RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01741
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated for “chronic right (dominant) 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 - 20081216	VARD - 20090722	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right (Dominant) Shoulder Pain	5099-5003	10%	Right Shoulder Injury Postoperative	5010-5201	20%	20090423	
Chronic Bilateral Knee Pain	Not Unfitting 	Left Knee Strain	5024	10%		
		Right Knee Strain	5024	10%		
Chronic Bilateral Shin Splints		Bilateral Shin Splints	5311	NSC		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Chronic Right (Dominant) Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right shoulder surgery in January 2007 for superior labrum anterior and posterior repair.  The CI continued to have pain and stiffness, and a second surgery was performed in April 2008 for subacromial decompression and distal clavicular resection.

During the 7 July 2008 MEB NARSUM evaluation, 9 months prior to separation, the CI complained of right shoulder pain; dislocations were not reported.  Physical examination showed no evidence of instability.  There was tenderness and crepitus with movement.  Flexion was 110 degrees (normal 180) and abduction was 120 degrees (normal 180); painful motion was present.  At the 21 August 2008 physical therapy evaluation, 7 months prior to separation, the CI reported right shoulder pain and stiffness.  Physical examination showed a slight decrease of the right shoulder strength 4/5 and tenderness.  Flexion was 120 degrees and abduction was 105 degrees; painful motion was not addressed.

At the 23 April 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported daily right shoulder pain.  He denied instability, giving way, or locking, but had painful flare-ups approximately 2-3 times per month.  Physical examination showed no obvious right shoulder or clavicle deformity.  There was no edema (swelling), shoulder joint tenderness, weakness, instability, or incoordination.  Flexion was 110 degrees and abduction was 85 degrees; painful motion was present.  Repetitive ROM did not render additional pain, fatigability, or reduced ROM.  During the 10 May 2010 VA C&P examination, 13 months after separation, physical examination showed flexion to 45 degrees (normal 180) and abduction to 45 degrees (normal 180).  Pain was elicited with repetitive range of 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 painful motion.  The VA rated the right shoulder condition 20%, coded 5010-5201 (arthritis, due to trauma-arm, limitation of motion), based on the C&P evaluation, citing arm motion limited at the shoulder level.

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) to support a 20% rating.  The panel agreed that the initial C&P ROM examination, 1 month after separation, most approximated the CI’s ROM disability at separation to support a 20% rating.  Although the resection of the distal clavicle may in some way be characterized as a non-union of the clavicle (5203), panel members noted that the maximum 20% rating did not provide a rating advantage to the CI.  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment).  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.

Contended PEB Conditions:  Chronic Bilateral Knee Pain and Chronic Bilateral Shin Splints.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The contended conditions were L3 profiled after the CI entered the MEB process.  The final permanent L3 profile documented the CI was able to perform lower body weight training as well as the alternate walk event for the physical fitness test.  Additionally, in December 2008, 4 months prior to separation, the CI participated in elliptical trainer activities for 30 minutes 3 times per week as well as 1 hour of dancing 5 days per week.  Neither contended condition was implicated by the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the chronic right (dominant) shoulder pain condition, the panel recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  In the matter of the contended chronic bilateral knee pain and chronic bilateral shin splints conditions, the panel recommends no change from the PEB determinations as not unfitting.  There are 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 the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right (Dominant) Shoulder Pain	5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170329, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180005843 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