RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02480
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070301

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic pain left shoulder” and “chronic right subacromial bursitis,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  Review of all conditions requested.  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 - 20070105	VARD - 20070824	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Shoulder Status Post (S/P) Subacromial Decompression and Distal Clavicle Resection	5099-5003	10%	Impingement Syndrome, Left Shoulder S/P Surgical Repair with Tear of the Supraspinatus Tendon	5201	20%	20070412	
Chronic Right Subacromial Bursitis	5019	0%	Bursitis, Right Shoulder with Residuals	5201	0%	20070412	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left Shoulder (Non-Dominant).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right-handed CI’s left shoulder condition began in December 2004 after he wrenched his shoulder as he tried to hold a gun turret that suddenly swung around.  He first underwent left shoulder surgery in February 2006 for a subacromial decompression and distal clavicle resection and in May 2006, he underwent an open excision of the residual distal clavicle due to continued left shoulder pain. 

At an orthopedic clinic visit on 23 August 2006, the CI complained of left shoulder pain.  Examination revealed a painful range of motion (ROM) and positive testing of shoulder impairment.  Further surgery (coracoclavicular ligament reconstruction) was recommended, but he declined the offer.  Physical therapy (PT) ROM measurements of the left shoulder on 25 September 2006 were flexion 130 degrees (normal 180) and abduction 105 degrees (normal 180), both with painful motion.  At a neurology visit on 25 September 2006 the CI reported some left arm and forearm numbness on the outer aspect.  Electrodiagnostic studies mild cervical nerve root irritability at the C6-C7 level on the left side without any evidence of radiculopathy. 

The 5 December 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of constant 7/10 pain with daily activity, 8/10 pain if he moved too quickly and even higher if he tried to lift something.  He reported that pain prevented him from falling asleep and pain woke him almost every night.  Physical examination showed strength testing at left shoulder 4/5 compared to the right secondary to pain.  PT referred to ROM measurements taken 6 November 2006, recording flexion of 110 degrees and abduction of 75 degrees, both with painful motion.

At the 12 April 2007 VA Compensation and Pension (C&P) examination, one month after separation, the CI reported residual pain in the left shoulder with limited pain from ROM occurring on a daily basis.  He reported using a TENS unit each evening with good relief.  Physical examination revealed a well-healed 5 x 1 cm scar that was tender with no atrophy.  The left shoulder ROM, following repetitive movement, showed flexion and abduction of 90 degrees each.  The examiner noted no additional limitations after three repetitions of the movement related to pain, fatigue, incoordination, weakness, or lack of endurance.  

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 (degenerative arthritis), citing that it was rated as slight and not requiring daily narcotic therapy, based on the U.S. Army Physical Disability Agency pain policy.  The VA rated the left shoulder condition 20%, coded 5201 (arm, limitation of motion), based on the C&P examination, citing pain without evidence of atrophy, and abduction limited to 90 degrees.  

The VASRD §4.71a threshold for rating for ROM impairment (code 5201) is “at shoulder level” (approximately 90 degrees from the side).  The 20% rating for the non-dominant arm requires motion limited to “at shoulder level” and the PT and C&P examinations reflected this degree of limitation.  There was no fibrous union or nonunion of the humerus to justify a higher rating under the 5202 code (humerus, other impairment), and there is no higher rating available under the 5203 code (clavicle or scapula, impairment).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left shoulder condition, coded 5201.  

Chronic Right Subacromial Bursitis.  According to the STR and MEB NARSUM, the CI’s bursitis condition began in December 2004 after he wrenched his shoulder as he tried to hold a gun turret.  An MRI dated 19 August 2005 revealed a tiny amount of inflammatory-appearing fluid within the subchoracoid bursa consistent with a subchoracoid bursitis.  The CI underwent PT with some improvement.  X-rays dated 19 September 2006 were normal.  

PT ROM measurements of the right shoulder on 25 September 2006 revealed flexion and abduction of 180 degrees each, with pain on motion.  A right shoulder MR arthrogram dated 27 September 2006 demonstrated mild rotator cuff tendonitis with some subdeltoid bursitis.  At an orthopedic clinic visit on 17 October 2006, 5 months prior to separation, the examiner indicated the condition was not worthy of a permanent profile in the absence of surgery or therapy and recommended that PT should be performed.  The MEB NARSUM examination noted complaints of his right shoulder causing him pain.   PT ROM measurements of 6 November 2006 recorded flexion to 160 degrees without pain and abduction 150 degrees with pain.  

At the VA C&P examination the CI reported aching and stiffness in his right shoulder two times per week for which he took over-the-counter analgesics as needed with minimal relief.  Physical examination showed no acute heat, redness, swelling, or tenderness.  The right shoulder ROM, following repetitive movement, showed normal flexion and abduction with no additional limitations noted (after three repetitions) related to pain, fatigue, incoordination, weakness or lack of endurance.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bursitis condition 0%, coded 5019 (bursitis), citing no ratable limitation of motion but movement limited by pain.  The VA also rated the bursitis condition 0%, coded 5201 (arm, limitation of motion), based on the C&P examination, citing no demonstration of arm motion limited to the shoulder level or functional loss based on pain, weakness, incoordination, fatigue or lack of endurance which would result in arm motion limited to the shoulder level.  

As noted with the left shoulder, the VASRD §4.71a threshold for rating for ROM impairment (code 5201) is “at shoulder level” (approximately 90 degrees from the side), and examinations of the right shoulder in evidence demonstrated motion above this level.  However, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion) based on the two PT examinations prior to separation as compared to the post-separation VA examination.  Furthermore, the PEB indicated the right shoulder was limited by pain, but assigned only a 0% rating.  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 right shoulder bursitis condition, coded 5019-5003.  

BOARD FINDINGS:  In the matter of the left shoulder condition, the panel recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  In the matter of the right shoulder bursitis condition, the panel recommends a disability rating of 10%, coded 5019-5003 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Pain Left Shoulder	5201	20%	
Chronic Right Subacromial Bursitis	5019-5003	10%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190006003, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure