RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03436
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20090307

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Infantryman, medically separated for “left shoulder rotator cuff tenosynovitis (non-dominant)” and “chronic right (dominant) shoulder pain,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  No specific contention was made.  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 - 20090105	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Rotator Cuff Tenosynovitis 	5024	10%	 No VA Examination Proximate to Separation in Evidence 	
Chronic Right Shoulder Pain 	5099-5003	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Left Shoulder Rotator Cuff Tenosynovitis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left shoulder condition began in 2004 during basic training.  He completed training and during deployment in December 2004 the shoulder pain worsened and he was diagnosed with AC joint strain.  He redeployed in September 2005, but the pain did not resolve.  An MRI showed a labral tear.  His unit sent him to a "fit for duty" examination in 2008 and was sent to an orthopedist for evaluation.  A subsequent left shoulder MRI in September 2008 documented mild rotator cuff tendonitis.  There were no bony abnormalities and the glenoid labrum was normal.

A physical therapy evaluation in November 2008 recorded range of motion (ROM) of abduction to 130 degrees (normal 180) and flexion to 155 degrees (normal 180); painful motion was present  The 17 December 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of tolerable pain which was exacerbated by activity.  Physical examination showed bilateral AC joint tenderness.  Bilateral ROM was “normal” for both flexion and abduction; painful motion was present.  Upper extremity strength was 5/5, deep tendon reflexes were normal and there was no instability.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, coded 5024 (tenosynovitis), citing limitation of one major joint and functional loss IAW VASRD §§ 4.10, 4.40, 4.45 and 4.59.  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 no limitation of motion to support a rating under the 5201 code, panel members agreed that a 10% rating was justified with application of VASRD §4.59 and §4.40 for painful motion with functional loss.  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).  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 left shoulder condition.

Chronic Right Shoulder Pain.  According to the STR and the MEB NARSUM, the CI’s right shoulder condition began in 2004 during basic training.  He completed training and during the aforementioned December 2004 deployment the shoulder pain worsened.  He was diagnosed with AC joint strain and treated with nonsteroidal medication.  A right shoulder MRI showed mild degenerative changes and a small cystic abnormality in the AC joint.

A physical therapy evaluation in November 2008 recorded flexion to 180 degrees and abduction to 135 degrees.  The 17 December 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of pain exacerbated by activity.  He experienced pain flare-ups with weight bearing on the shoulders or extensive use, especially overhead work.  Physical examination showed tender AC joints, bilaterally.  ROM was flexion and abduction both to 180 degrees.  Upper extremity strength was 5/5, deep tendon reflexes were normal, and no instability was noted. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing limitation of one major joint and functional loss IAW VASRD § 4.10, 4.40, 4.45 and 4.59.  As noted above, the VASRD §4.71a threshold for rating for ROM impairment is “at shoulder level” and the examinations in evidence demonstrated motion above this level.  Although there was no limitation of motion to support a rating under code 5201, panel members agreed that a 10% rating was justified with application of VASRD §4.59 and §4.40.  There was no malunion or recurrent dislocation of the humerus to justify a rating under code 5202; and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under code 5203.  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 left shoulder condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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 20170512, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008986, 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