RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01891
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve 04, Health Services Materiel Officer, medically separated for “post traumatic arthritis of the left shoulder” with a disability rating of 10%.  

CI CONTENTION:  Her condition continues to worsen and negatively impacts daily 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 FPEB - 20070926	VARD - 20080919	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Traumatic Arthritis of the Left (non-dominant) Shoulder	5010	10%	Post Traumatic Osteolysis of the Left Shoulder with a History of Surgery	5201	NSC	STR	
			Left Shoulder Condition	5201	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Post Traumatic Arthritis of the Left Shoulder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left (non-dominant) shoulder condition began around 1991 after a fall from a 3 foot wall during basic training.  Following the injury, she reported constant sharp pain in the left acromioclavicular joint (ACJ).  In June 2006 she underwent a distal clavicle resection without relief of the pain.  On 27 February 2007, 10 months prior to separation, range of motion (ROM) noted flexion to 150 degrees (normal 180).  The 1 March 2007 MEB NARSUM addendum examination, 9 months prior to separation, noted complaints of left shoulder pain despite surgery and conservative treatment.  The CI was able to run, but could not perform duties required in a deployed environment.  Physical examination showed tenderness all around the shoulder and scapula, including the muscles and joints, and painful motion of the shoulder.  The CI was “within 5% of shoulder motion, otherwise normal.”  During the 15 March 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, the CI reported a painful shoulder joint.  Physical examination documented left shoulder with “normal” flexion and adduction, absence of evidence of nerve impingement, and no tenderness over the ACJ.  There was no VA examination in proximate to separation evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, coded 5010 (arthritis due to trauma), citing tenderness to palpation with no swelling or deformity and a slightly decreased ROM with evidence of painful motion.  Radiographic studies showed post-traumatic osteolysis.  The VA determined the left shoulder condition was not service connected, coded 5201, (arm, limitation of motion of), based on insufficient evidence of a current condition.  

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 compensable limitation of motion, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion) and §4.40 (functional loss) as adjudicated by the PEB.  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).  The higher rating of 20% under 5010 requires radiographic evidence of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations.  The panel found no evidence of prescribed bedrest for this condition in the year prior to separation.  After due deliberation, considering all 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 left shoulder condition.  

BOARD FINDINGS:  In the matter of the post traumatic arthritis of the left shoulder 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

AR20180008649, 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