RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01467
BRANCH OF SERVICE:  army	SEPARATION DATE:  20041001

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantry, medically separated for “chronic right shoulder pain” with a disability rating of 10%.

CI CONTENTION:  The CI submitted a lengthy condition contending his unfitting condition and other 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 post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs (VA), 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 - 20040715	VARD - 20050118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Shoulder	5009-5003	10%	Status Post Right Shoulder AC (Acromioclavicular) x2 and Type II SLAP (Superior Labral Anteroposterior [Shoulder Lesion]) Repair…	5099-5010	10%	20040816	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Right Shoulder Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), this right-hand dominant CI’s right shoulder condition began in March 2002 while pushing a military vehicle during unit Organizational Day activities.  He was treated conservatively with activity restriction and non-steroidal anti-inflammatory medications but pain persisted.  The CI underwent right shoulder resection surgeries in August 2003 and February 2004.  Following a short period of good progress significant right shoulder pain returned.  Radiographic studies showed acromioclavicular joint resection without evidence of residual impingement.

During the 14 April 2004 MEB NARSUM evaluation, 6 months prior to separation, the CI reported daily right shoulder pain exasperated by overhead work or any activity requiring heavy lifting.  Physical examination showed no shoulder instability.  There was pain with cross body adduction.  Impingement and instability testing was negative.  Right shoulder flexion was 180 degrees (normal 180) with painful motion; abduction was not addressed.

At the 16 August 2004 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported constant right shoulder pain accompanied by creaking and popping and the inability to lift overhead.  Shoulder pain did not cause any incapacitation or lost work time.  Physical examination noted an abnormal looking right shoulder with seven arthroscopic surgical scars present.  Right shoulder ROM was forward flexion to 175 degrees and abduction 160 degrees (180 normal) with painful motion.  His right shoulder ROM was not additionally limited by pain, fatigue, weakness, lack of endurance, incoordination or repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, analogous coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy rated as slight and constant.  The VA also rated the right shoulder 10%, analogously coded 5099-5010 (arthritis due to trauma) citing painful motion.

The VASRD §4.71a threshold for rating the shoulder 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.  Although there was insufficient limitation of motion to support a rating under the 5201 code, panel members agreed that a 10% rating was justified based on painful limited motion IAW 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 rating higher than 10% available with any applicable VASRD code.  The panel noted that the PEB’s reliance on the USAPDA pain policy was not detrimental to arriving at the highest rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder condition.

BOARD FINDINGS:  In the matter of the chronic right shoulder pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore the panel, recommends no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180003339, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
						      					
Enclosure