RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03100
BRANCH OF SERVICE:  Army	BOARD DATE:  20150528
SEPARATION DATE:  20050601

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Wheeled Vehicle Mechanic) medically separated for chronic right shoulder pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  The CI was profiled to take the alternate aerobic portion of the Army physical fitness test.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Right shoulder impingement” was forwarded to the Physical Evaluation Board (PEB) as not meeting retention standards IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic right shoulder pain secondary to multidirectional instability” as unfitting, rated 10%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  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 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:

 IPEB – Dated 20050503	VA* - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain Secondary to Multidirectional Instability	5099-5003	10%	Right shoulder Tendonitis	5024	10%	20050719	
Other x 0 (Not In Scope)	Other x 1	
RATING:  10%	COMBINED RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20051014 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Right Shoulder Pain Secondary to Multidirectional Instability.  The CI was right-handed per his military entrance processing physical.  The narrative summary and treatment record noted onset of right shoulder pain in 2000 with exacerbation in October 2004 while performing push-ups.  Conservative treatments including physical therapy and medications did not alleviate the symptoms.  At the MEB exam, the CI reported significant pain with overhead use and lifting activities.  Pain was 4/10 and interfered with sleep.  The CI denied any frank shoulder dislocations or injury.  X-rays showed a Type II acromion (shallow “cup” portion of the shoulder joint) and magnetic resonance imaging (MRI) for right shoulder impingement syndrome showed slight abnormalities that “may represent” supraspinatus tendinosis.  The MEB physical exam documented “full active range of motion with abduction 180 degrees, external rotation to 60 degrees, internal rotation to T8.”  There was no weakness to the rotator cuff strength.  The CI had positive impingement signs (Neer and Hawkins testing) and had diffuse tenderness with a positive sulcus test (for ligament laxity).  The DD Form 2808, Report of Medical Examination, additionally noted bilateral shoulder crepitus and a popping sensation.

At the VA Compensation and Pension exam performed 2 months after separation, the CI reported a long history of general laxity in all his joints.  He complained of right shoulder pain that was intermittent in nature and only with movements up to 8/10.  He denied swelling, locking, giving way, or any shoulder dislocation.  An exam demonstrated hyperlaxity in all joints tested.  The right shoulder was tender with painful motion to flexion and extension of 180 degrees (normal).  Strength was normal and the CI had positive apprehension and impingement signs.  There was pain with Hawkins and Neer testing and he had a positive sulcus test.  Upper extremity reflexes and sensory testing was normal.  The examiner cited the in-service MRI and the diagnosis was supraspinatus tendonitis of the right shoulder.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB 10% rating was for pain (using the pain policy) and cited instability as well.  The VA 10% rating cited painful motion, and the 5024 (tendonitis) code has the same criteria as code 5003.  The record supported painful motion IAW VASRD §4.59 to support the 10% rating.  The Board considered other coding under 5201 (arm, limitation of motion), 5202 (humerus, other impairment), 5203 (clavicle or scapula, impairment); however, there was no indication that arm motion was limited to shoulder level (near 90 degrees), that there was loose motion of the shoulder joint, or that there was any shoulder deformity to warrant any rating above 10%.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB 10% rating 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the shoulder condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  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 20140625, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB	0 6 JUL 2016

MEMORANDUM FOR Commander, US Army Physical Disability Agency (AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXX, AR20160003178  (PD201403100)

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: