NAME:  XXXXXXXXXXXXXXX

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

CASE: PD-2017-04908

BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070203

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Petroleum Supply Specialist, medically separated for “chronic pain right shoulder” with a disability rating of 10%.

CI CONTENTION: “Status post [S/P] right shoulder surgery with osteoarthritis left shoulder impingement syndrome, and right shoulder residual scar.” 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 - 20061214	VARD - 20070522	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Right Shoulder	5099-5003	10%	S/P Right Shoulder Surgery	5003-5203	10%	20070514	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Chronic Pain Right Shoulder. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right shoulder pain condition progressed over a 2-year period resulting in two surgeries. The first surgery in April 2005, was for an open Bankart; the second surgery in October 2005, was for an adhesive capsulitis where a manipulation under anesthesia along with a diagnostic scope occurred. During a deployment in February 2006, he dislocated his shoulder and experienced numerous subluxations.

At the 15 September 2006 MEB examination, 5 months prior to separation, the CI reported 7/10 pain. Physical examination showed normal flexion and abduction of 180 degrees each, without pain. Muscle strength was 5/5 and there was no tenderness. The MEB NARSUM examination 2 weeks later noted complaints of moderate, frequent and constant pain. Physical examination showed abduction 120 degrees and flexion 180 degrees. There was significant guarding with load shift. No translation was noted secondary to guarding.  The 14 May 2007 X-rays showed modest

degenerative changes of the right shoulder to include moderate inferior osteophytic lipping at the glenoid and mild superior spurring at the acromioclavicular joint. The humeral head was smooth and well seated in the glenoid.  No acute finding was seen on either side.

At the VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported daily right shoulder symptoms of stiffness, weakness, fatigue, and difficulty sleeping. The CI reported lifting capability was less than 50 pounds. Physical examination showed a normal gait with arm swing; the opposite arm and shoulder were symmetrical. Strength was normal. Forward flexion was 145 degrees and abduction 150 degrees. The right shoulder demonstrated arc pain with forward flexion at 90-145 degrees and abduction pain 100-145 degrees. No crepitus present. The CI grimaced with ROM and reported discomfort of the right shoulder as the additional limitation secondary to pain.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic right shoulder pain 10%, analogously 5099-5003 (degenerative arthritis) citing repeated dislocations and subluxations; abduction 120 degrees and flexion 120 degrees. The VA also rated the s/p right shoulder surgery with osteoarthritis condition 10%, dual coded 5003-5203 (clavicle or scapula) based on the C&P examination, citing painful or limited motion of a major joint.

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), and the examinations in evidence demonstrated motion above this level. Although there was insufficient limitation of motion to support a rating under the 5201 code, 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 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the chronic pain right shoulder condition.

BOARD FINDINGS:      In the matter of the chronic right shoulder pain condition and IAW VASRD
§4.71, the panel recommends no change in the PEB adjudication. 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.

2	PD-2017-04908

Dear XXXXXXXXXXXXX

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.

Sincerely,

Enclosure