[AR Number],XXXXXXXXXX. 

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

	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

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.	CASE:  PD-2017-02034
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060319

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, AH-64 Armament/Electrical/Avionic Systems Repairer, medically separated for “chronic pain, right shoulder” with a disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 - 20060119	VARD - 20060307	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, R Shoulder…	5099-5003	10%	Adhesive Capsulitis, R Shoulder…	5203	10%	20051202	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Shoulder Chronic Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the right-hand dominant CI underwent surgery in May 2005 to repair tears of the rotator cuff and a torn labrum (SLAP repair).  An orthopedic examination performed on 14 November 2005, 4 months prior to separation, showed range of motion (ROM) was forward flexion of 165 degrees (normal 180) and 115 degrees of scaption (elevating the arms at approximately 30-45 degrees in the transverse plane, v-shape), external rotation (ER) was 50 degrees and internal rotation (IR) was 40 degrees.  Strength was graded 4/5 for resisted flexion and abduction.  There was no evidence of instability or impingement.  The CI was diagnosed with adhesive capsulitis of the right shoulder following surgery.

At the 2 December 2005 VA Compensation and Pension examination (which also served as the MEB examination), 4 months prior to separation, the CI reported continued right shoulder pain and decreased ROM.  The examiner noted the CI was right-hand dominant and there for examination of the right shoulder following surgery.  The CI did not have a history of surgery of the left shoulder.  Physical examination showed normal appearing shoulders with no tenderness.  The VA examiner indicated there were surgical scars of the left shoulder but not of the right, suggesting that there was a dictation error regarding the evidence for the shoulders, with the left and right being transposed.  The right shoulder muscle strength was graded 4/5 and ROM was recorded as flexion of 80 degrees and abduction of 180.  The VA examiner’s diagnoses were right shoulder rotator cuff tear status post-surgical repair and frozen right shoulder syndrome significant limited ROM.  

The 6 January 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of “marked limitation in range of motion” which prevented performance of military duties.  Physical examination showed well healed surgical portals without shoulder swelling.  Shoulder ROM was forward flexion of 165 degrees and 115 degrees of scaption, ER of 45 degrees and IR to L1 compared to T7 on the left, non-affected side.  Strength was normal and testing was negative for impingement and instability.  The CI was diagnosed with adhesive capsulitis of the right shoulder following surgery.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder 10%, coded 5099-5003 (analogous to degenerative arthritis), citing criteria from the US Army Physical Disability Agency pain policy.  The VA also rated the shoulder 10%, but used the 5203 code (impairment of the clavicle or scapula), based on the C&P examination.  

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).  The orthopedic and C&P examinations were just 2-3 weeks apart, but documented shoulder ROM that was difficult for the panel to reconcile.  Flexion was 165 at the orthopedic examination, with scaption motion also above shoulder height (90 degrees), yet at the C&P examination flexion was 80, (dramatically worse), and abduction, which almost always aggravates shoulder pain due to rotator cuff issues, was normal.  The MEB NARSUM examination, a second examination by the orthopedic examiner, documented the same flexion and scaption motion, with similar ER and IR to the previous orthopedic examination, but ER and IR were both less than the intervening C&P examination.  

The combination of ROM measurements at all the examinations proximate to separation supports the CI had ROM above shoulder level and no rating higher than 0% was supported under 5201.  The MEB NARSUM and VA C&P examinations also did not note findings such as swelling, muscle spasm, satisfactory evidence of painful motion or other evidence of functional loss to support a 10% rating IAW VASRD §§4.59, 4.40 or 4.45.  There was no malunion, deformity, or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment); and there was no nonunion or malunion of the clavicle or scapula to warrant any rating under the 5203 code (clavicle or scapula, impairment).  The panel noted that the PEB’s reliance on the USAPDA pain policy was not detrimental to arriving at the highest rating, and therefore no change to the PEB’s coding choice is recommended.  After due deliberation, considering all 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 condition.  

BOARD FINDINGS:  In the matter of the right shoulder chronic pain 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 20170312, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record