RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00568
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050415

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

CI CONTENTION:  “Review 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 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 - 20050223	VARD - 20141110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Shoulder…	5099-5003	10%	Left Shoulder Rotator Cuff Tendonitis	5201	0%	20141028	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Left Shoulder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left shoulder condition began in June 2004 after lifting a heavy object.  Diagnostic imaging (MRI) revealed left shoulder rotator cuff tendinosis without tendonitis or tear. Despite treatment, the left 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 “left shoulder pain with instability” for PEB adjudication.

A physical therapy examination on 05 August 2004, 8 months before separation, noted complaints of severe left shoulder pain without radicular or neck symptoms.  Physical examination revealed active range of motion (ROM) within normal limits with painful motion. 

An orthopedic examination on 27 October 2004, 6 months prior to separation, noted complaints of left shoulder pain and instability.  Physical examination showed negative apprehension, impingement and crossover testing, and negative acromioclavicular tenderness and grind.  The CI was positive for O’Brien’s and relocation testing, positive sulcus, and mild to moderate anterior, posterior subluxation.  The active ROM was slightly limited secondary to guarding. 

The MEB NARSUM examination on 17 November 2004, 5 months prior to separation, noted complaints of constant left shoulder pain which was worse with overhead activities.  Physical examination showed no evidence of nerve impingement, and there was no guarding or acromioclavicular tenderness or grind.  There was positive bilateral multi-directional laxity in both shoulder.  The active-goniometric ROM was forward flexion 125 degrees (normal 180) and abduction 75 (normal 180) with painful motion.   The 28 October 2014 VA Compensation and Pension (C&P) evaluation, was performed over 9 years after separation and did not offer probative value.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy rated for slight/constant pain.  The VA rated the left shoulder condition 0% effective January 2014, coded 5201 (arm, limitation of motion, based on the VA C&P examination over 9 years after separation, citing rotator cuff tendonitis without compensable symptoms.

The VASRD §4.71a threshold for rating shoulder ROM impairment (code 5201, arm limitation of motion) is “at shoulder level”.  The MEB NARSUM examination, which was the most thorough and proximate examination to separation, demonstrated motion limited to this level.  The next higher 40% rating for the non-dominant arm requires motion limited to “To 25° from side’” however, the STR did not reflect this degree of limitation.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation 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).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the left shoulder condition, coded 5201.

BOARD FINDINGS:  In the matter of the chronic pain left shoulder with instability condition, the Board recommends a disability rating of 20%, coded 5201 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 the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Pain, Left Shoulder with Instability	5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20160018760 (PD201500568)

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