RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01514
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, medically separated for “left shoulder subluxation/laxity” with a disability rating of 0%.   

CI CONTENTION:  Continued shoulder issues include possible nerve damage and affect employability.  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 - 20071211	VARD - 20080715	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Subluxation/
Laxity, Left Shoulder	5099-5003	0%	S/P Arthroscopy Surgery, Left Shoulder	5299-5203	10%	20080522	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Shoulder Recurrent Subluxation/Laxity.  According to service treatment record and MEB narrative summary (NARSUM), the CI’s left shoulder condition began in March 2003, after sustaining an injury during combative training.  In September 2004, he underwent a left Bankart lesion repair and fully recovered post-surgery to perform duties.  However, in 2005, while deployed, he re-injured his shoulder after falling.  He was treated with physical therapy (PT) and activity modification but had minimal symptom improvement, and in October 2006, he underwent a Bankart revision.  Despite 6 months of PT, rehabilitation, and activity modification/profiling, he continued to complain of mild pain over the left acromioclavicular (AC) joint with radiation into his fourth and fifth digits.  

The 28 September 2007 orthopedic examination, 4 months prior to separation, showed bilateral shoulder laxity but no tenderness, swelling, erythema, warmth, deformity, and no muscle atrophy or hypertrophy.  There was no bilateral AC joint/acromion tenderness or weakness observed.  Measured range of motion (ROM) was forward elevation (flexion) to 180 degrees (normal), with pain and subluxation.  

At the 16 October 2007 PT evaluation, ROM tests showed flexion to 172 degrees and abduction to 171 degrees (normal 180).  During the 19 October 2007 MEB examination (recorded on DD Forms 2807 and 2808), 3 months prior to separation, the examiner documented “good” ROM and normal strength.  

The 20 November 2007 MEB NARSUM examination, 2 months before separation, noted pain worsened by running, repetitive lifting over 60 pounds, swimming and all impact activities.  Treatment with PT, steroid injections, medications, and activity modification improved symptoms, however, the CI’s pain returned when activity resumption.  Physical examination showed apprehension and slightly decreased left shoulder ROM with increased pain during external rotation against resistance.  The examiner noted subluxation and laxity and referenced October 2007 PT goniometer ROM measurements.  Muscle strength was 5/5 and reflexes were 2/4 and symmetrical.  There was tenderness on the posterior aspect of the left acromion, but no swelling, erythema, or warmth, and no muscle atrophy or hypertrophy.  

At the 22 May 2008 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI complained of constant, sharp, cramping pain, rated at 9/10, that traveled to the clavicle, scapula and biceps.  Pain was elicited by physical activity and sleeping on the left side, and relieved with medication, heat/ice application, steroid injections and patches.  Functional loss of strength was also reported.  Physical examination showed no signs of edema, effusion, weakness, tenderness, redness, heat, subluxation or guarding of movement.  Left shoulder ROM showed both flexion and abduction to 180 degrees, with pain at 170 degrees in both planes.  ROM was additionally limited by fatigue, weakness, lack of endurance and incoordination after repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing painful ROM and no instability.  The VA rated the left shoulder condition 10%, analogously coded 5299-5203 (clavicle or scapula; impairment), based on the C&P evaluation, citing painful motion of a major joint.  The VASRD §4.71a threshold for rating ROM impairment under 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 code 5201, 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 code 5202 (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under code 5203 (clavicle or scapula, impairment of).  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.  

BOARD FINDINGS:  In the matter of the left shoulder recurrent subluxation/laxity condition, the panel recommends a disability rating of 10%, coded 5099-5003 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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Recurrent Subluxation/Laxity, Left Shoulder	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005234, 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. 

Sincerely,					      
Enclosure