RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00832
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E4, Infantryman, medically separated for “right shoulder pain” with a disability rating of 20%.

CI CONTENTION:  Current condition supports a higher rating.  The VA rating less than 12 months supports a higher rating.  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 - 20040515	VARD - 20050106 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5201	20%	Residuals, Injury of Right Shoulder	5202	50%	20050106	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) and Addendum, the CI underwent two right shoulder surgery (25 April 2002 and 15 May 2003) for pain and recurrent shoulder dislocations following an injury in October 2001.  The initial 23 August 2002 MEB NARSUM examination, prior to the CI’s second surgery, documented right shoulder range of motion (ROM) with flexion to 95 degrees (normal 180), a positive apprehension sign, guarding to all motion, and palpable and visible subluxation.

The 10 November 2003 MEB NARSUM Addendum examination, 6 months prior to separation, noted complaints of some numbness of the fourth and fifth digits of his right hand with some mild cubital tunnel-type symptoms.  Physical examination showed no hypothenar eminence wasting and no median nerve symptoms on the right hand.  The CI had positive apprehension and pain in his shoulder “with the CI not feeling the shoulder was stable as far as posterior stability.”  Some increase in inferior sulcus +2 was noted compared to the left side.  The diagnosis was “chronic right shoulder instability status-post reconstruction times two.”

On 17 March 2004, 2 month prior to separation, the CI was seen in the emergency department for right shoulder pain and right arm neurologic symptoms (numbness and tingling).  The diagnosis was recurring shoulder dislocation.  The 25 March 2004 emergency department visit noted a re-injury of the right shoulder 1 month prior due to a fall.  There was diffuse right shoulder tenderness and global decreased ROM due to pain.

At the 16 December 2004 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported chronic pain with decreased ROM.  He reported that he could not do any physical work that involved his right arm or his shoulder would dislocate.  His daily activities were limited and he had to brush his teeth with his left arm.  He could not reach over and do the seatbelt with his right arm and any activities that he would normally do with his right arm, he had to do with his left arm.  The CI used Percocet (narcotic pain medication) three times per day and detailed that pain was unbearable.  Physical examination documented ROM with flexion to 80 degrees and abduction to 30 degrees with painful motion.  The examiner indicated that there was additional limitations with repetitive use and during flare-ups, without specifying other ROM limitations.  VA clinic evaluations and orthopedic consultation throughout 2005 showed continuing evidence of right shoulder pain and frequent dislocations.  VA records show the CI had additional right shoulder surgery on 18 September 2006 (over 2 years remote from separation), and continued having right shoulder dislocations following that surgery.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 20%, coded 5201 citing abduction limited to 90 degrees.  The VA rated the right shoulder condition 50%, coded 5202 (humerus, other impairment) based on the C&P examination 7 months after separation, citing 30% due to inability to do work as right shoulder would dislocate.  An additional 20% was awarded for moderate functional loss based on VA examination showing chronic pain of the right shoulder.

The record clearly documented pre-separation re-injury of the right shoulder that occurred after the NARSUM examination and PEB.  The panel therefore adjudged that the C&P examination had the highest probative value for rating at separation.  The ROM examination demonstrated abduction limited to 30 degrees with forward flexion of 80 degrees and the panel discussed if the ROM limitations were closer to the 40% rating under code 5201 for “25 degrees from side” (40%) or “midway between side and shoulder level” (30%), or if the evidence better supported rating at 30% under code 5202 for “recurrent dislocation…frequent episodes and guarding of all arm movements.”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the right shoulder condition, coded 5201-5202.

BOARD FINDINGS:  In the matter of the right shoulder condition, the panel unanimously recommends a disability rating of 30%, coded 5201-5202 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; 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:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Shoulder Pain	5201-5202	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160916, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018013, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure