XXXXXXXXXX

Dear XXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05073
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070420

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Infantryman, medically separated for “chronic [right] shoulder pain” with a disability rating of 10%. 

CI CONTENTION:  In addition to the not-unfitting PTSD, the CI also requested review of 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 DoDI 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 - 20070309	VARD - 20070820	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5099-5003	10%	Right Shoulder Injury	5201	30%	20070625	
PTSD	Not Unfitting	PTSD	9411	30%	20070723	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60% 	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the right-handed CI’s right shoulder condition began in early 2006 after he experienced a painful “pop” while performing upper body strengthening exercises.  An MRI showed a possible SLAP (superior labrum anterior posterior) lesion.  The 7 November 2006 orthopedics examination showed full range of motion (ROM) of the right shoulder, without tenderness.  Provocative testing was negative for impingement signs, but was mildly positive for a labral tear.  There was no evidence of instability.  The surgeon noted no labral tear on review of the MRI and no surgery was recommended.  

The 20 November 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, showed full active ROM and normal strength.  Provocative testing to detect a labral tear was positive and there was tenderness at the anterior aspect of the right shoulder.
The physical therapy examination for right shoulder ROM for the MEB on 20 November 2006 showed 105 degrees of flexion and abduction (normal 180 for both) after three repetitions.  Right shoulder strength was normal. 

At the 25 June 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported right shoulder pain elicited by activity.  He denied weakness, stiffness, swelling, heat, redness, giving way, lack of endurance, locking, fatigability or dislocations.  He was unable to do overhead activities.  The shoulder condition did not cause incapacitation and the CI was not receiving any treatment.  Physical examination showed right shoulder tenderness, but no edema, effusion, weakness, redness, heat, abnormal movement, guarding of movement or subluxation.  The right shoulder ROM evaluation showed flexion of 122 degrees, with pain starting at 100 degrees, and 87 degrees of abduction, with pain starting at 50 degrees.  The right shoulder was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.

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 (degenerative arthritis), citing slight and frequent pain IAW the US Army Physical Disability Agency pain policy.  The VA rated the right shoulder condition 30%, coded 5201 (limitation of arm motion), based on the C&P examination, citing limitation of right arm abduction midway between side and shoulder level.

The panel considered the ROM evaluations proximate to separation and agreed the post-separation VA examination was complete and the most proximate examination to separation.  The VASRD §4.71a threshold for a 20% rating for the dominant arm for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side) and the VA examination reflected this degree of limitation.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher rating available under the 5203 code (clavicle or scapula, impairment of).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the right shoulder condition, coded 5201.  

Contended PEB Condition:  PTSD.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  The 10 January 2007 mental health MEB NARSUM, 3 months prior to separation, noted the CI’s chronic PTSD was in remission and the CI had “responded efficaciously to treatment.”  There was no decreased job performance noted with the CI’s duties in rear detachment.  The MEB psychiatrist determined the CI met retention standards with regard to the MH condition.  There was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right shoulder condition, the panel recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  In the matter of the contended PTSD, the panel recommends no change from the PEB determination as not unfitting.  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 Shoulder Pain	5201	20%