RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03045
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091023

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Food Service Operations, medically separated for “bursitis, left shoulder” with a disability rating of 10%.

CI CONTENTION:  Daily left shoulder pain remains constant.  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 – 20090924	VARD - 20100217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bursitis, Left Shoulder	5019	10%	Left Shoulder Bursitis	5019	10%	20091124	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:  

Left Shoulder Bursitis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left shoulder (non-dominant) condition began in September 2008 without specific etiology and he suffered an exacerbation in January 2009.  An MRI in March 2009 noted a lateral outlet impingement, minimal subacromial bursitis (inflammation of fluid-filled sacs between tissues), a possible Hill-Sachs deformity (humeral head depression from forceful anterior shoulder dislocation, and no definite evidence of labral (fibrocartilage ring where humerus articulates with scapula) tear.  The CI was seen by orthopedics twice and was offered surgery, but declined.  At the time of the orthopedic clinic visit on 6 April 2009, 7 months prior to separation, the CI reported progressively worse left shoulder pain; the pain was so bad he could not sleep on his side and experienced trouble lifting items, raising his arm above shoulder level and reported pain when he clenched his left hand.  The examiner recorded tenderness on palpation, painful motion, with pain during Neer and Hawkins-Kennedy rotator cuff impingement testing.  Despite treatment, the left shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a MEB.  The MEB forwarded “chronic left shoulder pain due to instability and impingement syndrome” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 23 July 2009, 3 months prior to separation, the CI reported left shoulder pain and “impingement/dislocation” and the examiner noted left shoulder weakness. Range of motion (ROM) was measured by physical therapy (PT) with a goniometer on 28 July 2009.  Left shoulder ROM, following repetitive movement, was flexion of 140 (normal 180) and abduction of 120 (normal 180) degrees with an audible popping present during measurements; “additional functional loss only due to pain” was noted.  

At the 21 August 2009 MEB NARSUM evaluation, 2 months prior to separation, the examiner referred to the DD Form 2808 examination and recorded “weakness of the muscle of the left shoulder.”  The examiner also referred to the July 2009 PT ROM evaluation and noted restriction of the left shoulder in all ROMs with pain.  

At the 24 November 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported he was lifting MRE ration boxes In November 2008 and developed pain.  His pain was noted to be constant, rated 6/10 in intensity with flare-ups 3-4 times a week precipitated by lifting above his head.  Relief was obtained by resting.  The CI reported one dislocation in December 2008.  The physical examination recorded joint symptoms as pain, limited motion and instability.  Left shoulder active ROM was flexion of 160 and abduction of 140 degrees.  The examination was silent for guarding or instability.    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5019 code (bursitis), citing satisfactory evidence of painful motion.  The VA also assigned a 10% rating using the same 5019 code based on the VA C&P examination 1 month after separation, citing painful or limited motion of a major joint or group of minor joints.  The VASRD §4.71a (code 5201, arm limitation of motion) threshold for a rating for ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion above this level.  Although there was insufficient limitation of motion to support a rating under 5201, Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating 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 20140620, 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 XXXXXXXXXXXXXXXXXXXX, AR20160008653 (PD201403045)

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