RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01140
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040710

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Indirect Fire Infantryman, medically separated for “left (non-dominant) shoulder pain” with a disability rating of 0%.  

CI CONTENTION:  His rating should have been higher rating.  Additional unfitting conditions were not considered.  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 - 20040427	VARD - 20040913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left (Non-Dominant) Shoulder Pain	5019	0%	Left Shoulder Bursitis	5299-5019	10%	STR	
	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Left (Non-Dominant) Shoulder Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left shoulder condition began in March 2003 after doing pull-ups and without any specific traumatic event.  

At a 3 March 2004 civilian (German) orthopedic and sports medicine specialist evaluation, 4 months prior to separation, the physical examination indicated no change compared to the examination during a previous appointment (4 February 2004). Left shoulder range of motion (ROM) was flexion to 140 degrees (normal 180) and abduction to 90 degrees (normal 180) with “almost free” external and internal rotations.  There was no loss of upper extremity sensation and reflexes were normal.  Electrodiagnostic testing showed no trapezius muscle pathologic findings, but other muscle testing revealed “suspected plexus brachialis neuropathy.”  Ultrasound showed an intact rotator cuff and bicep tendon with slight signs of effusion.  The specialist stated that “according to our clinical findings and the neurological examination [the CI] suffers from a Plexus brachialis neuropathy,” and recommended a course of steroids.  

During the 19 March 2004 MEB NARSUM examination, 4 months prior to separation, the CI reported that previous electrodiagnostic testing (from 3 March 2004) showed “compression of three nerves,” however, the examiner indicated no report was in the record.  Physical examination showed left shoulder pain with palpation.  Shoulder ROM was abduction to 180 degrees with painful motion and crepitus from 140 to 180 degrees; internal and external rotation were limited and painful, with some abnormal scapular motion (flexion was not recorded).  Sensory and motor testing as well as pulses were normal.  During the 14 April 2004 MEB NARSUM addendum examination, 3 months before separation, physical examination showed repetitive left shoulder flexion to 105 degrees and abduction to 100 degrees with painful motion.  There was no VA examination proximate to separation for the panel to review.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 0%, coded 5019 (bursitis) citing abduction ROM and no pain medication use.  The VA rated the left shoulder condition 10%, analogously coded 5299-5019, based on the STR, citing painful or limited motion.  The panel adjudged that ROM measurements from both NARSUM examinations were closest to separation and had the highest probative value for rating.  The VASRD §4.71a threshold for rating ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations 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); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment).  There was no unfitting muscle weakness or unfitting neurologic deficit noted on examinations proximate to separation, and therefore no additional shoulder ratings are supported.  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 left shoulder condition, coded 5299-5019.  

BOARD FINDINGS:  In the matter of the left (non-dominant) shoulder pain condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5019 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	
Left (Non-Dominate) Shoulder Pain	5299-5019	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160930, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment

AR20170019434, 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