RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03128
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060219

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Chemical Operations Specialist, medically separated for “chronic left shoulder pain” with a disability rating of 20%.

CI CONTENTION:  The CI contends for his unfitting left shoulder and two conditions not identified by either the MEB or PEB.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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:  

SERVICE PEB - 20051227	VARD - 20060427	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	20%	Degenerative Joint Disease, S/P Operative Acromioplasty, Left Shoulder	5010-5201	30%	20060221	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Left Shoulder Pain. According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left shoulder surgery [right hand dominant] in February 2005 for arthroscopic superior labral debridement, distal clavicle excision, and subacromial decompression.  Despite treatment, the left shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “left shoulder pain” for PEB adjudication.  A left shoulder arthrogram in August 2005, 6 months post-surgery, showed mild degenerative changes at the acromioclavicular and glenohumeral articulations, an intact bicipital tendon, no rotator cuff tear, and a normal synovial joint capsule.  The NARSUM, written in September 2005, 5 months prior to separation, indicated the CI complained of continued pain that interfered with his sleeping and job performance.  Physical examination showed that many of the shoulder tests were difficult to perform because of the CI’s pain, with a limited range-of-motion (ROM) to 80 degrees of flexion (normal 180) and 50 degrees of abduction (normal 180) secondary to pain.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated October 2005, 4 months prior to separation, the CI reported left shoulder pain.  Physical examination showed tenderness to palpation, ROM limited by pain, and 4/5 motor strength.  At the VA Compensation and Pension (C&P) examination in February 2006, performed 2 days after separation, the CI reported daily shoulder pain, constant in nature.  Physical examination showed no muscle atrophy and tenderness throughout the left shoulder.  ROM was limited to 80 degrees of flexion (normal 180) and 60 degrees of abduction (normal 180).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under an analogous 5099-5003 code (degenerative arthritis), citing the US Army Physical Disability Agency Pain Policy.  The VA assigned a 30% rating using an analogous 5010-5201 code (arthritis, due to trauma, substantiated by X-ray findings and arm, limitation of motion of) based on the VA C&P examination 2 days after separation, citing functional loss due to pain, weakened movement, and excessive fatigability with use.  The VASRD §4.71a (code 5201, arm limitation of motion) threshold for rating for ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion at this level.  The highest 30% rating for a non-dominant arm requires motion limited to “25 degrees from side,” but examinations did not reflect this degree of limitation. There was no fibrous union or nonunion of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available under the 5203 code (clavicle or scapula, impairment of).  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 adjudication for the left shoulder condition. 

BOARD FINDINGS:  In the matter of the left 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.  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 20140628, 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-00), 2900 Crystal Drive, Suite XXX, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160011122 (PD201403128)

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