RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00044
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090817

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Indirect Fire Infantry, medically separated for “chronic right shoulder pain and immobility” with a disability rating of 10%.  

CI CONTENTION:  The CI contends for his unfitting condition as well other conditions not within the panel’s scope.  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 - 20090511	VARD - None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain and Immobility	5099-5003	10%	No VA Claim in Record	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain and Immobility.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI’s chronic right shoulder pain and immobility condition began when he injured his right shoulder in December 2004 during a snowboarding fall while on leave.  Radiographic studies showed findings consistent with a grade IV acromioclavicular (AC) dislocation.  His pain resolved over a 6 month course of physical therapy, however, the CI reinjured his right shoulder in April 2007 while ruck marching in Vicenza Italy.  On 29 June 2007, the CI underwent right shoulder decompression and modified Weaver-Dunn surgery (includes excision of the distal clavicle).  Physical therapy had little positive results and the CI underwent his second right shoulder surgery (right shoulder revision) on 2 July 2008.  Despite treatment and surgeries, the right shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty. 

During the 1 April 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported a painful right shoulder with a lump and limited abilities with the right arm.  Physical examination showed “near-full” range of motion (ROM) of the right shoulder with marked pain with resisted abduction and with palpation of the AC joint.  

The 17 April 2009 MEB NARSUM evaluation, 4 months prior to separation, noted complaints of pain and instability of the right shoulder which precluded the CI from performing the duties required of his MOS as well as push-ups, pull-ups and carrying a rucksack.  X-rays showed distal clavicle resection and inter bony calcification in the AC joint.  Magnetic resonance imaging (MRI), dated 23 May 2008, showed a degenerative SLAP tear, AC separation and postsurgical changes and artifact.  The examiner narrative and physical examination was taken from the most recent orthopedics evaluation on 26 November 2008, 9 months prior to separation.  At that appointment, the CI reported right shoulder pain at 1-2/10 with activities, but 5-7/10 with running or other jerking actions.  The examiner noted a “mild to moderate deformity at the distal clavicle” and mild to moderate tenderness over the AC joint area.  ROM was flexion of 160 degrees and abduction of 150 degrees (normal is 180 degrees for each).  There was positive testing for impingement and painful motion.  There was moderate upper lateral arm pain with resisted abduction.  Motor strength was 5/5 (normal) in the upper extremities.  ROMs copied from the 1 April 2009 physical therapy evaluation, 4 months prior to separation, recorded right shoulder flexion to 141 degrees and abduction to 140 degrees (normal is 180 degrees for each).  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5099-5003 code (degenerative arthritis), citing functional loss due to pain.  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.  Although there was insufficient limitation of motion to support a rating under the 5201 code, 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).  

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 chronic right shoulder pain 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 20160123, w/atchs
Exhibit B.  Service Treatment Record

AR20170013204, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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,