RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01985
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091030

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

CI CONTENTION:  Review all conditions.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20091009	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Left (Non-Dominant) Shoulder Dislocations	5202	20%	No VA Exam in Evidence	
Right Knee Patellar Tendinitis	Not Unfitting
Cat III		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Recurrent Left (Non-Dominant) Shoulder Dislocations.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s recurrent left shoulder dislocations condition began in January 2009 after he injured it in basic training on the obstacle course.  The CI’s shoulder condition existed prior to entry after falling off his bike in 2006 and entry physical indicate the CI was recovered from surgery with full range of motion (ROM) and advanced healing of the left shoulder, with no restrictions or pain.  

At the time of the 2 June 2009 emergency room examination, the examiner recorded that the CI had dislocated his left shoulder, exhibited tenderness to touch, and had full ROM.  X-rays revealed that the glenohumeral joint was unremarkable, with no acute fractures.  Magnetic resonance imaging (MRI) performed on 9 July 2009, revealed diminished labrum and mild tendinopathy.  

According to the 10 July 2009 orthopedic examination, the left shoulder demonstrated glenohumeral joint pain, apprehension, and guarding with attempted load and shift.  The left shoulder examination revealed injury to the ring of cartilage surrounding the socket.  The 28 July 2009 primary care clinic appointment recorded decreased left shoulder motion, with inability to raise the arm to 90 degrees, and pain while reaching across chest or behind.  

Despite treatment, the left shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “chronic left shoulder pain and instability” for PEB adjudication.  

The 22 September 2009 MEB NARSUM examination, 2 months prior to separation, noted CI complaints of chronic left shoulder pain and instability despite conservative therapy.  Physical examination showed decreased ROM secondary to pain only, and not limited by weakness, fatigue, lack of endurance or incoordination.  The CI had well-healed arthroscopic surgical portal scars, and had a non-tender prominent mid clavicle bump.  He exhibited normal strength in upper extremities bilaterally.  The examiner noted positive apprehension and guarding with attempted load and shift, and mild pain while testing for glenohumeral joint labral tear.  Tendon pathology testing was negative.  The left shoulder ROM following repetitive movement showed flexion of 180 degrees (normal 180 degrees) abduction of 175 degrees (normal 180 degrees) internal rotation of 90 degrees, and external rotation of 85 degrees.  There was no change in ROM after repetitions.  There was no VA examination or rating in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the recurrent left (non-dominant) shoulder dislocations condition 20%, coded 5202 (humerus, other impairment of), citing guarding of arm movement at shoulder level.  The PEB noted sufficient medical evidence that the condition was unfitting, existed prior to service (EPTS), and was permanently service aggravated.  There was no fibrous union or nonunion of the humerus to justify the next higher 40% or 50% rating.  There was likewise no route to a higher rating for limitation of motion (5201), and no higher ratings available under the 5203 code (clavicle or scapula, impairment).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left shoulder condition.  

Contended PEB Condition:  Right Knee Patellar Tendinitis.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the recurrent left (non-dominant) shoulder dislocations condition and IAW VASRD §4.71a, the panel unanimously or majority recommends no change in the PEB adjudication.  In the matter of the contended right knee patellar tendinitis condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150715, w/atchs
Exhibit B.  Service Treatment Record

AR20170010020, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.