RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00559
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070420

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Supply Specialist, medically separated for “left shoulder pain status post (S/P) left shoulder dislocation with Bankart reconstruction in July 2006, without neurologic abnormality,” with a disability rating of 10%.  

CI CONTENTION:   The applicant makes no specific contention in the application.  The applicant’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 based upon a 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 - 20070327	VARD - 20070917	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain S/P Shoulder Dislocation with Bankart Reconstruction….	5099-5003	10%	Left Acromioclavicular Joint Dislocation, S/P Arthroscopic Repair	5201	0%	20070904	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Shoulder Pain S/P Shoulder Dislocation with Bankart Reconstruction.  The CI is right-hand dominant.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left shoulder condition began in May 2006 while crawling up a hill; he felt a pop in his left shoulder followed by significant pain.  Diagnostic imaging showed a left humerus dislocation.  The CI underwent left shoulder surgery in July 2006 (9 months prior to separation) for a unidirectional anterior traumatic dislocation with Bankart lesion (lesion in the labrum/cartilage socket of the shoulder).  
Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty and the CI was referred for an MEB.  The MEB forwarded “left shoulder dislocation with Bankart reconstruction” for PEB adjudication.  

The MEB NARSUM examination on 9 February 2007, approximately 2 months prior to separation, noted complaints of chronic left shoulder pain and having disrupted sleep due to the shoulder pain.  He had functional limitations of an inability to wear his IBA, and an inability to lift objects over 25 pounds.  Diagnostic imaging showed reduction of the prior shoulder dislocation in an anatomic position.  There was a deformity in the humeral head (possible Hill-Sachs deformity) and the acromioclavicular joint was at the upper limits of normal.  The physical examination findings were from an orthopedic examination which documented normal strength, normal sensory exam, and no signs of impingement or dislocation; and physical therapy MEB range of motion (ROM) testing from 5 February which showed left shoulder forward flexion and abduction to 180 degrees (normal) with capsular tightness and no changes on repetition.  

At the 4 September 2007 VA Compensation and Pension (C&P) evaluation, performed approximately 5 months after separation, the CI reported left shoulder tenderness with lifting, carrying, pulling, pushing or throwing as well as with repetitive use; intermittent crepitus and mild stiffness, mild weakness, excess fatiguability and lack of endurance.  X-ray of the left shoulder was normal.  The physical examination showed left shoulder forward flexion and abduction to 180 degrees (normal) with “mild tenderness at 180 degrees.”  The left shoulder surgical scar was well healed.  There was no additional limitation of motion by pain, fatigue, weakness or lack of endurance following repetitive use.  Neurologic examination was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, coded analogous to 5003 (Arthritis, degenerative (hypertrophic or osteoarthritis)), citing the U.S Army Physical Disability Agency pain policy.  The VA rated the left shoulder condition 0% coded 5201 (Arm, limitation of motion of), based on the VA C&P examination approximately 5 months after separation, citing a noncompensible ROM of 180 degrees.  The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level.  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 pain s/p shoulder dislocation with Bankart reconstruction…. 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 20150602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXX, AR20160014884 (PD201500559)

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