RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-02806
BRANCH OF SERVICE:  Army 	BOARD DATE:  20150602
SEPARATION DATE:  20060719  

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Abrams Tank Systems Maintainer) medically separated for a right (dominant) shoulder condition which could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty (MOS).  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The condition “recurrent right shoulder instability with ... pain” was forwarded as the sole submission to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “chronic right shoulder pain [elaborating surgical history]” as unfitting, rated 10%, referencing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.  

CI CONTENTION:  “Instability/dislocation of dominate shoulder.  Due to this I was restricted by my surgeon from wearing combat gear and was not permitted to qualify with my assigned weapon which was an M-16.  Due to Army regulations all Service Members were required to be able to be combat effective.  Upon release from Service I was not evaluated for PTSD either, which I am now diagnosed with having from my service.”  [sic]  

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

IPEB – Dated 20060517	VA* (4 Mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5099-5003	10%	Surgical Residuals, Right Shoulder	5203	10%	20061117	
Other x 0	Other x 3	
RATING:  10%	RATING:  30%	
*Derived from Decision Review Officer (DRO) Decision dated 20071113.  

ANALYSIS SUMMARY:  

Right Shoulder.  An early entry in the available service treatment record (STR) documents a history of right shoulder instability and dislocations dating to 1989, overlapping with a period of prior service.  The CI experienced several dislocations soon after reenlisting in 1997, and multiple STR entries indicate significant joint instability.  Magnetic resonance imaging (MRI) revealed tears of the labrum (rim of the shoulder socket) and of a rotator cuff tendon (infraspinatus) and the CI underwent arthroscopic surgical interventions in May 2002 and October 2003.  These procedures failed to fully stabilize the shoulder and open surgery with tendon grafting was performed in December 2005 (7 months prior to separation).  Post-operative STR evidence indicates that this intervention was successful with no recurrent dislocations; and, multiple entries documented grossly normal and painless range-of-motion (ROM) with a stable joint.  A subsequent arthrogram (MRI dye study) and X-ray series with stress views were normal (intact ligaments, tendons, and joint capsule without laxity to stress).  There is no STR evidence (proximate to separation) for significant ROM limitation, joint deformity, instability, joint impingement, or periods of incapacitation after surgical recovery.  

The narrative summary (NARSUM) was conducted 29 March 2006 (4 months prior to separation), and documented the favorable post-operative course reflected above, with pain “down to 1 out of 10 at its worse and ... resolution of his instability.”  The examiner made note, however, of an injury a month earlier resulting in a clinical setback, stating “his pain has improved somewhat and he is feeling that he is getting back to the point where he was in Rehab just prior to this re-injury.”  The pain was characterized as “frequent” and “moderate,” specifying profile limitations and lifting restriction to 5 pounds.  The NARSUM physical examination recorded the absence of tenderness or significant instability (negative apprehension sign) and some residual weakness (4/5) with internal rotation.  The NARSUM measured ROM was forward flexion to 170 degrees (normal 180, minimum compensable 90) and abduction to 120 degrees (same parameters), annotating painful motion.  

A VA Compensation and Pension (C&P) examination was conducted 17 November 2006 (4 months after separation), and documented a complaint of “residual history of instability with certain range of motions ... approximately 2-3 times per week ....”  Pain severity and specific limitations were not elaborated.  The VA physical examination recorded “well-healed scars” but no other joint findings; and, provided ROM measurements of forward flexion and abduction to 170 degrees each, annotating painful motion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating analogous to 5003 (degenerative arthritis) cited the “slight ... frequent” criterion of the USAPDA pain policy, but was consistent with VASRD §4.71a criteria for the service ROM and ratable findings (conceding painful motion).  The VA decision (DRO revised from original 0%) conferred the minimum 10% rating under code 5203 (clavicle or scapula, impairment of), citing painful motion.  With the lack of any ratable ROM limitation, ankylosis, or bone injury, there is no §4.71a route to a rating higher than 10%.  Consideration was given to an analogous rating under 5299-5202 (humerus, other impairment of) which would confer ratings for instability and recurrent dislocations.  The residual subjective instability documented by the VA examiner could arguably result in functional impairment fairly captured under 5299-5202; but, members agreed that there was scant evidence to corroborate any functional consequences of instability at separation, especially considering the ample evidence that there was no significant objective instability.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the right shoulder 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 was operant in this case and it was adjudicated independently of that policy by this Board.  In the matter of the right shoulder 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX 
President 
DoD 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 XXXXXXXXXXXXXXXXXXXX, AR20150012808 (PD201302806)

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						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA