RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	    CASE:  PD-2014-02908
BRANCH OF SERVICE:  Army	BOARD DATE:  20150430
SEPARATION DATE:  20071107

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Radio Operator/Maintainer) medically separated for a shoulder condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The “left shoulder instability, status post several dislocations” 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 secondary to labral tear” as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The shoulder condition was noted to have existed prior to service (EPTS), but to have been permanently service aggravated.  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 20070904	VA* - (~3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	0%	Left Shoulder Strain	5099-5203	10%	20080205	
Other x 0 (Not In Scope)	Other x 0 (Not in Scope)	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20080306 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chronic Left Shoulder Pain.  The CI seen for left shoulder pain which he reported had begun 2 years earlier after he injured it in a basketball game (prior to service).  He endorsed exacerbations with discomfort and occasional dislocations since; this was not disclosed at accession.  He became symptomatic again after carrying a rifle in a field training exercise.          X-rays that day were normal.  He was referred to orthopedic and noted to have multidirectional instability.  An arthrogram on 11 May 2007 showed an avulsion of the labrum (a tear in the shoulder socket cartilage), a thickened ligament which could have been congenital or secondary to a chronic injury, and changes in the rotator cuff.  The narrative summary was dated 21 August 2007.  The CI reported the above history and daily pain.  On examination, the range- of-motion (ROM) was normal with evidence of multi-directional instability.  The PEB was dated 4 September 2007 and noted the multidirectional instability without subluxation or dislocation.  The CI’s decision to decline surgery was deemed appropriate.  

At the VA Compensation and Pension (C&P) examination performed on 5 February 2008, 3 months after separation, the CI reported the pre-service history of shoulder problems, but no issues in the service until a field training exercise.  He was working at a local store and denied lost duty time from the shoulder.  The motor examination was normal, but the ROM reduced (below) and painful.  X-rays were negative.  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
(20070821) p.26	VA C&P ~3 Mo. Post-Sep
(20080205) p.337	
Flexion (180 Normal)	180	170 (pain at 140)	
Abduction (180)	180	136 (pain at 90)	
Comments	Multidirectional instability	Painful motion	
§4.71a Rating	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The CI had an EPTS left shoulder condition manifested by subjective subluxation and dislocations.  The CI reported aggravation of his shoulder while in field training.  The PEB rated the left shoulder at 0% using the analogous code 5099-5003 (degenerative arthritis).  The VA rated the left shoulder at 10% also using an analogous code, 5099-5203 (impairment of the clavicle or scapula).  Review of the evidence shows that the CI clearly had a shoulder which was symptomatic with activity prior to accession for at least a year.  The evidence does not show that he sustained a second injury while on active duty; however, the examination at accession was recorded as normal and the PEB stated that an EPTS deduction is indeterminate.  The arthrogram, along with his examinations by the MEB and the VA, supports a 10% rating using the code 5003 for limited and painful motion of the shoulder.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority 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.  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, the Board majority 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	
Chronic Left Shoulder Pain Secondary to (a) Labral Tear 	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140605 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 XXXXXXXXXXXXXXXXXX, AR20150018808 (PD201402908)

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