RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01785
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030330

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Field Artillery Systems Mechanic) medically separated for left shoulder pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The “left shoulder instability with persistent pain after arthroscopic Bankart repair” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “left shoulder pain” as unfitting, rated 20%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:   “Please consider all conditions.”

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:  

IPEB - Dated 20021230	VA* - (~2 Yrs., 11 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain	5201	20%	Left Shoulder Instability	5201	10%	20060303	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0 (equals SC, NSC & deferred)	
RATING:  20%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20060407 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:   

Left Shoulder Pain.  The narrative summary and treatment record noted the CI was left-handed and had left shoulder injury with recurrent dislocations since July 2001.  He had a successful surgical repair of his shoulder (arthroscopic Bankart repair in March 2002).  However, he had chronic post-surgical left shoulder pain that limited duty performance.  At the MEB exam, the CI reported continued left shoulder pain and limited mobility without any post-surgical shoulder dislocations.  The MEB physical exam noted pain-limited shoulder motion with no instability.  There were no motor, sensory, or vascular deficits in the left arm.  Formal range-of-motion (ROM) testing is summarized below.  There were no VA exams proximate to separation.  At the VA Compensation and Pension (C&P) exam performed 2 years and 11 months after separation, the CI reported left shoulder instability, pain, stiffness, and weakness with an inability to do overhead activity or pick up heavy objects.  X-rays documented possible calcific bursitis and ROMs are noted below.  

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
(Degrees)	MEB ~3 Mo. Pre-Sep	VA C&P ~2 Yrs., 11 Mo. Post-Sep	
Flexion (180 Normal)	135	160	
Abduction (180)	90	140	
Comments:  
Surgery 13 Mo. Pre-Sep	Pain-limited	Pain-limited	
§4.71a Rating	20%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the left (major) shoulder condition at 20% coded 5201 (arm limitation of motion), while the VA used the same code with a 10% rating based on an exam remote from separation.  Service ROMs of 90 degrees of abduction met the 5201 rating criteria of limitation “at shoulder level.”  There was insufficient documentation to support shoulder motion (or function) limited to “midway between side and shoulder level" (about 45 degrees) to warrant a higher rating.  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:  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.  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 20140422, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

		
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 XXXXXXXXXXXXXXXXXXXXX AR20160003396 (PD201401785)

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:

CF:
( ) DoD PDBR
( ) DVA