RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX                                                                      	CASE:  PD-2014-01100
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080913

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E-4, FA Surveyor, medically separated for “left shoulder pain subsequent to several dislocations and two surgical procedures,” with a disability rating of 20%.  

CI CONTENTION:  The applicant states his shoulder condition continues to worsen.  He was not evaluated for his PTSD condition.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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:  

SERVICE PEB - 20080602	VARD - 20090212	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain 	5201	20%	Left Shoulder Pain 	5202	20%	20081022	
COMBINED RATING 20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left Shoulder Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right handed CI underwent his first left shoulder surgery in December 2005 for recurrent dislocation and a second surgery in August 2007 for instability and a partially torn tendon.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left shoulder pain” for PEB adjudication.  A physical therapy (PT) evaluation on 2 January 2008 (5 months after surgery and 8 months prior to separation) recorded complaints of persistent left shoulder pain not progressing well with post-operative rehabilitation.  Instability or dislocations were not mentioned.  Left shoulder flexion was 170 degrees (normal 180 degrees) and abduction was 120 degrees (normal 180 degrees).  At the MEB examination recorded on DD Forms 2808 dated 18 April 2008 (approximately 5 months prior to separation) the examiner noted left shoulder decreased range of motion (ROM), decreased strength (4/5) and tenderness.  According to the MEB NARSUM evaluation on 28 April 2008 the CI’s chief complaint was left shoulder pain, described as constant and worsened by lifting and movement.  Further shoulder dislocations were not mentioned.  He endorsed limitations in all functional activities, including dressing, lifting and opening doors, and noted interference with sleep.  ROM determinations by PT on 9 May 2008 showed left shoulder flexion after repetition of 117 degrees and abduction of 89 degrees.  

At the VA Compensation and Pension (C&P) examination on 22 October 2008 (approximately a month after separation), the CI reported a re-injury of the left shoulder 3 weeks previously.  Prior to re-injury he experienced daily pain of 7/10 severity.  Dislocation was not reported.  The physical examination showed left shoulder flexion of 110 degrees and abduction of 100 degrees with no change after 3 repetitions.  Painful motion was present and muscle strength was 4/5.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under code 5201 (arm, limitation of motion of), citing limitation of motion and consideration of functional loss.  The VA assigned a 20% rating using code 5202 (humerus, other impairment of) based on the VA C&P examination approximately a month after separation, citing infrequent episodes of dislocation of the scapulohumeral joint with guarding of arm movements at the shoulder level.  The VASRD §4.71a threshold for a rating for ROM impairment is “at shoulder level” (approximately 90 degrees from the side), and abduction measured by PT, 4 months prior to separation, demonstrated motion at this level.  The PEB’s 20% rating was therefore justified.  The highest 30% rating for a non-dominant arm requires motion limited to “25 degrees from side,” but examinations did not reflect this degree of limitation.  There was no fibrous union or nonunion of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available under the 5203 code (clavicle or scapula, impairment of).  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 for the left shoulder condition.  

BOARD FINDINGS:  In the matter of the left 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.  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 20140224, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

28 JUL 2016

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, AR20160007268 (PD201401100)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (000 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