RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02399
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 National Guard E2, Trainee, medically separated for “left shoulder instability…,” with a disability rating of 10%.

CI CONTENTION:  His condition continues to worsen and negatively impact daily activities. 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 - 20060504	VARD - 20150520	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Instability…	5010	10%	Status Post Superior Labral Anterior Posterior (SLAP) Lesion with Instability, Left Shoulder to Include Impairment of the Humerus	5202	20%	20150508	
			Status Post Superior Labral Anterior Posterior (SLAP) Lesion with Instability, Left Shoulder	5201-5019	10%	20150508	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Shoulder Instability.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left shoulder condition began in basic training without a specific injury.  No pathology was recorded on the examination of the shoulder and the right dominant CI was treated with medications and limited duty.  In primary care, on 29 August 2005, he was noted to have full active range of motion (ROM).  Signs of instability were absent.  His symptoms persisted and he was referred to physical therapy.  On 30 November 2005, he was seen in physical therapy and found to have signs of impingement on examination.  The ROM was limited to 140 degrees of flexion and abduction by pain (normal is 180 for both).  Signs of impingement were absent.  The CI was thought to have an impingement.  An magnetic resonance imaging (MRI) showed a probable labral tear (the cartilage lining of the joint) as well as injury to the rotator cuff.  The CI was examined in orthopedics on 16 March 2006 and found to have motion limited to 90 degrees of abduction and 120 degrees of forward flexion.  Some signs of instability were present, but the examination was limited by pain (guarding).  Atrophy was absent.  He was thought to have multi-directional instability although the examination was limited by pain.  He was also thought to have a tear of the labrum and rotator cuff.  The CI was presented the option of surgery or a MEB.  He opted to separate and then pursue surgery outside the military.  

The MEB NARSUM examination on 27 March 2006 was accomplished by the same orthopedist who evaluated the CI on 16 March 2006 and the history and physical mirrored that evaluation.  During the MEB examination (recorded on DD Forms 2807-1 and 2808) dated 31 March 2006, 2 months prior to separation, the CI reported trouble with his shoulder since basic training.  The examiner recorded recurring subluxation which was progressive.  The panel observed that this was not recorded elsewhere in the record.  The examiner also documented “sign pain with ROM, impingement and instability” without further elaboration.  The CI was seen in physical therapy for ROM evaluation measurements on 11 April 2006 and had flexion of 140, 141, and 143 degrees and abduction of 100, 101, and 104 degrees.  No comment was made on stability or impingement.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder instability condition at 10%, coded 5010 (traumatic arthritis) for painful motion.  The VA rated the left shoulder instability at 20%, coded 5202 (impairment of the humerus [including subluxation]) and 10%, coded 5201-5019 (limitation of motion of the shoulder-bursitis).  The panel observed that its recommendations are based on the VASRD in effect at the time of separation.  The VASRD did not support multiple ratings for the shoulder until several years after the date of separation.  Accordingly, the panel is limited to a single rating in its recommendation.  

The panel considered the evidence.  The examination by the orthopedic surgeon supported a 20% rating for limitation in abduction to 90 degrees using the code 5201 (limitation in motion).  However, this was an outlier from the other ROM measurements in the record including two by physical therapy and also from the VA examination.  While the latter was remote from separation, it is consistent with the majority of examinations proximate to separation and supports the validity of these values.  A 10% rating, coded 5010, is supported by painful and limited motion with MRI evidence of pathology.  The panel also considered the code 5202 (other impairment of the humerus).  The record was carefully reviewed.  It was noted that the CI did not have signs of instability at the initial troop clinic examination in August 2005 or the physical therapy examination in November 2005.  The orthopedic examiner did diagnose multi-directional instability, but noted that the examination was compromised by pain.  Neither subluxation nor dislocation was demonstrated on this examination or any other found in evidence.  The panel majority did not find clinical evidence to support either code at a 20% level of 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 instability condition.  

BOARD FINDINGS:  In the matter of the left shoulder instability condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommends modification to 20% and elected not to submit a minority opinion. There are 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 20150915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012629, 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.

Sincerely,