RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03582
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Trainee, medically separated for “right shoulder pain and instability” with a disability rating of 10%.  

CI CONTENTION:  “It’s affected me in my everyday life.  It has caused severe insomnia and pain.  When I was discharged they never applied all my injuries that should have been added on with my shoulder problems.”  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 - 20090313	VARD - 20090610	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain and Instability	5099-5003	10%	Scapular Dyskinesis and Impingement Right Shoulder	5299-5203	10%	20090413	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Shoulder Pain and Instability.  According to the service treatment record and MEB narrative summary (NARSUM), the right-hand dominant CI injured her right shoulder in August 2008 during physical training.  The CI had a steroid/anesthetic injection of the right shoulder after physical therapy for 2 weeks without improvement.  X-rays of the right shoulder on 17 September 2008 were normal.  An MRI done on 9 December 2008 showed no evidence of a labral tear.  Findings were consistent with myxoid degeneration, a partial tear of the distal supraspinatus tendon, and mild impingement of the supraspinatus tendon caused by degenerative changes of the AC (acromioclavicular) joint.  At the time of the orthopedic clinic appointment on 9 January 2009, 3 months prior to separation, the CI reported continued right shoulder pain.  The examiner noted pain in the CI’s right shoulder in the glenohumeral joint in the subacromial region with a popping sound and a snapping/clicking/grinding sensation; however, the right shoulder did not feel unstable.  Pain was elicited during the Neer’s impingement test and during a Hawkin’s-Kennedy impingement test (to identify subacromial impingement).  Both shoulders showed laxity, but were normal in appearance.  Palpation of the shoulders showed no abnormalities and there was no muscle spasm.  Range of motion (ROM) was normal. No labral tears were noted and there was no weakness.  An anterior shift test of the right shoulder (to determine glenohumeral stability) was positive as was a sulcus sign (to test for instability).  Surgery was not recommended.  

During the 13 January 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported pain in the right shoulder.  Physical examination revealed right shoulder instability and mild impingement/degenerative changes.  According to the 9 February 2009 MEB NARSUM evaluation, 2 months prior to separation, the CI complained of chronic right shoulder pain and instability with pain of 5/10 that increased to 8/10 with certain activities and certain positions while lying down.  Physical therapy provided no significant improvement.  Physical examination showed the right shoulder ROMs were forward flexion of 172 degrees (normal 180) and abduction of 188 degrees (normal 180), both with pain.  There was no snapping or mechanical locking with the ROMs.  The shoulders showed no scars or obvious deformities, and the glenohumeral and AC joints were nontender.  Sulcus and apprehension signs (to test for instability and a possible torn labrum) were positive bilaterally.  Load shift testing was equal bilaterally.  O’Brien’s test (to determine a glenohumeral joint labral tear) was negative bilaterally.  Neer’s and Hawkin’s tests were positive on the right.  Muscle strength was normal and equal bilaterally.  The biceps tendons were nontender.  

At the 13 April 2009 VA Compensation and Pension (C&P) examination, 2 weeks after separation, the CI reported pain, mild weakness, and some instability without any true dislocation or traumatic episodes in the shoulder.  She described her pain as sharp in both the anterior and posterior aspects of the shoulder, but primarily on the superior aspect and the posterior scapula.  Pain radiated to right trapezius and paraspinal muscles in the cervical spine as well and occasionally down her right arm.  Exercise and overhead activity caused increased pain, which was alleviated by rest.  Physical examination showed normal alignment with no obvious deformity.  She was mildly tender over the anterior shoulder and nontender to the AC joint.  ROM of the right shoulder was 180 degrees forward flexion and 185 degrees abduction.  She had mild scapular winging on the right with repetitive forward elevation, indicating a weakness of the serratus anterior muscle.  There was a very mild impingement without a painful arc.  She had a negative Speed’s sign and Yergason’s test (to test for a superior labral tear or bicipital tendonitis) and normal belly press and lift-off tests.  There was no sign of any full thickness rotator cuff tear or any instability of the right shoulder in the absence of apprehension to anterior or posterior loading.  The examiner further stated the CI had a genetic predisposition to joint laxity; however, she did well prior to entering the service without any symptoms related to her current right shoulder condition.  The examiner noted that her condition was due to overuse most consistent with dyskinesis (alteration in the normal position or motion of the scapula) and impingement, both of which were expected to resolve with physical therapy or, if it failed, surgery.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5099-5003 code (arthritis, degenerative), citing painful motion.  The VA also assigned a 10% rating using an analogous 5299-5203 code (clavicle or scapula, impairment of), citing painful and slightly limited 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 that 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 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no dislocation or nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment of).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that 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.  

AR20180015297, 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.