RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03581
BRANCH OF SERVICE:  Army 	SEPARATION DATE: 20011127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Administrative Specialist, medically separated for “left shoulder, status post anterior shoulder reconstruction,” with a disability rating of 20%.  

CI CONTENTION:  The applicant has asked for consideration of all his conditions.  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 – 20010810	VARD – Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain, with Feeling of Instability after Anterior Shoulder Reconstruction	5201	20%	Left Shoulder Pain, Status Post Anterior Shoulder Reconstruction and Capsular Shrinkage	5201	20%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY: 

Left Shoulder.  In December 1997, this right-handed CI injured his left shoulder while playing football.  In October 1998, he had left shoulder reconstruction surgery.  In March 2001, he underwent an arthroscopic capsular shrinkage procedure.  However, in spite of all treatment efforts (operative and non-operative), the CI continued to have problems with his left shoulder. Due to the chronic, persistent nature of his shoulder symptoms, a Medical Evaluation Board (MEB) was initiated.  The MEB narrative summary (NARSUM) was dated 12 July 2001.  On physical examination (PE), the appearance of the shoulder was normal.  There was no atrophy, and the surgical scars were well healed.  The anterior region of the left shoulder was tender.  Active range of motion (ROM) testing revealed 160 degrees of forward flexion and 120 degrees of abduction.  The shoulder was stable to stress, and there was no sign of instability.

The CI was medically separated from service on 27 November 2001.  Thirty-seven (37) months later, in January 2005, he had a VA Compensation and Pension (C&P) exam.  He reported pain and stiffness of the left shoulder.  The symptoms were worse with cold, wet weather.  He reported difficulty with overhead activities.  On PE of the left shoulder, there was a positive apprehension sign.  He had 55 degrees of forward flexion, and 55 degrees of abduction, and there was pain with motion.  The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, are summarized in the chart below.
       
Left Shoulder ROM
(Degrees)	MEB ~5 Mo. Pre-Sep
(20010712)	C&P exam ~ 3 years Post-Sep
(20050111) 	
Flexion (180 Normal)	160	55	
Abduction (180)	120	55	
Comments	No instability	Painful motion	
                          
 The Board directed attention to its rating recommendation based on the above evidence.  The January 2005 C&P exam was more than 3 years after separation and therefore had diminished probative value.  The Board determined that the best source of information upon which to base its recommendation, was the July 2001 MEB exam.  The Board carefully reviewed the clinical data from the July 2001 MEB exam.  At that exam, the left shoulder was stable to stress, and there was no sign of instability.  The CI had 160 degrees of forward flexion, and 120 degrees of abduction. 

The Board determined that the left shoulder condition was essentially non-compensable based solely on the VASRD §4.71a diagnostic codes for loss of shoulder motion (codes 5200 and 5201).  However; IAW VASRD §4.40, §4.45, and §4.59, when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A compensable rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  There was no path to a higher rating for the left shoulder since there was insufficient evidence of a seriously disabling bone or joint abnormality that would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the unfitting left shoulder condition.  

BOARD FINDINGS:  In the matter of the left shoulder condition, and IAW VASRD §4.40, §4.45, and §4.59; 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 20140730, with attachments
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, AR20160008663 (PD201403581)

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.

Enclosure

CF:
( ) DoD PDBR
( ) DVA