RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02474
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050601

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

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 - 20050311	VARD - 20051201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rt Shoulder Pain and Instability	5202	20%	Rt Shoulder; Multidirectional Instability	5201	10%	20050802	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right (Dominant) Shoulder Pain and Instability.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right shoulder condition began in January 2001 during physical training.  X-rays on 24 June 2003, 23 months prior to separation, revealed a normal acromioclavicular (A/C) and glenohumeral joint.  He had a type II acromion and small calcifications in the coracoacromial ligament, which may be compatible with a calcific tendinitis.  

At the time of the physical therapy clinic appointment on 21 July 2004, 11 months prior to separation, the CI reported right shoulder multidirectional instability.  On examination, strength was 5/5 and sulcus test, anterior apprehension test, empty can test, and a load shift test were all positive.  Right shoulder range of motion (ROM) was full and painful motion was noted.  

During the 10 September 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, the CI reported right shoulder pain and instability.  Physical examination revealed right shoulder tenderness.  There was no heat, swelling or crepitus present.  Right shoulder ROM was full.  The 13 October 2004 MEB NARSUM examination, 8 months prior to separation, noted complaints of constant right shoulder pain that increased with nearly any activity.  The CI stated pushups, ruck marches, running, wearing a flak vest, and any overhead activity aggravated the pain.  The CI reported self-subluxation on demand in several different directions.  Physical examination showed mild wasting of the right posterior shoulder musculature when compared to the left.  Anterior and posterior subluxation testing was positive (apprehension test).  Rotator cuff injury (Hawkins sign) was positive.  There was mild tenderness over the right acromioclavicular (AC) joint; however, testing for AC pathology was negative (cross-arm testing).  Tests for inferior instability (sulcus sign) and biceps tendon pathology (Yergason or Speed testing) were negative.  Right shoulder ROM showed flexion was full and abduction of 130 degrees (normal 180).  

At the 2 August 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported right shoulder instability and pain, especially when working overhead.  Physical examination showed right shoulder crepitus and popping on demand.  There was point tenderness of the right AC joint.  Painful right shoulder ROM, after repetitive motion, showed flexion and abduction were 140 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 20%, coded 5202 (humerus, other impairment), citing that it was rated as recurrent dislocation with infrequent episodes and guarding of movement at shoulder level.  The VA rated the right shoulder condition 10%, coded 5201 (arm, limitation of motion), based on the C&P examination, citing a restricted ROM with pain and evidence of osteophyte formation.  The panel noted there was no malunion with marked deformity of the humerus or frequent episodes of recurrent dislocation with guarding of all arm movements to warrant the next higher 30% rating.  There was likewise no route to a higher rating under 5201 (or 5203 (clavicle or scapula, impairment).  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 pain and instability 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  

AR20190005996, 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