RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00796
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060906

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Military Police, medically separated for “left shoulder pain,” with a disability rating of 10%.

CI CONTENTION:  The CI contends he was given a higher rating for his condition.  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 - 20060714	VARD - 20070514	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, L Shoulder…	5099-5003	10%	L Shoulder Bicipital Tendonitis	5099-5024	10%	20070205	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:  

Left Shoulder Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI underwent left shoulder surgery in February 2004 for a torn labrum.  At the time of the Troop Medical Clinic (TMC) appointment on 20 March 2006, 6 months prior to separation, the CI reported having crepitus and popping with some numbness and tingling in his left arm when riding a motorcycle.  On examination he had crepitus on motion which was “loud as if bone on bone with some subluxation.”  His range of motion (ROM) was normal, but pain was elicited on motion.  An MRI of the left shoulder dated 25 March 2006 was read as essentially negative.  At the TMC visit on 3 April 2006, 5 months prior to separation, the CI reported left arm numbness that radiated from the medial aspect of the arm down to his palm, described as “arm and hand went to sleep.”  He had no difficulty with performing pushups but did have pain following the activity.  On examination the CI’s left shoulder forward flexion and abduction was normal, but there was “crepitus on palpation and loud, audible popping with ROM.”  The examiner noted that the CI’s left shoulder appeared to mildly sublux with apprehension tests and showed laxity. 

Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic left shoulder pain secondary to superior labrum anterior to posterior tear, after arthroscopic repair” for PEB adjudication.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 1 June 2006, 3 months prior to separation, the CI reported left shoulder pain with numbness in his arm and fingers as well as sharp and severe pains all of the time that limited his ROM.  Physical examination showed limited ROM as indicated in the chart below, but painful motion was not discussed.  According to the MEB NARSUM evaluation on 5 June 2006 (3 months prior to separation) the CI complained of shoulder pain with “grinding and mechanical symptoms.”  His pain was somewhat responsive to non-steroidal medications.  Physical examination showed no evidence of instability.  His ROM was limited as indicated in the chart below and there was evidence of painful motion.  He had normal muscle bulk and tone and normal motor strength.  Sensation and vascular functions were also intact.

At the VA Compensation and Pension (C&P) examination in February 2007, performed 5 months after separation, the CI reported sharp pain in his left shoulder that “clicks.”  His pain flared after lifting more than 20 pounds.  Physical examination showed limited and painful motion as indicated in the chart below.  After repetitive motion his forward flexion decreased and his abduction was not additionally limited.  There was swelling and tenderness in his left shoulder. 

Left Shoulder ROM
(Degrees)	MEB ~3 Mos. Pre-Sep	NARSUM ~3 Mos. Pre-Sep	VA ~5 Mos. Post-Sep	
Flexion (180 Normal)	165	175	135 w/rep 120	
Abduction (180)	120	160	122 w/rep 128	
Comments	Limited motion	Painful motion	Painful motion	
§4.71a Rating	0%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis), citing slight and constant pain IAW the US Army Physical Disability Agency’s pain policy.  The VA assigned a 10% rating using an analogous 5024 code (tenosynovitis) for painful limited motion.  The VASRD §4.71a (code 5201, arm limitation of motion) threshold for a rating for ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion above this level.  Although there was insufficient limitation of motion to support a rating under 5201, Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  Although the examiner at the TMC clinic on two occasions documented “mildly sublux” and “some subluxation,” months before separation, there was no evidence of subluxation (dislocation) at the NARSUM, 3 months before separation or at the C&P examination, 5 months after separation.  There were no other entries in the STR where dislocation or subluxation of the shoulder joint was mentioned, and radiographic evidence of dislocation was absent.  Therefore, Board members agreed, rating criteria were not met for a higher rating under the 5202 code (humerus, other impairment of, recurrent dislocation, or malunion of).  There were no additional applicable codes to consider.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left shoulder condition.

BOARD FINDINGS:  In the matter of the left shoulder condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

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

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 XXXXXXXXXXXXXXXXXXXX, AR20160015157 (PD201500796)

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,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA