RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00193
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Heavy Wheeled Vehicle Mechanic, medically separated for “left anterior shoulder pain and instability” with a disability rating of 10%. 

CI CONTENTION:  The condition continues to worsen and negatively affect his activities.  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 Medical Evaluation Board (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 –  20031121	VARD - 20050318	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Anterior Shoulder Pain and Instability	5201	20%	Pain Left Shoulder	5237	NSC	20040922	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Anterior Shoulder Pain and Instability.  According to the service treatment record and MEB narrative summary (NARSUM), the right-hand dominant CI underwent left shoulder surgery to repair a ligament injury in 2001.  Follow-up X-ray studies performed in 2003 and 2004 indicated expected post-surgical changes, but were otherwise normal.  

The 21 July 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, showed left shoulder range of motion (ROM) for abduction to 90 degrees (normal 180) and flexion to 100 degrees (normal 180), with laxity and pain.  During the 21 October 2003 MEB NARSUM examination, 3 months before separation, the CI complained of left shoulder pain and symptoms consistent with instability; any excessive motion caused numbness throughout the left arm.  Physical examination revealed left shoulder tenderness, and both flexion and abduction were measured at 90 degrees.  Provocative testing for rotator cuff impingement signs was positive (equivalent to painful motion) with signs of joint instability.  

At the 22 September 2004 VA Compensation and Pension (C&P) examination, 8 months after separation, measured ROM showed left shoulder flexion to 105 degrees and abduction to 110 degrees, both limited by pain.  Shoulder ROM was not additionally limited 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 20%, coded 5201 (limitation of arm motion), citing abduction limited to 90 degrees.  The VA did not service connect the left shoulder.  Members noted that the VASRD §4.71a threshold for rating ROM impairment under code 5201 is “at shoulder level” (approximately 90 degrees from the side), and the pre-separation examinations in evidence demonstrated motion limited to this level.  The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level,” but the treatment record did not reflect this degree of limitation.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under code 5202 code (humerus, other impairment of); and no higher ratings available under the code 5203 (clavicle or scapula, impairment of).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the left shoulder condition.  

BOARD FINDINGS:  In the matter of the left anterior shoulder pain and instability and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161120, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180012736, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

       The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

       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 been provided to the counsel you listed on your application, disabled American Veterans, PO Box 14301, Cincinnati, OH 45250-0301.

	Sincerely,					       

Enclosure