RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01512
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080718

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Tracked Vehicle Mechanic, medically separated for “chronic right (non-dominant) shoulder pain” with a disability rating of 10%.  

CI CONTENTION:  In addition to his right shoulder condition, the CI requested review of other 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 - 20080626	VARD - 20081020	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right (Non-Dominant) Shoulder Pain	5099-5003	10%	Degenerative Changes, Right Shoulder	5010-5203	10%	20080717	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent diagnostic arthroscopic right shoulder surgery in August 2005 for complains of instability and in June 2006, he underwent a posterior capsulolabral (Bankart) repair due to inflammation and damage from the first surgery.  After numerous dislocations in November 2007, he underwent a revision posterior Bankart repair.  Post-surgical X-rays revealed no evidence of complications from the final Bankart repair.  

During the orthopedic clinic appointment on 28 February 2008, 3 months after surgery, the CI reported right shoulder soreness, but was doing relatively well.  On examination, posterior load shift was stable.  Right shoulder range of motion (ROM) testing showed full forward flexion and abduction and internal rotation was slowly coming back.  He was a little tender throughout ROM, which was most likely secondary to some muscular soreness from work the day prior.  At the primary care clinic appointment on 24 March 2008, 4 months prior to separation, the CI reported that his right shoulder felt like it would slip out of place and could be dislocated voluntarily.  Right shoulder active abduction was decreased due to painful motion and laxity.  

During the 5 May 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported right shoulder pain with loss of mobility.  Physical examination revealed a loss of mobility with only 80 degrees of elevation (flexion).  The 5 June 2008 MEB NARSUM examination, 1 month prior to separation, noted complaints of pain, stiffness and continued posterior instability despite aggressive rehabilitation.  Physical examination showed no evidence of atrophy about the deltoid or rotator cuff muscles.  There was tenderness of the posterior shoulder and posterolateral rotator cuff and some discomfort with Kim and jerk testing, as well as “2+ posterior load shift” and “1+ anterior load shift.”  There was no evidence of a sulcus sign.  Right shoulder ROM testing showed flexion of 60 degrees (normal 180) and abduction of 140 degrees (normal 180).  

At the 17 July 2008 VA Compensation and Pension (C&P) examination, 1 day before separation, the CI reported right shoulder pain and stiffness.  Physical examination revealed symmetric shoulders and no evidence of AC separation, redness, swelling or scapular winging.  Right shoulder ROM testing showed flexion of 140 degrees and abduction of 160 degrees.  There was an additional 40 degree loss of flexion and 20 degree loss of abduction after repetition.  Pain and crepitus was also noted during ROM testing.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, analogously coded 5003 (arthritis, degenerative), citing satisfactory evidence of painful motion.  The VA also rated the right shoulder condition 10%, dual coded 5010-5203 (arthritis, due to trauma-clavicle or scapula, impairment of), based on the C&P examination, citing evidence of functional loss due to pain which affects the performance of normal working movements of the right shoulder with normal excursion, strength, speed, coordination and endurance.  

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).  The 20% rating for the non-dominant arm requires motion limited to “shoulder level and the MEB NARSUM examination reflected this degree of limitation.  There was no fibrous union or nonunion of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher rating available under the 5203 code (clavicle or scapula, impairment of).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority 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 majority 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	
Chronic Right (Non-Dominant) Shoulder Pain	5201	20%	

AR20190002476, 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.