RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01441
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20051218

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E7, Infantryman, medically separated for “right shoulder pain” with a disability rating of 10%.  

CI CONTENTION:  “Review all Conditions.”  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 - 20050928	VARD - 20060308	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Subacromial Impingement Syndrome	5099-5003	10%	Chronic Right Shoulder Tendonitis, Status Post AC Joint Separation Surgical Repair (Dominant)	5201	20%	20060130	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Shoulder Subacromial Impingement Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the right-dominant CI injured his right shoulder in 1999 during a parachute jump and later reinjured it in a motorcycle accident.  He was treated for acromioclavicular (AC) joint separation and underwent two right shoulder subacromial decompression surgeries in June 2003 and April 2005.  

During the 16 May 2005 physical therapy (PT) visit, 7 months before separation, the CI reported improved pain and range of motion (ROM) post-operatively.  Physical examination revealed full active ROM in flexion and abduction, a normal Apley's scratch test (limitations in motion), and tenderness to palpation at the anterior shoulder/subacromial area.  At the 12 July 2005 PT appointment, 5 months before separation, the CI reported worsening pain with running and performing wall pushups, and intermittent resting pain.  Physical examination noted full ROM without pain, and the examiner opined the CI would continue to have irritation with functional activities.  

The 12 September 2005 MEB NARSUM examination, 3 months prior to separation, documented complaints of a constant dull ache in the shoulder, sharp pain with overhead activity, and required medication once a week for pain relief.  Physical examination showed positive cross-arm testing and tenderness of the proximal biceps tendon and AC area, but no atrophy.  Repetitive ROM measurements showed flexion and abduction to 180 degrees (normal) with painful motion. Neer/Hawkins (impingement), speed, and Yergason (biceps tendon) tests were positive, while sulcus (instability), apprehension, and translation to load shifting tests were negative.  Muscle strength was normal (5/5).  Radiographic images revealed a short, flat acromion with a portion of the distal clavicle absent.  The examiner noted the CI had reached maximum medical improvement and no further surgical options were available.  

At the 30 January 2006 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported "constant" right shoulder pain.  The pain was aggravated by all overhead activity, lifting anything over 15 pounds, and sleeping on the right shoulder.  Physical examination showed positive impingement, no crepitus or effusion, and normal muscle strength. Painful ROM showed flexion of 170 degrees and abduction of 160 degrees.  Abduction was reduced to 100 degrees, due to painful repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing moderate/frequent pain.  The VA rated the right shoulder condition 20%, coded 5201 (arm, limitation of motion), based on the C&P evaluation, citing arm motion limited at shoulder level.  The VASRD §4.71a threshold for rating for ROM impairment under code 5201 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 code 5201, members agreed a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating 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 adjudication for the right shoulder pain condition.  

BOARD FINDINGS:  In the matter of the right shoulder subacromial impingement syndrome and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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 20170223, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004884, 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