RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00349
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Radar Operator) 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).  He was issued a permanent U3 profile which allowed for an alternate aerobic event to satisfy physical fitness standards and referred for a Medical Evaluation Board (MEB).  “Left shoulder superior labral tear status post reattachment and fixation” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic left shoulder pain, status post arthroscopic SLAP lesion repair” as unfitting rated 0% citing criteria of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.   

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  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 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 20061204	VA* - (~5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	0%	Residuals of Repair of a Superior Labral Tear of the Left Shoulder	5099-5003	10%	20070612	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 10 	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20070906 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  
Left Shoulder Pain:  The CI experienced three separate episodes of dislocating his left shoulder from 2001 through 2004.  Secondary to his persistent instability and positive X-ray analysis, he underwent a labral repair in October 2005.  Despite post-operative physical therapy (PT) the CI developed mild ‘numbness’ in his left upper extremity.  Electrodiagnostic (Edx) studies of the upper left extremity conducted on 16 March 2006 were normal.  Subsequent to persistent pain, the CI was permanently profile in August 2006 with a diagnosis of left shoulder pain.  The commander’s statement implicated the CI’s shoulder condition as the reason he was unable to perform duties pertaining to his MOS.  At the narrative summary (NARSUM) dated 5 October 2006 (12 months after surgery and 3 months pre-separation) the CI endorsed left shoulder pain and numbness that periodically extends down his arm.  Although the physical therapist measured left shoulder range-of-motion (ROM) as decreased, the NARSUM examiner (3 weeks later) stated, “He does have full ROM of his left shoulder with pain at the extremes and on active abduction of his shoulder.”  Additional physical examination (PE) parameters of sensory, motor and vascularity of the left upper extremity were normal.  His diagnosis remained left shoulder superior labral tear, status post reattachment and fixation, with persistent pain.  At the VA Compensation and Pension (C&P) examination dated 12 June 2007 (5 months post-separation) the CI endorsed 3-5/10 left shoulder pain and persistent feelings of instability.  His PE revealed painful and limited ROM.  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.

Left Shoulder ROM	PT ~4 Mo. Pre-Sep 	NARSUM ~3 Mo. Pre-Sep	VA C&P ~5 Mo. Post-Sep 	
Flexion (180 normal)	130	‘full ROM’	157	
Abduction (180)	90		155	
AO Comments	painful motion	painful motion	painful motion	
§4.71a Rating	20%	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  Utilizing the Army pain policy, the PEB rated 0% under analogous code of 5003 (degenerative arthritis), whereas the VA rated 10% utilizing the same coding scheme.  Board members first acknowledged that the persistent evidence of painful motion was easily supported under VASRD §4.59 to achieve a minimal compensable 10% rating.  Board members then considered and deliberated on the probative value (PV) of the above charted exams and concluded that the NARSUM provider’s stated evidence of having ‘full ROM’ supported nearly exclusive PV in this case.  Additional support for that conclusion included its close time reference to the date of separation and correlates with the continued improvement in range-of-motion noted in the C&P exam.  There was no clinical evidence of ankylosis or nonunion/malunion of any component of the shoulder girdle; and, no history of recurrent shoulder dislocations after surgical correction; thus, no shoulder joint code under VASRD §4.71a would yield a rating greater than the recommended 10%.  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 left 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 the left shoulder was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the left shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 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:  

CONDITION	VASRD CODE	RATING	
Left Shoulder Condition	5201	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140104, 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 XXXXXXXXXXXXXXXXXXXXXXXX, AR20160000435 (PD201400349)

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:

CF: 
(  ) DoD PDBR
(  ) DVA