RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00151
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard or National Guard E6, Infantry, medically separated for “posttraumatic arthritis, right glenohumeral joint with impingement,” with a disability rating of 0%.  

CI CONTENTION:  He was given a higher rating for his conditions by the VA.  The 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 on 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 - 20071024	VARD - 20050531	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Traumatic Arthritis, Right Shoulder with Impingement	5010	0%	Degenerative Arthritis of the Right Shoulder with Tendinosis of the Supraspinatus and Biceps Tendon, Tear of the Superior Labrum, and Hill-Sach’s Region of the Proximal Humerous	5201-5024	10%	20050106	
Anxiety Disorder	Not Unfitting	Post-Traumatic Stress Disorder	9411	50%	20050103	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Post-Traumatic Arthritis, Right (Dominant) Shoulder with Impingement.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right hand dominant CI’s shoulder condition began after knocking down a door in Iraq in October 2003.  Surgery for a superior labral lesion was performed in November 2003 and repeated for persistent pain in August 2005.  Radiographic imaging (MRI) in June 2006 documented degenerative joint disease (rotator cuff tendinopathy, chondromalacia, and superior labral degeneration).  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 MEB forwarded post traumatic degenerative arthritis of the right glenohumeral and acromioclavicular joints (AC), pain, and impingement for PEB adjudication.  

At four separate visits to physical therapy and orthopedics (in July, October, November 2006 and January 2007), the physical examinations documented forward flexion to 130, 120, and 110 degrees (normal 180), respectively.  Abduction was documented to at or near shoulder level (60, 90 and 88 degrees, respectively) with painful motion.  At a fifth visit to physical therapy in November 2006, abduction was described as “painful past 90 degrees but patient tolerates near full ROM [range of motion] without pain.”  

At five separate visits to physical therapy and orthopedics (in January, February, October and December 2006), the physical examinations documented forward flexion to 120, 150, 123, 110, and 140 degrees, respectively.  Abduction was documented to be above shoulder level (110, 120, 105, 105, 120 degrees respectively).  There was consistent evidence of painful motion throughout the STR.  

At the 13 February 2007 MEB examination (recorded on DD Forms 2808), 10 months prior to separation, the physical examination showed abduction to 90 degrees with decreased strength of flexion and abduction throughout.  At the 26 June 2007 MEB NARSUM examination, 6 months pre-separation, the CI reported constant pain, and pain during activities of daily living, such as putting on clothes, opening doors, and causing difficulty sleeping.  The physical examination showed a forward flexion of 128 degrees and abduction to 110 degrees with evidence of painful motion, tendonitis, and AC joint arthritis.  There was no VA Compensation and Pension (C&P) evaluation performed within 12 months of separation in evidence.  The VA did evaluate and rate the condition 3 years prior to separation as noted below.

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated 0% for the right shoulder condition coded 5010 (traumatic arthritis), citing passive forward flexion of 150 degrees and abduction of 110 degrees, with difficulty and pain performing activities of daily living.  The VA rated 10% for the shoulder condition analogously coded 5201-5024 (arm, Limitation of motion; tenosynovitis), based on the December 2005 VA C&P examination 3 years before separation, citing a forward flexion of 160 degrees and abduction of 140 degrees with evidence of painful motion.  The VASRD §4.71a (code 5201, arm limitation of motion) threshold for rating for ROM impairment is “at shoulder level” and specifically does not include an actual measurement to allow for flexibility in assessing disability.  There were several STR examinations with ROMs that demonstrated motion at this approximate level that intermittently improved during physical therapy.  However, in consideration of functional loss, there was sufficient evidence in support of a 20% rating under 5201.  The higher 30% rating for a major/dominant arm requires motion limited to “midway between side and shoulder level,” but the examinations in evidence did not reflect this degree of limitation.  There was no fibrous union or nonunion of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available under the 5203 code (clavicle or scapula, impairment of).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), §4.7 (higher of two evaluations), §4.40 (functional loss), and §4.45 (the joints), the Board majority recommends a disability rating of 20% for the left shoulder condition coded analogously as 5010-5201.  

Contended PEB Condition:  Anxiety Disorder.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right dominant shoulder condition, the Board unanimously recommends a disability rating of 20%, coded 5010-5201 IAW VASRD §4.71a.  In the matter of the contended anxiety disorder condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Post-Traumatic Right Shoulder Arthritis, with Impingement	5010-5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150210, 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, AR20170002974 (PD201500151)

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 20% 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