RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00865
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090909

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Petroleum Supply Specialist, medically separated for “left (non-dominant) shoulder limitation of motion,” with a disability rating of 20%.  

CI CONTENTION:  “Please 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 on 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 - 20090518	VARD - 20091216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left (Non-Dominant) Shoulder Limitation of Motion	5099-5003-5201	20%	S/P Left Shoulder Surgery (x2) with Residual Decreased Range of Motion, Strength and Pain	5201	0%	20090318	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Shoulder.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left (non-dominant) shoulder surgery in June 2008 for a Bankart repair (repair of torn cartilage in the shoulder joint).  The CI continued to have significant problems post-surgery and in August 2008, underwent a second procedure to manipulate the joint under anesthesia.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic left shoulder pain and decreased range of motion due to left shoulder anterior instability and arthrofibrosis status post arthroscopic Bankart repair” for PEB adjudication.  

The range of motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Left Shoulder ROM
(Degrees)	VA ~6 Mos. Pre-Sep	MEB ~5 Mos. Pre-Sep	
Flexion (180 Normal)	180	140	
Abduction (180)	180	95	
Comments:  Surgery ~12 Mos. Pre-Sep	No pain, weakness, or fatigue; negative DeLuca	Limited by pain	
§4.71a Rating	0%	20%	

Physical therapy (PT) treatments from November 2009, 10 months prior to separation showed limited shoulder ROMs with abduction varying between 85 degrees and 155 degrees (normal 180).  The PT clinic examination on 21 January 2009, 4 months post-surgery and 8 months prior to separation, found the CI experienced continued left shoulder pain with elevation.  Physical examination showed tenderness at the shoulder joint, and limited active ROM with pain at the end range of all motion.  There was “generalized weakness” with muscle atrophy noted.  

At the March 2009 MEB examination (recorded on DD Forms 2807 and 2808), 6 months after surgery and 6 months prior to separation, the CI reported shoulder instability.  Physical examination referenced the VA examination (see below).  

At the 18 March 2009 VA Compensation and Pension (C&P) general medical evaluation, performed 6 months post-surgery and 6 months before separation, the CI reported left shoulder pain and decreased ROM.  Pain was aggravated by exercise, lifting, running, overhead movements, carrying excessive weight on the shoulders, and cold weather.  Medication and rest alleviated the pain.  Flare-ups occurred only with aggravating factors, with a pain intensity of 7/10 lasting 2-3 days.  Physical examination was essentially normal with no painful or limited motion, no muscle weakness, and no swelling or joint effusion.  ROM measurements were recorded per the chart above.  

The MEB NARSUM examination on 14 April 2009, 7 months post-surgery and 5 months prior to separation, noted complaints of left shoulder pain, present with certain exercises.  Pain intensity was 2-6/10.  The CI could not do any overhead exercises or lift as much with his left arm, relative to his right (the examiner noted the CI was right-hand dominant).  The CI could not wear body armor, Kevlar, do push-ups or pull-ups, and cold weather aggravated the condition.  Physical examination showed tenderness to palpation at the shoulder joint.  Rotator cuff and impingement signs were negative.  ROM measurements were recorded per the chart above.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 20%, analogously coded 5099-5003-5201 (arm, limitation of motion of), citing limitation (of motion) at shoulder level.  The VA rated the left shoulder condition 0%, coded 5201 (arm, limitation of motion of), based on the C&P examination 6 months before separation, citing a noncompensable evaluation due to normal ROM without pain.  The Board noted that the VA increased the shoulder ratings over 5 years remote from separation.  

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 MEB NARSUM examination demonstrated motion limited to this level.  The highest 30% rating for a non-dominant arm requires motion limited to “25 degrees from side,” but examinations did not reflect this degree of limitation.  There was no fibrous union or nonunion 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 left (non-dominant) shoulder condition.  

BOARD FINDINGS:  In the matter of the left (non-dominant) 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 20150605, 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 
XXXXXXXXXXXXXXXXXX, AR20170000817 (PD201500865)

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