[AR Number], XXXXXXXXXX

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XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

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

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX	CASE:  PD-2017-02264
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061205

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Wheeled Vehicle Mechanic, medically separated for “persistent left shoulder pain” with a disability rating of 0%.  

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 - 20061013	VARD - 20070320	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Persistent Lt Shoulder Pain	5099-5003	0%	Lt Shoulder Acromioclavicular Joint Arthritis	5003	10%	20070208	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Persistent Left Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left (dominant) shoulder arthroscopy surgery in December 2005 for superior labral and synovial debridement.  During the 30 June 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported chronic left shoulder pain.  Physical examination revealed left shoulder range of motion (ROM) abduction of 90 degrees (normal 180), with pain at all ranges.  Forward flexion measurements were not recorded.  
At the 24 July 2006 physical therapy (PT) clinic, the CI reported left shoulder pain aggravated by overhead activities and carrying greater than 35 pounds.  Physical examination showed tenderness with no significant strength deficits (4+/5).  Goniometer-measured ROM following repetitive movement showed flexion of 120 degrees and abduction of 110 degrees (normal is 180 for each) with discomfort at the end of the range.  

The 26 July 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of limited left shoulder pain at rest and significant pain with load bearing and overhead motion.  Physical examination revealed the CI had no tenderness over the AC joint or evidence of deformity or atrophy about his shoulder girdle.  He had mild discomfort with Neer and Hawkins testing and pain with O’Brien’s testing.  The patient had no evidence of shoulder instability with a negative sulcus sign and anterior and posterior load shift test.  Flexion was 120 degrees and abduction 110 degrees.  

At the 8 February 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported constant left shoulder pain with minimal limitations.  Physical examination showed the CI had good muscle strength and shoulder girdle musculature.  Flexion and abduction were each 180 degrees.  There was painful motion at the end point and crepitus. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 0%, analogously coded 5003 (degenerative arthritis), citing application of the US Army Physical Disability Agency pain policy.  The VA rated the left shoulder condition 10%, using the same code (5003), based on the C&P examination, citing painful or limited motion of a major joint.  

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 preponderance of the evidence demonstrated motion above this level.  Panel members agreed a 10% rating was justified with application of VASRD §4.59 (painful motion) based on the PT clinic evaluation and VA C&P examination proximate to separation.  There was no malunion or recurrent dislocation of the humerus and no dislocation or nonunion of the clavicle or scapula to justify a higher rating under the 5202 (humerus, other impairment) or 5203 (clavicle or scapula, impairment) codes.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left shoulder condition, analogously coded 5003.  

BOARD FINDINGS:  In the matter of the persistent left shoulder pain condition, the panel recommends a disability rating of 10%, analogously coded 5003 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	
Persistent Left Shoulder Pain	5099-5003	10%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170330, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record