RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03552
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030808

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve, O2, Infantryman, medically separated for “right shoulder pain,” with a disability rating of 10%.

CI CONTENTION:  His shoulder condition worsened requiring two additional surgeries.  He also suffers from secondary neck, back and arm pain.  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 - 20030328	VARD - 20030610	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5099-5003	10%	…Right Distal Clavicle Excision…	5003-5203	10%	20030501	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Right Shoulder.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the left hand dominant CI developed right shoulder pain without specific trauma in November 2000.  Magnetic resonance imaging of the right shoulder on 22 November 2000 showed degenerative changes of the acromioclavicular joint and multiple partial thickness tears of the rotator cuff.  The CI underwent right shoulder open distal clavicle excision surgery in February 2001, but had limited relief.  Orthopedic follow-up evaluations noted no history of shoulder subluxations, but there was laxity of both the right and left shoulders.  The CI underwent an arthroscopic surgery in May 2002 for shoulder stabilization.  Following the surgery the CI reported improvement in the stability of his shoulders, but persistent pain.  At the time of the orthopedic clinic appointment on 24 September 2002, the CI reported resolution of his instability symptoms but persistent pain and the next visit on 16 October 2002 indicated there was no change in symptoms, with no instability noted.  At the orthopedic visit 7 November 2002, 9 months prior to separation the exam noted severe crepitus and testing indicated ligamentous laxity.  Shoulder range of motion (ROM) was normal as indicated in the chart above.  Despite treatment, the right shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.

The 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 ~9 Mos. Pre-Sep	MEB ~7 Mos. Pre-Sep	VA C&P ~3 Mos. Pre-Sep	
Flexion (180 Normal)	180	180	180	
Abduction (180)	180	180	180	
Comments	Tenderness crepitus	Painful motion and instability	Painful motion and fatigue	
§4.71a Rating	10%	10%	10%	

The MEB examination (originally recorded on DD Form 2807 and 2808 and later recorded on the MEB NARSUM) dated 7 January 2003, 7 months prior to separation, showed full ROM with pain.  There was also diffuse tenderness of the right shoulder and the examiner noted a “slightly hypermobile clavicle.”  There was evidence of ligamentous laxity with a negative apprehension sign (pain or guarding with abduction and external rotation of the arm).  Exam of the neck was normal and there was no evidence of cervical radiculopathy.  Strength, sensation, and reflexes of the upper extremities were normal.

At the VA Compensation and Pension (C&P) examination on 1 May 2003, performed 3 months before separation, the CI reported “pain, weakness, stiffness, fatigue, and lack of endurance” of the right shoulder with precipitating factors of “physical activity and inclement weather.”  The examiner recorded that there had been “no frank dislocations.”  Physical exam showed diffuse tenderness and the left clavicle was lower than the right.  Shoulder ROM was as indicated in the chart above, but painful motion was noted.  The shoulder joint was “weaker throughout ROM when resistance was applied” and there was fatigability and increased pain with repetitive use.  Testing for rotator cuff injury was negative and there was a negative apprehension test.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis), citing slight and frequent pain IAW the US Army Physical Disability Agency’s (USAPDA) pain policy.  The VA also assigned a 10% rating using diagnostic code 5003-5203 (degenerative arthritis with impairment of the clavicle or scapula), for painful motion.  The VASRD §4.71a (code 5201, arm limitation of motion) threshold for a rating for ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion above this level.  Although there was no limitation of motion sufficient to support a rating under 5201, Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion), coded 5299-5203, an analogous code for rotator cuff injury or coded as 5099-5003 for limited motion of a single major joint with imaging evidence of degenerative arthritis.  There was no evidence of humerus impairment with recurrent dislocations or shoulder ankylosis to justify a rating under the 5202 code (humerus, other impairment of) or the 5200 code (scapulohumeral joint ankylosis); and no evidence of nonunion of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula impairment).  The Board noted that the PEB’s reliance on the USAPDA pain policy was not detrimental to arriving at the highest rating and in this case a 10% rating coded as 5099-5003 is compliant with the VASRD.  Therefore, no change to the PEB’s coding choice is recommended.

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 right shoulder condition.

BOARD FINDINGS:  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.  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 20140728, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

JUL 28 2016

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, AR20160008183 (PD201403552)

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.

Enclosure

CF:
( ) DoD PDBR
( ) DVA