RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00850
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Infantryman, medically separated for “right shoulder pain,” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention.  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 - 20070605	VARD - 20080205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5099-5003	0%	Right Shoulder Biceps Tendinitis…	5224	0%	20071213	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Chronic Right Shoulder Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was right-hand dominant and his right shoulder condition began in November 2005 while in Basic Training.  The CI reported no specific injury or trauma.  The shoulder injury was assessed as being “overuse.”  Radiographic studies in December 2005, showed a normal shoulder.  Later diagnostic imaging (MRI) in June 2006 showed hypertrophic changes in the acromioclavicular joint, and indicated impingement syndrome.  Surgical repair was attempted in October 2006 (labral debridement and distal clavicle excision; 9 months prior to separation).  Electrophysiologic studies of the right upper extremity were normal.  Evaluation by orthopedic concluded no additional surgery was needed.  Despite surgery and further treatment, the 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 “right shoulder pain with decreased range of motion” for PEB adjudication.

At the time of the orthopedic clinic appointment on 30 April 2007, 3 months prior to separation, the CI reported popping in the right shoulder especially with cross over procedures.  There was no pain with overhead activities, however, the CI was unable to wear his protective equipment over the right shoulder area.  Daily pain medications were not required.  On examination, the ROM was 175 flexion (normal 180) and abduction 185 (normal 180), crossover crepitus and tenderness, tenderness over the AC area, and a normal neurovascular examination distally.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated May 2007, 2 months prior to separation, the CI reported chronic right shoulder pain.  Physical examination showed right upper extremity weakness with decreased range of motion (ROM) and tenderness to palpation.

The MEB NARSUM examination on 15 May 2007, 2 months prior to separation, noted complaints of decreased ROM, numbness and tingling in the fourth and fifth fingers on the right hand going to the elbow.  The CI reported decreased strength and dexterity of the right hand.  Physical examination showed the CI displayed significant weakness with shoulder motion, and weakness in the right hand grip was noted.  Adductor pollicis test demonstrated normal strength, and finger abduction and adduction were normal.  The ROM, performed by physical therapy, was limited to 90 degrees of flexion and abduction due to pain.

At the 12 December 2007 VA Compensation and Pension (C&P) evaluation, performed 5 months after separation, the CI reported pain 3-4/10 on average and flares with increased use.  The CI denied incapacitating events.  Radiographs showed post-surgical changes with good joint spaces.  Physical examination showed prominent medial winging of the scapula with poor elevation of the arm.  The CI had pain over the anterior aspect of the shoulder, which was worsened by Speeds test (suggestive of bicipital tendon issue, suggests painful motion) and Yergason’s test (suggestive of bicipital tendon issue, suggests painful motion).  No tenderness was noted at either the acromioclavicular joint, the sternoclavicular joint or greater tuberosity.  Neer (shoulder impingement test) and Hawkins (shoulder/tendon injury test) test were negative with normal (5/5) strength in the rotator cuff.  The ROM was flexion and abduction to 180 degrees; painful motion was not addressed.  Diagnosis was right shoulder biceps tendinitis and right shoulder medial· winging of the scapula.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the shoulder condition 0%, coded 5099-5003 (analogous arthritis, degenerative), citing normal ROM.  The VA rated the right shoulder condition 0% coded 5224 (thumb, ankyloses of) [likely typo for code 5024 – tenosynovitis], based on the VA C&P examination 5 months after separation, citing full ROM, motion not limited by pain and radiographic changes.

The Board deliberated on the probative value of the disparate examinations in evidence and adjudged that the single MEB NARSUM examination documenting extremely limited ROMs due to pain was an outlier, did not provide complete ROM testing, and was not indicative of the ROMs and disability depicted in the preponderance of the record.  The physical therapy ROMs cited by the PEB depicted 175 degrees (normal 180) of shoulder flexion and painful motion, while the VA C&P examination cited 180 degrees of flexion and abduction.

Although there was insufficient limitation of motion to support a rating under the 5201 code (once the NARSUM measurements were excluded), Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating 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 10% for the right shoulder condition.

BOARD FINDINGS:  In the matter of the chronic right shoulder pain condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5203 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 Right Shoulder Pain	5099-5203	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150604, 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 XXXXXXXXXXXXXXXXXXXXX, AR20170000100 (PD201500850)

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