RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00584
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Chemical Operations Specialist, medically separated for “chronic pain/instability, right shoulder” with a disability rating of 10%.

CI CONTENTION:  The CI requested consideration of 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 - 20060223	VARD - 20060822	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain/Instability, Right Shoulder	5099-5003	10%	Right Shoulder Instability	5003-5201	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Pain/Instability, Right Shoulder.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI injured his right shoulder in July 2005 while swimming.  Imaging studies were normal showing no arthritis or structural abnormalities.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right shoulder instability” for PEB adjudication.  An Orthopedic examination on 15 September 2005, 7 months prior to separation, revealed right shoulder instability as the “shoulder was subluxed” (a painful, but temporary and partial dislocation).

A physical therapy (PT) evaluation on 31 October 2005, 5 months prior to separation, revealed painful and decreased range of motion (ROM) of the right shoulder; flexion was 55 degrees (normal = 180) and abduction was 75 degrees (normal = 180).  At the MEB NARSUM evaluation on 9 February 2006, 2 months prior to separation, the CI’s chief complaint was listed as “right shoulder pain and instability”.  His physical examination (PE) revealed painful motion.  The examiner did not numerically annotate ranges of motion, but rather stated, “…extremely poor AROM [active range of motion] right upper extremity”.  Additionally stated, “The right shoulder joint is unstable.”  His overall pain was assessed as “slight and constant”.  There was no VA Compensation and Pension (C&P) examination within the case file for the CI “failed to report” for a scheduled examination proximate to separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the analogous 5003 code (degenerative arthritis), citing ‘slight/constant’ pain and the US Army Physical Disability Agency (USAPDA) Pain Policy.  The VA assigned a 0% rating using a dual code 5003-5201 (degenerative arthritis; arm, limitation of motion) citing that the CI did not attend his examination.  The VASRD §4.71a code of 5201 threshold for a rating for ROM impairment is “at shoulder level” (90 degrees from the side), and the single numerical ROM in evidence at 5 months prior to separation demonstrated a range below this level, but not to a degree level indicative of the next higher impairment rating.

Board members extensively deliberated and agreed that the documented parameters of the right shoulder being subluxed, unstable, with “poor” ROM  above the mid-way point between the body side and shoulder level would support VASRD §4.40 (functional loss) for a 20% impairment rating.  Absent joint ankylosis (5200), mal-union or recurrent dislocation of the humerus (5202), there was no support for the next higher impairment rating.  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 right shoulder condition. 

BOARD FINDINGS:  In the matter of the right shoulder condition, the Board unanimously 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 his prior medical separation: 

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Pain/Instability, Right Shoulder	5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, 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 
XXXXXXXXXXXXXXXXXX, AR20170000266 (PD201500584)

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