RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200993 SEPARATION DATE: 20080918 BOARD DATE: 20130118 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard SPC/E-4 (11B/Infantryman), medically separated for chronic right shoulder pain. CI had a history of right collar bone fracture self-reported on 1998 induction physical. The CI re-injured his right shoulder in a June 2006 motor vehicle crash and again during physical training in June of 2007 while preparing for deployment. After a series of injections, physical therapy (PT), and surgery, the chronic right shoulder pain condition could not be adequately rehabilitated for the CI to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded chronic right shoulder pain status post shoulder surgery with osteoarthritis and posttraumatic stress disorder for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the chronic right shoulder pain condition as unfitting, rated 20%. The CI made no appeals, and was medically separated with a 20% disability rating. CI CONTENTION: “s/p Right Shoulder Arthroscopy. Subacromial decompression. No movement in right arm is a spur” SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. The remaining conditions rated by the VA at separation and listed on the DD Form 294 are not within the Board’s purview. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20080808 VA (~12 Mos.Post-Separation) – All Effective Date 20080919 Condition Code Rating Condition Code Rating Exam Chronic Rt Shoulder Pain 5099-5003 20% Right Shoulder Injury 5201 10%* 20090901 .No Additional MEB/PEB Entries. Major Depressive Disorder 9411-9434 30% 20090204 0% X 2 / Not Service-Connected x 1 20090901 Combined: 20#% Combined: 30%** *changed to 5010 (degenerative joint disease) with a rating of 10% effective 20080919; Additional conditions added with increased rating from 20091023 VARD. **Overall combined rating increased to 50% effective 20080919 ANALYSIS SUMMARY: Chronic Right Shoulder Pain Condition. There were two goniometric range-of-motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below. Right Shoulder ROM (Degrees) MEB NARSUM ~4 Mos. Pre-Sep (20080502) VA C&P ~12 Mos. Post-Sep (20090901) Flexion (180 normal) 105 160 Abduction (180) 105 150 Comments +Tenderness. +pain, weakness, endurance. +Tenderness +pain, fatigue, endurance, 50 degree loss of abduction w/ repetition. §4.71a Rating 10% (PEB 20%) 10% The MEB narrative summary on 2 May 2008, 4 months prior to separation, noted the right- handed CI injured the right shoulder doing pushups during PT in June 2007. He reported unsatisfactory results from shoulder injections and PT. He then had surgery in October 2007 with distal clavicle resection and subacromial decompression. He could not recover enough to perform within his MOS. Examination revealed tenderness of the right shoulder along the distal third of the clavicle and anterior in the area of the acromion, lateral acromioclavicular joint, supraspinatus, anterior joint capsule, and region of the biceps tendon. ROM is noted in the chart. Additionally crepitus, and weakness, lack of endurance, and increased pain with recurrent motion was noted. At the VA Compensation and Pension exam on 1 September 2009, 12 months after separation, the CI reported the condition initially occurred in a motor vehicle accident. He reported weakness, stiffness, locking, fatigability, deformity, tenderness and pain, daily flare ups precipitated by physical activity and stress, no incapacitation. The CI was not receiving any treatment for condition. The ROM is summarized above. During the examination, additional pain, fatigue, lack of endurance, and loss of 50 degrees of abduction after repetitive motion, were noted. The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the right shoulder 20% coded 5099-5003 (analogously to degenerative arthritis) citing impairment from pain, fatigue and weakness (permanent aggravation of existing prior to service condition without deduction). The VA adjudicated a 10% rating citing painful motion. The right shoulder ROM in both examinations was to the above shoulder level which did not meet the threshold for limitation of arm motion (5201). However, the PEB cited additional pain, fatigue and lack of endurance in its 20% rating. There was no dislocation, instability or malunion with deformity for rating under code 5202. A 10% rating would be supported under code 5203, impairment of clavicle or scapula. Functionally, the CI later reported to the VA that he went to work for a private security firm after he was discharged. There was no clinical and/or radiologic evidence that suggested ankylosis, loss of the humeral head, nonunion, malunion, fibrous union, deformity, nonunion or dislocation of the scapula, or recurrent dislocations of the humerus that would have justified any alternate shoulder code with higher rating potential. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic right shoulder pain condition. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. In the matter of the chronic right shoulder pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING Chronic Right Shoulder Pain 5099-5003 20% COMBINED 20% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120613, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / XXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20130003907 (PD201200993) I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail. BY ORDER OF THE SECRETARY OF THE ARMY: Encl XXXXXXXXXXXXXXXX Deputy Assistant Secretary (Army Review Boards)