RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03405
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050128

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Helicopter Repairer, medically separated for “chronic right shoulder pain” with a disability rating of 20%. 

CI CONTENTION:  In addition to his right shoulder, the CI requested review of an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20041112	VARD - 20050505	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5099-5003	20%	Right Shoulder Impingement 	5201	10%	20050323	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the right-handed CI underwent right shoulder surgery to repair a torn labrum in June 1999.  He reinjured his right shoulder in June 2000 and underwent Bankart repair and medial capsular shift for severe instability in August 2000.  He was returned to full duty in March 2001, but aggravated his condition while doing push-ups during a physical fitness test.  X-rays showed degenerative joint disease and an MRI revealed rotator cuff tendinopathy.  He underwent a third surgery in December 2003, but continued to have signs of impingement and a very weak rotator cuff.  He underwent a forth surgery in May 2004 with “mini open biceps tenodesis, subacromial decompression, bursectomy and debridement of a superior labral remnant.”  

The 29 October 2004 physical therapy range of motion (ROM) study, 3 months prior to separation, showed right shoulder flexion of 139 degrees (normal 180) with 4/10 pain on motion and right shoulder abduction of 142 degrees (normal 180) also with 4/10 pain on motion.  During the 1 November 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported chronic right shoulder pain despite four surgeries.  Physical examination showed decreased ROM of the right shoulder with adduction and abduction.  The MEB NARSUM examination, conducted on the same day by the same physician, noted complaints of tenderness, pain and swelling.  Physical examination showed normal strength.  The examiner referenced the above physical therapy ROM measurements.

At the 23 March 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported right shoulder discomfort aggravated by lifting more than 20 pounds or by doing any above-shoulder activity.  Physical examination showed no joint line tenderness, swelling or instability and the CI could dress and undress without difficulty.  The ROM evaluation showed 160 degrees of flexion and abduction with pain in both planes of movement.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 20%, analogously coded 5099-5003 (degenerative arthritis), citing marked and constant pain IAW the US Army Physical Disability Agency pain policy.  
The VA rated the right shoulder condition 10%, coded 5201 (limitation of arm motion), based on the C&P examination, citing painful motion.  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.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available under the 5203 code (clavicle or scapula, impairment of).  Therefore, there was no higher rating than the 20% PEB rating under any applicable code.  After due deliberation, considering all of 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.  

AR20180015342, 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.