RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD -2014-03610		
BRANCH OF SERVICE:  Army	BOARD DATE:  20150702
Separation Date:  20060106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Combat Medic, medically separated for a right shoulder condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “right shoulder labral tear,” “partial supraspinatus tear” and “chronic right shoulder instability” to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “right shoulder pain post repair of labral tear and supraspinatus tear” 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 CI contended for his shoulder, back and neck 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 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 20051012	VA* - (9 Days Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain…	5099-5003	10%	Status Post(S/P) Right Shoulder Anterior Labral Repair	5299-5019	10%	20051228	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 2	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 200513 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  The three MEB conditions were all related to the right shoulder and were appropriately combined by the PEB (and VA) into a single rating for the right shoulder.

Shoulder Condition.  The CI initially injured his right shoulder in September 2004.  He suffered three shoulder dislocations and continued to have limited painful motion.  Despite temporary profiles and aggressive physical therapy (PT), there was no improvement.  A right shoulder MRI done in April 2005 showed a tear in the tendon, a lesion in the humerous (long bone in arm) and a finding that possibly represented an impingement.  The CI underwent a right shoulder arthroscopy with tendon repair in May 2005 (approximately 8 months prior to separation).  

The MEB Narrative Summary (NARSUM) exam approximately 5 months prior to separation (approximately 3 months after surgery) documented chronic right shoulder pain, a feeling of a sense of instability in that the shoulder might dislocate, and frequent shoulder popping.  The examiner noted that the range-of-motion (ROM) evaluation had been performed by PT.  The DD Form 2808, Report of Medical Examination, documented painful and limited motion with no swelling.  The MEB NARSUM physical exam and PT findings are summarized in the chart below.  

The VA Compensation and Pension (C&P) exam, approximately 10 days prior to separation, documented complaints of recurrent subluxations (with feeling of popping), pain and occasional right arm numbness and tingling.  The examiner opined that there was constant and slight pain, with decreased ROM after three repetitions, however the CI had full abduction.  The VA C&P physical exam findings are summarized in the chart below.  

Right Shoulder ROM
(Degrees)	PT ~5 Mo. Pre-Sep	MEB ~5 Mo. Pre-Sep	VA C&P 10 Days Pre-Sep	
Flexion (180 Normal)	140/145/150	Limited external rotation; limited extension	160	
Internal rotation (70)	80/80/85		90	
External rotation (90)	60/60/65		90	
Abduction (180)	120/140/150		180	
Comments:  Surgery ~8 Mo. Pre-Sep	Passive ROM greater than active ROM	Strength, sensation nml; no tenderness; DD Form 2808 painful motion	Pain at maximum ROM’s; grip strength nml	
§4.71a Rating	-	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the shoulder condition analogous to 5003 (Arthritis, degenerative [hypertrophic or osteoarthritis]) and rated at 10% with application of the USAPDA pain policy.  The PEB also used the passive (versus active) ROM abduction of 165 degrees in their rating.  The VA coded the shoulder condition analogous to 5019 (Bursitis) and rated at 10%.  Multiple exams proximate to separation documented painful motion and no exam specifically documented “painless ROM.”  Application of VASRD §4.59 (painful motion) warranted a 10% rating for the shoulder for painful motion.  There was no indication that ROM was limited to shoulder level (approximately 90 degrees), that there was recurrent dislocation with guarding of movement at shoulder level, or malunion with loose movement to warrant any rating higher than 10% (codes 5201, 5202, or 5203).  

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 shoulder condition.  

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 shoulder condition was operant in this case and the condition was adjudicated independently of that policy by the 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 recharacterization of the CI’s disability and separation determination.   

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140409 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY
251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

SAMR-RB

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

06 JUL 2016

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160003329 (PD201403610)

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