RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02300
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070221

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantryman, medically separated for “osteoarthritis, left shoulder…” with a disability rating of 0%.  

CI CONTENTION:  The CI’s condition continues to worsen and negatively impact 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 - 20070125	VARD - 20071127	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis, Left Shoulder…	5099-5003	0%	Left Shoulder Labral Tear, Left Shoulder Cyst and Tendinopathy, with DJD Distal Clavicle 	5203-5024	10%	20070830	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Osteoarthritis, Left (Non-Dominant) Shoulder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right dominant CI injured his left shoulder in early 2006 while lifting weights.  The initial examination showed normal range of motion (ROM) and strength, but with tenderness.  An X-ray showed minimal degenerative joint disease (DJD) of the collar bone near the shoulder.  He was treated with medications, duty limitations, and physical therapy (PT), but his pain persisted.  Magnetic resonance imaging (MRI) studies 28 July 2006 showed degenerative changes and a tear of the labrum (cartilage lining of the shoulder).  He was referred to orthopedics.  There was no surgical indication.  A steroid injection was performed, but was not beneficial and the CI was not able to return to unrestricted duty.  The MEB forwarded “osteoarthritis, left shoulder” for PEB adjudication.  According to the MEB NARSUM evaluation on 9 January 2007 (1 month prior to separation) the CI complained of shoulder pain that caused him to be unable to move his arm when he ‘tweaks’ his shoulder.  Shoulder dislocations or subluxations were not reported.  Left shoulder range of motion (ROM) flexion was 170 degrees (normal 180 degrees) and abduction was 165 degrees (normal 180 degrees).  Motion was limited by pain.  At the VA Compensation and Pension (C&P) examination, performed on 30 August 2007, 6 months after separation, the CI reported difficulty lifting his arms above shoulder level and occasional giving way.  Left shoulder flexion and abduction were normal and not additionally limited by pain, fatigue, weakness or lack of endurance following repetitive use.  Painful motion, tenderness and effusion were not present although his baseline pain increased with use.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5099-5003 code (degenerative arthritis), citing ROM limited by pain.   The VA assigned a 10% rating using a 5203-5024 dual code (impairment of clavicle or scapula and tenosynovitis) for MRI documentation of degenerative changes and chronic pain of the shoulder.  The Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion) under the code 5003 (degenerative arthritis).  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.  

BOARD FINDINGS:  In the matter of the left shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.59 and 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	
Osteoarthritis, Left Shoulder	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150830, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004238, 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