RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-00208
BRANCH OF SERVICE: ARMY 	SEPARATION DATE:  20050610

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E3, Basic Trainee, medically separated for “chronic right shoulder pain and weakness” with a disability rating of 10%.  

CI CONTENTION:  “The condition should be changed due to increased severity of the condition.”  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 - 20050524	VARD - 20060630	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain and Weakness	8519	10%	Thoracic Nerve Palsy and Limitation of Shoulder Motion	5201	20%	STR	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain and Weakness.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s non-dominant right shoulder condition began in March 2005 after falling from an obstacle.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow completion of basic training.  

At the 2 May 2005 physical therapy evaluation, 12 days prior to separation, the CI complained of right shoulder pain that was increased by raising the arm above the shoulder level and by lifting objects.  The physical examination showed winging of the right scapula throughout flexion and abduction motions.  Pain increased from 3/10 to 5/10 with motion.  

The 5 May 2005 MEB NARSUM examination, 9 days prior to separation, noted complaints of bilateral arm weakness, right greater than left which prevented the CI from doing pushups or carrying field gear.  The physical examination showed weakness of the right shoulder girdle due to palsy of the serratus anterior muscle (innervated by the long thoracic nerve) that was most prominent with forward arm extension.  The CI had good strength in the other muscle groups of both upper extremities.  The examination was silent regarding shoulder range of motion (ROM).  Imaging studies of the right shoulder on 12 May 2005 revealed a slight obliquity of the scapula (due to winging) but there were no other significant findings or fracture.  

The 12 May 2006 VA orthopedic evaluation, 12 months after separation, noted complaints of winging of the right scapula and pain.  The physical examination showed very prominent winging of the right shoulder with a positive Hawkins and Neer sign (impingement signs).  The examiner noted limitation with internal and external rotation but did not quantify.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, coded 8519 (long thoracic nerve, paralysis of, incomplete, moderate).  The VA rated the right shoulder condition 20%, coded 5201 (Arm, limitation of motion), based on the STR and the 12 May 2006 orthopedic clinic evaluation, citing painful and limited arm motion.  

Although there was insufficient limitation of motion to support a rating under the 5201 code, panel members agreed that a minimal compensable rating of 20% 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 a rating under the 5203 code (clavicle or scapula, impairment of).  Members agreed that an additional rating using code 8519 would violate VASRD §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the chronic right shoulder pain and weakness condition, dual coded 8519-5201.  

BOARD FINDINGS:  In the matter of the chronic right shoulder pain and weakness condition, the panel unanimously recommends a disability rating of 20%, dual coded 8519-5201 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel 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 Right Shoulder Pain and Weakness	8519-5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160409, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170014105, 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