RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01182
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20041204

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 “chronic pain, left shoulder” with a disability rating of 0%.

CI CONTENTION:  Current condition supports a 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 - 20041007	VARD - 20041221	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Shoulder	5099-5003	0%	Chronic Left Shoulder Strain	5024	10%	20041013	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY.

Chronic Pain, Left Shoulder.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left shoulder condition began in February 2004 while performing physical training during basic training.  No specific injury was noted.  He was able to graduate, but failed a physical fitness test while during advanced individual training.  Physical therapy revealed signs of rotator cuff irritation.  During a 4 May 2004 acute care appointment, the CI complained of left shoulder pain and stiffness.  The examiner noted no left shoulder swelling, erythema, warmth, deformity, or muscle atrophy.  There was shoulder tenderness.  Range of motion (ROM) testing showed full ROM with pain elicited during abduction.  Strength and X-Ray studies were normal.  An MRI on 20 August 2004 was normal other than minimal changes in the shoulder joint of uncertain significance.  The rotator cuff was normal.  During the 19 May 2004 primary care visit, physical examination revealed normal left shoulder ROM except for abduction limited to 160 degrees (normal 180); painful motion was not addressed.  Atrophy was absent.  The 2 July 2004 physical therapy visit showed flexion from 130 to 170 degrees; painful motion was present.  Motor function was normal.

At the MEB NARSUM examination dated 10 August 2004, 4 months prior to separation, the CI reported left shoulder pain, stiffness and the inability to perform overhead activities.  Physical examination revealed left shoulder flexion and abduction to 115 degrees (normal 180); painful motion was present, and 4/5 strength.  During the 17 August 2004 occupational therapy visit, left shoulder abduction and flexion were also 115 degrees; painful motion was not addressed.

At the 13 October 2004 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported difficulty with overhead work, stabbing pain, numbness, and loss of strength.  He denied incapacitation or time lost from work.  Physical examination showed left shoulder flexion and abduction to 90 degrees; limited by pain.  However, repetitive ROM was not limited by pain, fatigue, weakness, lack of endurance, or incoordination.  Left shoulder strength and X-rays were normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the left shoulder condition 10%, coded 5024, (tenosynovitis), based on the C&P examination 2 months before separation, citing pain and limited motion of a major joint.

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).  The panel agreed that the preponderance of STR examinations demonstrated motion well above this level; the VA ROM examination was considered an outlier.  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) documented by STR and VA examinations.  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 left shoulder condition, coded 5003.

BOARD FINDINGS:  In the matter of the chronic pain, left shoulder condition, the panel unanimously recommends a disability rating of 10%, coded 5003 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 Pain, Left Shoulder	5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161004, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018492, 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