RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-03358
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060721

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Network Switching System Operator/Maintainer, medically separated for “chronic left shoulder pain” with a disability rating of 0%.

CI CONTENTION:  Her current condition affects her 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 - 20060623	VARD - 20070914	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Lt Shoulder Pain	5003	0%	Lt Shoulder Strain w/Bicipital Tendonitis	5305-5024	10%	20070828	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Left Shoulder Pain.  According to the MEB narrative summary (NARSUM) and service treatment record, the left-hand dominant CI’s left shoulder condition began in approximately September 2004 after lifting heavy cables.  Left shoulder X-rays dated 11 August 2005 were normal.  On 12 September 2005 the CI had bicipital groove tenderness, tenderness with motion; and shoulder range of motion (ROM) was full.  The CI was treated with physical therapy (PT) where bilateral scapular winging was noted.  An empty can test (to determine supraspinatus integrity), Neer’s test (to determine subacromial impingement), and Speed’s test (to determine superior labral tears or bicipital tendonitis) were positive on 19 September 2005.  The examiner’s impression was biceps tendonitis.  A left shoulder MRI on 17 November 2005 demonstrated acromioclavicular joint (AC joint) arthropathy with an underlying rotator cuff tear.  Left shoulder X-rays dated 3 January 2006 did not reveal a fracture-dislocation, focal osteoporosis (weak-brittle bone), periosteal reaction (new bone formation due to injury) or lytic lesions (bone destruction due to disease).  At an orthopedic clinic visit on 3 January 2006, the CI reported a popping sound along with a snapping sensation, and the left shoulder caught during movement.  Examination revealed AC joint tenderness, pain in the left shoulder while “walking the wall,” and pain with internal and external rotation of the shoulder.  The CI had an injection of the acromioclavicular joint and was prescribed medication for pain.  At an orthopedic clinic visit on 17 April 2006, examination findings were similar to those of the prior visit.  Left shoulder X-rays dated 4 May 2007 showed a slight asymmetry across the AC joint, but were otherwise unremarkable.

During the 15 May 2006 MEB PT examination, 2 months prior to separation, the left shoulder flexion was 175 degrees (normal 180) and abduction was 178 degrees (normal 180) with painful motion.  At the 5 June 2006 MEB NARSUM examination, 2 months prior to separation, the CI reported left shoulder pain.  Physical examination revealed the upper extremities had 5/5 strength, and no erythema, edema, deformity, or instability.  Upper extremities ROM was “full” with some discomfort raising the arms bilaterally.  

During the 28 August 2007 VA Compensation and Pension (C&P) examination, 13 months after separation, the CI reported shoulder pain elicited with physical activity and stress, but he denied incapacitation.  Physical examination revealed left shoulder tenderness without edema, effusion, weakness, guarding of movement, or subluxation (partial dislocation).  Bilateral shoulder flexion and abduction were 180 degrees.  There was no ROM loss following repetitive use due to pain. Left shoulder X-rays revealed normal mineralization, well maintained joint spaces, no soft tissue calcifications, nor fractures or osseous abnormalities.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, coded 5003 (degenerative arthritis), citing X-ray degenerative arthritis evidence, but no joint motion loss.  The VA also rated the left shoulder condition 10%, dual coded 5305-5024 (Group V:  elbow supination-tenosynovitis), based on C&P examination, citing moderate muscle disability.  The panel agreed that the VASRD §4.71a threshold for rating ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the STR and VA ROM evidence did not support a 20% rating.  However, there was satisfactory evidence of painful motion (VASRD §4.59), as recorded on the MEB PT examination to support a 10% rating.  The panel also agreed there was no fibrous union or nonunion of the humerus (5202), or clavicle or scapula impairment (5203), although there was scapula winging, but no nonunion or weakness, to support a higher rating.  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 left shoulder condition, coded 5099-5003.

BOARD FINDINGS:  In the matter of the left shoulder condition, the panel recommends a disability rating of 10%, coded 5099-5003 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, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Shoulder Pain	5099-5003 	10%	
The following documentary evidence was considered:

, XXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

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

Enclosure