RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01605
BRANCH OF SERVICE:  army	SEPARATION DATE:  20041006

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantryman, medically separated for “chronic right shoulder pain” with a disability rating of 0%.  

CI CONTENTION:  The military gave a 0% rating for his condition, the VA gave a 30% rating, and a 30% rating for post-traumatic stress disorder (PTSD).  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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20040721	VARD - 20041207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain 	5099-5003	0%	Residuals Gun Shot Wound, Right Forearm	5201	30%	20041104	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-handed CI’s shoulder condition began in December 2003 after receiving a gunshot wound during combat operations.  He underwent initial wound debridement and was admitted for surgical evaluation on 3 January 2004.  Examination showed a “through-and-through” soft tissue wound that did not affect the “bone, nerves or vascular structures.”  The surgeon noted “great axillary brachial, radial and ulnar pulses” with no sign of neurologic deficiency.  The CI underwent wound debridement and closure and was discharged on 8 January 2004.  Radiographic (X-ray) studies on 12 January 2004, showed shrapnel in the soft tissue with no evidence of neurovascular or bone damage associated with the injury.  

A 14 January 2004 orthopedics clinic evaluation recorded a well-healing, right shoulder wound, and range of motion (ROM) showing flexion to 90 degrees (normal 180).  At a 12 March 2004 physical therapy (PT) appointment, 7 months prior to separation, the examiner noted the wound was healing well with shoulder flexion to 110 degrees and abduction to 100 degrees (normal 180).  The CI could rotate to T12 internally and 60 degrees externally with painful motion.  

The 2 June 2004 MEB NARSUM examination, 4 months before separation, noted complaints of right shoulder and upper arm pain.  Physical examination showed flexion and abduction both to 90 degrees, with painful motion.  The examiner noted the bullet entered through the right upper arm and exited through the shoulder axilla area. The upper extremity was neurovascularly intact with a well-healed wound over the lateral portion of the upper arm and axilla.  A 12 July 2004 PT examination, 3 months prior to separation, documented passive ROM with flexion to 120 degrees and abduction to 122 degrees. 

An orthopedic evaluation on 27 September 2004, 9 days prior to separation, referenced a right shoulder MRI which showed a complex partial tear of the distal supraspinatus tendon and an anterior glenoid labrum (rotator cuff).  Examination revealed increased instability from prior evaluations, and the provider felt anterior shoulder subluxing with loading.  

During the 4 November 2004 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported decreased right shoulder ROM due to a gunshot wound received in Afghanistan.  Physical examination showed right shoulder tenderness and an entrance wound at the posterior medial aspect of the upper right forearm approximately 4 inches below the axilla with no neurovascular defect.  The entrance wound scar was approximately a 1 x 1 cm, while the exit wound scar was approximately 2 x 2 cm; both were well-healed.  Right shoulder ROM was markedly decreased with flexion and abduction to 90 degrees with cracking in the joint, but no pain on motion.  Subsequent VA evidence indicated the CI underwent right axillary scar revision and shoulder surgery (Bankart repair) on 1 November 2005, 13 months after separation. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the shoulder condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing “abduction being 125 degrees (not ratable)…rated for pain” with likely application of the US Army Physical Disability Agency pain policy.  The VA rated the shoulder condition 30%, coded 5201 (arm, limitation of motion of), based on the C&P examination 1 month after separation, citing limitation of arm motion midway between side and shoulder level.  Members noted the PEB used passive ROM measurements, but that VASRD ratings are based on active ROMs.  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 both the MEB and VA examinations reflected this degree of limitation.  There was insufficient evidence of dominant arm motion limited to “midway between side and shoulder level” on examinations proximate to separation, for the next higher 30% rating.  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 rating available under the 5203 code (clavicle or scapula, impairment of).  Although the CI had retained shrapnel with entry and exit wounds, and had a history of  gun wound debridement, there was no evidence of elbow disability, and so alternative rating under VASRD §4.73 (schedule of ratings-muscle injuries) would rate no higher than 20%, and offer no benefit to the CI.  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 chronic right shoulder pain condition, coded 5201.  

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 20161024, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20180002550, 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