RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00977
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040618

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Infantryman, medically separated for “left shoulder pain and instability” with a disability rating of 0%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20040512	VARD - 20040927	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain and Instability	5099-5003	0%	Left Shoulder Instability	5299-5202	20%	20040624	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Shoulder Pain and Instability.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI injured his left shoulder while performing training exercises in October 2003.  Radiographic studies showed a possible labral tear.  In January 2004 an MRI arthrogram was unremarkable.  

During the 5 March 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported a painful shoulder for a period of 6 months.  The physical examination showed a history of left shoulder dislocation.  The 5 March 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of subluxation of the left shoulder.  The CI declined surgery, and was unable to perform push-ups, pull-ups, or ruck.  The physical examination showed full range of motion (ROM) of the left shoulder with a forward flexion and abduction of 180 degrees (normal).  There was a positive apprehension sign, positive Jobe's relocation sign, and a Grade II sulcus (for instability).  At the 31 March 2004 orthopedic clinic evaluation, the CI complained of shoulder pain and physical examination noted painful left shoulder motion.  

At the 24 June 2004 VA Compensation and Pension (C&P) evaluation, one week after separation, the CI reported pain and spontaneous left shoulder dislocations.  The physical examination revealed ranges of motion (ROMs) as 0-180 degrees of extension and 0-180 degrees of abduction.  There was no weakness and no change to ROM after repetition.  There was palpable grinding in the shoulder (acromioclavicular joint) which the physician indicated was a sign of shoulder instability.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder pain condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing abduction to 180 degrees and “rated for pain,” with likely application of the US Army Physical Disability Agency pain policy.  The VA rated the left shoulder pain condition 20%, analogously coded 5299-5202 (humerus impairment) based on the C&P examination one week after separation, citing grinding and tenderness with motion.  

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 insufficient or no limitation of motion to support a rating under the 5201 code, panel members agreed there was satisfactory evidence of painful motion or other evidence of functional loss to support a 10% rating IAW VASRD §4.59, §4.40 or §4.45.  Although there was shoulder instability and mention of subluxation or dislocation, there was insufficient evidence of recurrent dislocation and guarding of movement at the shoulder level 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). After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left shoulder condition, analogously coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left shoulder condition, the panel unanimously or majority recommends a disability rating of 10%, analogously coded 5099-5003 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Shoulder Pain and Instability	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160921, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018481, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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