RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01339
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Food Service Specialist, medically separated for “chronic left shoulder pain” with a disability rating of 10%.  

CI CONTENTION:  Requested review of left shoulder condition and hearing loss.  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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20041109	VARD - 20050603	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	10%	Degenerative Joint Disease of Left Shoulder	5010-5201	20%	20050413	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left Shoulder Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-dominant CI fell on and injured his left shoulder in 2002 during obstacle course training.  He underwent an arthroscopic reverse Bankart repair in December 2002 and a superior labrum anterior and posterior (SLAP) repair in June 2004 due to continued pain.  Despite the surgeries, CI continued to experience left shoulder pain both at rest and with activity.  

The 7 September 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of left shoulder pain that prevented the CI from adequately performing his duties.  Shoulder dislocations were not reported.  Physical examination showed evidence of instability with a positive impingement sign, but was no erythema or swelling.  Range of motion (ROM) measurements showed “decreased to approximately 100 degrees of abduction” (normal 180), and full internal and external rotation.  There was moderate tenderness in the superior aspect of the shoulder laterally over the deltoid muscle and superior aspect of the glenohumeral joint.  There was crepitus on passive shoulder movement through the superior aspect of the ROM arc.  

At the 13 April 2005 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported that he could not lift any weight over his head and had a frequent popping sensation and discomfort when he moved his arm.  He had constant left shoulder pain rated at 4/10 which increased to 10/10 during flare-ups.  Physical examination showed decrease motor strength in the left upper extremity and normal reflexes.  There was crepitus with left shoulder movement and slight left arm atrophy.  ROM measurements showed forward flexion of 110 degrees and abduction of 100 degrees with pain in both planes.  Following repetitive use, there was no further loss of motion due to pain, weakness, fatigue or incoordination.  X-ray studies showed subchondral sclerosis of the left humeral head and adjacent glenoid, most likely due to degenerative arthritis.  VA evidence showed that the CI underwent a third left shoulder surgery in August 2005, 8 months after separation, for recurrent instability with repairs of posterior Bankart and recurrent SLAP lesion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy and pain as “slight and frequent.”  The VA rated the left shoulder condition 20%, dual coded 5010-5201 (arthritis, due to trauma-arm, limitation of motion) citing 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 “at shoulder level” and examinations reflected this degree of limitation.  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 recommends a disability rating of 20% for the left shoulder condition, coded 5010-5201. 

BOARD FINDINGS:  In the matter of the chronic left shoulder pain condition, the panel unanimously recommends a disability rating of 20%, coded 5010-5201, 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	
Chronic Left Shoulder Pain	5010-5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161004, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180001394, 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