RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02082
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050412

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 “tendonitis and adhesive capsulitis with residual right shoulder pain,” with a disability rating of 0%.  

CI CONTENTION:  The CI’s condition continues to worsen and negatively impacts daily activities.    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 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 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 - 20050315	VARD - 20060602	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tendonitis and Adhesive Capsulitis with Residual Right Shoulder Pain	5024	0%	Right Shoulder Condition	5201	NSC	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  --	

ANALYSIS SUMMARY:  

Tendonitis and Adhesive Capsulitis with Residual Right (Dominant) Shoulder Pain.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI injured his right shoulder on 23 May 2004.  An MRI from 6 July 2004 showed mild to moderate edema (fluid) in the area of the deltoid muscle.  There was minimal fluid in the sub-deltoid bursa.  There was mild to moderate fluid along the head of the biceps tendon.  The rotator cuff was intact.  A bone scan from 23 August 2004 was normal.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “rotator cuff tendinitis of the right shoulder symptomatic” and “adhesive capsulitis” for PEB adjudication.  During the MEB examination (recorded on DD Forms 2807 and 2808) dated 26 September 2004, 7 months prior to separation, the CI reported his shoulder was painful and he could not raise it above his head.  The examiner noted the CI continued to have pain, limited range of motion (ROM), radiculopathy and right hand paresthesia.  On physical examination right shoulder ROM was flexion 90 degrees (normal 180) and abduction was 98 degrees (normal 180).  At the time of the orthopedic clinic appointment on 5 October 2004, 6 months prior to separation, the CI reported no improvement with pain even with use of medications.  He complained of numbness to his ring and small fingers.  Physical examination showed right shoulder flexion ROM was 90 degrees.  There was crepitus and painful motion.  According to the MEB NARSUM evaluation on 6 January 2005, 3 months prior to separation, the CI complained of ulnar parathesias and shoulder pain with sharp radiating symptoms up his neck and down his arm.  Shoulder dislocations were not reported.  ROM measurements were taken by the examiner; however, they were recorded as passive rather than active measurements.  Tenderness and painful motion were present.  At the time of the physical therapy clinic appointment on 17 January 2005, 3 months prior to separation, the CI was seen by an examiner to have ROM measurements taken.  Right shoulder flexion ROM was 107, 96 and 100 degrees and abduction was 70, 74 and 73 degrees after repetitive motion.  The CI did not attend his scheduled VA Compensation and Pension (C&P) evaluation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 5024 code (tenosynovitis), citing “pain limits the ratable range of motion as well as not meeting minimal rating criteria.”  The VA did not service connect the right shoulder pain condition, coded 5201 (limitation of motion of arm).  The VASRD §4.71a threshold for rating ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side).  The 20% rating for the dominant arm requires motion limited to “at shoulder level” and examinations proximate to separation reflected 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 rating available 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 recommends a disability rating of 20% (coded 5201) for the right shoulder condition.  

BOARD FINDINGS:  In the matter of the right shoulder condition, the Board unanimously recommends a disability rating of 20%, coded 5201 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	
Tendonitis and Adhesive Capsulitis with Residual Right Shoulder Pain	5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150725, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170004077 , XXXXXXXXXXXXXXXXXX

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,