RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02824
BRANCH OF SERVICE:  Army	BOARD DATE:  20150415
SEPARATION DATE: 20090731

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-2 (Armament/Electrical Systems Repairer) medically separated for a right shoulder condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty but he was authorized to perform an alternate physical fitness test (per PROFILE).  He was issued a permanent U3L3 profile and referred for a Medical Evaluation Board (MEB).  The “right shoulder instability” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “right shoulder instability” as unfitting, rated 10%, with likely application of 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 20090713	VA* - ~12 months Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Instability	5099-5003	10%	Residuals, Right Shoulder Sprain	5203	10%	20100713	
Other x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20100721 (most proximate to date of separation [DOS]). 

ANALYSIS SUMMARY:

Right Shoulder Instability.  The narrative summary noted that the CI injured his right shoulder while doing push-ups during physical training (PT) and that imaging studies, including X-rays, magnetic resonance imaging, and arthrogram were unremarkable.  An orthopedic evaluation, on 6 January 2009, noted positive testing for shoulder instability and the CI was diagnosed with multidirectional instability (MDI) of the right shoulder.  Despite PT and a period of convalescent leave, the CI continued to have shoulder pain and instability.  Range-of-motion (ROM) was flexion of 116 degrees (normal 180) and abduction of 110 degrees (normal 180), with painful motion and a “popping” sensation at all end ROM.  Physical therapy ROM, documented for the MEB on 9 June 2009, noted flexion of 115, 117, 115 degrees and abduction of 110, 110, 111 degrees.

At the MEB exam, the CI reported shoulder pain aggravated by PT.  The MEB physical exam noted the CI was left handed.  Right shoulder exam noted no swelling or deformity.  ROM was flexion of 116 degrees (normal 180) and abduction of 110 degrees (normal 180).  Neurological exam was normal.

At the VA Compensation and Pension (C&P) examination on 13 July 2010, 12 months after separation, the CI reported intermittent shoulder tenderness, pain, stiffness, and swelling, with mild flare-ups very 1 to 2 months treated with ice, rest, and pain medication as needed.  The CI reported a history of a right clavicle fracture in high school.  On exam, normal strength, sensation, and reflexes were noted throughout.  The VA C&P Joints exam, on the same day, noted shoulder tenderness, crepitus, and guarding of movement.  Shoulder ROM was flexion of 170 degrees and abduction of 175 degrees.  There was objective evidence of pain with motion, but no additional limited motion after repetition.  Right shoulder X-rays were normal without evidence of degenerative joint changes.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, coded 5099-5003, and the VA rated it 10%, coded 5203 (impairment of the clavicle or scapula).  The Board agreed that the evidence supports a 10% rating under multiple §4.71a codes such as 5201 for painful limited joint ROM; analogously to 5203 for rotator cuff impairment; or, according to 5003 criteria for tenosynovitis of one major joint.  The Board reviewed to see if a higher rating was supported by any coding approach.  There was no evidence of limited arm motion based on ROM alone, nonunion of the clavicle or scapula with loose movement, or ankyloses to provide a higher evaluation.  The CI was noted to have MDI of the shoulder, which is looseness of the joint that may be present since birth (“double jointed”) or may develop over time with overhead activities such as baseball or gymnastics; however, there was no history of dislocation or subluxation of the shoulder joint.  Thus, there was no evidence to a support higher or additional rating for instability.  After due deliberation in consideration of the preponderance of the evidence, 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.  In the matter of the 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 20140509, with attachments
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 XXXXXXXXXXXXXXXXXX, AR20150018853 (PD201402824)

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