RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00699
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Trainee, medically separated for “right shoulder pain,” with a disability rating of 0%.  

CI CONTENTION:  The CI condition has worsened despite rehabilitation.  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 - 20080410	VARD - NONE	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5099-5003	0%	No VA Rating or Examinations in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right hand dominant CI was medically released from the Marine Corps for a right shoulder condition in February 2007.  He then enlisted in the Army on 17 September 2007, obtaining a waiver for his right shoulder condition for Service entry.  While in Army basic training doing pushups, the CI heard a loud pop and experienced right shoulder pain.  An X-ray on 26 September 2007 demonstrated cortical irregularities of the glenoid process with no acute process with the right shoulder.  No orthopedic surgery intervention was indicated.  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 PEB adjudication.  

At the orthopedic clinic appointment on 26 November 2007, 3 months prior to separation, the CI reported moderate right shoulder pain and inability to move the shoulder without pain.  Right shoulder range of motion (ROM) was forward flexion to 45 degrees (normal 180) and abduction to 50 degree (normal 180).  There was a 1+ anterior and 1+ posterior load test (for instability).  Rotator cuff muscles demonstrated “4/5 strength decreased secondary to poor effort and pain.”  There was no neurologic or vascular deficits, and diagnostic imaging showed no acute bony pathology, labral or rotator cuff pathology.  

At the physical therapy (PT) clinic examination on 26 November 2007, 2 months prior to separation, the CI reported right shoulder pain at 4/10 with maximum pain 5/10.  Physical examination showed the CI exhibited “decreased right upper extremity movement, but with no wincing or guarding while removing jacket” and he was able to transfer and ambulate with no apparent increase in pain.  The CI’s back and neck demonstrated full ROM; however, the examiner noted wincing and pain with right side bending, forward flexion and extension of the back due to changing right arm position.  Right shoulder ROM was 71 degrees flexion and 56 degrees abduction with pain limiting motion in all planes.  

The MEB NARSUM examination on 17 December 2007, 1 months prior to separation, noted complaints of shoulder pain on cold days and with physical activity (particularly pushups).  Pain was 6-7/10 in intensity.  The CI denied any dislocations.  Physical examination showed the CI walked with a smooth, non-antalgic gait.  The right shoulder ROM measurements demonstrated forward flexion to 45 degrees and abduction to 50 degree.  No crepitus was noted.  Anterior load shift was 1+ and posterior load shift was 1+ (instability), with a negative sulcus sign, negative Hawkins and negative Neer test (no signs of impingement).  “Testing of the rotator cuff muscles demonstrates 4-5 strength, decreased secondary to poor effort and pain.”  The CI’s right upper extremity was neurovascularly intact.  The physician summarized the present condition as “He is unable to lift any objects with his right hand or raise his arm above shoulder level.”  There were no VA records in evidence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency (USAPDA) pain policy.  Ratings for the CI’s dominant (major) right shoulder in this case rely predominantly on ROM measurements.  The Board considered if the orthopedic evaluation and NARSUM evaluations were distinctly separate and the PT examiner’s comment on no objective evidence of painful motion with jacket removal as distinct from painful motion with formal ROM testing.  The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) at 20% is “at shoulder level” (approximately 90 degrees from the side), and the PT and MEB NARSUM examinations proximate to separation reflected this degree of limitation.  The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level;” both the orthopedic and NARSUM measurements equated to that level, but the PT measurements showed slightly greater ROM.  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 rating 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), the Board recommends a disability rating of 30% for the right shoulder pain condition, coded 5201.  

BOARD FINDINGS:  In the matter of the right shoulder condition, the Board unanimously recommends a disability rating of 30%, 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Shoulder Pain	5201	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150529, 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, AR20170000056 (PD201500699)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

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:

	a.  Providing a correction to the individual’s separation document  showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

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:

			       
						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA