RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01074
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060416

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Health Care Specialist, medically separated for “right (dominant) shoulder labral and rotator cuff tear” with a disability rating of 0%.  

CI CONTENTION:  The CI requested that his back and knee conditions be considered.  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 - 20060224	VARD - 20071005	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right (Dominant) Shoulder Labral and Rotator Cuff Tear	5201	0%	Right Shoulder Partial Rotator Cuff Repair	5099-5024	10%	20070625	
Patellofemoral Pain of Left Knee	Not Unfitting	Patellofemoral Joint Syndrome, Synovitis, S/P Medial
Meniscectomy X2, and S/P Lateral Release, Left Knee	5257	10%		
Chronic Low Back Pain Strain		Back Disability	5237	NSC		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right (Dominant) Shoulder Labral and Rotator Cuff Tear.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right shoulder condition began in approximately 2004 without any specific trauma or injury.  An MRI performed on 21 January 2005 showed a mild acromioclavicular (AC) joint and osteoarthritic change and labral tear.  Arthroscopic surgery (debridement of labrum) was performed 7 April 2005.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right shoulder pain” for PEB adjudication.  

The MEB NARSUM examination on 01 December 2005, 5 months prior to separation, noted complaints of constant pain in his right shoulder which increased to 7/10 pain scale with overhead use.  The physical examination revealed motion limited by pain.  His right shoulder flexion range of motion (ROM) was 160 degrees (normal 180) and abduction was 120 degrees (normal 180).  ROM was measured with goniometer.  There was no visible atrophy.  There was some soreness to palpation of the AC joint.  The CI had a positive Hawkins test (rotator cuff injury and painful motion) and positive O'Brien test for labral pathology.  No instability signs were present.  

At the 25 June 2007 VA Compensation and Pension (C&P) evaluation, performed 14 months after separation, the CI reported constant pain that traveled to his neck and back.  The physical examination showed no signs of edema, effusion, tenderness, abnormal movement, subluxation or guarding of movement.  His right shoulder ROM flexion was 140 degrees (normal 180) and abduction was 140 degrees (normal 180).  His right shoulder was functionally limited by pain, fatigue, weakness, and lack of endurance after repetitive use.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, coded 5201 (Arm, limitation of motion of), citing ROM limited by pain, to 120 degrees.  ROM was pain limited and there was tenderness about the joint.  The VA rated the right shoulder condition 10% coded 5099-5024 (Tenosynovitis), citing painful or limited motion of a major joint.  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, 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 and no dislocation or nonunion of the clavicle or scapula to justify a 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 right shoulder condition, coded 5099-5024.  

Contended PEB Conditions:  Patellofemoral Pain of Left Knee and Chronic Low Back Pain Strain Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  According to the NARSUM, the left knee condition was not profiled and the CI’s knee symptoms had not interfered with his required activities.  X-rays of the left knee in June 2007 showed no evidence of fracture or other significant abnormality.  The low back condition was also not profiled and neither contended conditions were implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right (dominant) shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5024 IAW VASRD §4.71a.  In the matter of the contended patellofemoral pain of left knee and chronic low back pain strain conditions, the Board recommends no change from the PEB determination as not unfitting.  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	
Right (Dominant) Shoulder Labral and Rotator Cuff Tear	5099-5024	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150608, 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, AR20170001111 (PD201501074)

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