RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01031
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040626

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “left shoulder dislocation treated by surgery with a left open Bankart surgical procedure” with a disability rating of 20%.  

CI CONTENTION:  The CI contends that he was originally rated for a left shoulder scar, but that rating was taken away.  He also contends that his high blood pressure that he did not have before entering the service causes problems.  He also suffers from hearing loss due to cannon fire.  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 - 20040426	VARD - 20041006	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Dislocation Treated by Surgery	5099-5003	0%	Left Shoulder Dislocation…with Bankart Legion	5202-5201	20%	20040920	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Shoulder Dislocation Treated by Surgery.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI underwent left shoulder surgery in September 2003 for longstanding shoulder instability.  At the 10 March 2004 MEB NARSUM orthopedic evaluation, 3 months prior to separation, the CI complained of poor ROM and continued pain.  Post-surgical shoulder dislocations were not reported.  The physical examination showed no evidence of instability.  Forward flexion was 70 degrees and abduction was 60 degrees.  His upper extremity muscle strength was normal.  

At the 16 March 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the examiner recorded that the CI had decreased left shoulder range of motion (ROM) with pain.  There was also numbness in the left shoulder/arm area related to the surgery.  The physical examination showed decreased ROM and pain in both shoulders with left more restricted than right.  The examiner did not include actual ROM measurements in his findings.  The 5 April 2004 MEB NARSUM ROM Addendum, 2 months prior to separation, showed that the CI had 50 degrees of flexion after repetition and 70 degrees of abduction after repetition in his left shoulder.  The examiner also indicated that the CI had pain at the limits of his ROM.

At the 20 September 2004 VA Compensation and Pension (C&P) examination, performed 3 months after separation, the CI reported intermittent daily left shoulder pain and pain with movement above shoulder level.  The physical examination showed surgical scars were “without redness or tenderness, elevation or depression, soft tissue adhesions or loss.”  Left arm forward flexion was 81 degrees after repetition and abduction was 65 degrees after repetition.  Painful motion was noted during forward flexion and external rotation movements.  There was no crepitus noted during ROM testing.  The CI denied flare-ups and the examiner noted that the CI’s strength was “good.”  

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

Left Shoulder ROM
(Degrees)	Ortho ~4 Mos. Pre-Sep	MEB ~3 Mos. Pre-Sep	VA ~3 Mos. Post-Sep	
Flexion (180 Normal)	70	50 50 50	81	
Abduction (180)	60	70 70 70	65	
Comments	Painful Motion	Painful Motion	Painful Motion	
§4.71a Rating	20%	20%	20%	

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating using code 5099-5003 (analogous to degenerative arthritis), citing “rated for pain” with likely use of the US Army Physical Disability Agency (USAPDA) Pain Policy.  “The pain limits abduction to 70 degrees.  The [CI] has pain at the extreme ROMs with passive ROM.  The VA assigned a 20% rating using codes 5202-5201 (impairment of the humerus causing limitation of motion of the arm), for “limitation of arm motion midway between side and shoulder level or for limitation of arm motion at shoulder level.”  

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).  A 20% rating for the non-dominant arm requires motion limited to shoulder level or midway between side and shoulder level and examinations in evidence reflected this degree of limitation.  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).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left shoulder condition.  

BOARD FINDINGS:  In the matter of the left shoulder condition, the panel unanimously recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  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	
Left Shoulder Dislocation Treated with Surgery	5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160902, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018584, 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