RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00369
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060410

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee, medically separated for “right shoulder pain” with a disability rating of 0%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20060323	VARD - 20070622	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain…	5099-5003	0%	Residual Acromioclavicular Joint Separation, Right, Mild	5203	NSC	20070426	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI injured her right shoulder in August 2005 while low crawling during Initial Entry Training.  The CI reported that she had a history of dislocating her shoulder in college prior to service.  Radiographic studies showed she had no obvious bony injury but did show evidence of a history of a dislocation with post-reduction films present.  The CI reported to the urgent care clinic where she had a closed reduction performed.  The CI was evaluated by orthopedics and underwent an arthroscopic Bankart procedure (procedure performed to stabilize the shoulder) in October 2005.  Three months of follow-up therapy and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  According to the 10 February 2006 MEB NARSUM evaluation, 2 months prior to separation, the examiner noted first that “she had a range of motion of 0-180 degrees (180 normal) in her shoulder with pain at extreme ranges of motion,” but then stated “she had forward flexion of 140 degrees” and “extension was to 110 degrees.”  The CI had negative load shift, apprehension and relocation testing.  She had 5/5 shoulder strength in her right shoulder.  At the 9 March 2006 Physical Therapy appointment, 1 month prior to separation, the CI’s shoulder ROM was measured with a flexion of 180 degrees (180 normal) and adduction of 180 degrees (180 normal).  

At the 26 April 2007 VA Compensation and Pension (C&P) examination, performed 12 months after separation, the CI reported intermittent right shoulder pain with no flare ups.  Physical examination showed near normal right shoulder ROM.  The flexion was 170 degrees (180 normal) and adduction was 170 degrees (180 normal) with painful motion and tenderness.  Radiographic studies showed a mild acromioclavicular joint separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder pain condition 0%, coded analogously as 5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA determined the right shoulder pain condition was not service-connected.  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 of).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right shoulder condition.  

BOARD FINDINGS:  In the matter of the right shoulder pain condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.59.  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	
Right Shoulder Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170015437, 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