RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1201696
BRANCH OF SERVICE:  Army	BOARD DATE:  20130522
SEPARATION DATE:  20020425

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PVT/E-1 (77F00/Petroleum Supply Specialist) medically separated for chronic right shoulder condition.  CI complained of right dominant shoulder pain.  At that time, he had pain and felt "a pop" after performing push-ups.  He states that ever since then he has had pain with performing push-ups.  The chronic right shoulder condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The chronic right shoulder condition(s), characterized as right shoulder bicipital tendinitis/impingement syndrome was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated chronic right shoulder pain with impingement syndrome as unfitting, rated 0% with application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals, and was medically separated.

CI CONTENTION:  “The condition of my for which I am rated has become worse and now due to over compensation there are issues with my other arm.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting chronic right shoulder condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  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 Board for Correction of Military Records.

RATING COMPARISON:  
   
Service IPEB – Dated 20020425	VA -  based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain with Impingement Syndrome	5099-5003	0%	Right Bicipital Tendinitis/Impingement Syndrome (Dominant)	5201	20%	STR 	
No Additional MEB/PEB Entries	 	STR	
Combined:  0%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20020607 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.

Chronic Right Shoulder Pain with Impingement Syndrome Condition.  The narrative summary notes that the CI developed right shoulder pain shortly after beginning basic training.  He had been doing pushups and felt “a pop” in his shoulder.  Subsequently, he experienced pain whenever he did pushups.  After about 2 weeks, he was examined and entered into the physical therapy rehabilitation program (PTRP) for 2 weeks.  This resulted in some relief of his symptoms, but when he returned to duty the pain recurred.  He was subsequently returned to the PTRP.  At the MEB exam, the CI reported that the pain was mostly over the anterior aspect of the right shoulder.  It was exacerbated by engaging in such activities as eating, shaving, and writing.  He denied numbness and tingling as well as pain with overhead work or with sleeping on the shoulder.  The MEB physical exam noted a positive impingement sign, a positive Hawkins test, a positive Neer test and a negative AC joint test.  Range-of-motion was recorded as follows:  Forward flexion was 90 degrees on the right and 180 degrees on the left (normal 180 degrees).  “Adduction” (likely abduction) was 140 degrees on the right and 180 degrees on the left (normal abduction 180 degrees).  Internal rotation was to T8 bilaterally.  There was tenderness to palpation over the right bicipital tendon.  Routine X-rays of the right shoulder were interpreted as being within normal limits.  There was no fracture or subluxation.  The commander’s statement indicates that the CI was unable to participate in physical training or grenade qualification, both of which were basic requirements for retention in the Army.  Instead of conducting its own Compensation and Pension exam, the VA used the service treatment records to arrive at its rating decision.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB characterized the shoulder condition as “chronic right shoulder pain with impingement syndrome.  It coded it analogously as 5099-5003 and awarded a disability rating of 0% based on pain being described as “slight and occasional” IAW the USAPDA pain policy.  The VA characterized the condition as “right bicipital tendonitis/impingement syndrome.”  It coded it as 5201 (limitation of motion of the arm) and rated it at 20% for limitation of motion of the arm to the level of the shoulder.  The Board considered the limitation of motion demonstrated on the MEB exam and concluded that the VA’s choice of coding options and its rating of 20% were supported by the evidence available.  To reach a higher (30%) rating under this coding strategy would require limitation of motion of the arm to midway between the side and shoulder.  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 the Veterans Affairs Rating for Scheduling Disabilities (VASRD) §4.3 (Reasonable doubt), the Board recommends a disability rating of 20% for the 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the right shoulder pain was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic right shoulder pain condition, the Board unanimously recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Right Shoulder Pain with Impingement Syndrome	5201	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120716, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for AR20130015036 (PD201201696)

1.  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 to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA