CRECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01487
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20040629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Army National Guard E6, Infantryman, medically separated for “chronic right shoulder pain” with a disability rating of 0%.  

CI CONTENTION:  Review of additional conditions 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 - 20040520	VARD - 20040817	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain (Dominant)	5099-5003	0%	Right Shoulder Rotator Cuff Impingement	5299-5020	10%	20040602	
			Right Shoulder Injury With Status Post Mumford	5010-5203	10%	20040602	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI’s chronic right shoulder pain began in October 2002 with increased use of the extremity shortly after recovering from left shoulder surgery in July 2002.  An X-ray series dated 10 December 2002 demonstrated deformity of the humeral head suggesting an old Hill-Sachs deformity (compression injury to the humeral head) with mild degenerative changes and no acute dislocation.  The CI underwent physical therapy in August 2003 for decreased right shoulder range of motion (ROM) and strength as well as right shoulder pain.  An MRI revealed acromioclavicular degenerative joint disease with supraspinatus tendinopathy without cuff rupture and an intact labrum.  Despite several injections into the shoulder, pain persisted, and the CI underwent a right shoulder Mumford procedure (excision of the right distal clavicle) surgery on 20 February 2004.  On 31 March 2004, 5 weeks postoperatively, the CI reported he was “about the same” as preoperatively and could not carry weight.  Because of “very slim gains” the CI was recommended for an MEB.  Six weeks postoperatively the CI reported his pain level as 3-4/10 intermittently and the right shoulder ROM was within functional limits.  Scapulothoracic movement was good with slight winging.  

The 6 April 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints that his pain was about the same as preoperatively and the surgery had not successfully relieved his symptoms of impingement.  Physical examination of the right shoulder showed a well healed scar.  ROM of the right shoulder was 170 degrees of adduction (normal 120) (should be abduction (normal 180)) and 170 degrees of forward flexion (normal 180) with 90 degrees each of internal and external rotation.  Painful motion was not mentioned.  During the 13 April 2004 MEB examination (recorded on DD Forms 2807-1 and 2808) 3 months prior to separation, the CI reported both shoulders disturbed his sleep.  The examiner noted bilateral shoulder pain and status post right Mumford surgery in the summary of defects and diagnoses.  

At the 2 June 2004 VA Compensation and Pension (C&P) evaluation, 4 weeks before separation, the CI reported daily “ache” type pain on a 5/10 scale that sometimes radiated to the neck and limited his right shoulder ROM, particularly when working overhead.  Physical examination showed a stable right shoulder with a 9 cm x 1 cm non-tender scar.  ROM measurements were recorded as 120 degrees of adduction and 140 degrees of abduction (180 normal) with 40 degrees of internal rotation and 90 degrees external rotation.  The CI reported pain with facial grimacing on all planes.  The examiner noted guarding was not present.  Additionally, the right shoulder was stable.  

At a physical therapy visit on 28 June 2004, 1 day prior to separation, the CI complained of pain with benching/pushing and remained unable to lie on his right side.  On examination, he was tender over the distal clavicle on the right and the active ROM was normal with manual muscle testing of 5/5.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, coded 5099-5003 (arthritis, degenerative (hypertrophic or osteoarthritis)), citing no significant loss of shoulder motion or evidence of joint instability.  The VA rated the right shoulder condition 10%, coded 5020 (synovitis), based on the C&P examination 4 weeks before separation, citing persistent severe painful impairment of the right shoulder.  The VA additionally rated the right shoulder condition another 10%, coded 5203 (clavicle or scapula, impairment of) citing painful limited motion. 

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), and the examinations in evidence demonstrated motion above this level.  However, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion) based on the VA examination prior to separation.  There was no malunion or recurrent dislocation of the humerus and no dislocation or nonunion of the clavicle or scapula to justify a rating under the 5202 (humerus, other impairment of) or 5203 (clavicle or scapula, impairment of) codes. However, the panel did note that the CI had surgical removal of the distal third of the right clavicle; however there was no loose movement, which could also conceivably warrant a 10% rating.  However, to do so would invoke VASRD §4.14 (avoidance of pyramiding).  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 chronic right shoulder pain condition, coded 5099-5003.  
BOARD FINDINGS:  In the matter of the chronic right shoulder condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 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 Right Shoulder Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160928, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001616, 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