RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04253
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060628

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E6, Motor Transport Operator, medically separated for “chronic pain, right shoulder” with a disability rating of 0%.  

CI CONTENTION:  “I am happy with my current rating.  Some conditions are getting worse as I am now 70 years old.”  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 - 20060531	VARD - 20070119	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Shoulder	5099-5003	0%	Right Shoulder Cuff Tear With Subsequent Orthoscopic Repair	5299-5201	20%	20061006	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right (dominant) shoulder rotator cuff surgery prior to Service entry with a second right shoulder rotator cuff surgery in March 2005 due to a line of duty injury.  Radiographic studies revealed a humeral head subluxated superiorly, evidence of distal clavicle resection, and calcification within the acromioclavicular joint.  

During the 27/30 March 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI marked block 12a (painful shoulder).  Physical examination showed range of motion (ROM) of flexion and abduction both to 160 degrees (normal 180).  The 28 March 2006 MEB NARSUM examination noted complaints of crepitus with major difficulty doing overhead work.  Surgery had improved ROM but not overhead functionality, and he still had pain.  Physical examination showed full flexion and abduction with external rotation decreased to 30 degrees (left 48) and internal rotation to L3 (T8 on left).  There was pain and decreased strength of the supraspinatus on the right, but the examiner noted no difficulty with removal of the shirt, and negative signs for Hawkins, Neer and joint tenderness tests.  The diagnosis was “right shoulder pain with persistent rotator cuff tear post rotator cuff repair.” Restrictions included “no pushups or duty use of right upper extremity overhead.”  

At the 6 October 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported the inability to reach for items and abduct the right shoulder more than 90 degrees without pain, describing the effect on activities of daily living as mild.  Physical examination showed flexion to 180 degrees and abduction to 170 degrees, with pain beginning at 90 degrees in both planes.  There was no additional loss of motion on repetition.  In physical therapy on 1 February 2007, 7 months after separation, flexion and abduction were both recorded as 151 degrees, and the provider noted the CI needed no assistance to lower his arm, but that it dropped at approximately 90 degrees (likely indicating pain).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing mild/frequent pain and the US Army Physical Disability Agency pain policy.  The VA rated the right shoulder condition 20%, analogously coded 5299-5201 (arm, limitation of motion of:  at shoulder level), based on the C&P examination, citing evidence of abduction and flexion characterized by pain at 90 degrees.  The VASRD §4.71a threshold for rating for ROM impairment under code 5201 (arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence all demonstrated motion above this level.  However, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  Given X-ray evidence of distal clavicle resection, without loose movement, and continued rotator cuff tear, a 10% rating analogous to code 5203 (clavicle or scapula, impairment of) was best supported.  There was no nonunion with loose movement and no dislocation of the clavicle or scapula to warrant the next higher 20% rating.  There was likewise no higher rating for limitation of motion (5201) or for malunion or recurrent dislocation of the humerus (5202).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right shoulder condition, coded 5099-5203.    

BOARD FINDINGS:  In the matter of the right shoulder condition, the panel recommends a disability rating of 10%, coded 5099-5203 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	5099-5203	10%	

The following documentary evidence was considered:
AR20190010067,  

Dear XXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified.  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.