RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00001
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060708

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E7, Information Systems Operator Analyst, medically separated for “chronic right shoulder pain,” with a disability rating of 0%.

CI CONTENTION:  The CI contends his right shoulder still causes him pain, along with plantar fasciitis, right knee, and lower back 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 based upon a 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 - 20060428	VARD - 20061031	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5099-5003	0%	DJD, Right Shoulder	5010	0%	20060804	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI experienced an onset of right (dominant) shoulder pain in 1997 during combatives training.  The pain persisted and subsequently there was a possible (records unavailable) subluxation or dislocation.  There were two arthroscopic surgical interventions in July and December of 2003 which addressed chondromalacia (damaged joint cartilage) and labral injuries (the labrum is the attachment for the joint capsule), but there was no indication of ligamental disruption.  The condition was managed conservatively over the ensuing years, with at least one re-injury, but there was no evidence of subluxations or dislocations.  Serial X-rays demonstrated degenerative changes only.  The last range of motion (ROM) evidence from available records, prior to the MEB findings below, was from November 2004 (20 months before separation) and recorded measurements of forward flexion to 150 degrees (normal 180, 90 for minimum 20%) and abduction to 120 degrees (same parameters), specifying painful motion.  There was no indication for additional surgery; a protracted trial of conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for an MEB which in turn forwarded “chronic right shoulder pain secondary to post-traumatic osteoarthritis” to the Physical Evaluation Board (PEB).  

The NARSUM evaluation in March 2006 (3 months before separation) documented “significant” chronic shoulder pain exacerbated by “pushups, pull-ups, overhead activity, lifting, and running.”  The physical examination recorded some atrophy, but 5/5 muscle strength.  There were mixed signs of impingement and positive apprehension without frank instability.  The ROM measurements were forward flexion to 160 degrees and abduction to 170 degrees, specifying “pain at the extremes of motion.”

The August 2006 VA Compensation and Pension (C&P) examination, performed 1 month after separation, documented “daily” pain rated 8/10 exacerbated by “a lot of repetitive movement.”  The physical examination recorded grossly normal findings and strength.  Measured ROM was normal in all planes, and the examiner specified the absence of painful motion both “initially and with repetition.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 0% rating analogous to code 5003 (degenerative arthritis), cited only “without loss” of ROM.  The VA’s 0% rating under code 5010 (traumatic arthritis, defaulting to criteria of 5003), cited the C&P evidence for normal ROM without painful motion.  There was no evidence of ROM limitation to a minimum compensable degree, but the Service evidence (both STR clinical entries and the NARSUM) provided adequate documentation of painful motion in support of the minimum compensable (10%) rating per VASRD §4.59.  Although the VA’s 0% rating was consistent with VASRD §4.71a criteria premised solely on the C&P evidence, members agreed that Service evidence for painful motion was more probative to the Board’s recommendation; and, that §4.59 and/or §4.40 (functional loss) should, in fairness, be conceded in support of a 10% service rating.  There was no ankylosis, fracture (nonunion/malunion) or subluxation/instability that would support a higher rating under any alternate code.  After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the Board recommends a 10% rating for the right shoulder condition under code 5010.

BOARD FINDINGS:  In the matter of the right shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5010 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Labral Injury with Surgical Residuals, Right Shoulder	5010	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141230, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

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, AR20160018439 (PD201500001)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA