RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00063
BRANCH OF SERVICE:  army	SEPARATION DATE:  20050223

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

CI CONTENTION:  “Right shoulder surgery to remove bone spurs and stabilize shoulder.  Abdominal pain related to ulcers still continues almost unabated.”  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 - 20041103	VARD - 20050407	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Instability	5201	0%	Residuals of Right Shoulder Injury, Postoperative	5203	10%	20041214	
Duodenal Ulcer Disease	Not Unfitting	Duodenal and Peptic Ulcer Disease	7305	0%	20041214	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Shoulder Instability.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-handed CI underwent right shoulder stabilization surgery (Bankart repair) in June 2003 following multiple shoulder dislocations, but continued to experience post-operative right shoulder instability and limited motion.  Magnetic resonance imaging (MRI) in June 2004 showed a SLAP lesion (a tear in the joint lip, or labrum), and further surgery was not recommended.  

Orthopedic evaluations in April, June, and August 2004 documented limited right shoulder range of motion (ROM) with the most limited measurement being abduction to 108 degrees (normal 180), and most examinations documenting painful motion.  During the 24 August 2004 MEB NARSUM examination, 6 months prior to separation, the CI reported right shoulder instability.  Physical examination showed some limitation in abduction and elevation of the right arm with painful motion.  The 6 October 2004 acute care evaluation documented recent CI complaints of increasing right shoulder subluxation with a dislocation the prior evening.  Right shoulder examination showed a 2+ apprehension test, significant tenderness and limited ROM.  The CI declined a recommendation for surgery and treatment included a sling and medications.  

At the 14 December 2004 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported right shoulder instability, and that he had switched many activities of normal daily living to his left hand.  He frequently had to support his right elbow and shoulder with his left hand due to pain.  Physical examination documented right shoulder flexion to 130 (normal 180) degrees, decreasing to 115 degrees after repetition and abduction of 95 degrees decreasing to 92 degrees after repetition, with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, coded 5201 (arm, limitation of motion), citing non-operative instability, abduction to 130 degrees, and not meeting the minimal rating criteria for code 5201 or the US Army Physical Disability Agency pain policy.  The VA rated the right shoulder condition 10%, coded 5203 (clavicle or scapula, impairment of), based on the C&P evaluation 2 months before separation, citing decreased ROM with pain on motion.  In assigning probative value to the somewhat conflicting examinations, members noted the STR detailed a worsening shoulder condition following the orthopedic and MEB evaluations, but before separation.  The C&P evaluation was judged by panel consensus to be carry the highest probative value as it was prior to, and closest to separation.  The threshold for a 20% rating under code 5201 is ROM limited “at shoulder level,” as was documented in the VA examination.  There was no fibrous union or nonunion of the humerus to justify a higher rating under code 5202, and no higher rating available under code 5203.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 20% for the right shoulder instability condition, coded 5201.  

Contended PEB Condition:  Duodenal Ulcer Disease.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right shoulder instability condition, the panel majority recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  In the matter of the contended duodenal ulcer disease condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  The single voter for dissent recommended modification to 10% and did not elect to submit a minority opinion.  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	
Right Shoulder Instability	5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161212, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20180003287, 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