RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX 	CASE:  PD-2017-03974
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090424

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cavalry Scout, medically separated for “right shoulder pain and stiffness” and “left shoulder pain from subscapular bursitis,” rated 10% each, with a combined disability rating of 20%.    

CI CONTENTION:  Review all conditions as well as 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 Do DI 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 - 20090301	VARD - 20090619	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain and Stiffness	5099-5003	10%	Right Shoulder Tendinosis	5203	10%	20090320	
Left Shoulder Pain	5099-5019	10%	Left Shoulder Tendinosis	5203	10%	20090320	
Epistaxis	Not Unfitting 	Epistaxis	6599-6502	NSC	20090320	
Mild Left Sided Sciatica		Lumbar Spine Spondylosis	5239	10%	20090320	
Allergic Rhinitis		Allergic Rhinitis	6522	0%	20090320	
Pruritus Ani		No VA Placement	
History of Labile Hypertension		No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right (Dominant) Shoulder Pain and Stiffness.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI experienced right shoulder pain while doing push-ups in December 2007, and an MRI on 4 February 2008 revealed a bicipital labral complex irregularity consistent with a superior labral tear from anterior to posterior (SLAP) lesion.  

At an orthopedic appointment on 12 June 2003, 10 months prior to separation, the CI reported bilateral shoulder pain, left greater than right.  The right shoulder pain was localized to the anterior glenohumeral joint line with motion, and the examiner described what appeared to be a 2+ anterior and 1+ posterior drawer signs as well as a palpable clunk of the shoulder reducing back into place.  Positive results were noted during SLAP, O’Brien, jerk and Kim testing, but Hawkins, Neer, Yergason, and cross-body tests were all negative.  There was full symmetric range of motion (ROM) of both shoulders. 

The 6 January 2009 MEB NARSUM examination, 4 months before separation, noted continued complaints of right shoulder pain, rated at 3/10, and increased to 6-7/10 with repetitive overhead activity.  Medications included Percocet (narcotic) as needed for severe pain only, Flexeril (muscle relaxant) and Motrin (anti-inflammatory).  Physical examination showed mild tenderness to the anterior deltoid region, but no crepitus, deformity, erythema or effusion.  Limited ROM was noted, but without actual measurement, and there was no evidence of fatigue, lack of endurance or instability.  Shoulder ROM measurements performed by physical therapy (PT) on 28 January 2009, 3 months before separation, showed right shoulder flexion of 134 degrees (normal 180) and abduction of 127 degrees (normal 180), with painful motion after three repetitions.

At the 20 March 2009 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported left greater than right shoulder pain.  Physical examination showed 1+ crepitus with repetitive movement, but both shoulders were symmetrical with no scapular winging.  The CI exhibited mild to moderate manifestations of pain and stiffness during the examination, and right shoulder ROM following repetitive movement showed both flexion and abduction to 180 degrees. The examiner estimated functional ROM limited to 150 degrees during flare-ups, with no evidence of additional loss of motion, lack of endurance, fatigability or weakness after repetition.  

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 forward flexion of “137 degrees” limited by pain.  The VA also rated the right shoulder condition 10%, but coded 5203 (clavicle or scapula, impairment of), based on the C&P examination, citing painful motion.    The VASRD §4.71a threshold for rating ROM impairment under 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.  However, 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 code 5202 (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under code 5203 (clavicle or scapula, impairment of).  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.  

Left Shoulder Pain from Subscapular Bursitis.  According to the STR and MEB NARSUM, the CI’s left shoulder condition began in 2007 while deployed.  Although no specific injury was reported, he attributed the pain to putting on body armor and wearing equipment.  An MRI showed left snapping scapular syndrome.  At the 12 June 2008 orthopedic visit, the CI reported bilateral shoulder pain, left greater than right with a persistent grinding snapping sensation that started in the inner aspect of the left shoulder and radiated out laterally to the upper angle of the scapula.  There was full symmetric ROM bilaterally, and testing of the left glenohumeral joint showed no significant findings with negative impingement and labral signs.  

The MEB NARSUM examination noted complaints of continued left shoulder pain, rated at 5/10, which was easily aggravated with overhead activities, lifting greater than 25 pounds or abduction.  Physical examination showed left shoulder crepitus and posterior scapular tenderness superiorly, but no deformity and winging.  Limited ROM was noted, but not quantified.  Measured ROM by PT on 28 January 2009 showed left shoulder flexion of 111 degrees and abduction of 130 degrees, with painful motion after three repetitions.  At the C&P examination, the CI reported left greater than right shoulder pain.  Physical findings and ROM for both shoulders were as noted above in the discussion for the right shoulder.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, analogously coded 5099-5019 (bursitis), citing “134 degrees forward flexion and 127 degrees abduction.”  The VA also rated the left shoulder condition 10%, coded 5203, based on the C&P examination, citing painful motion.  Panel members agreed that the examinations in evidence demonstrated left arm motion above shoulder level, but that a 10% rating was justified with application of VASRD §4.59.  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 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.  

Contended PEB Conditions:  Epistaxis, Mild Left Sided Sciatica, Allergic Rhinitis, Pruritus Ani and History of Labile Hypertension.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right and left shoulder conditions and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended conditions, the panel recommends no change from the PEB determinations as not unfitting.  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-2017-03974

AR20190010936, XXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXX

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-2017-03974