RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02072
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Military Police, medically separated for “chronic right shoulder pain” with a disability rating of 20%.  

CI CONTENTION:  “Ongoing deteriorating health and livelihood.” 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 - 20090818	VARD - 20100610	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5201	20%	Right Shoulder Instability	5203	10%	20091118	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right-hand dominant CI initially injured his right shoulder during combative maneuvers and reinjured it in July 2006 when putting on a fully loaded ruck sack.  At that time, he said his shoulder dislocated and he reduced it with help from a fellow soldier.  Subsequent evaluations failed to show a source of the shoulder pain or demonstrate instability.  Shoulder X-rays were normal and a magnetic resonance arthrogram only indicated sub-acromial bursa fluid.  The CI was offered a diagnostic arthroscopy and examination under anesthesia, but declined.  Multiple STR entries showed right shoulder flexion and abduction greater than 90 degrees (normal 180 for both), and while tests for rotator cuff impingement, bicipital tendinitis, and instability were all positive, these findings were not consistent from one test to another.  

During the 20 July 2009 MEB NARSUM examination, 3 months prior to separation, the provider referred to 24 March 2009 orthopedic findings which noted tenderness over the anterior aspect of the shoulder, but no deformity; and negative test results for impingement, labral tear, and acromioclavicular joint pathology.  The orthopedist also documented pain with apprehension testing and guarding with load shift maneuvers.  The NARSUM examiner performed goniometric range of motion (ROM) tests which demonstrated forward flexion of 130 degrees and abduction of 90 degrees, with pain throughout all motions.  An additional loss of “approximately 10 degrees of ability” was estimated with fatigue, weakness, lack of coordination or endurance due to pain.

At the 18 November 2009 VA Compensation and Pension (C&P) examination, 11 months after separation, the CI reported continued shoulder pain with use and several episodes of dislocation or subluxation per year; he denied flare-ups and was not taking medications.  Physical examination revealed pain and weakness, but no deformity, giving way, stiffness, incoordination, locking, effusion or inflammation.  Right shoulder ROM showed flexion to 95 degrees and abduction to 110 degrees, with painful motion, but further limitation with repetition.  The examiner noted a history of right shoulder instability, but no specific testing was documented. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the shoulder condition 20%, coded 5201 (arm, limitation of motion), citing limited motion.  The VA rated the shoulder condition 10%, coded 5203 (clavicle or scapular impairment of), citing “increasing pain with repetitive active and passive range of motion.”  Members noted that 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 NARSUM and VA examinations support this, albeit for different motions.  Criteria for the next higher 30% rating were note met for dominant arm motion limited to “midway between side and shoulder level.” There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under code 5202 (humerus, other impairment of), and no higher ratings under the code 5203.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder condition. 

BOARD FINDINGS:  In the matter of the chronic right shoulder 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 20170301, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

[AR Number], 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