RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04149
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030718

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E2, Basic Trainee, medically separated for “chronic pain, right shoulder” with a disability rating of 10%.

CI CONTENTION:  His condition continues to worsen and negatively impacts his daily activities. 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 - 20030604	VARD - 20030728	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Shoulder…	5099-5003	10%	Residual, Status Post Traumatic Injury, Right Shoulder	5299-5203	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Pain, Right Shoulder.  According to service treatment records and the MEB narrative summary (NARSUM), the CI injured his dominant right shoulder in November 2002 when he fell on outstretched hands while negotiating an obstacle course; X-rays did not reveal any abnormalities.  Despite treatment with physical therapy and medications, the pain continued.  During an orthopedic clinic appointment on 14 April 2003, the CI reported constant 6/10 pain, increased with activities such as push-ups, lifting, or wearing a backpack.  The exam noted muscle strength was 4/5 on external rotation and 5/5 on internal rotation.  There was tenderness but no evidence of significant impingement.  Range-of-motion (ROM) was abduction to 175 degrees (normal 180).  Magnetic resonance imaging (MRI) on 24 April 2003 did not show any rotator cuff tears.  However, the radiologist noted the study was incomplete and that the glenoid labrum (fibrocartilage rim around the shoulder socket) could not be assessed for tears.  At a physical therapy clinic visit on 8 May 2003, 2 months before separation, the CI reported pain deep in the shoulder and across the anterior chest.  The physical examination showed a full active ROM, with pain at elevations greater than 120 degrees.  Manual muscle testing indicated good strength with pain in all planes.  Testing for labral injury was positive.  The CI’s shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for a Medical Evaluation Board (MEB).

At the MEB NARSUM exam on 13 May 2003 (2 months prior to separation), the CI complained of constant right shoulder pain radiating into his neck and aggravated by activities.  The physical examination showed no evidence of instability or impingement.  There was tenderness over the anterior shoulder and ROM was measured with flexion to 170 degrees (normal 180).  

The MEB exam (recorded on DD Form 2807 and 2808) dated 15 May 2003 (2 months prior to separation) noted pain and weakness with resisted flexion and extension of the shoulder.

There was no VA Compensation and Pension (C&P) exam in record performed within 12 months of separation (the first was performed more than 5 years after discharge from the service).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under analogous code 5099-5003 (arthritis, degenerative), citing the US Army pain policy.  The initial VA Rating Decision assigned a 10% rating using analogous code 5299-5203 (clavicle or scapula impairment) and cited painful motion and general functional impairment based on the service treatment records and MEB/PEB evidence.  The VASRD §4.71a threshold for a minimum rating using code 5201 (arm, limitation of motion) for ROM impairment is “at shoulder level” (90 degrees from the side), and the evidence demonstrated motion above this level.  Although ROM measurements did not support a minimum rating, Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion) coded as 5099-5003, as adjudicated by the PEB.  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment of).  Finally, there was no evidence of shoulder ankylosis to warrant rating under the 5200 code (scapulohumeral joint ankylosis).  The Board noted that the PEB’s reliance on the US Army pain policy was not detrimental to arriving at the highest rating and that a 10% rating for limited shoulder motion coded as 5099-5003 is complaint with the VASRD.  Therefore, no change is recommended to the PEB’s coding choice.  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 chronic pain 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 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 AR20160006099 (PD201404149)

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