RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00854
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050727

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Construction Equipment Repairer, medically separated for pain and instability of his right shoulder, with a disability rating of 10%.

CI CONTENTION:  The applicant requests that all conditions be considered.  

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:  

IPEB - Dated 20050503	VA* - (~4 Mos. Pre-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain…R Shoulder	5099-5003	10%	Right Shoulder Instability	5299-5201	NSC	20050322	
Other MEB/PEB Conditions x 0 	Other x 3	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20050830 (most proximate to date of separation [DOS]).  

Right Shoulder Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right hand dominant CI injured his right shoulder in October 2002 while performing his duties.  Magnetic resonance imaging showed minimal tendon impingement and mild ligamentous laxity suggesting instability.  Surgical options were not chosen due to potential detriment to future duty fulfillment.  At the NARSUM examination on 8 February 2005 (6 months prior to separation) the CI reported right shoulder pain and instability.  He complained of “pain and grinding sensation with activity such as push-ups, pull-ups, overhead work, and carrying greater than 15 pounds” as well as occasional numbness in his right hand with activities such as prolonged walking.  Shoulder dislocations were not reported by the CI.  The examination noted no guarding or functional limitations of the right shoulder and no swelling or loss of muscle contour.  The absence of guarding was noted.  There was mild tenderness to palpation on the front and back of the shoulder.  One maneuver was positive for painful motion, but others were not.  Evidence of shoulder ligament laxity was present but frank dislocation was not reported.  According to the MEB evaluation (as recorded on the DD Forms 2807-1 and 2808) on 1 March 2005 (5 months prior to separation) the CI reported right shoulder pain and instability.  The examiner noted a normal physical examination, but also annotated right shoulder instability under summary of defects and diagnoses.  Shoulder dislocations were not reported.  At the VA Compensation & Pension (C&P) examination on 22 March 2005 (4 months prior to separation) the CI reported constant right shoulder pain, but no functional impairment or incapacitation.  The examiner noted a normal physical examination.  Tenderness, painful motion, instability or dislocation was not reported, and there was no additional limitation after repetitive motion.  X-ray findings were normal.  The examiner indicated there was “no diagnosis because there is no pathology to render a diagnosis” for the right shoulder.

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 use of the USAPDA Pain Policy.  The VA applied an analogous 5201 code (limitation of shoulder motion) but determined the condition was not service connected (NSC) because, based on the C&P examination findings, there was no evidence of a permanent residual.  The VASRD §4.71a threshold for compensable ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion above this level.  Although the limitation of motion did not support a minimum rating (5201), Board members agreed that a 10% rating was reasonably conceded with application of VASRD §4.59 (painful motion) based on some examination findings of painful motion.  While signs of possible instability were noted in multiple examinations, 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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder condition.

BOARD FINDINGS:  In the matter of the right 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, AR20160015159 (PD201500854)

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: