RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00860
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041001

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Military Police, medically separated for “left shoulder pain post three surgeries” with a disability rating of 0%.

CI CONTENTION:  Her condition continues to worsen and impact her daily life and she requests a review of 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 - 20040810	VARD - 20150619	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain Post Three Surgeries	5099-5003	0%	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Left Shoulder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured her left shoulder in November 2001 after conducting a roll on her left shoulder during training and hearing a popping sound.  Shoulder X-rays 4 November 2001 showed acromioclavicular (AC) joint separation.  There was no evidence of fracture or dislocation.  Repeat shoulder X-rays 5 February 2002 indicated a normal left shoulder with no evidence of fracture, inflammation, or arthritic changes.  Orthopedic evaluation on 30 April 2004 diagnosed a rotator cuff tear (RCT) and subluxation of the shoulder anteriorly. The CI underwent surgery 23 May 2002 for left RCT repair and decompression and shoulder stabilization.  Following surgery the CI did well, but continued to report shoulder weakness and less than full range of motion (ROM).  She had not had any recurrent dislocations.  Diagnostic imaging studies (MRI) 4 January 2003 showed rotator cuff tendinopathy versus a partial RCT.  Left shoulder arthroscopy with repair of RCT was performed 31 January 2003.  The CI did well after this surgery until September 2003 when she had recurrence of her shoulder pain while swimming and repeat MRI 29 September 2003 revealed rotator cuff tendinopathy with possible RCT.  Left shoulder arthroscopy was performed 15 October 2003 with repair of partial thickness RCT, debridement and distal clavicle excision for decompression and X-rays indicated an adequate distal clavicle excision.  Following three surgeries, further treatment did not result in improvement sufficient to allow unrestricted duty.  The orthopedic surgeon noted permanent restrictions of no lifting more than 10-15 pounds and minimal overhead and repetitive use of the left arm.  The permanent profile dated 19 April 2004 listed no overhead duty.  The MEB forwarded “chronic left shoulder pain especially with movement” for PEB adjudication.  

The MEB NARSUM examination on 24 June 2004, 3 months prior to separation, noted complaints of daily chronic left shoulder pain, with decreased ROM, and loss of strength of her left shoulder. The CI reported pain graded 3-5/10, aggravated by lifting and any overhead use.  The MEB examiner noted the pain prevented the CI from lifting or carrying with the left or overhead or performing the duties of her military specialty to include performing the physical fitness test.  The physical examination showed pain with palpation over the AC joint.  Physical therapy measured shoulder ROM for the MEB on 8 June 2004 and ROM was limited in flexion/abduction at 155 degrees each (normal 180 degrees for each) after three repetitions.  There were no VA Compensation and Pension examinations in record proximate to separation. The original VA Rating Decision in 2015 did not address the shoulder.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the analogous 5099-5003 code (arthritis, degenerative), citing painful motion. The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level.  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45). There was no malunion, nonunion or recurrent dislocation of the humerus and no dislocation or nonunion of the clavicle or scapula to justify a higher rating under the 5202 (humerus, other impairment of) or 5203 (clavicle or scapula, impairment of) codes.  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 left shoulder condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left shoulder pain condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 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	
Left Shoulder Pain…	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150606, 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, AR20170000854 (PD201500860)

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