RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03604
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Imagery Analyst, medically separated for “chronic right shoulder pain…,” with a disability rating of 10%.

CI CONTENTION:  Please consider all conditions.  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 – 20040211	VARD – 20040519	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain…	5099-5003	10%	Snapping Scapula Syndrome…	5203	10%	20031021	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Right Shoulder Pain.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered an atraumatic onset of pain and “snapping” of the right (dominant) shoulder in May 2001 soon after basic training.  The symptoms persisted and “extensive bursitis” was demonstrated by imaging (3-D CT).  Surgical intervention (arthroscopic bursectomy) ensued in April 2003, and the same procedure was repeated that June (10 months prior to separation).  Despite treatment, the right shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “snapping scapula syndrome or functional shoulder pain without anatomic abnormality” to the PEB.  

The outpatient STR evidence probative to rating was consistent with that from the examinations which follow.  At the VA Compensation and Pension (C&P) examination on 21 October 2003 (6 months before separation, 4 months after surgery) the CI reported pain aggravated by sleeping on his shoulder, working overhead, and lifting over 30 pounds.  The physical examination recorded the absence of tenderness and atrophy, crepitus and “mild discomfort” with motion, the absence of instability, and normal strength (including grip).  Measured ROM was normal (forward flexion 180 degrees, abduction 180 degrees), but the examiner noted snapping of the scapula at 100 degrees abduction.

During the MEB NARSUM examination on 14 January 2004, 3 months before separation, the CI reported pain with overhead lifting and push-ups.  The examination recorded “mild” deltoid atrophy and the absence of instability or impingement.  Normal ROM measurements were documented with the same description of scapular snapping at 100 degrees abduction.  The Board noted a conflicting NARSUM “abduction of 90 degrees” entry which renders a 20% rating; but, all members agreed that in context with the total documentation that this was a typographical error (referring to internal rotation, with abduction being erroneously recorded as ‘extension’ to 180 degrees).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under code 5099-5003 (analogous to degenerative arthritis), citing criteria from the US Army Physical Disability Agency Pain Policy; although, the rating was compliant with criteria of VASRD §4.71a.  The VA also assigned a 10% rating, but used the 5203 code (clavicle or scapula, impairment of) citing “pain on motion with snapping under the scapula.”  There was no ROM limitation which would achieve a rating higher than 10%; and, there was no ankylosis, fracture (nonunion/malunion) or subluxation/instability that would support a higher rating under any other joint code.  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 20140725, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

JUL 22 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, AR20160008670 (PD201403604)

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