RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01779
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040803

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated for “right shoulder pain” with a disability rating of 0%.  

CI CONTENTION:  Current right shoulder condition support higher rating.  Additional conditions, post-traumatic stress disorder and asthma contended.   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 - 20040511	VARD - 20041007	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5009-5003	0%	S/P Traumatic Injury and Surgical Intervention, Right Shoulder	5201-5203	10%	20040629	
Asthma	Not Unfitting	Bronchial Asthma	6602	10%	20040629	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right shoulder condition began in February 1998 following an obstacle course training exercise.  No injury or trauma was reported and the CI was treated with over-the-counter anti-inflammatory medication (Motrin) and a 2-week profile without improvement.  The CI was referred to a civilian orthopedic specialist in 2000 after 2 years of shoulder pain.  In September 2001 the CI underwent surgical repair of a labral tear.  Physical therapy (PT) followed with full range of motion (ROM) returning, however constant pain persisted.  In June 2002, the CI underwent a second surgery with debridement, followed by physical therapy again, but shoulder pain continued.  On 31 March 2003, X-rays with weights showed degenerative changes of the acromioclavicular (AC) joint with a questionable AC separation and the CI was placed on a 90-day profile, but was cleared to deploy.  In April 2003, the CI deployed and re-injured his shoulder while doing battle drills including “a fireman’s carry” of another solider.  The CI reported stepping in a hole and the solider fell on his right shoulder resulting in a probable dislocation that was relocated by the CI himself.  On 6 November 2003, magnetic resonance imaging (MRI) showed a possible small superior labral tear, but the radiologist indicated there was no evidence of an acute abnormality.  

At the 12 December 2003 MEB orthopedic consult, 7 months before separation, the CI reported inability to tolerate repetitive overhead motions, push-ups, rucking, heavy lifting or carrying or firing a weapon due to chronic shoulder pain.  He also reported a recent episode where he felt his shoulder come out of the joint and spontaneously relocate.  On physical examination testing for a labral tear (O’Brien’s test) was equivocal.  Shoulder ROM was forward flexion of 180 degrees (normal 180) and abduction 100 degrees (normal 180).  No tenderness about the AC joint was noted.  Testing for instability was positive (positive sulcus sign, anterior and posterior load shift, and apprehension sign).  Strength and sensation were normal.  The impression was persistent right shoulder instability.  The orthopedic specialist noted the X-ray findings noted above and indicated there was no evidence of rotator cuff or labral pathology on the MRI.  

During the February 2004 MEB examination (recorded on DD Forms 2807 and 2808) 6 months prior to separation, the CI reported pain radiating to his upper back and down right arm.  Physical examination showed no tenderness, full ROM, and pain on abduction and reaching overhead.  The CI was unable to resist downward force on his elevated right arm.  Strength was graded 3/5.  The 18 February 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of constant right shoulder pain.  The pain was aggravated by any overhead motion, lifting, carrying, carrying any object on his shoulder such as a weapon, or rucksack, and prolonged salute.  Physical examination noted the CI was ambidextrous, and otherwise cited the same findings as the DD Form 2808 examination summarized above.   On 5 March 2004 physical therapy reported right shoulder abduction of 175 degrees.

At the 29 June 2004 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported difficulty when the arm was raised to a certain position.  Physical examination showed normal and symmetric right shoulder outline with no noted muscle atrophy, without heat, redness, swelling, or effusion detected.  Strength and sensation were normal.  Shoulder ROM showed flexion 140 degrees with pain (normal 180), abduction 150 with pain (normal 180), external rotation 75 with pain (normal 90), and internal rotation 90 with pain (normal 90).  Pain, weakness, lack of endurance, fatigue or incoordination did not cause additional loss of ROM with repetition.  Right shoulder X-rays were normal.  The VA examiner indicated that the shoulder condition did not interfere with the CI’s “ordinary lifting or carrying, activities of daily living or service functions.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, coded 5099-5003 (analogous to arthritis, degenerative), citing abduction to 100 degrees, some degenerative changes, and no analgesics required.  The VA rated the right shoulder condition 10%, coded 5201-5203 (arm, limitation of motion – clavicle or scapula impairment), based on the C&P examination 2 months after separation, citing painful or limited motion of the shoulder.  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.  Although there was insufficient limitation of motion to support a rating under the 5201 code, panel members agreed that a 10% rating was justified coded under 5003 for degenerative changes of a single major joint on X-rays with painful, limited motion.  There was no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment of).  Although two episodes of probable shoulder dislocation were noted in the STR (while deployed in 2003 and just before the MEB orthopedic consult) and instability was present on the orthopedic examination, there was no history of recurrent dislocation of the humerus with guarding at shoulder level to justify a higher rating under the 5202 code (humerus, other impairment of).  There was therefore no higher rating available with any applicable VASRD code.  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 right shoulder condition, coded 5099-5003.  

Contended PEB Condition:  Asthma.  The panel’s main charge is to assess the fairness of the PEB’s determination that the asthma condition was not unfitting.  The asthma condition was given a P3 permanent profile on 13 April 2004 and judged to fail retention standards, but the 29 April 2004 commander’s statement did not implicate the asthma condition.  At the time of the MEB for the shoulder condition the CI was noted to have a history of shortness of breath with exertion and he used a bronchodilator (BD) inhaler before exercise and one to two times per week.  He had never been evaluated for asthma and was referred for spirometry and a pulmonary consult.  The spirometry showed a moderate obstructive defect and a significant response to BD medication.  The 5 March 2004 pulmonary consult noted exercise induced symptoms but also occasional symptoms of wheezing and night symptoms approximately three times per week.  At the time the CI was only using a BD inhaler intermittently.  He used the BD inhaler before runs, but noted no benefit.  The physical examination noted no wheezing on lung auscultation.  The diagnosis was moderate persistent asthma and a steroid containing (anti-inflammatory) inhaler was prescribed (Advair) at moderate dose and the BD inhaler as needed was continued.  The pulmonolgist noted that the CI was able to complete all military duties and wear his gas mask to standards.  The CI reported that he ran three times per but would not be able to pass the two mile run, but the examiner noted he had not taken a physical fitness test in two years due to the shoulder condition.  The final permanent profile prohibited the 2-mile run, but allowed alternate aerobic walk, swim, or bike events.  There was no performance-based evidence from the record that the asthma condition significantly interfered with satisfactory duty performance.  The panel concluded therefore that there was not a preponderance of evidence to overcome the PEB’s fitness adjudication.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the asthma condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the right shoulder condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended asthma condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were 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	
Right Shoulder Pain With Instability	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161122, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180000024, 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