RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01740
BRANCH OF SERVICE:  Army	BOARD DATE:  20141022
SEPARATION DATE:  20070727

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (91W10/Health Care Specialist) medically separated for right shoulder arthritis.  The condition could not be adequately rehabilitated 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 shoulder condition characterized as “post-traumatic degenerative arthritis of the right glenohumeral joint” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “post-traumatic arthritis right (dominant) shoulder with recurrent symptoms following arthroscopy for frayed anterior labrum and osteochondral deficit” as unfitting, rated 0%, with likely application of the US Army Physical Disability Agency (USAPDA) pain policy.  Two weeks after the initial PEB, the CI submitted a rebuttal.  After review, the PEB found the rebuttal contained no new objective medical or performance evidence which would warrant a change to the original findings of 0% impairment.  The CI was then medically separated.

CI CONTENTION:  “PLEASE CONSIDER ALL CONDTIONS” [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 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; 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 Corrections of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20070524	VA - (2 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Arthritis Right (Dominant) Shoulder with Recurrent Symptoms following Arthroscopy for Frayed Anterior Labrum and Osteochondral Deficit	5010	0%	S/p Right Subacromial Decompression with Scar Claimed as Right Shoulder Arthritis	5297-5010	10%	20070913	
Other x 0  (Not in Scope)	                      Other x 3 	
Combined:  0%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20080513(most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  

Right Shoulder Condition.  More than one mechanism of injury is documented in early service treatment record (STR) entries, but it would appear that right shoulder pain surfaced in January 2006 after feeling a “pop” while lifting weights.  The shoulder pain persisted despite extensive conservative measures to include medication, physical therapy (PT), injections and rest.  Radiology testing revealed arthritis, tendonitis and a cartilaginous cyst within the right shoulder joint.  The CI was referred to orthopedics and subsequently underwent an arthroscopy with debridement of the right shoulder on 3 May 2006.  Improved range-of-motion (ROM) was documented in STR entries over his post-operative course; although pain with various (MOS critical) activities persisted; and, a MEB was initiated.  No STR entries documented instability, subluxation or any positive neurovascular findings.  He was permanently profiled in February 2007 with a diagnosis of right shoulder pain.  At the narrative summary dated 3 April 2007 (4 months prior to separation and 11 months after surgery) the CI endorsed right shoulder pain “whenever he moves his arm away from his body.”  The physical examination revealed limited and painful motion of the right shoulder.  There was no comment with regards to instability or impingement signs.  The pain rating was described as “constant” in frequency and “moderate” in intensity.  

At the VA Compensation and Pension (C&P) examination dated 13 September 2007 (7 weeks after separation) the CI reported a daily, intermittent, sharp, 7 of 10 pain in the right shoulder made worse with activities and relieved with rest and ice.  He denied “weakness, heat, redness, give way, lack of endurance, locking, fatigability, and or dislocation.”  The examination revealed painful motion.  Repetitive use increased pain, but without additional limitation in ROM.  There was no comment with regards to the presence of spasms or abnormal neurovascular findings.  The examiner noted, “The [CI] reports no limitation due to this condition.”  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

      Right Shoulder ROM
(Degrees)	MEB ~3 Mo. Pre-Sep
(20070403) 	PT ~2.5 Mo. Pre-Sep
(20070515)	VA C&P ~2 Mo. Post-Sep
(20070913)	
Flexion (180 Normal)	70	85	180	
Abduction (180)	75	65	180	
Comments		painful motion		painful motion	painful motion 	
§4.71a Rating	30%	30%	10%	

The Board directs attention to its rating recommendation based on the above evidence.  Both the PEB and the VA cited painful limitation of motion and rated the right shoulder under the primary code of 5010 (post-traumatic arthritis) at 0% and 10% respectively.  Board members first acknowledged that the VA’s analogous prefix of 5297 (removal of ribs) was an error in documentation and that the primary code of 5010 alone was appropriate.  The Board next agreed that the persistence of painful motion on both the PEB and VA exams was easily supported under the VA Schedule for Rating Disabilities (VASRD) §4.59 to achieve the minimal compensable 10% rating.  The Board next considered the vast differences in the ROM during the 5 months depicted in the above charts and could not account for the dramatic improvement as revealed at the C&P exam and therefore, probative value was discussed acknowledging the significant impact on the Board’s final rating recommendation.  The Board carefully reviewed the file for other corroborating evidence.  After extensive deliberation, Board members agreed that both the MEB and PT examinations, although consistent, were extremely cursory in depth by simply measuring ROM; whereas, the VA examination was very detailed to include documentation on the absence of edema, effusion, weakness, tenderness, redness, heat, subluxation or guarding of shoulder movement.  Additionally, the exam noted normal neurologic findings to the upper extremities.  Members agreed to assign the greatest probative value to the VA examination based upon the above findings.
There was no ROM impairment of the most probative exam to achieve a compensable rating under code 5201 (limitation of motion) and painful motion was present to support the 10% rating under 5010.  There was no clinical evidence of ankylosis or nonunion/malunion of any component of the shoulder girdle; and, no history of recurrent shoulder dislocation; thus, no shoulder joint code under VASRD §4.71a would yield a rating greater than 10%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a Service disability rating of 10% 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.  As discussed above, PEB reliance on the USAPDA pain policy DoDI 1332.39 for rating the right shoulder was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the right shoulder condition, the Board unanimously recommends a disability rating of 10% coded 5010 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	
Right Shoulder; Posttraumatic Arthritis	5010	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140418, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX, AR20150008233 (PD201401740)

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						     XXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA