RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2021-00049
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Military Police, medically separated for “painful range of motion of the right, dominant shoulder…” with a disability rating of 20%.    

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 - 20080908	VARD - 20090324	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Painful Range of Motion of the Right, Dominant Shoulder…	5201	20%	Right Shoulder Impingement	5099-5024	10%	20090213	
Low Back Pain	Not Unfitting	Lower Back Lumbago	5299-5237	NSC	20090213	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Painful Range of Motion (ROM) of the Right, Dominant Shoulder.  According to the service treatment record and MEB narrative summary (NARSUM), the right hand dominant CI’s right shoulder pain began in May 2007 after doing pushups and physical training.  Imaging of the right shoulder (not in evidence) performed in November 2007 revealed distal supraspinatus tendinitis, but was otherwise unremarkable.  At the orthopedic clinic examination on 27 February 2008, 9 months prior to separation, the CI complained of right shoulder pain at 7/10, with 10 being the worst pain.  The examiner diagnosed tendonitis rotator cuff and a probable SLAP tear.  The CI was deemed a surgical candidate, but declined surgery.  Subsequently, a P3 profile was issued.

During the 18 April 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported “0 results” from conservative treatment of his right shoulder pain.  Examination diagnosed right shoulder pain with no further physical findings annotated.  
At the Physical Therapy clinic examination on 22 April 2008, 7 months prior to separation, ROM of the right shoulder showed flexion to 155 degrees (normal 180), abduction to 155 degrees (normal 180), internal rotation to 70 degrees (normal 90) and external rotation to 90 degrees (normal 90).  ROM was performed using a goniometer.  The examiner noted ROM was limited by pain, with no swelling, muscle spasm, atrophy, deformity or scarring evident.

At the 5 May 2008 MEB NARSUM examination, 7 months prior to separation, the CI noted baseline pain as 6/10 without medication.  Physical examination did not include ROM measurements, however, it was noted that as the CI went through three additional repetitions of active ROM, there were limitations caused by pain, fatigue, lack of endurance and incoordination of the right shoulder.  It was specifically noted that upon repetitive motion the CI was not able to go above 90 degrees of lateral motion due to pain, fatigue and weakness (DeLuca).

At the 13 February 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported sharp pain with any use of the right arm above shoulder level.  Physical examination revealed tenderness over the long head of the biceps in the bicipital groove.  Otherwise, there were no other physical findings.  ROM showed normal abduction (180 degrees), forward flexion (180 degrees), external rotation (90 degrees) and internal rotation (90 degrees).  Strength was 5/5 in all planes.  Tests for impingement and instability were negative.  Assessment of Deluca requirements showed no additional functional limitation after repetitive motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder pain 20%, coded 5201 (arm, limitation of motion of), citing abduction limited to shoulder level, IAW VASRD 4.10, 4.40, 4.45 and 4.59.  The PEB noted the rating included consideration of functional loss (DeLuca) due to factors such as pain on repeated use and painful motion, fatigability, incoordination, and weakness with repetitive use and flare-ups.  The VA rated the right shoulder pain 10%, coded 5099-5024 (degenerative arthritis and tenosynovitis), based on the C&P examination, citing painful or limited motion of a major joint.  The VA rating specifically noted evidence did not show limitation of arm 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 MEB NARSUM examination demonstrated motion limited to this level, after repetitive motion (Deluca requirements).  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 of), and no higher ratings 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder pain.  

Contended PEB Condition:  Low Back Pain.  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 or implicated in the commander’s statement, and did not fail retention standards.  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 pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended low back pain condition, the panel majority recommends no change from the PEB determination as not unfitting.  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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20200721, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

	

AR20210016045, XXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX:

	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.

Sincerely,