RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01741
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070518

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E7, Cannon Crewmember, medically separated for “chronic right shoulder pain” with a disability rating of 0%.

CI CONTENTION:  “Please review all conditions.”  The CI’s 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 progression or complications of service-connected conditions after separation.  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 – 20070406	VARD - 20071219	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5099-5003	0%	Residuals, Right Shoulder Rotator Cuff Tear	5203	0%	20071031	
Chronic Left Shoulder Pain	Not Unfitting	Residuals, Left Shoulder Injury	5203	0%		
Right Foot Pain with Bunion		Plantar Spur, Right Foot	5299-5278	0%		
		Residuals, Right Foot Bunionectomy	5280	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent for right shoulder arthroscopy, subacromial decompression, and anterior labral repair in December 2005.   Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “bilateral shoulder pain” for PEB adjudication.  

At the 10 July 2006 orthopedic clinic appointment, 11 months prior to separation, the CI reported some pain with weather changes and could not do enough pushups to pass the physical readiness test.  Physical examination showed pain, near full active range of motion (ROM), and normal strength.  There was no shoulder swelling, stiffness, locking, popping, snapping, clicking, grating, catching, giving way, instability, or dislocation.  

In the 16 March 2007 MEB NARSUM addendum, 2 months prior to separation, the CI stated “that his left shoulder has no significant limitations and feels pretty good but the right shoulder is the main limiting factor in his military service.”  He complained of 2-3/10 pain that occurred approximately 25-50% of the day.  The right shoulder examination revealed tenderness over the acromioclavicular (AC) joint.  ROM measurements showed a flexion of 100 degrees (normal 180) and abduction of 100 degrees (normal 180).  There was pain with extremes of all directions of motion and a mildly positive O’Brien’s (assesses glenoid labrum and AC joint) test.  

At the 31 October 2007 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported “No current trouble with right shoulder except stiffness of shoulders and neck with cold days.”  The right shoulder examination revealed tenderness with no joint ankylosis, inflammatory arthritis, bone loss, or evidence of recurrent dislocations.  Pain-limited active ROM was flexion of 112 degrees and abduction of 130 degrees.  There was no additional loss of ROM on repetitive use.  The right shoulder radiographic (X-ray) studies were unremarkable with no evidence of osseous or articular abnormality.  

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 pain limited ROM.  The VA also assigned a 0% rating under the 5203 code (clavicle or scapula, impairment of), citing no evidence of malunion or nonunion of the clavicle or scapula and no X-ray evidence of osseous or articular abnormality.  

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.  There was no malunion 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.  However, panel members agreed that a 10% rating was justified with application of VASRD §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 10% for the right shoulder condition.  

Contended PEB Conditions:  Left Shoulder Pain and Right Foot Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that chronic left shoulder pain and right foot pain with bunion conditions were not unfitting.  While the chronic left shoulder pain condition was profiled and implicated in the commander’s statement, it was not judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the left shoulder pain condition and so no additional disability rating is recommended.  The right foot pain condition was not profiled, implicated in the commander’s statement, or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the right foot pain condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic right shoulder pain condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended chronic left shoulder pain and right foot pain conditions, the panel unanimously recommends no change from the PEB determination as not unfitting.  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	
Chronic Right Shoulder Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150615, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008888, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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