborating surgical details]”as unfitting, rated 10%, citing criteria 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 20040426	VA* (3 Mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain…	5099-5003	10%	Right Shoulder Tendonitis ...	5201-5014	10%	20041006	
Other x 0 (Not In Scope)	Other x 4	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20050202 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Shoulder Condition.  The service treatment record (STR) indicates that the CI injured his shoulder rope climbing (training) in April 2001 (over 3 years prior to separation).  The earliest treatment note in evidence is from October 2001, which documents persistent right shoulder pain with full (but painful) range-of-motion (ROM).  There are STR entries over subsequent months documenting ongoing pain with ROM measurements of forward flexion (FF) from 160 to 180 degrees (180 degrees normal, 90 degrees minimum compensable) and abduction (Ab) of 160 degrees (same parameters as flexion).  Imaging (MRI) suggested a SLAP tear (superior labrum anterior and posterior, the ring of cartilage that surrounds the socket of the shoulder joint); and, surgical intervention (arthroscopic debridement with distal clavicle resection) was undertaken in September 2002 (22 months prior to separation).  The post-operative course was uncomplicated; but, a protracted trial of rehabilitation was unsuccessful at restoring full MOS and general soldiering capabilities.  Early measured ROM was somewhat compromised (FF 120 – 140 degrees, Ab 85 degrees), but the last outpatient ROM evidence was FF 140 degrees and Ab 120 degrees.  It is noted, however, that there is a 16-month interval from the last outpatient entry in the available STR until separation.  There are STR exams indicating that the joint was stable and none to the contrary; and, follow-up X-rays demonstrated normal alignment with expected post-surgical changes.

The narrative summary (NARSUM) was conducted on 2 April 2004 (3 months prior to separation), and documented “more or less constant” pain rated 8/10 prohibiting heavy lifting or overhead work.  The NARSUM physical exam documented tenderness and some “mildly positive” signs of impingement, but no signs of instability.  The NARSUM measured ROM was FF 90 degrees and Ab 80 degrees.  Abduction of 75 degrees was recorded on the MEB physical exam performed a month earlier by a different physician.

A VA Compensation and Pension (C&P) examination was conducted on 6 October 2004 (3 months after separation), and documented “He is unable to lift the right arm above the head.  The symptoms are constant.”  The CI was employed as a truck driver.  The VA physical exam documented joint tenderness without further elaboration.  The VA measured ROM was FF 100 degrees and Ab 90 degrees.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating analogous to 5003 (degenerative arthritis) is consistent with VASRD §4.71a criteria for that code; but, is not compliant with VASRD §4.7 (higher of two evaluations), in that the NARSUM (and MEB physical) ROM evidence supports a 20% rating under code 5201 for limitation of motion at shoulder level (90 degrees).  The VA’s 10% rating under 5201-5014 (chondromalacia, defaulting to criteria of 5003) is also counter to §4.7 in that the C&P abduction of 90 degrees satisfies the 20% criterion of 5201 as the rated code.  There was no ankylosis, instability, or fracture that would justify application of any other joint code under §4.71a.  After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the Board recommends a 20% rating for the right shoulder condition under code 5201.

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 right shoulder condition, the Board unanimously recommends a disability rating of 20%, coded 5201 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:

CONDITION	VASRD CODE	RATING	
Joint Injury and Surgical Residuals, Right Shoulder 	5201	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140611, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXX, AR20150018717 (PD201402763)

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,   I accept the Board’s recommendation to modify the individual’s disability rating to 20% without recharacterization 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
(  ) DVA