RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00736
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20050921

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

CI CONTENTION:  “Was rushed through process and should have had left shoulder fixed and evaluated before separation.”  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 - 20050614	VARD - 20061102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain 	5099-5003	10%	Right Shoulder Subluxation	5203	20%	20060823	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the right hand dominant CI underwent right shoulder surgery for a torn labrum on 15 June 2004.  Following surgery, he continued to experience right shoulder pain.  On 23 February 2005, he reported to the emergency room (ER) with right shoulder pain and complained that his shoulder was “going out and back in.”  The 11 March 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of intermittent shoulder pain, aggravated by shrugging while holding weight, forceful internal rotation, and drawing his bow in preparation of hunting season.  There were no complaints of dislocation.  Physical examination showed tenderness at the acromioclavicular joint with well-healed scars.  Tests were positive for rotator cuff impingement, but the examiner did not mention any instability or subluxation.  The CI had full strength in forward flexion, internal and external rotation and extension.  Range of motion (ROM) was reported as follows:  “He externally rotates at his side 80 degrees bilaterally.  He internally rotates and adducts to T7 on the left and T10 on the right.  He externally rotates with the arm in an adducted position 95 degrees bilaterally and internally rotates 70 degrees bilaterally.  At the time of his 9 June 2005 physical therapy appointment, 3 months before separation, the examiner reported right shoulder flexion was 165 degrees (normal 180) and abduction was 180 degrees (normal 180) after repetitive motion.  

At the 23 August 2006 VA Compensation and Pension (C&P) evaluation, 11 months after separation, the CI reported 7/10 pain in both shoulders, flaring occasionally to 10/10 with heavy lifting, sudden use of an arm or elevation above shoulder level.  Shoulder pain was also aggravated by driving and prolonged extension of the arms.  He claimed his right shoulder continued to give out, that he had dropped his children a few times and both shoulders subluxed, dislocated, and were not stable.  Physical examination showed shoulders that were stiff, swollen, and lacked endurance.  The examiner stated that the shoulders had fatigability and gave way easily, with incoordination and lack of endurance.  Right shoulder ROM was flexion of 110 degrees and abduction of 85 degrees, limited by pain.  X-rays were normal. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, coded 5099-5003 (analogous to arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated the right shoulder condition 20%, coded 5203 (clavicle or scapula, impairment of), based on the C&P examination, citing dislocation of the clavicle or scapula or nonunion of the clavicle or scapula with loose movement.  Board members agreed that a 20% rating was justified for dislocation of the clavicle/scapula or nonunion of the clavicle/scapula with loose movement under code 5203.  The ROM examinations demonstrated motion above shoulder level which did not support a higher rating under diagnostic code 5201 (arm limitation of motion).  There was no malunion or recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of).  The panel noted the disparity between the various examinations.  The CI visited the ER on 23 February 2005, complaining of his right shoulder giving way.  This event was not mentioned in the NARSUM completed two weeks later, and the panel noted that the NARSUM examiner did not address instability at all despite the CI’s history of dislocations prior to surgery.  The panel noted that the objective evidence at the C&P examination was consistent with the subjective claims of the CI (“the right shoulder continues to give out”), and also noted that there was no other evidence proximate to separation which would add weight favoring the 10% versus the 20% rating.  Therefore, in consideration of reasonable doubt (§4.3) as well as the functional limitations (§4.40, §4.45) described in the MEB and VA examinations, the panel concluded there was not a preponderance of evidence to favor the 10% rating over the 20% rating and therefore recommended the 20% rating.  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 right shoulder condition, coded 5203.  

BOARD FINDINGS:  In the matter of the right shoulder condition, the panel recommends a disability rating of 20%, coded 5203 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 	5203	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004798, 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