RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxx	CASE:  PD-2017-05161
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080907

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Health Care Specialist, medically separated for “right shoulder pain” with a disability rating of 20%.  

CI CONTENTION:  Review of the shoulder condition was requested along with 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 - 20080520	VARD - 20081204	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5201	20%	Right Shoulder Impingement Syndrome Status Post Surgery	5201	20%	20080820	
COMBINED RATING:  20%	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 CI underwent right (dominant) shoulder surgery in December 2006 for arthroscopic anterior Bankart repair and another surgery in August 2007 for right shoulder arthroscopy and “debridement of retained suture.”  The 9 April 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of daily pain of 2 out of 10 in intensity.  Physical examination of the right shoulder, following repetition, showed painful range of motion (ROM) with flexion of 75 degrees (normal 180) and abduction of 90 degrees (normal 180).  

At the 20 August 2008 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported his shoulder was stable and sometimes too tight.  The shoulder would ache and was painful when he moved in certain directions.  It was aggravated by overhead activity or heavy lifting greater than 20 pounds, at which time it flared with sharp pain and then ached.  Physical examination of the right shoulder showed painful flexion of 75 degrees and abduction of 85 degrees.  There was no change in ROM with repetitive movement and no additional loss of ROM due to pain, weakness, impaired endurance, fatigue, incoordination, or flare-ups.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and the VA rated the right shoulder condition 20%, coded 5201 (arm, limitation of motion), citing limitation of motion to 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 examinations in evidence demonstrated motion limited to this level.  The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level.”  However, examinations did not reflect 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), and no higher ratings available 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 right shoulder condition.  

BOARD FINDINGS:  In the matter of the right shoulder condition and IAW VASRD §4.71a, 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.  

AR20190008585,  

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.