RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02352
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060308

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E6, Ammunition Specialist, medically separated for “chronic left shoulder pain” with a disability rating of 10%.  

CI CONTENTION:  No specific contention 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 - 20051220	VARD - 20070319	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	10%	Chronic Left Shoulder Strain	5299-5201	10%	20060710	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Left Shoulder (Non-Dominant) Pain.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI underwent left shoulder arthroscopy for partial tear of the rotator cuff.  The diagnoses at surgery were left shoulder impingement, partial rotator cuff tear, and osteoarthritis of the shoulder and acromioclavicular joints.  The 17 November 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of constant pain, increased with increased activity.  The CI reported his lifting was limited along with overhead work.  He denied numbness, tingling, or weakness in his upper extremity.  Physical examination showed tenderness and mild crepitus.  Strength was normal.  Left shoulder flexion was 190 degrees (normal 180) and abduction was 180 degrees (normal 180) after repetition, with painful motion.  

At the 10 July 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported constant pain described as burning, aching, and sharp which was elicited by physical activity and stress.  Physical examination showed signs of tenderness.  Left shoulder flexion was 180 degrees and abduction was 180 degrees with pain, and there was no additional limitation of joint function after repetitive use.  Shoulder x-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing application of the US Army Physical Disability Agency pain policy.  The VA also rated the left shoulder condition 10%, analogously coded 5299-5201 (arm, limitation of motion of), 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), and the examinations in evidence demonstrated motion above this level.  Although there was no limitation of motion to support a rating, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion), coded analogously to 5003 or related code.  The panel considered other VASRD shoulder codes, but all were less applicable and/or not advantageous for rating.  The panel found that the PEB’s reliance on the USAPDA pain policy was not detrimental to arriving at the highest rating, and in this case a 10% rating coded analogously to 5003 is VASRD compliant 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 left shoulder condition.  

BOARD FINDINGS:  In the matter of the left shoulder condition 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 20170228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180015170, 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