RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00371
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20060303

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E4, Bradley Fighting Vehicle System Maintainer, medically separated for “ “right shoulder pain” with a disability rating of 0%.  

CI CONTENTION:  The CI requested a review of all conditions.  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 progression or complications of service-connected conditions after separation.  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 - 20060216	VARD - 20060829	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain…	5201	0%	Right Shoulder, Instability with Pain	5202	30%	20060809	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right shoulder surgery on 6 September 2005 for shoulder arthroscopic Bankart repair and capsular shift.  According to the 16 October 2005 MEB NARSUM evaluation, 5 months prior to separation and 8 weeks after surgery, the CI complained “my right shoulder bothers me and pops out of joint and I have pain in it.”  The examiner noted that the CI has generalized laxity of his joints to include ability to touch his thumb to his forearm, hyperextension of his elbows, externally rotate his hips greater than 90 degrees, and hyperextension of his knees.  Physical examination showed range of motion (ROM) with flexion of 140 degrees (180 normal) and a normal abduction of 180 degrees.  There was normal strength, and no erythema, edema, or warmth.  The CI did have the ability to sublux his shoulder and had a 1+ load shift test.  Radiographic (X-ray) and magnetic resonance imaging (MRI) studies were consistent with a Bankart lesion but no damage to the rotator cuff was noted.  No guarding was evident during the examination.  The examiner reported that the CI did not want an additional surgery.  At the 2 November 2005 physical therapy clinic appointment, 4 months prior to separation, for MEB NARSUM ROM measurements, the CI reported no pain and occasional tingling in his right hand.  The examiner noted that the CI could cause subluxation of his right shoulder repeatedly at approximately 100 degrees of flexion and abduction with pain at 90 degrees abduction.  ROM measurements showed flexion of 125 degrees (180 normal) and abduction of 165 degrees (180 normal) after 3 repetitions.  Additional ROM measurements showed flexion of 175 degrees and abduction of 205 degrees.  At the 13 December 2005 follow up physical therapy clinic appointment, 3 months prior to separation, the examiner reported that the CI had full ROM, significant crepitus, and pain with certain movements.  At the 23 January 2006 post-surgery orthopedic clinic appointment, 2 months prior to separation, the examiner reported no shoulder pain, swelling, or stiffness.  Examination of the shoulder showed normal motion, pain was elicited on motion, instability was noted, no swelling, no edema, no deformity, and no atrophy of the shoulder muscles.  The humeral head was not displaced sub coracoid, and there was no tenderness or spasm noted.  At the 9 August 2006 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported constant pain with stiffness.  He denied swelling, heat, redness, or locking, but has instability with lifting more than 25 pounds, and stated that he has repeated dislocations despite his surgery.  His flare-up pain reached severe pain which occurred about 4 days a week and last up 2 to 3 hours.  The CI reported the pain was aggravated by daily activities such as lifting his daughter or doing household chores that required lifting and reaching.  Physical examination showed ROM measurements of flexion at 160 degrees (180 normal) with pain and abduction of 160 degrees (180 normal) with pain.  The ROM was not additionally limited by pain, fatigue, weakness, or lack of endurance following repetitive use.  No guarding was evident during the examination.  The shoulder was positive for laxity, instability with positive sulcus and positive anterior posterior apprehension test with 6 mm displacement, and crepitus with popping was noted.  X-ray studies on 9 August 2006 were negative with no evidence of recent fracture, dislocation or other bone or joint abnormality.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder pain condition 0%, coded 5201 (arm, limitation of motion), citing abduction to over 90 degrees.  The VA rated the right shoulder pain condition 30%, coded 5202 (humerus, other impairment of), citing constant pain with stiffness and easy instability with lifting more than 25 pounds.  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.  However, 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 and no dislocation or nonunion of the clavicle or scapula to justify a higher rating under the 5202 (humerus, other impairment of) or 5203 (clavicle or scapula, impairment of) codes.  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%, analogously coded 5201-5003 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	5201-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160701, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170015438, 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