RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2017-03871 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050702

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Automated Logistical Specialist, medically separated for “chronic pain, right shoulder/scapular region” with a disability rating of 10%.

CI CONTENTION: “My myofascial pain, right shoulder and scapular region condition was so severe I could not sit without back support and could not have a bra strap on the shoulder. I could not wear LBE or Kevlar gear. I felt my board was rushed once found undeployable. My condition has since gotten worse as reflected by my VA rating.” 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 - 20050406	VARD – 20051004	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Shoulder/Scapular Region	5099-5003	10%	Myofascial Pain, Right Shoulder and Scapular Region	5243	10%	STR	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Chronic Pain, Right Shoulder/Scapular Region. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the onset of the CI’s right shoulder pain was in late 2001
- early 2002, after placing a duffel bag over her shoulder during training. Consultations prior to September 2004 noted "no sustained improvement with meds, physical therapy, trigger point injection, and profiles.” C and T spine and right shoulder X-rays were normal as was an EMG.

MRI of the right shoulder done in February 2004 showed reduced space between the humeral head and acromial roof and there was minimal supraspinatus edema compatible with tendinitis. Right shoulder X-ray in December 2004 was normal.

The 9 December 2004 MEB physical STR note indicated complaints of right shoulder and neck pain for over one year which was constant and increased with activity. Physical examination showed the CI’s posture had the right shoulder lower than the left, and she avoided any right shoulder movement. The CI complained of pain with any movement of the neck or right shoulder. Range of motion (ROM) was abduction to 80 degrees (normal 180) before being limited by pain in the supraspinatus area/mid acromial area. Strength was roughly 4+/5 diffusely. Instability testing was unable to be performed due to pain. There was pain with light touch to skin over supraspinatus, neck, down to the superior edge of the rhomboid and extending down the triceps.  The diagnosis was myalgia and myositis.

During the 15 December 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, physical examination noted decreased ROM in the right upper extremity with equal strength bilaterally. The MEB NARSUM dated the same day, noted complaints of pain with any movement of the neck or right shoulder, and referenced the DD Form 2808 and 9 December 2004 examination summarized above. 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 right shoulder/scapula condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy. The VA rated right shoulder and scapular region myofascial pain10%, coded 5243 (intervertebral disc syndrome), based on the STR, citing localized tenderness, pain and reduced ROM.

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). The 20% rating for the dominant arm requires motion limited to “at shoulder level” and the MEB physical examination reflected this degree of limitation. 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), and no higher rating available 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 recommends a disability rating of 20% for the right shoulder/scapula condition, coded 5201.

BOARD FINDINGS: In the matter of the right shoulder/scapula condition, the panel recommends a disability rating of 20%, coded 5201 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 Pain, Right Shoulder/Scapular Region	5201	20%	

PD-2017-03871 

AR20190010901, XXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

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.

PD-2017-03871