RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01434
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040316

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantryman, medically separated for “chronic pain, left shoulder” with a disability rating of 0%.  

CI CONTENTION:  “L shoulder has given me problems since separation.  Dislocated multiple times & surgically repaired.  Lost some range of motion & have trouble performing duties at work.” [sic]  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 - 20040224	VARD - 20040319	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Shoulder	5099-5003	0%	Left Glenohumeral Instability Status Post Dislocation	5399-5305	10%	2031028	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Left Shoulder Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI injured his left shoulder in March 2003 during pugil stick training.  X-rays the same day revealed anterior dislocation of the humerus head without fracture.  Post-reduction X-rays showed satisfactory realignment with a large Hill-Sachs compression deformity of the posterolateral head.  A 9 July 2003 physical therapy examination, 6 months prior to separation, revealed left shoulder range of motion (ROM) within normal limits, normal strength, no tenderness, and negative apprehension testing (but with increased posterior shoulder pain during the test).  A 22 September 2003 physical examination, 5 months before separation, showed the CI’s left shoulder ROM within normal limits, but with some mild pain during measurements. 

At the 4 November 2003 MEB NARSUM evaluation, 4 months prior to separation, the examiner noted continued, unpredictable pain with any type of shoulder movement.  The CI was able to do slow physical training movements like pull-ups or pushups, but could suddenly have an exacerbation of the pain.  The provider referred to previous examinations for history and symptoms.  

During the 28 October 2003 VA Compensation and Pension (C&P) evaluation, performed 5 months before separation, the CI reported continued instability with occasional subluxation and pain, which occurred as often as every 2 days and lasted a few minutes each time.  He could not do heaving lifting, outstretched reaching, work above shoulder level, push-ups, pull-ups or carry a ruck sack.  Physical examination showed an abnormal appearing left shoulder with findings of mild atrophy and instability noted.  ROM showed flexion to 180 degrees (normal), abduction to 180 degrees (normal), external rotation to 80 degrees (normal 90), and internal rotation to 70 degrees (normal 90).  The ROM was limited by pain but not by fatigue, weakness, lack of endurance or incoordination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA also rated the left shoulder condition 10%, but analogously coded 5399-5304 (group IV muscle injuries), based on “moderate disability of the intrinsic muscle and tendons of the shoulder joint, manifested by instability of the joint, uncertainty of movement, fatigue-pain and mild muscular atrophy.”  The VASRD §4.71a threshold for rating 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 limitation of motion to support a rating under the 5201 code, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus 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 of).  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 chronic left shoulder pain condition, analogously coded 5099-5003.  

BOARD FINDINGS:  In the matter of the chronic left shoulder pain condition, the panel unanimously 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	
Chronic Left Shoulder Pain	5099-5003	10%	

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 

AR20180001599, 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