RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00585
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080918

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Air Defense Tactical Operations Center Operator, medically separated for “arm, limitation of motion of right shoulder” with a disability rating of 20%.

CI CONTENTION:  The rating for his arthritic shoulder should be changed and that his amputated finger, back issues, shoulder scars, asthma and mental health disorders should have been rated.  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 -20080821	VARD – 20090414	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arm, Limitation of Motion Right Shoulder	5201	20%	Right Shoulder Strain	NA	30%	20081105	
Low Back Pain	Not Unfitting	Lumbar Spine Conditions	NA	NSC	20081105	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Limitation of Motion Right Shoulder.  According to service treatment record and MEB narrative summary (NARSUM), the right dominant CI underwent arthroscopic surgical repair of his right shoulder in February 2008.  Following surgery, he progressed very slowly; pain control was poor, and the right shoulder was not able to return to preoperative ranges of motion (ROM).  At the 21 July 2008 physical therapy (PT) examination, right shoulder ROM testing revealed flexion to 73 degrees (normal 180) and abduction to 86 degrees (normal 180).  
At the 31 July 2008 MEB NARSUM examination, 2 months prior to separation, the CI complained of “persistent right shoulder pain.”  On physical examination, there was right shoulder tenderness and provocative testing to elicit tendon or joint pathology.  ROM testing showed flexion of 80 degrees and abduction of 70 degrees.  The examiner noted pain with flexion, abduction, external rotation and internal rotation.  

During the 5 November 2008 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported right shoulder pain, rated at 5/10, that increased with activity.  Physical examination revealed right shoulder tenderness. and ROM testing showed flexion of 60 degrees and abduction of 100 degrees, with pain on motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 20%, coded 5201 (arm, limitation of motion,) citing painful ROM with abduction at 79 degrees, flexion at 80 degrees, and external rotation of 30 degrees.  The VA rated the right shoulder condition 30%, based on the C&P evaluation, citing forward flexion of 60 degrees or midway between side and shoulder.  The panel noted that the case file did not contain a copy of the VA’s rating decision and was unable to determine which diagnostic code the VA used to rate the right shoulder condition.  The VASRD §4.71a threshold for a 20% rating for ROM impairment (code 5201) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion limited to this level.  The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level.”  However, the panel noted that examinations did not reflect this degree of limitation.  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 concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the right shoulder condition.  

Contended PEB Condition:  Low Back Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right shoulder condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended low back pain condition, the panel recommends no change from the PEB determination as not unfitting.  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 20170217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006529, 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