RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03524
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20041029

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Light-Wheel Vehicle Mechanic) medically separated for right shoulder pain.  The right shoulder condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “right shoulder pain status post right shoulder labral repair” condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic pain, right shoulder,” 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:  The applicant requests consideration of all conditions in his application.  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 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 20040909	VA* - (C&P Exam not attended &
Service Treatment Records not available) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Shoulder	5099-5003	10%	Chronic Right Shoulder Pain	5201	NSC	--	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  NSC	
*Derived from VA Rating Decision (VARD) dated 20051012 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Right Shoulder Condition.  In September 2003 the CI presented to the emergency department and was diagnosed with a right acromioclavicular joint separation.  A magnetic resonance imaging (MRI) study dated 19 December 2003 revealed superior and anterior labral (ring of soft tissue around the shoulder socket) tears.  On 29 March 2004 the CI underwent arthroscopic labral repair.  Postoperatively the CI continued to report right shoulder pain.  The narrative summary (NARSUM) physical examination approximately 2 months prior to separation demonstrated mild tenderness with vigorous range-of-motion (ROM). The CI did not report to his initial VA Compensation and Pension (C&P) examination. At the VA examination 18 months after separation the CI reported chronic right shoulder pain.  The physical examination demonstrated painful motion. Radiographic evaluation noted 1 centimeter separation of the acromion to the distal clavicle.  The goniometric 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)	PT ~4 Mo. Pre-Sep	MEB ~3 Mo. Pre-Sep	VA C&P ~18 Mo. Post-Sep	
Flexion (180 Normal)	“Normal”	170	130	
Abduction (180)		170	120	
Comments	-	Painful motion	  No-show to initial C&P	
§4.71a Rating	0%	10%	10%	

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 5203 (clavicle impairment) respectively.  There was no evidence of nonunion with loose movement or arm limitation of motion at shoulder level for a higher rating.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the right 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 20140718, 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 XXXXXXXXXXXXXXXXXXXXX AR20160004316 (PD201403524)

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