RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00188
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070822

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Cannon Crewmember) medically separated for a left shoulder condition.  The left shoulder 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).  “Recurrent anterior dislocation, left shoulder” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions that met retention standards (bilateral knee pain and back pain) for PEB adjudication.  The Informal PEB adjudicated “chronic left (non-dominant) shoulder instability…” as unfitting, rated 20%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.  

CI CONTENTION:  His condition continues to worsen and negatively impact him.  His complete submission is at Exhibit A.

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 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: 

Service Admin Correction – Dated 20070703	VA* - (~8 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic L Shoulder (Non-Dominant) …	5202	20%	S/P L Shoulder Injury…	5201	20%	20080430	
Back Pain	Not Unfitting	Lumbar Spine Strain	5237	20%	20080430	
Bilateral Knee Pain	Not Unfitting	Left Knee RPPS 	5260	NSC	20080430	
		Right Knee RPPS 	5260	NSC	20080430	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3 	
RATING:  20%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20080515 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:  

Left (Non-Dominant) Shoulder Instability.  The first record in evidence for the left shoulder condition is an X-ray report dated 6 April 2006 which noted a history of chronic subluxation (a partial dislocation) in the history.  The X-ray was normal.  A primary care note dated 20 November 2006 recorded that the CI had an anterior dislocation in December 2005 when a heavy object fell on his left shoulder.  He reported pain with movement, but had a stable shoulder (he could not dislocate it voluntarily).  The range-of-motion (ROM) was full and strength was normal.  Atrophy was absent.  Magnetic resonance imaging (MRI) the next day showed a labral tear (part of the lining of the shoulder socket) as well as congenital hypoplasia of the glenoid (the socket of the shoulder joint).  The CI was referred to physical therapy (PT) and was again noted to have full, but painful ROM on examination on 24 January 2007.  The CI was seen on a regular basis over the next few months and was noted to have full ROM in primary care on 9 March 2007 and in orthopedics on 19 March 2007.  In the latter evaluation, he reported subjective instability.  On examination, the ROM was full but painful.  Sensation and strength were normal.  Instability was not recorded.  A provocative test for a labral tear was negative.  At a follow-up orthopedic evaluation on 23 April 2007, the motor and sensory examinations remained normal.  Atrophy was not present, but some provocative tests for shoulder instability were positive.  In primary care on 4 May 2007, the ROM was noted to be normal for all extremities.  At the MEB examination on 7 May 2007, the CI reported ongoing shoulder pain.  The examiner noted that the CI did not desire to have surgery and that the pain precluded performance of his MOS requirements.  On examination, the ROM and strength were noted to be reduced, but not quantified.  The narrative summary (NARSUM) was dated 30 May 2007.  The CI reported a history of multiple dislocations and that he could not lift anything overhead.  It was noted that the CI had declined surgery for the shoulder.  The examiner referred to the 23 April 2007 orthopedic examination for the physical findings.  The VA Compensation and Pension (C&P) examination was performed on 30 April 2008, 8 months after separation, but is not in evidence.  The VA rater did reference it in detail though in the 15 May 2008 rating decision.  The CI reported chronic recurrent dislocations or subluxations 2-3 times a week, but denied swelling or locking.  The ROM was painful and limited to 45 degrees in flexion and abduction (previously it typically was noted as normal).  An apprehension test was consistent with instability.  Repetitive motion did not further limit the ROM.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the shoulder at 20%, coded 5202 (other impairment of the humerus).  The VA also rated the shoulder at 20%, coded 5201 (limitation of motion of the arm).  The Board considered the findings and found no route to a higher rating using these or other coding options for the shoulder condition.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the left shoulder instability condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the bilateral knee pain and back pain were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Neither condition was profiled, implicated in the commander’s statement, or noted to fail retention standards.  There was no performance based evidence from the record that either condition significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either contended condition and so no additional disability ratings are recommended. 
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 left shoulder condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended back and bilateral knee conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140101, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

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 XXXXXXXXXXXXXXXXX, AR20160000153 (PD201400188)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA