RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXXx	CASE:  PD-2017-06065
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060906

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Indirect Fire Infantryman, medically separated for “chronic right (dominant) shoulder pain” with a disability rating of 0%.  

CI CONTENTION:  Review all conditions.  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 - 20060531	VARD - 20070306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right (Dominant) Shoulder Pain	5099-5003	0%	Bony Bankart Defect of the Right Shoulder	5201	20%	20070103	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Right (Dominant) Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s shoulder condition began with atraumatic onset in late 2002 during basic training.  The right shoulder locked-up while swimming in 2005.  Radiographic studies in October 2005 revealed a partial tear of the supraspinatus and a probable osteochondral defect.  Surgical repair was offered, but reasonably declined.  At the 3 February 2006 orthopedic examination, 7 months prior to separation, the CI complained of right shoulder pain.  Right shoulder appearance was symmetric with no atrophy.  Range of motion (ROM) testing showed flexion of 180 degrees (normal) and abduction of 65 degrees (normal 180).  There was no evidence of laxity, instability or impingement, and strength was normal.  During the March 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported right shoulder pain and inability, and could not hold anything with his right arm without pain.  Physical examination revealed decreased right shoulder ROM with abduction and external rotation. 

The 28 April 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of 3-8/10 right shoulder pain aggravated by push-ups, sit-ups, overhead work, wearing of rucksack or body armor, lifting, upper body physical training, running, rope climbing, pull-ups and standing at the position of parade rest for more than 2-3 minutes.  Physical examination revealed tenderness and pain, and the O’Brien’s test (for labral tears) was positive.  Right arm goniometric ROM testing on 21 March 2006 by physical therapy, after repetitions, showed flexion and abduction of 115 degrees, with pain limiting motion in both planes.  

At the 3 January 2007 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported constant right shoulder pain, weakness, stiffness and locking, which affected activities of daily living to include handwriting, lifting and moving objects.  He had lost no work time due to the shoulder condition.  Physical examination showed decreased strength (4/5) on the right.  The ROM study showed flexion of 135 degrees and abduction of 100 degrees with excruciating pain.  Repetition produced no decrease in ROM, but did exacerbate the pain. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, analogously coded 5003 (arthritis, degenerative), citing slight and occasional pain IAW the US Army Physical Disability Agency pain policy.  The VA rated the right shoulder condition 20%, coded 5201 (limitation of arm motion), based on the C&P examination, citing an overall disability picture more closely approximating the 20% evaluation based upon limited ROM.  The VASRD §4.71a threshold for rating for ROM impairment (code 5201) is “at shoulder level” (approximately 90 degrees from the side).  The 20% rating for the dominant arm requires motion limited to “at shoulder level” and the orthopedics and VA examinations reflected this degree of limitation.  Panel members considered other shoulder and analogous codes, but all were less applicable or not advantageous to rating.  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.  

BOARD FINDINGS:  In the matter of the right shoulder condition, the panel recommends a disability rating of 20%, coded 5201 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	5201	20%	

The following documentary evidence was considered:

AR20200004650

Dear XXXXXXXXXXXXXXXXXXXXXXXX:

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 to the counsel you listed on your application