RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-02285 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20061002

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Fire Support Specialist, medically separated for “chronic right shoulder pain” with a disability rating of 0%.

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 - 20060915	VARD - 20070622	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5099-5003	0%	Anterior Soft Tissue Impingement, Status Post Rotator Cuff Repair, Right Shoulder	5201	20%	20070531	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Right Shoulder Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a right shoulder rotator cuff repair on April 2005, but his symptoms never resolved after surgery. During the 26 July 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported right shoulder pain, and the examiner noted  decreased  range  of  motion  (ROM),  but  no  weakness  or  tenderness.  The 21 August 2006 MEB NARSUM examination, 1 month before separation, noted complaints of constant right shoulder pain aggravated by lifting, wearing body armor, overhead movements, and running. Physical examination showed tenderness over the anterior acromion on the right shoulder, but tests for impingement, instability, subscapularis injury, and acromioclavicular pain

were all negative (Hawkin's, Neer’s, anterior and posterior load shift, lift-off and cross-body tests). The examiner noted full active ROM which was limited by pain after repetition. The next day, the MEB physical therapy ROM study showed right shoulder flexion to 140 degrees (normal
180) and abduction to 130 degrees (normal 180) after repetition, with both limited by pain.

At the 31 May 2007 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported continued right shoulder pain with limited ROM. Physical examination showed both right shoulder flexion and abduction to 170 degrees after repetitive motion, with pain beginning at 90 degrees in both planes. There was no additional impairment following repetition.  Right shoulder X-rays were unremarkable.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right shoulder condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy. The VA rated the right shoulder condition 20%, coded 5201 (arm, limitation of motion of), based on the C&P examination, citing arm motion limited to shoulder level.  Panel members noted that the VASRD
§4.71a threshold for rating ROM impairment under code 5201 is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level. However, the panel agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion). While the VA examination showed pain beginning at shoulder level, VASRD ratings for ROM are based on the CI’s achievable ROM, with or without pain. 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 code 5202 (humerus, other impairment of) or 5203 (clavicle or scapula, impairment of). 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 right shoulder condition, coded 5099-5003.

BOARD FINDINGS: In the matter of the shoulder condition, the panel recommends a disability rating of 10%, coded 5099-5003 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	
Chronic Right Shoulder Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 201703, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190012143, 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.

Sincerely,

Enclosure

	PD-2017-02285