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Dear XXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified to 10% 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

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX 	CASE:  PD-2017-00099
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040706

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic left shoulder pain and instability” with a disability rating of 0%.   

CI CONTENTION:  In addition to the unfitting left shoulder condition and not unfitting asthma, the CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the MEB, but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040506	VARD - 20050128	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain and Instability 	5099-5003	0%	Left Shoulder Dislocation 	5203	10%	STR	
Intermittent Mild Asthma	Not Unfitting	Asthma	6602	NSC	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Left Shoulder Pain and Instability.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right-hand dominant CI underwent a left shoulder Bankart repair for instability in March 2003.  An MRI arthrogram performed on 29 October 2003 showed post-surgical changes without any acute abnormality and an intact labrum and rotator cuff.  In November 2003, the CI felt a pop while sleeping, which caused him severe pain.

At the 2 December 2003 orthopedic examination, 7 months prior to separation, the CI reported his shoulder felt loose.  The left shoulder range of motion (ROM) evaluation showed abduction of 170 degrees (normal 180), with pain, and forward flexion of 140 degrees (normal 180).  Provocative testing for instability was positive.  Revision surgery was offered; however, the CI requested an MEB rather than surgery.  

The 17 February 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, revealed left shoulder abduction of 150 degrees and flexion of 160 degrees.  On 12 March 2004, the physical therapy ROM evaluation showed left shoulder flexion of 170 degrees and abduction of 170 degrees.  Painful motion was not addressed.  

The 30 March 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of continuous left shoulder pain exacerbated by overhead work.  The left shoulder ROM evaluation showed forward flexion of 170 degrees and abduction of 180 degrees.  Provocative testing to detect instability was positive.  Painful motion was not addressed.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left shoulder condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing an unstable shoulder without significant loss of joint motion and no clinical subluxations/dislocations.  The VA rated the left shoulder condition 10%, coded 5203 (clavicle or scapula impairment), based on the STR examination, citing pain without significant loss of joint motion and instability, but no clinical subluxation or dislocation.

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), 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) as reported during the orthopedic examination.  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.  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 left shoulder condition, coded 5099-5003.  

Contended PEB Condition:  Intermittent Mild Asthma.  The panel’s main charge is to assess the fairness of the PEB 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.  The 31 January 2003 pulmonologist’s assessment was periodic bronchitis versus exercise induced asthma or mild extrinsic asthma.  On 26 February 2003, the pulmonologist indicated the CI had two to three episodes of shortness of breath every winter, but was usually asymptomatic the rest of the year, and episodes were usually controlled with an albuterol inhaler.  X-rays on 14 July 2003 showed no evidence of acute cardiopulmonary disease.  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, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left shoulder condition, the panel recommends a disability rating of 10%, coded 5299-5003 IAW VASRD §4.71a.  In the matter of the contended asthma condition, the panel agrees it cannot recommend it for additional disability rating.  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 the date of 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 20161128, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record