RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-01606 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070627

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Military Intelligence Systems Maintainer/Interrogator, medically separated for “chronic bilateral shoulder pain and subluxation” with a disability rating of 0%.

CI CONTENTION: “Chronic bilateral shoulder pain and subluxation.” 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 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 – 20070501	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Shoulder Pain, Subluxation	5099-5003	0%	No VA Examination in Evidence	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Chronic Bilateral Shoulder Pain and Subluxation. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral shoulder condition began in 2005, with an insidious onset of pain accompanied by cracking and popping, and a sense of instability in each shoulder. Plain X-rays of both shoulders were within normal limits, as was a left shoulder MRI. Surgical treatment was discussed; however, she was not a good candidate for elective surgery due to her history of having had a pulmonary embolism, as well as general ligamentous laxity, and the fact that she had problems on both sides were poor indicators for an optimal outcome.

At the physical therapy (PT) examination on 23 January 2007, 5 months prior to separation, the examiner noted full active range of motion (ROM) for the left shoulder with shoulder pain once above shoulder height. Testing for painful motion and instability were positive. The CI was discharged from PT as having maximized benefit. The 5 April 2007 MEB NARSUM examination,  3 months prior to separation, noted complaints of bilateral shoulder pain and a sense of instability.  On examination the bilateral shoulder ROM following repetitive movement  showed

normal flexion and abduction of 180 degrees each. Pain with motion was not addressed. There was slight pain with resisted abduction. The apprehension, sulcus and relocation signs were positive, suggestive of instability. Crepitus with motion was noted. Under the “current functional status” section the examining orthopedic surgeon indicated “performing any work overhead produces a dead arm syndrome, (heaviness, numbness, tingling).” There was no VA examination in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB bundled the right shoulder and the left shoulder conditions and applied a single 0% rating, coded analogously to 5003 (degenerative arthritis), with application of the USAPDA pain policy. In this case, both shoulders were considered to fail retention standards, both were implicated by the NARSUM and commander’s statement, and both were profiled. The panel concluded that there was not a preponderance of evidence in the STR which overcame the panel’s presumption that the bundled right and left shoulder conditions were reasonably considered separately unfitting. The panel then considered its rating recommendation for each unfitting 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 for each shoulder. Although there was insufficient limitation of motion to support a rating under the 5201 code, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion) as demonstrated by the PT examination, or functional loss IAW VASRD §4.40 or §4.45 at the NARSUM examination for each shoulder. The panel considered other VASRD shoulder and analogous codes, but all were less applicable and/or not advantageous for rating. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% each for the right and left shoulder conditions, both coded 5099-5203.

BOARD FINDINGS: In the matter of the bilateral shoulder condition, the panel recommends that each joint be separately adjudicated as follows: an unfitting right shoulder condition coded 5099- 5203 and rated 10%, and an unfitting left shoulder condition, coded 5099-5203 and rated 10%, both 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 the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Shoulder Pain, Subluxation	5099-5203	10%	
Chronic Right Shoulder Pain, Subluxation	5099-5203	10%	
	COMBINED	20%	

AR20190014367, XXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

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.