RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03292
BRANCH OF SERVICE: Army 		SEPARATION DATE:  20070630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Human Resource Specialist) medically separated for “right shoulder pain,” rated at 10%.

CI CONTENTION:  The CI contends for all of his conditions.  The applicant’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 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:  

IPEB - Dated 20070515	VA* - (~1 Mo. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5099-5003	10%	Right Rotator Cuff Tendonitis with Impingement	5024-5201	20%	20070803	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 2	
RATING:  10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20070821 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Right Shoulder Condition.  The service treatment record (STR) corroborated the history in the narrative summary (NARSUM) of an atraumatic onset of right (dominant) shoulder pain in 2002.  Pain continued despite conservative treatment; magnetic resonance imaging in 2005 demonstrated rotator cuff tendonopathy (infraspinatus and supraspinatus) with possible impingement; and, in May 2006 (13 months pre-separation) the CI underwent surgical intervention (arthroscopic subacromial decompression with distal clavicle resection).  Symptoms continued and further attempts at rehabilitation were unsuccessful.  Outpatient STR range-of-motion (ROM) evidence after surgical recovery documented forward flexion in the range of 90-100 degrees and abduction to 80 degrees (one outlier at 40 degrees).  The measurements from the MEB’s DD Form 2808 are charted below.  There was STR post-operative documentation of joint stability and the lack of mechanical impingement, although there was some objective weakness of proximal muscle groups.  There was no STR documentation of specific functional deficits or periods of incapacitation after surgical recovery.

The NARSUM (titled Addendum Medical Evaluation Board) was conducted 8 March 2007 (3 months pre-separation) and documented constant pain limiting heavy lifting, push-ups and load bearing; with observed “difficulty with removal of upper garments with a considerable amount of pain.”  The NARSUM physical examination recorded joint tenderness, 4/5 proximal strength, negative signs for impingement, and did not comment on stability.  The NARSUM measured ROM is charted below, as are measurements for the MEB by physical therapy (PT) performed 2 weeks later.

A VA orthopedic Compensation and Pension (C&P) examination was conducted 3 August 2007 (a month post-separation) and was supplemented by a general C&P examination (9 May 2007, 7 weeks pre-separation).  The VA general examiner documented continued pain “when he lifts his arm above neck level” in addition to heavy lifting.  The VA orthopedic examiner documented “problems with lifting and carrying” and “significant” occupational impairment, although noting that the CI was employed full time in an administrative position.   

The VA physical examination (deferred by general examiner) recorded joint tenderness, the absence of instability or subluxation, and the absence of locking but positive signs of impingement (Hawking’s and Neer’s).  The VA measured ROM is charted below.

The ROM evaluations referenced above, which the Board weighed in arriving at its rating recommendation, are summarized in the chart below.

Right Shoulder Active ROM	MEB DD 2808
 ~4 Mo. Pre-Sep	NARSUM
~3½ Mo. Pre-Sep	MEB PT 
~3 Mo. Pre-Sep	VA C&P
~1 Mo. Post-Sep	
Forward Flexion (180⁰)	130⁰	135⁰	90⁰	90⁰	
Abduction (180⁰)	150⁰	135⁰	95⁰	100⁰	
§4.71a Rating	10%	10%	20%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating analogous to 5003 (degenerative arthritis) cited the USAPDA pain policy, but was consistent with VASRD §4.71a criteria for the NARSUM ROM evidence and other ratable findings.  The VA’s rating under code 5201 for limitation of motion (20% for limitation at shoulder level) was supported by the C&P ROM evidence.  There was no evidence in support of instability or recurrent subluxation for consideration of a higher rating under code 5202 (humerus, other impairment); and, there was no ankylosis, deformity, fracture complication or other ratable feature which would support a higher rating under any alternative §4.71a joint code.  Members deliberated whether the preponderance of the ROM evidence favored the PEB rating or a recommendation for a 20% rating under code 5201.  Although the NARSUM ROM measurements were corroborated by the DD 2808 evidence from two weeks earlier, the outpatient STR ROM evidence and the MEB PT measurements after the NARSUM were more aligned with the VA C&P measurements (which were also the most temporally proximate to separation).  Furthermore, the functional statements in both the NARSUM (difficulty with garments) and C&P (pain with arm movement above neck level) imply disability consistent with the §4.71a 20% threshold irrespective of the measured ROM.  Members thus agreed that reasonable doubt favored concession of the higher recommendation.  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:  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.  

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	
Surgical Residuals, Rotator Cuff Injury, Right Shoulder 	5201	20%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140430, 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 XXXXXXXXXXXXXXXXXXXX, AR20160004513  (PD201403292)

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, accept the Board's recommendation to modify the individual's disability rating to 20% without re-characterization 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 
( ) OVA