RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD1301235
BRANCH OF SERVICE:  Army	BOARD DATE:  20140618
SEPARATION DATE:  20040816

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (97E/Interrogator) medically separated for a right (non-dominant) shoulder condition.  The shoulder was injured in 2002, required surgery in 2004, and could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “chronic right shoulder pain status post acromioplasty with tendinitis, impingement and adhesive capsulitis,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic right shoulder pain secondary to impingement syndrome” as unfitting, rated 10%, citing criteria of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Over the past couple of years my injured shoulder has progressively increased in stiffness, pain, and limited range of motion which has impacted my daily life.”

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 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.

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.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20040629	VA (1 Mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain … 	5099-5003	10%	Right Shoulder S/P Acromioplasty	5201-5024	10%	20040907	
Rating:  10%	Rating: 10%	
Derived from VA Rating Decision (VARD) dated 20040930 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Shoulder Condition.  The earliest reference to this condition in the available service treatment record (STR) commences in October 2003, but the narrative summary (NARSUM) confirms that the CI injured his right shoulder during parachute training in November 2002.  It was treated conservatively with a working diagnosis of tendonitis over the ensuing months, but failed to improve.  Imaging of October 2003 noted some damage to the rotator cuff (partial tears in the articular surfaces of the supraspinatus and infraspinatus) and a diagnosis of impingement syndrome was made; which failed to respond adequately to joint injections and continued physical therapy (PT).  Arthroscopic surgical intervention was accomplished in January 2004 with decompression of the impingement (acromioplasty - removal of offending bony structure and repair of rotator cuff).  Although improved after surgery, the CI could still not accommodate his MOS and an MEB was recommended in March 2004.  There is no STR evidence of (or clinical basis for) instability, ankylosis or other ratable features except limited range-of-motion (ROM) and, no documentation of incapacitating episodes.  Outpatient ROM evidence, including that from the MEB’s DD Form 2808, Report of Medical Examination, is charted below.  The NARSUM documented persistent limitations of basic soldiering requirements and a 10-pound lifting and carrying limit for the right arm.  The NARSUM physical examination documented joint tenderness and “positive impingement signs,” 4/5 strength on the right vs. 5/5 on the left and the absence of joint laxity.  The NARSUM ROM evidence is charted below.  The VA compensation and pension (C&P) examination, a month post-separation, could not be retrieved for review; but, the VARD documents the ROM evidence charted below.

There were numerous goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation; and, these are summarized in the chart below.

Right Shoulder Active ROM	PT ~6 Mo. Pre-Sep	PT ~5 Mo. Pre-Sep	MEB H&P ~3 Mo. Pre-Sep	MEB PT ~3 Mo. Pre-Sep	VA C&P ~1 Mo. Post-Sep	
Flexion (180⁰)	107⁰	120⁰	87⁰	76⁰	150⁰	
Abduction (180⁰)	67⁰	105⁰	85⁰	82⁰	150⁰	
§4.71a Rating	20%	10%	20%	20%*	10%	
           * Passive ROM was 132⁰ for each, as invoked in PEB’s DA Form 199.
The Board directs attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating is premised on analogous 5003 (degenerative arthritis) coding and, quoted the MEB PT passive ROM measurements (footnoted above), thereby circumventing active ROM measurements, which are well established as the basis for VASRD rating.  The VA’s 10% rating under code 5201 (limitation of motion), coded as 5024 (tenosynovitis), is compatible with the ROM evidence from the C&P examiner.  The threshold for a 20% rating (minor) under code 5201 is limitation to shoulder level (90 degrees) and most of the Service ROM evaluations support that rating as charted above.  There is not a ready explanation for the significantly improved ROM elicited by the VA examiner, but it appears to be an outlier compared to even the least limited ROM measurements documented by numerous examiners.  All members agreed, especially with deference to VASRD §4.3 (reasonable doubt) and §4.7 (higher of two evaluations), that a 20% rating under code 5201 was well supported.  There was no clinical evidence of ankylosis, bone damage, nonunion/malunion of any component of the shoulder girdle, or history of recurrent shoulder dislocation that would yield a higher rating applying any other code available under VASRD §4.71a.  After due deliberation, considering the totality of evidence, the Board recommends a disability rating of 20% under code 5201 for 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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the right shoulder 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	
Surgical Residuals, Right Shoulder	5201	20%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130909, 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 XXXXXXXXXXXXXXXXXX, AR20140018981 (PD201301235)

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						     XXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA