RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00616
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030521

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Helicopter Repairer, medically separated for “right (dominant) shoulder pain,” with a disability rating of 20%.

CI CONTENTION:  “Review all 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 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 – 20030206	VARD - 20030513	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder	5201	20%	Right Shoulder	5201	30%	20030422	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Shoulder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right shoulder condition began in November 1999 after a fall.  An 11 December 2001 right shoulder diagnostic imaging (MRI) study showed a very large Hills-Sachs lesion (humeral head depression from forceful anterior shoulder dislocation), a bony and cartilaginous Bankart lesion (anterior/inferior glenoid labrum injury from anterior shoulder dislocation), a glenohumeral ligament tear, and acromioclavicular (AC) joint degenerative changes.  On 22 March 2002, the CI underwent right shoulder arthroscopy and an open Bankart repair.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “limited motion and pain in the right shoulder” for PEB adjudication.  The 28 August 2002 physical therapy (PT) right shoulder range of motion (ROM) was flexion of 145 (180 normal) and abduction of 80 (180) degrees.  The 10 October 2002 PT right shoulder ROM was flexion of 160 (180) and abduction of 90 (180) degrees.  At the 5 November 2002 MEB examination, 6 months prior to separation, the CI reported right shoulder pain, limited motion, and tingling from his shoulder to his fingers.  The physical examination showed restricted flexion of 100 (180) and abduction of 55 (180) degrees.  Right upper extremity strength was 4/5.  The 19 November 2002 MEB NARSUM examination, 6 months prior to separation, noted complaints of right shoulder pain and limited motion interfering with his ability to be a mechanic.  Prior to surgery the CI reported multiple recurrent dislocations.  Subsequent to surgery (open Bankart repair), the CI had no further dislocations.  The physical examination showed a normal appearing shoulder with well-healed surgical scars.  Forward flexion was limited to less than 90 (180) degrees.  There was a positive apprehension (assesses anterior shoulder instability) test and negative drop arm (assesses for rotator cuff [supraspinatus] tears), Hawkin’s (assesses impingement of rotator cuff and subacromial bursa), and relocation (assesses anterior and posterior shoulder instability) tests.  At the 22 April 2003 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported pain and limited ROM and a sensation of right shoulder instability.  The CI denied dislocations after his surgery in March 2002.  The author did not perform a right shoulder examination and documented “As per physical examination from medical board.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 20%, coded 5201 (arm, limitation of motion of), citing range of motion to 90 degrees.  The VA rated the right shoulder condition 30% coded 5201, based on the VA C&P examination 1 month before separation, citing “limited motion to less than 90 degrees or to shoulder level.  An evaluation of 30% is granted for limitation of arm motion midway between side and shoulder level in the dominant upper extremity.”  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 flexion and abduction motion was limited to this level.  The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level” and the exams did not reflect this degree of limitation.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available 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 right shoulder condition.  

BOARD FINDINGS:  In the matter of the right 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 20150603, 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 XXXXXXXXXXXXXXXXXXXXX, AR20170000284 (PD201500616)

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