RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-03466
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080327

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

CI CONTENTION: Review of his right shoulder requested along with additional conditions 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 - 20080326	VARD - 20080917	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Chronic Pain,	5099-5003	10%	Status Post Right AC Surgery	5201-5010	10%	20080605	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Right Shoulder Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent right shoulder arthroscopic surgery in May 2006 for right shoulder impingement, rotator cuff tear and acromioclavicular (AC) joint arthrosis. In February 2007 he underwent a second arthroscopic surgery for rotator cuff repair. Right shoulder MRI on 20 July 2007 showed mild degeneration and tendinosis of the rotator cuff tendon with a two screw tunnel overlying the greater tuberosity related to previous surgery. There was an old partially torn posterior-superior glenoid labrum. The subscapularis and superior gleno-humeral ligaments were unremarkable as was the biceps tendon.  At the time of the primary care   clinic

appointment on 31 August 2007, 7 months prior to separation, the CI reported constant aching right shoulder pain at 4/10. On examination there were well-healed incisions and tenderness at the anterior shoulder region. Right shoulder range of motion (ROM) showed flexion of 180 degrees (normal) and abduction of 170 degrees (normal 180). The rotator cuff showed positive supraspinatus, negative infraspinatus and positive subscapularis/Jobe liftoff test. There was positive Hawkins impingement and a positive cross arm adduction test. There was negative instability or atrophy and Yergason’s and O’Brien’s tests were negative. Motor strength was 5/5 and sensation was intact. The orthopedic consultant noted motion was excellent with an intact rotator cuff and follow up should occur as needed.

The 20 September 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of chronic right shoulder pain. Physical examination showed the right shoulder was tender with the insertion of the supraspinatus as was the posterior deltoid and posterior joint capsule. There was a positive empty can sign and positive impingement sign. He had weakness in his arm when it was abducted away from his body greater than 20 degrees. Right shoulder ROM measured with a goniometer showed flexion of 180 degrees with pain and abduction of 150 degrees with pain beginning at 140 degrees. Extension was to 90 degrees. There was crepitus with ROM and there was no swelling, warmth or redness in the shoulder or upper extremity. Internal and external rotation was to 80 degrees with pain. Pain was rated moderate and constant per pain rating.

At the 5 June 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported daily right shoulder pain. He had flare-ups brought on by using his arm overhead or using it straight out in front of him for prolonged periods of time. Too much lifting aggravated the pain. He did not use a brace, sling or any support and he had not lost any work due to this condition. He worked as a mechanic for 2 weeks and took tramadol for pain. Physical examination showed asymmetry in the AC area when compared to the left. There was slight prominence and he had small stab scars from previous surgical intervention. He was slightly tender around the AC area. Right shoulder ROM showed flexion of 180 degrees with difficulty getting there and abduction of 170 degrees. He had slight crepitus with motion and he complained of increased pain associated with abduction and internal rotation. There were no signs of fatigability, lack of endurance, or incoordination.

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 (degenerative arthritis), citing flexion of 110 degrees, and abduction of 160 degrees, and rated for slight/constant pain. The VA also rated the right shoulder condition 10%, dual coded 5201-5010 (arm, limitation of motion -arthritis, due to trauma), based on the STR and C&P examination, citing mild degeneration and tendinosis associated with a two screw tunnel overlying the greater tuberosity related to previous surgery and pain on 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. Although there was insufficient 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 (painful motion). 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 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.

PD-2017-03466

AR20190010665, XXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

	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.

PD-2017-03466