RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-04299
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080815

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Cannon Crewmember, medically separated for “right (dominant) shoulder pain and instability following posterior labral repair” with a disability rating of 10%.

CI CONTENTION:  Review all conditions.  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 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 - 20080603	VARD - 20081224	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right (Dominant) Shoulder Pain and Instability	5099-5003	10%	Status Post Labral Repair, Right Shoulder	5299-5203	10%	STR	
Sensorineural Hearing Loss	Not Unfitting	Bilateral Hearing Loss	6100	NSC	STR	
Lower Back Pain	Not Unfitting	Lumbago	5299-5237	NSC	STR	
Knee Pain	Not Unfitting	Chondromalacia…Right Knee	5099-5014	0%	STR	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	
	
ANALYSIS SUMMARY:

Right Shoulder Pain and Instability. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent an arthroscopic right shoulder posterior labral repair and cyst decompression in April 2007. At a physical therapy (PT) visit on 9 November 2007, 9 months prior to separation, the CI reported no change from before surgery, and complained of generalized weakness despite therapy. On examination, there was right shoulder tenderness and deltoid atrophy. Range of motion (ROM), measured while sitting, showed both flexion and abduction to 110 degrees (normal 180 both); ROM from a supine position revealed flexion to 120 degrees and abduction to 160 degrees. During the 20 February 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months before separation, the examiner documented tenderness, right deltoid atrophy, and decreased abduction and muscle strength with ROM limited by pain.       The MEB NARSUM examination, 8 days later, noted complaints of increased

shoulder pain with any military duties as well as pushing and pulling activities, sudden movements, and when sleeping on the right shoulder. Physical examination showed tenderness and pain during both Neer’s and Hawkin’s tests (to identify subacromial impingement). There was mild shoulder instability with 1+ inferior subluxation, and measured ROM following repetition showed both flexion and abduction to 140 degrees, limited by pain. 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 condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing periarticular pathology with limited ROM and VASRD 4.59 (painful motion). The VA also rated the right shoulder condition 10%, but analogously coded 5299-5203 (clavicle or scapula, impairment), based on the STR, citing malunion or nonunion of the clavicle or scapula. Panel members noted that 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, there was evidence of painful motion for a 10% rating 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 right shoulder condition.

Contended PEB Conditions: Sensorineural Hearing Loss, Lower Back Pain, and Knee Pain. 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 implicated in the commander’s statement, and while the CI had bilateral hearing loss and used a hearing aid on the left, the condition was profiled H2 with no restrictions, and it did not fail retention standards. The low back and knee pain were not profiled, and also did not fail retention standards. Thus, 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 shoulder condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended hearing loss, lower back, and knee pain, 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.

The following documentary evidence was considered:

2	PD-2017-04299

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY
251 18TH STREET SOUTH, SUITE
385
ARLINGTON, VA 22202-3531

AR20200000167, 

Dear XXXXXXXXXXXXXXXX
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.