RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01460
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060921

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

CI CONTENTION:  The CI made no specific contention.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’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 panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determinations is based on 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 panel 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 panel 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 - 20060911	VARD - 20070227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5099-5003	0%	Internal Derangement, Right Shoulder	5299-5201	20%	20070117	
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 left-hand dominant CI injured his right shoulder in December 2005 while lifting weights.  There were no radiographic studies available in the record.  On 19 May 2006 the CI underwent right shoulder arthroscopic anterior stabilization.  Despite treatment, physical therapy and surgery, the right 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.  

At the 4 August 2006 MEB NARSUM by orthopedic surgery, 2 months before separation, the CI complained of severe shoulder pain, instability, and popping.  The right shoulder examination revealed well healed incisions.  Active range of motion (ROM) was forward flexion of 100 (180 normal), external rotation of 35 (90), and internal rotation of 45 (90) degrees.  All of these measurements are by goniometer.  They are all limited by stiffness.  The shoulder is grossly stable.  He now has a negative sulcus sign [assesses inferior shoulder instability].  Apprehension test [assesses anterior and posterior shoulder instability] is difficult to interpret given his postoperative status.”  

At the 17 January 2007 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI complained of pain, weakness, fatigability, locking, and instability of his right shoulder.  He was not able to lift more than 15 pounds due to his condition.  The CI described his pain as 4-5/10 constantly and 8/10 flares caused by any activity.  He stated rest alleviated the pain and he was not taking any medications.  Right shoulder goniometer measured ROM was forward flexion of 150 (180), abduction of 75 (180), external rotation of 75 (90), and internal rotation of 40 (90) degrees.  There was joint pain throughout ROM, but ROM was not additionally limited by pain, fatigue, weakness, or lack of endurance with repetition (X3).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5003 code (arthritis, degenerative) citing right shoulder pain, status post arthroscopic anterior stabilization procedure, mild non-ratable limitation of motion due to postoperative stiffness, no pain medications, and rated for pain (occasional/minimal).  The VA assigned a 20% rating under an analogous 5201 code (arm, limitation of motion of) based on the VA C&P examination 4 months after separation, documenting “An evaluation of 20 percent is assigned for limitation of arm motion midway between side and shoulder level or for limitation of arm motion at shoulder level.”  Based upon the MEB NARSUM examination, there was no compensable limitation of motion for consideration under 5201 (at shoulder level [90 degrees] is minimum 20% rating).  The ROM in the C&P examination was consistent with the 20% rating.  The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level.”  However, examinations did not reflect this degree of limitation.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available under the 5203 code (clavicle or scapula, impairment of).  The panel agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the right shoulder condition, coded 5201. 

BOARD FINDINGS:  In the matter of the right shoulder condition, the panel unanimously recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  The panel 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 Shoulder Pain	5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007430, XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	 
Enclosure