RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-04386 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090101

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

CI CONTENTION: The shoulder condition has continued to worsen. 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 - 20081107	VARD - 20090213	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5099-5003	10%	Right Shoulder Strain	5201	20%	20080911	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Right (Dominant) Shoulder Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered a right shoulder injury during an IED blast and underwent right shoulder SLAP (Superior Labrum Anterior and Posterior) surgery in October 2007. He underwent a second SLAP surgery in April 2008, but continued to experience anterior and posterior capsular shift and pain despite aggressive physical and occupational therapy. Radiographic studies (X-ray) performed in September 2008 were normal.

The 17 July 2008 MEB NARSUM examination, 6 months prior to separation (3 months after surgery), noted complaints of constant right shoulder pain (4/10 to 6-7/10 with   exacerbation),

worsened by any overhead work, lifting objects, weather changes, driving, running, excessive movement or being stationary,. The pain also awakened him from sleep when rolling over the shoulder. Physical examination showed the CI in a moderate amount of discomfort with range  of motion (ROM) showing forward flexion of 165 degrees and abduction of 155 degrees. There was no reference to any other ratable features. At an orthopedic examination the same day, the CI complained of continued shoulder pain that could be controlled with oral medications (prescribed meloxicam; a non-steroidal anti-inflammatory). Physical examination noted ROM of 160 degrees flexion and abduction. The 28 August 2008 physical therapy examination recorded right shoulder ROMs of 160 degrees of flexion and abduction with painful motion on repetition and limitation by pain and scarring.

During the 11 September 2008 VA Compensation and Pension (C&P) examination, 4 months prior to separation, the CI reported shoulder pain, rated at 4/10, that was aggravated by repetitive use and alleviated by rest. Physical examination showed ROM of 180 degrees flexion and abduction, with pain on abduction at 150 degrees and when stressed. There was no additional ROM limitation from pain, fatigue, weakness, or lack of endurance following repetitive use.

At the 29 January 2009 VA C&P examination the CI reported intermittent sharp and dull pain, rated daily at 3/10 up to 7/10 with flare-ups (usually caused by lifting, weather and overuse). The shoulder affected activities of daily living to include chores, driving, exercising, and sports. Physical examination showed ROM of forward flexion to 150 degrees with pain, and abduction to 140 degrees with pain beginning at 0 degrees. There was an additional limitation due to increased pain to 90 degrees abduction.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the shoulder condition 10%, analogously coded 5003 (degenerative arthritis), citing limit of ability to perform overhead activities and rated for limitation of motion of one major joint. The VA rated the shoulder condition 20%, coded 5201 (arm, limitation of motion), based on the C&P examination, citing reduced abduction to 90 degrees on flare-ups or repetitive use.

The panel deliberated the probative value of the examinations in evidence. The CI’s second surgery was within 9 months of separation, and post-surgery detailed evaluations documented multiple positive special tests for instability and painful motion. STR ROM evaluations recorded in the NARSUM and prior notes did not address repetitive motion. The VASRD §4.71a threshold for rating for ROM impairment (code 5201) is “at shoulder level” (approximately 90 degrees from the side), and multiple examinations in evidence prior to separation, including the pre-separation VA examination, demonstrated motion above this level.

Although the second VA examination, the month of separation, supported limitation at shoulder level following flares or repetitive motion, the panel majority adjudged that the examination was an outlier and not indicative of the disability level depicted in the preponderance of the record. There was therefore insufficient limitation of motion to support a rating under the 5201 code. Panel member consensus was 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); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating 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 majority concluded 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 majority  recommends  no  change  in  the    PEB  adjudication.	The  single  voter  for   dissent

recommends modification to 20% and did not elect to submit a minority opinion. 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:

PD-2017-04386 

AR20190012731, XXXXXXXXXXXXXXXXXXXXXX 

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.

PD-2017-04386