RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01704
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060502

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Patient Administration Specialist, medically separated for “chronic left shoulder pain” with a disability rating of 10%.  

CI CONTENTION:  “Left shoulder has had two additional surgeries since active duty service…”  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 - 20060302	VARD - 20070717	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	10%	Impingement with Instability, Left Shoulder	5299-5203	10%	20060620	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Chronic Left Shoulder Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent left shoulder surgery for rotator cuff instability as a result an injury sustained during physical fitness training.  He described excellent results until 26 August 2004, when he felt shoulder pain after lifting a small grill from his car.  He reported worsening left shoulder instability, and an arthrography on 19 October 2004 showed some edema in the humeral head, but no signs of any rotator cuff tear or labral avulsion.  At an orthopedic evaluation on 29 April 2005, the CI was able to fully abduct his left arm with some pain.    
During the 14 November 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported left shoulder pain and instability which was confirmed by physical examination.  The 15 December 2005 MEB NARSUM examination, 5 months before separation, noted continued complaints of left shoulder instability.  The examiner documented active range of motion (ROM) with flexion to 161 degrees (normal 180) and abduction to 95 degrees (normal 180), and pain in all planes.  He had a positive apprehension test, a 2+ posterior load and shift test with guarding, a 1+ anterior load and shift test, and a 1+ sulcus examination.  There was no atrophy or motor/sensory deficits. 

At the 20 June 2006 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported continued left shoulder pain.  Physical examination showed abduction and flexion of 0-180 degrees.  He had a positive apprehension sign and relocation tests indicating instability, and symptoms of bursitis and impingement in the subacromial region.  There was no pain with cross arm testing (acromioclavicular joint degeneration) and the Speed’s (superior labral tears or bicipital tendonitis) and O’Brien’s (glenohumeral joint labral tear) tests were negative.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated the left shoulder condition 10%, analogously coded 5299-5203 (clavicle or scapula, impairment of), based on the C&P examination, citing pain and limitation of forward flexion.  Members considered the conflicting examinations, and agreed the VA examination held more probative rating value than the MEB NARSUM examination because it was more proximate to separation.  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 ROM tests showed motion above that level.  However, 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 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the chronic left shoulder condition.  

BOARD FINDINGS:  In the matter of the left shoulder condition 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 20170303, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180010085, 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