RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03278
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040928

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Unmanned Aerial Vehicle Operator) medically separated for a right shoulder condition.  The 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).  “Right shoulder pain status-post surgical repair” and “right shoulder decreased range of motion status-post surgical repair” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “right rotator cuff tear” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI requests the Board consider all conditions.  His complete submission is at Exhibit A.

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 20040608	VA* - (~2 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Rotator Cuff Tear	5099-5003	10%	Right Shoulder Rotator Cuff Tear…	5201	10%	20040722	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 13 	
RATING:  10%	COMBINED RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20041124 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Right Rotator Cuff Tear Condition.  The CI sustained a right shoulder injury in August 2002.  A magnetic resonance arthrogram dated 18 October 2002 demonstrated a small partial rotator cuff tear.  On 16 December 2002 the CI underwent a right shoulder arthroscopic rotator cuff, debridement and decompression.    The CI was treated post-operatively with physical therapy.  An orthopedic evaluation dated 10 March 2003 noted reports of persistent pain and catching with activity.  On 1 August 2003 the CI underwent a second rotator cuff repair and decompression.  Post-operative the CI continued to report right shoulder pain.  At the narrative summary the CI reported daily constant 2/10 dull anterior right shoulder pain, which increased to 4/10 with any lifting, twisting, sudden movement, and movement of the arm away from and up from the body; occasional sharp 8/10 pain with popping and grinding; and marked pain with direct pressure. On physical examination there was decreased right shoulder range-of-motion and tenderness to palpation at coracoid process (a small hook-like structure on the edge of the scapula) under the scar.  

At the VA Compensation and Pension (C&P) examination performed approximately 2 months prior to separation, the CI reported chronic right shoulder pain, popping and decreased motion.  On physical examination there was right deltoid muscle atrophy (decreased right shoulder muscle mass), decreased muscle strength and painful motion.  The goniometric range-of-motion (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)	Ortho ~ 5 Mo. Pre-Sep	VA C&P ~2 Mo. Pre-Sep	
Flexion (180 Normal)	170	140	
Abduction (180)	-	130	
													
The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA rated the right shoulder condition at 10%, coded 5099-5003 (analogous to degenerative arthritis) and 5201 (arm limitation of motion).  The Board considered whether the evidence supported a higher than 10% rating.  There was no evidence of limitation of motion at shoulder level, ankylosis, or loose movement of the scapula or clavicle for a higher rating.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed Board consensus was that a disability rating of 10% for the right shoulder 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 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 20140701, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160004507  (PD201403278)

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