RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02483
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041027

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “painful right shoulder…” with a disability rating of 10%.  

CI CONTENTION:  The CI contends for his unfitting right shoulder and conditions not identified by either the MEB or PEB.  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 review of disability ratings assigned 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 or non-compensable.  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 determination 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(s) 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 - 20040831	VARD - 20050419	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Painful Right Shoulder…	5099-5003	10%	Right Shoulder Injury With Chronic Strain	5203-5019	10%	20041220	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Painful Right Shoulder.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right hand dominant CI began having right shoulder pain in November 2000 while doing pull-ups during platoon physical training.  He underwent right shoulder surgery on 5 April 2002 for a subacromial decompression with repair and debridement of a superior labrum, anterior to posterior (SLAP) lesion.  The CI continued to have shoulder pain and underwent an examination under anesthesia with diagnostic right shoulder arthroscopy in January 2004 which showed some inflammation in his biceps anchor, synovitis as well as grad II chondromalacia (rough cartilage) of the glenoid.  Debridement of the loose cartilage was performed at that time.  Following surgery further treatment did not result in significant improvement.  

At a 1 March 2004 orthopedic clinic appointment, 2 months after surgery and 8 months prior to separation, the examiner recorded there were no signs of instability.  Right shoulder flexion was 150 degrees (normal 180) and abduction was 140 degrees (normal 180).  

The 1 June 2004 MEB NARSUM examination, 5 months after surgery and 5 months prior to separation, the CI complained of shoulder pain that caused difficulty with overhead activities, physical training and infantryman-specific tasks.  Shoulder dislocations and instability were denied.  The physical examination showed no evidence of instability (load shift was stable bilaterally).  He had pain with apprehension, which resolved with relocation.  He had negative Neer and Hawkins impingement signs.  Right shoulder flexion was 175 degrees (normal 180) and abduction was 175 degrees (normal 180).  

At the 20 December 2004 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported his shoulder hurt daily with a constant ache.  He reported flares 2 to 3 times a month.  He felt his arm had a popping like it was going to come out of its socket.  He did not miss any work because of his shoulder condition.  On examination, right shoulder flexion was 180 degrees (normal) and abduction was 180 degrees (normal).  Painful motion was present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating coded 5099-5003 (analogous to degenerative arthritis), citing pain with repetitive motion or strenuous use.  The VA also assigned a 10% rating using a dual 5203-5019 code (impairment of clavicle or scapula and bursitis), citing painful or limited motion of a major joint or group of minor joints.  

The VASRD §4.71a threshold for rating shoulder 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 well above this level.  Although there was insufficient limitation of motion to support a rating under 5201, panel 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 to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder condition.  

BOARD FINDINGS:  In the matter of the painful right shoulder condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  

The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150713, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013253, XXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
						      					
Enclosure