RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01450
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040524

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Computer/Automated System Repairman, medically separated for “chronic right shoulder pain” with a disability rating of 10%.  

CI CONTENTION:  The CI made a contention for his shoulder.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040317	VARD - 20040806	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5099-5003	10%	Arthroscopic Debridement of Frayed Superior and Posterior Labrum, Right Shoulder	5299-5201	20%	20040628	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI underwent right shoulder surgery in December 2002 for arthroscopic debridement of frayed superior and posterior labrum; anterior capsular shrinkage.  At the 4 November 2003 Physical Therapy (PT) appointment, 7 months prior to separation, the CI reported that he still had problems with popping and dislocation/slipping symptoms.  Physical examination showed range of motion (ROM) measurements with forward flexion to 150 degrees (normal 180) and abduction to 145 (normal 180).  There was a negative load and shift test, and palpable click with circumduction, horizontal abduction and adduction that the patient reported as “deep” and painful.  The examiner recommended an orthopedic consult.  

At the 24 November 2003 orthopedics clinic appointment, 6 months prior to separation, the CI reported “pain in the right shoulder and a feeling of instability.”  Physical examination showed supple ROM with a 1+ anterior drawer and posterior drawer, and a positive apprehension sign.  The examiner reported that radiographic (X-ray) studies were normal and gave an impression of “multi-directional mild instability of the right shoulder, status post thermal shrinkage procedure.”  

According to the 4 March 2004 MEB NARSUM evaluation, 3 months prior to separation, the CI complained of right shoulder pain and instability.  The CI had severe limitations, could hardly do any overhead lifting, climbing onto tactical vehicles, using a weapon, or pushups.  The commander’s statement reported that the CI could not perform his Military Occupational Specialty because of his inability to lift and climb.  Physical examination (recorded on DD Forms 2807-1 and 2808) on 30 January 2004, showed ROM measurements with forward flexion to 100 degrees and abduction to 100 degrees.  The CI had tenderness at all extremes of motion and had significant popping at extremes of motion, which caused a significant amount of pain.  There was no effusion.  He had a positive apprehension test and anterior and posterior drawer tests were positive.  The examiner reported that the CI “understands he had a significantly impaired right shoulder that may or may not improve with a complex reconstruction, and he had declined further surgery at that time.  He preferred to leave the Army and pursue a career in administration.” 

At the 28 June 2004 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported persistent popping, grinding with overhead ROM, sensation of right shoulder slippage with carrying more than 10-15 pounds with his right arm.  Physical examination showed ROM measurements with a forward flexion of 75 degrees and an abduction of 75 degrees.  There was crepitus, no atrophy, and slight decrease in muscle strength 4+/5.  There was impingement with minimal abduction.  There was pain, fatigue, weakness or incoordination noted with repetition.  The examiner estimated a 30% decrease of ROM with repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the shoulder condition 10%, analogous coded (arthritis, degenerative), citing limited abduction and flexion of 100 degrees and no episodes of subluxation/dislocations.  The VA rated the right shoulder condition 20%, analogously coded 5201 (arm, limitation of motion), citing limitation of motion of forward flexion and abduction of 75 degrees.  The panel agreed that a 20% rating was justified for a ROM impairment that was at shoulder level (approximately 90 degrees from the side) or less coded 5201, (arm limitation of motion), as shown on the VA examination in evidence.  The C&P examination showed a limitation of motion of 75 degrees that was above that required for the next higher 30% rating which requires motion limited to “midway between side and shoulder level” (45 degrees).  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available 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 20% for the right shoulder condition.  

BOARD FINDINGS:  In the matter of the chronic right shoulder pain condition, the panel unanimously recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends 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 Right Shoulder Pain	5201	20%	

The following documentary evidence was considered:

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

AR20180003424, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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