RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00116
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050818

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Infantryman, medically separated for “chronic pain and subluxation, right shoulder” rated 0%.

CI CONTENTION:  “Shoulder has since deteriorated.”  The CI’s 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 – 20050712	No VA examination in evidence	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Shoulder	5099-5003	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Pain and Subluxation, Right Shoulder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right dominant CI underwent right shoulder surgery in March 2005 to repair a torn labrum (the cartilage surrounding the socket of the shoulder joint). Right shoulder post reduction films showed typical anterior inferior humeral head dislocation with normal approximation following reduction.  

During the MEB examination (recorded on DD Forms 2807 and 2808) dated 17 May 2005, 2 months after surgery and 3 months prior to separation, the CI reported continued right shoulder pain and instability, and that the shoulder continued to “pop in and out” of the socket.  Physical examination showed tenderness of the shoulder joint, with the shoulder blade demonstrating winging (the shoulder blade protruding abnormally from the patient’s back) when the arm was “moved forward”.  
Shoulder joint range of motion (ROM) was recorded as flexion and abduction both limited to 30 degrees (180 normal for each), with marked pain elicited on motion.  The examiner opined the CI experienced significant limitation of ROM and pain in the right shoulder with movement or any stress.  He had chronic popping and dislocation of the shoulder and it was very unstable.  VA record review was not consented to by the CI.  Three years after separation, the CI re-enlisted in the Army with a waiver for the right shoulder in June 2008.  He went on to serve on three combat tours as an infantryman, with final separation from active duty in May 2014.  The right shoulder was not the cause of the second separation.  The Board directed attention to its rating recommendation based on the above evidence.  

The PEB assigned a 0% rating under the 5099-5003 code (analogous to degenerative arthritis), citing the US Army Physical Disability Agency Pain Policy, which rated the injury as slight/intermittent.  The NARSUM examiner described the winging of the scapula as the impairment that caused the dislocation that responded to manual reduction.  Winging of the scapula was identified by the NARSUM examiner and appeared to be the substrate for the shoulder issues.  Winging of the scapula is a relatively rare condition that auto corrects in 12-24 months after surgery.  Improvement of his condition had clearly occurred to support his re-acceptance into the Army after a 3 year separation.  Panel members agreed that the chronic pain right shoulder condition was likely due to the impairment of the scapula, coded 5203, and rated 20%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the right shoulder condition, coded 5203.

BOARD FINDINGS:  In the matter of the right shoulder pain and subluxation, the Board unanimously recommends a disability rating of 20%, coded 5099-5003 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  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	
Chronic Pain and Subluxation, Right Shoulder	5203	20%	
COMBINED	20%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20160311, with attachments
Exhibit B.  Service Treatment Record

AR20170013360, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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