RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01896
BRANCH OF SERVICE:  Army	BOARD DATE:  20140507
SEPARATION DATE:  20040608

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (31F/Network Switching Systems Operator) medically separated for a right shoulder condition.  The CI had a long standing history of right shoulder pain which began after an injury during training.  Surgery was performed in November 2000 and once again in June 2001 after re-injury.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent profile and referred for a Medical Evaluation Board (MEB).  The right shoulder condition, characterized as “recurrent multidirectional instability of right shoulder with pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “right shoulder pain with recurrent multidirectional instability after several surgical procedures and injuries” as unfitting, rated 0%, with likely application of the Department of Defense Instruction (DoDI) 1332.39.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I had 2 shoulder operations on my right shoulder.  First one on Nov 14, 2000 during this operation the doctor had to repair a Bankart lesion, an overall patulous capsule, and used the electrothermal assisted capsulorrhaphy to the posterior band of the inferior glenohumeral ligament, the Coll anterior band of inferior glenohumeral ligament, and the middle of the glenohumeral ligament.”  His complete submission, with attachments, is at Exhibit A.

RATING COMPARISON:

Service IPEB – Dated 20040225	VA – (6 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5099-5003	0%	Right Shoulder Tendonitis of Rotator Cuff w/Scars	5024-5201	20%	20041221	
No Additional MEB/PEB Entries	Other x 4	20041221	
Combined:  0%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20041221 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Right Shoulder Condition.  This CI has had a long history of right shoulder problems.  He was treated with many different treatment modalities, including two arthroscopic surgical procedures.  However, the shoulder problems persisted and an MEB was initiated.  The MEB narrative summary was dated 7 January 2004.  On physical examination of the right shoulder, the acromioclavicular joint was non-tender.  Apprehension sign was positive, but tests for ligamentous laxity were negative.  Range-of-motion (ROM) was measured and is summarized in the chart below.  The CI was separated from service on 8 June 2004.  Six months later, in December 2004, he had a VA Compensation and Pension exam.  Both shoulders were normal appearing.  The ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Right Shoulder ROM
(Degrees)	MEB ~ 18 wks. Pre-Sep
(20040202)	VA C&P ~ 28 wks. Post-Sep
(20041221)	
Flexion (180 Normal)	155	90	
Abduction (180)	155	90	
Comments	Pain at the limits of ROM		

The Board directs attention to its rating recommendation based on the above evidence.  The Army PEB and the VA chose different coding and rating options for the right shoulder condition.  The Board noted the disparity in the examinations shown above.  The Board determined that the February 2004 MEB exam had greater probative value.  It was conducted in a thorough manner and was closer in temporal proximity to the date of separation.  At that exam, the CI had 155 degrees of flexion and 155 degrees of abduction.

After a thorough review of the treatment record, the Board determined that the CI’s right shoulder condition was essentially non-compensable based solely on the VA Schedule for Rating Disabilities (VASRD) §4.71a codes for the shoulder and arm (5200 through 5203).  However, IAW VASRD §4.40 (functional loss), §4.45 (the joints) and §4.59 (painful motion) a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  After reviewing the evidence, all Board members agreed that a rating of 10% was appropriate for the chronic right shoulder condition.  The Board tried to find a path to a rating higher than 10%, using other codes which could be applied to the shoulder condition.  The other VASRD codes that were considered did not result in a higher rating, since the treatment record did not show sufficient evidence of a disabling shoulder condition which would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the unfitting right shoulder condition.  It is appropriately coded 5299-5201 and IAW VASRD §4.40, §4.45 and §4.59; meets criteria for a 10% rating due to painful motion of a major joint.

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 noted above, PEB reliance on DoDI 1332.39 may have been operant in this case and the condition was adjudicated independently of that instruction by the Board.  In the matter of the right shoulder condition and IAW VASRD §4.40, §4.45, and §4.59, the Board unanimously recommends a disability rating of 10%, coded 5299-5201. There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, 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	
Right shoulder pain, with recurrent multidirectional instability	5299-5201	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130925, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review
SAMR-RB			

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXX, AR20150001303 (PD201301896)

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 10% 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						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA