RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01435
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090416

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Avenger Crewmember, medically separated for “multiple dislocations right shoulder” with a disability rating of 10%, overall effect.   

CI CONTENTION:  The shoulder dysfunction has not resolved despite surgery.  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 - 20080418	VARD - 20091001	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Multiple Dislocations Right Shoulder	5099-5003	10%	Residuals of Right Anterior Labrum Tear with Surgical Repair	5299-5201	10%	20090730	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Shoulder Multiple Dislocations.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right shoulder condition began in late 2006 after the CI fell from a 5-ton vehicle.  Following the injury, the CI experienced daily shoulder dislocation which he manually reset.  In November 2007, the shoulder was reinjured when the CI was hit by a motorized vehicle and sustained a labral tear to the right shoulder.  In March 2008, the CI underwent a SLAP repair, but anterior and posterior shoulder pain continued.  During the 5 November 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, physical examination showed tenderness to anterior right shoulder.  Forward flexion was 70 degrees (normal 180) and abduction at 50 degrees (normal 180).   The 16 December 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic anterior and posterior shoulder pain.  Physical examination showed normal muscle strength and reflexes, and no swelling. There was tenderness in the right acromioclavicular joint area and right axillary.  Forward flexion was 90 degrees and abduction was 70 degrees.  

At the 30 July 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported right shoulder locking, cracking, popping, and daily pain.   The CI described pulsing pain that became sharp with certain movements or added load to the shoulder.  Physical examination showed diffuse right shoulder tenderness and popping with abduction.  The examiner noted right-hand dominance with 5/5 upper extremity strength.  The range of motion (ROM) was flexion and abduction to 130 degrees with painful motion.  After repetitive motion there was no objective evidence of pain or additional limitation of motion due to pain, weakness or lack of coordination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the multiple dislocation of the right shoulder condition 10%, analogously coded 5099-5003 (degenerative arthritis) citing full strength, no swelling, and pain-limited motion.  The VA also rated the residuals of right anterior labrum tear with surgical repair condition 10%, analogously coded 5299-5201 (arm, limitation of motion), based on the C&P examination, citing objective evidence of pain.  The VASRD §4.71a threshold for rating for ROM impairment using code 5201) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level. The panel noted that all pre-separation right shoulder ROM measurements were at or below shoulder level.  The panel placed higher probative value on the pre-separation evidence which supported a 20% rating for limitation of shoulder flexion and abductions to shoulder level.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the right shoulder condition, coded 5201.  

BOARD FINDINGS:  In the matter of the right shoulder condition, the panel 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 the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Multiple Dislocations Right Shoulder	5201	20%	

AR20190004067, XXXXXXXXXX

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Dear XXXXXXXXXX:

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.