RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00645
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040412

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Light Wheeled Vehicle Mechanic, medically separated for “status post Bankart repair (right shoulder),” with a disability rating of 0%.  

CI CONTENTION:  The CI requests 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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB – 5099-5003	VARD - 20040511	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Bankart Repair	5099-5003	0%	Status Post Bankart Repair, Right Shoulder	5201	20%	20040226	
Low Back Pain (LBP)	Not Unfitting	Lumbosacral Strain	5237	10%	20040226	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Shoulder.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the right-hand dominant CI injured her right shoulder in July 2002 during a field training exercise.  The CI underwent an open Bankart procedure in March 2003 for recurrent right shoulder dislocation.  

The 5 November 2003 MEB NARSUM examination, 5 months prior to separation, noted complaints of persistent pain with motion of the right shoulder, inability to reach overhead, and inability to actively turn a wrench, turn a screwdriver or hammer a nail.  She could not carry heavy objects or a tool box, or crawl or climb into vehicles.  There was no history of post-surgical shoulder dislocations.  Diagnostic imaging showed mild-to-moderate attenuation of the cartilaginous labrum which may represent post-surgical changes or a labral tear, as well as internal debris of the glenohumeral joint.  The physical examination showed right shoulder range of motion (ROM) measured in degrees of forward flexion 0-170, abduction 0-150, external rotation 0 and internal rotation of 0.  There was no evidence of instability or apprehension.  Under “present condition,” the orthopedics physician stated that the CI “does have pain with motion of her right upper extremity including the inability to reach overhead.”  

At the 26 February 2004 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported daily pain and no reoccurrence of dislocation of the right shoulder.  The physical examination showed a tender anterior right shoulder scar.  ROM was 0-120 degrees of forward flexion and 0-120 degrees of abduction with pain at maximum ROM.  External rotation was 0-5 degrees and internal rotation was 0-10 degrees.  There was increased pain on repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing near full ROM and rated for pain.  The VA rated the right shoulder condition 20%, coded 5201 (arm limitation of motion), based on the C&P examination 2 months before separation, citing forward flexion of 120 degrees and 0-120 degrees of abduction with marked decrease in internal and external rotation.  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).  Panel consensus was that the NARSUM examiner’s indication of “inability to reach overhead,” the markedly decreased measured internal and external rotation with noted functional disability and the pre-separation C&P ROMs, most nearly approximated the disability picture for the 20% rating criteria.  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 rating available under the 5203 code (clavicle or scapula, impairment of).  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 rating 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 panel majority recommends a disability rating of 20% for the right shoulder condition, coded 5201.  

Contended PEB Condition:  LBP.  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, 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 right shoulder condition, the panel majority recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  The single voter for dissent recommended modification to 10% and did not elect to submit a minority opinion.  In the matter of the contended back condition, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Status Post Bankart Repair	5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160912, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180002705, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX: 

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure