RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01712
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20041017

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

CI CONTENTION:  The CI contended that the VA rating for his injury was greater than 10%.  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 - 20040629	VARD - 20050601	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Shoulder	5099-5003	10%	Residuals, Left Shoulder…	5201	0%	20050318	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Pain Left Shoulder, Status Post Open Reconstruction.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI underwent two operations on his left shoulder while in service.  The CI fell on his shoulder and the shoulder popped out.  He reported multiple subluxations/dislocations of his shoulder.  The first operation was an arthroscopy of the left shoulder in April 2003.  The findings showed a significant loss of the anterior bony glenoid.  There was a large engaging Hill Sach's lesion (cortical depression in the posterolateral head of the humerus).  Arthroscopic surgery was terminated due to the extent of pathology.  A second surgery in August 2003 accomplished an open capsular shift and interval closure and bone graft (harvested from the iliac crest) to the anterior glenoid.  At the time of the orthopedic clinic appointment on 14 May 2004, 10 months post-surgery and 5 months prior to separation, the CI reported constant pain and was unable to do his job as a supply specialist.  

During the 24 May 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 10 months post-surgery and 5 months prior to separation, the CI reported a painful shoulder due to surgery.  He experienced impaired use of his arm due to the shoulder surgery.  Physical examination showed painful, limited motion of the left shoulder.  Particular difficulty was noted with adduction and external rotation.  At the 25 May 2004 physical therapy clinic examination, 10 months post-surgery and 5 months prior to separation, physical examination recorded ROM measurements per chart below.  The examiner noted the CI continue to demonstrate atrophy in the left shoulder and he required improved strength.

At the 26 May 2004 MEB NARSUM examination, 10 months post-surgery and 5 months prior to separation, the CI reported his left shoulder did not “come out of joint,” but it was painful and stiff.  Pain occurred three quarters of the day and night.  He self-treated the pain with non-steroidal anti-inflammatory medication which was effective, however it caused unpleasant side effects with his stomach.  Physical examination showed well-healed anterior shoulder scars.  Apparent atrophy was noted at the deltoid muscle.  There was a negative apprehension test and a load shift test showed a stable left shoulder joint.  Pain rating was frequent/moderate.  

At the 18 March VA Compensation and Pension (C&P) examination (NOTE:  two VA examinations occurred this day by two different examiners – one a general medical examination and the other a specialty examination for the joints – with the results combined and summarized herein), 5 months after separation, the CI reported minimal residual problems post-surgery with his left shoulder but did have pain with movement of the left shoulder.  Physical examination noted the CI to be in excellent shape.  Tenderness was noted in the left shoulder.  The CI used no mechanical aid and he was capable to manage his daily activity without any functional impairment.  ROM measurements were recorded per chart below.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, coded 5099-5003 (arthritis degenerative), citing the US Army Physical Disability Agency Policy/Guidance memorandum #13, dated 8 April 2002, subject: Rating Pain.  Pain rated as slight and frequent, not requiring daily narcotic therapy.  The VA rated the left shoulder condition 0%, coded 5201, (arm, limitation of motion of: ) based on the C&P examination 5 months after separation, citing a non-compensable evaluation unless arm motion is limited at shoulder level which would then warrant a rating of 20 percent.

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.  The 20% rating for the non-dominant arm requires motion limited to “at shoulder level” and orthopedic and NARSUM examinations proximate to separation 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).  Although there were countermanding examinations both prior to and after separation which showed left shoulder ROM above shoulder level, the panel recognized the well documented atrophy in the left shoulder and considered this evidence as representative of additional functional loss and thus IAW VASRD §4.7 (higher of two ratings), the panel agreed the 20% rating was justified.  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 chronic pain left shoulder  condition, coded 5201.  

BOARD FINDINGS:  In the matter of the chronic pain, 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	
Chronic Pain Left Shoulder	5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170019758, 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