RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01195
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20090706

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E4, Human Resources Specialist, medically separated for “left shoulder pain” with a disability rating of 10%.  

CI CONTENTION:  “Constant weakness and pain.  Effects everyday 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 - 20090601	VARD - 20100827	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	10%	Status Post Left Shoulder Repair for Chronic Dislocations	5201	10%	20100803	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Left Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the right hand dominant CI’s left shoulder pain began in September 2007 after a pugil stick injury in basic training caused a dislocation of his left shoulder.  The shoulder was relocated, but dislocated again later while weight training.  In June 2008 he underwent arthroscopic shoulder surgery (Bankart procedure), but his symptoms did not improve.  Physical therapy following the shoulder surgery in 2008 provided little improvement; his range of motion (ROM) improved some, but he was still not able to lift heavy objects.  Final diagnosis was chronic left shoulder pain due to residual of previous shoulder dislocation and surgery.  
During a physical therapy clinic visit on 9 December 2008 the CI reported 2/10 left shoulder pain.  Physical examination showed the left shoulder ROM flexion was 168 degrees (normal 180) and abduction was 168 degrees (normal 180).  Painful motion was not addressed.  ROM measurements were the same at a physical therapy clinic visit on 11 December 2008, without pain.  X-ray images taken on 7 January 2009 revealed potential cystic changes at the glenoid labrum indicating possible arthritic change.  The humeral head, AC joint, and clavicle appeared normal.  MRI findings on 13 January 2009 showed no fractures or dislocations.  Overall findings were normal with signs of prior surgical procedures.  

The 1 April 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic daily left shoulder pain.  The CI reported flare-ups, which would last up to an hour, when leaning on the shoulder, sleeping on the wrong side, or trying to lift heavy objects.  Physical examination showed no ligamentous laxity, guarding, muscle spasms, or impingement signs.  ROM measurements obtained using a goniometer and repeated three times showed flexion of 148 degrees and abduction of 142 degrees without painful motion.  No weakness, incoordination, or lack of endurance was noted. 

At the 3 August 2010 VA Compensation and Pension (C&P) examination, 13 months after separation, the CI reported improvement after a second Bankart surgery on 1 April 2010 (after military separation), but he still had pain and flare-ups with overuse.  The flare-ups were moderate in nature and occurred every 2 to 3 weeks and lasted for 1 hour.  Since the surgery, he had no additional dislocations but could not sleep on the left shoulder because of pain.  Physical examination showed the left shoulder to have instability, pain, stiffness, weakness, incoordination, and tenderness.  There was no ankylosis, deformity, dislocation, locking, or effusion.  Flexion was 105 degrees and abduction was 130 degrees after repetition with pain on motion.  

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 IAW VASRD 4.10; 4.40; 4.45, and 4.59, to include consideration of functional loss due to factors such as pain, including pain on repeated use and painful motion; fatigability; incoordination; weakness with repetitive use and flare-ups.  The VA rated the left shoulder condition 10%, coded 5201 (arm, limitation of motion of), based on the C&P examination, citing evidence of painful limited motion.  

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 no 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 concluded that 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 shoulder pain 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 20170306, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007336, 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.

Sincerely,					      
Enclosure