RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02486
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050613

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Track Vehicle Repairer, medically separated for “chronic right shoulder pain” with a 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 - 20050415	VARD - 20051019	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic t Shoulder Pain	5099-5003	10%	Residuals, Injury To Rt Shoulder with Scapular Pain (Dominant)	5203	10%	20050921	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI injured his dominant right shoulder in January 2004.  He reported progressively worsening right shoulder/scapular pain.  A physical therapy examination on 26 July 2004 showed full active range of motion (ROM) of the shoulder with asymmetric scapula-thoracic rhythm and a palpable click of the scapula.  Radiographic studies including MRI of the right shoulder and scapula on 30 October 2004 were normal showing no arthritis or structural abnormalities.  A 17 November 2004 physical medicine examination diagnosed myofascial pain/snapping scapula syndrome (snapping of bones and soft tissues of the scapular area with arm movement which may cause muscle inflammation, scarring weakness or scapular bursitis).  Acupuncture and trigger point injections did not resolve the CI’s pain and there was no surgical indication.  

During the 17 February 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported constant pain which was more pronounced with activity.  Physical examination showed shoulder crepitus, no limitation of movement, and normal motor strength.  Painful motion was not addressed.  The 4 March 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of a constant ache with an audible "grinding" sound with movement. Physical examination showed tenderness with associated muscle trigger points and taut muscle bands along the right levator scapulae/rhomboids/middle/lower trapezius muscles.  There was no swelling/erythema or muscle atrophy noted.  There was audible crepitus with right shoulder motion.  Muscle strength was normal.  On examination the right shoulder ROM following repetitive movement showed passive flexion of 162 degrees (normal 180) and abduction of 174 degrees (normal 180), limited by pain in all planes.  

At the 21 September 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant pain in the scapular area, worse with lifting and reaching, but no flares associated.  He was employed as a mechanic and had not lost any work time due to the condition.  Physical examination showed tenderness of the right scapular area.  On examination the right shoulder ROM following repetitive movement showed normal flexion and abduction.  There was no pain with motion noted and there was no additional limitation noted after repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, analogously coded as 5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy and that the condition was ‘slight’ - not requiring daily narcotics/constant.  The VA also rated the right shoulder condition 10%, coded 5203 (impairment of clavicle or scapula), based on the C&P examination, citing in-service treatment and pain on motion testing.  

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 insufficient limitation of motion to support a rating under the 5201 code, panel members agreed that a 10% rating was justified for limitation of motion coded analogous to 5003, supported by shoulder crepitus with motion noted at the MEB NARSUM examination.  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment).  There was therefore no higher than a 10% rating supported under any applicable VASRD code.  The panel noted that the PEB’s reliance on the USAPDA pain policy was not detrimental to arriving at the highest rating 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 right shoulder condition.  

BOARD FINDINGS:  In the matter of the right 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 20170316, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190006013, 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