RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-05486 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060930

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

CI CONTENTION: He was given a higher rating by the VA for the bilateral shoulder condition. 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 - 20060727	VARD - 20070917	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Chronic Bilateral Shoulder Pain	
5099-5003	
10%	Rotator Cuff Impingement
Right Shoulder	5201	20%	STR	
			Rotator Cuff Impingement Left Shoulder	5099-5010	10%	STR	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Chronic Bilateral Shoulder Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral shoulder condition (right hand dominance) began in July 2005 with no associated traumatic injury. An MRI of both shoulders in April 2006 showed mild tendinopathies of the supraspinatus and infraspinatus bilaterally. X-rays performed in May 2006 showed no shoulder abnormality bilaterally.

During the 2 June 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the physical examination revealed bilateral shoulder pain with normal range of motion (ROM) and 4/5 strength. The examiner noted the ROM maneuvers were performed with ease. There was no tenderness over the AC joints. All tests showed no evidence of instability.

The 22 June 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of right greater than left shoulder pain with increased pain when the arms were abducted away from his body. Physical examination revealed tenderness over the greater tuberosity and the acromioclavicular joint, bilaterally. Right shoulder ROM was flexion 150 degrees (normal 180) and abduction to 140 degrees (normal 180). Left shoulder ROM was flexion to 168 degrees and abduction to 140 degrees. All ROM was limited by pain. .

At the 28 December 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported constant and moderate (6/10) bilateral shoulder pain. Physical examination revealed bilateral, diminished supraspinatus strength, 4/5 and positive Hawkins sign for supraspinatus rotator cuff impingement and the empty can test. Flexion and abduction were to 170 degrees bilaterally.

At the 13 July 2007 occupational therapy clinic appointment, 10 months after separation, the CI reported it hurt to reach up or back. Physical examination of the right shoulder revealed ROM as flexion of 155 degrees and abduction was 125 degrees. The left shoulder showed flexion to 150 degrees and abduction to 155 degrees. The examiner noted a positive right shoulder impingement test and the left was also mildly positive.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral shoulder condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy. The VA rated the right shoulder condition 20%, coded 5201 (arm, limitation of motion), based on the STR, citing right arm motion was limited at shoulder level; the left shoulder was rated 10%, analogously coded 5099-5010 (arthritis, due to trauma, substantiated by X-ray findings) based on the STR, citing painful and limited ROM of a major joint.

The panel first considered if each shoulder could be reasonably justified as separately unfitting. A bilateral condition was profiled, implicated in the commander’s statement, and failed retention standards. Panel members agreed the functional limitations of each shoulder contributed to the CI’s inability to perform his military duties, therefore; each shoulder could be reasonably justified as separately unfitting.

The panel then considered its rating recommendation. 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 no 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) for each shoulder. 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, and considering all the evidence, the panel recommends a disability rating of 10% for the left shoulder and 10% for the right shoulder, analogously coded 5299-5201.

BOARD FINDINGS: In the matter of the bilateral shoulder pain condition, the panel recommends that each joint be separately adjudicated as follows: an unfitting left and right shoulder conditions, respectively, with each analogously coded 5299-5201 and rated 10%, both 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 Left Shoulder Pain	5299-5201	10%	
Chronic Right Shoulder Pain	5299-5201	10%	
	COMBINED	20%	

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

AR20200004161, 

Dear XXXXXXXXXXXXXXXXXX:

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.

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