RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00808
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060609

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Network Switch Systems Operator/Maintainer, medically separated for “chronic left shoulder pain…” with a disability rating of 10%.  

CI CONTENTION:  The CI contends “I have ongoing pain and instability in my primary shoulder (L) that causes me difficulty in day to day tasks.”  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 - 20060516	VARD - 20070411	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5010	10%	Closed Anterior Dislocation of the Left Shoulder with Upper and Lower Labral Tears	5202	20%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Left Shoulder Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI felt a “pop” in the left shoulder while doing push-ups.  Initial X-rays were normal, but shoulder pain and dislocations continued. Magnetic resonance imaging (MRI) in November 2004 was interpreted as normal.  The CI continued to experience shoulder dislocations.  An orthopedic evaluation in February 2005 interpreted the MRI as indicating a Bankart lesion (soft tissue/bone injury resulting from shoulder dislocation injury) and the exam showed shoulder instability.  The CI underwent left shoulder surgery in 2005 for repair of a Bankart and shoulder stabilization.  Following surgery the CI continued to have pain and instability symptoms without frank dislocations.  The permanent profile listed “limit overhead exercise/work to tolerance.”  Further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left shoulder instability” and “early arthritis of the left shoulder” for PEB adjudication.  

The MEB NARSUM examination on 24 April 2006, 1 month prior to separation, the CI complained of left shoulder instability without dislocations.  Physical examination showed good parascapular musculature with no evidence of atrophy.  The MEB NARSUM examination cited the PT MEB ROM.  There was a positive apprehension test and a positive relocation test (tests for instability, without subluxation observed.  The CI had tenderness to palpation of the shoulder and normal upper extremity strength and sensation.  The orthopedic MEB examiner stated that the CI was unable to do overhead work or any work requiring abduction and external rotation of his shoulders, due to a feeling that the shoulder would dislocate.  Physical therapy performed shoulder range of motion measurements for the MEB on 10 April 2006, 2 months prior to separation.  Shoulder range of motion (ROM) was recorded as flexion of 145 degrees (180 normal) and abduction of 125 degrees (180 normal).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under 5010 code (arthritis, due to trauma, substantiated by X-ray findings), citing loss of motion.  Originally the VA assigned a 20% rating using 5202 code (humerus, other impairment of), citing episodes of dislocation of the scapulohumeral joint with guarding of arm movements at the shoulder and evidence of malunion of the humeral head with marked or moderate deformity based on service medical records.  However, inexplicably the VA Rating Decision (VARD) on 14 March 2008 changed the CI’s condition to “Not Service Connected,” citing the CI failed to show for C&P examination on 29 December 2006.  The VA cited no evidence that showed a sustained injury to the left shoulder, purportedly also based upon the STR.  The CI was scheduled for another C&P examination on 19 June 2008, but was again a no show and the next VARD on 30 July 2008 again failed to service connect the CI’s left shoulder condition.  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.  Although there was no limitation of motion to support a rating under the 5201 code, Board majority 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 majority 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 chronic left shoulder pain condition and IAW VASRD §4.71a, the Board majority 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/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 
XXXXXXXXXXXXXXXXXX, AR20170000790 (PD201500808)

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