RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-03309
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090622

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Military Policeman, medically separated for “right (non-dominant) shoulder pain” with a disability rating of 10%.  

CI CONTENTION:  The condition continues to worsen and negatively affects daily activities.  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 - 20090320	VARD - 20090629	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right (Non-Dominant) Shoulder Pain	5099-5003	10%	Status Post Right Shoulder Surgery	5201-5019	10%	20090126	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right (Non-Dominant) Shoulder Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent arthroscopic surgery (repair of inferior labral tear, subacromial decompression, and arthroplasty with distal clavicular resection) in April 2008 (14 months before separation).  Post-operative STR entries documented an uncomplicated course with restoration of good range of motion (ROM), but persistent pain that did not respond adequately to conservative measures.  There were multiple entries after surgical recovery that documented ROM measurements.  These recorded forward flexion ranging from 160 to 180 degrees (normal 180) and abduction from 150 to 180 degrees (normal 180).  There was post-operative STR documentation of the absence of instability or impingement, with no contrary findings or evidence for other ratable features.

At the 26 January 2009 VA Compensation and Pension (C&P) examination, 5 months before separation, the CI reported “daily” pain rated 4/10 that was aggravated by “exercise, lifting, bending, [and] changes in weather.”  Physical examination recorded no tenderness and normal strength without note of impingement, instability, or any positive findings.  Measured ROM was forward flexion to 150 degrees and abduction to 140 degrees, without specifying painful motion, but noting the absence of ROM degradation with repetition.  

The 19 February 2009 MEB NARSUM examination, 4 months prior to separation, noted complaints of “constant” pain rated 2-5/10 that interfered with overhead work and lifting (10 pound limit, right arm).  The physical examination recorded “moderate” tenderness, “mildly positive impingement signs,” and normal strength without note of instability or other positive findings.  Measured ROM by the NARSUM examiner was forward flexion to 135 degrees and abduction to 130 degrees, specifying painful motion.  Formal ROM measurements for the MEB had been conducted by physical therapy six weeks earlier (5 January) and were reported as forward flexion to 150 degrees and abduction to 140 degrees, specifying painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing “limitation of motion of one major joint.”  The VA also rated the condition 10%, coded 5201-5019 (limitation of motion rated as bursitis, defaulting to criteria of 5003), referencing the C&P findings and citing “decreased [ROM] without pain.”  None of the ample ROM evidence in this case supported the minimum compensable rating under code 5201 for limitation of motion.  There was no malunion or recurrent dislocation of the humerus to justify a rating under code 5202 (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under code 5203 (clavicle or scapula, impairment of).  Therefore, the evidence did not justify a rating higher than the PEB’s 10% under any applicable code IAW VASRD §4.71a.  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 20170902, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180012284, 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