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 and the counsel you listed on your application, XXXXXXXXXX, 

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05101
BRANCH OF SERVICE:  army	SEPARATION DATE:  20070323

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 “chronic right shoulder pain” with a disability rating of 0%.

CI CONTENTION:  “Limited range of motion, degenerative changes, constant pain and tightness and weakness.”  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 - 20070302	VARD - 20080111	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5099-5003	0%	Status Post Arthroscopic Procedure, Right Shoulder with Residuals	5201	10%	20071106	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Chronic Right Shoulder Pain.  According to the MEB narrative summary (NARSUM) and service treatment record (STR), the right hand dominant CI underwent surgical repair of his right shoulder in 1998.  The right shoulder was traumatically dislocated while playing football in January 2006 resulting in additional repair surgery in March 2006.  The pain did not subside with post-operative rehabilitation.

The physical therapy range of motion examination on 20 June 2006, 9 months before separation, showed right shoulder flexion of 110 degrees (normal 180) and abduction of 100 degrees (normal 180).  There was significant weakness (3/5 flexion and abduction), but painful motion was not specifically addressed.  An orthopedic examination on 18 October 2006, 5 months before separation, revealed right shoulder tenderness, weakness and reduced right shoulder motion.  It was unclear if painful shoulder motion was for the right or left shoulder.  Instability and impingement testing was negative.  The 17 January 2007 MEB physical therapy examination, 2 months prior to separation, recorded repetitive right shoulder flexion of 110 degrees and abduction of 113 degrees.  Pain limited motion was present.  

At the 22 January 2007 MEB NARSUM examination the CI reported constant right shoulder pain aggravated when carrying twenty pounds or more, or with overhead use.  Physical examination revealed “decreased” right upper extremity ROM, normal motor strength, normal reflexes and intact sensation.  Painful motion was not addressed.  There was tenderness of the acromioclavicular joint and subacromial bursa, and crepitus was noted throughout the examination.  Testing for instability and impingement was negative.  

During the 6 November 2007 VA Compensation and Pension (C&P) examination, 7 month after separation, the CI reported right shoulder ROM loss and constant pain aggravated by overhead use.  The ROM evaluation revealed right shoulder flexion to 110 degrees and abduction to 90 degrees.  Painful motion was present.  Right shoulder X-rays showed slight arthritic changes in the glenohumeral joint.

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 pain-limited motion.  The VA rated the right shoulder condition 20%, coded 5201 (arm, limitation of motion), based on the C&P examination, citing limitation of motion at shoulder level.

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 pre-separation examinations proximate to separation demonstrated motion above this level.  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 and no dislocation or nonunion of the clavicle or scapula to justify a higher rating under the 5202 (humerus, other impairment of) or 5203 (clavicle or scapula, impairment of) codes.  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 5099-5003.

BOARD FINDINGS:  In the matter of the right shoulder condition, the panel recommends a disability rating of 10%, coded 5099-5003 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 Right Shoulder Pain	5099-5003	10%