RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00803
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050905

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Track Vehicle Repairer, medically separated for “right shoulder pain,” with a disability rating of 0%.

CI CONTENTION:  The CI requests a 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 - 20050520	VARD - 20060404	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5099-5003	0%	S/P Right Shoulder AC Joint Separation	5201	20%	20051122	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI reportedly suffered an acromioclavicular (AC) separation of his right (dominant) shoulder in March 2004 (deployed to Iraq, no source records available).  There was persistent pain and functional limitations upon re-deployment; but, no history of recurrent subluxation or dislocation, and no complaint of instability.  Imaging (MRI arthrogram) was normal, with no indication of rotator cuff or ligamental injury and no AC joint pathology.  An orthopedic consultant diagnosed a strain or partial tear and opined that there were no surgical indications.  There were multiple range of motion (ROM) measurements evidenced in outpatient STR entries.  Forward flexion was variously assessed as “full” or measured at 170 degrees (normal 180, “shoulder level” [90 degrees] for minimum 20%), and the lowest measurement of abduction was 130 degrees (same parameters as forward flexion).  Painful motion was specified in several entries, and there were no entries contrary to the preceding evidence.  There were some STR entries with equivocal findings of impingement and/or instability, but none that were significantly probative (or logically consistent with the imaging evidence).  A trial of conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for an MEB which in turn forwarded “chronic shoulder pain with a history of acromioclavicular separation” to the PEB.

The NARSUM examination in March 2005 (5 months before separation) documented persistent pain rated 4/10 that was “worse with active movement, overhead activity, heavy lifting, push-ups or wearing a flak jacket.”  The physical examination recorded AC joint tenderness, normal strength without atrophy, “no instability” (corroborated by examination signs), no signs of impingement, and “full [ROM] but did have pain at extremes of motion.”

A VA Compensation and Pension (C&P) examination in November 2005 (3 months after separation) documented “constant” pain rated 1/10 with exacerbations to 4/10 “once a day when he is lifting,” adding “still has decreased [ROM] over his head.”  The physical examination recorded “mild” AC joint tenderness, full strength, and did not document any signs of impingement or instability.  Measured ROM was forward flexion to 145 degrees and abduction to 140 degrees, specifying painful ranges but no ROM degradation with repetition.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated 0% under code 5099-5003 (analogous to degenerative arthritis).  The VA assigned a 20% rating under code 5201 (limitation of motion), citing the C&P ROM measurements.  The 20% threshold of 5201 was not supported by the ROM measurements, and no rationale was provided in the decision (speculatively the rater may have been influenced by the VA examiner’s comment regarding “overhead” ROM limitation).  There was no ROM limitation supporting a rating higher than 10% (conceding painful motion); and, there was no ankylosis, fracture (nonunion/malunion) or subluxation/instability that would support a higher rating via any other applicable code available under §4.71a.  After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the Board recommends a 10% rating for the right shoulder condition; proposing code 5099-5010 (traumatic arthritis)

BOARD FINDINGS:  In the matter of the right shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5010 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	
Strain and Acromioclavicular Arthritis, Right Shoulder 	5099-5010	10%	

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, 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, AR20170000744 (PD201500803)

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 10% 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