RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02415
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080709

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty  E4, Aircraft Powertrain Repairer, medically separated for “limitation of motion, left shoulder” with a disability rating of 20%.   

CI CONTENTION:  Requested review of his shoulder condition and mental health.  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 - 20080320	VARD - 20080722	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Limitation of Motion, Left Shoulder 	5201	20%	Left Shoulder Dislocation	5299-5203	10%	20080519	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Shoulder Limitation of Motion.  According to the service treatment record and MEB narrative summary (NARSUM), the left hand-dominant CI underwent a left shoulder arthroscopy with a superior labral anteroposterior (SLAP) repair on 1 December 2006.  However, he reinjured his shoulder in November 2007, whereby he had pain with decreased range of motion (ROM).

During the 25 January 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported that he was unable to fully use his left arm due to lack of motion.  Physical examination revealed normal bilateral upper extremity strength and localized left shoulder tenderness with pain elicited by all ROM.  The 7 February 2008 MEB NARSUM evaluation, 5 months before separation, noted complaints of decreased left shoulder ROM due to pain, but no shoulder dislocations.  Physical examination showed no generalized ligamentous laxity or objective instability and normal upper extremity neurological parameters.  Left shoulder flexion was to 90 degrees (normal 180) and abduction to 90 degrees (normal 180).  

At the 19 October 2008 VA Compensation and Pension (C&P) examination, 2 months prior to separation, the CI reported continued left shoulder pain and limited ROM with no shoulder dislocations.  Physical examination revealed forward flexion of 160 degrees and abduction of 170 degrees, with pain at extremes of ROM and local tenderness.  There was no additional limitation upon repetitive motion and no evidence of instability.
 
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 20%, coded 5201 (arm, limitation of motion), citing flexion and abduction of 90 degrees.  The VA rated the left shoulder condition 10%, analogously coded 5203 (clavicle or scapula, impairment of), based on the C&P evaluation, citing objective evidence of painful motion.  The VASRD §4.71a threshold for rating for ROM impairment under code 5201 motion is “at shoulder level” (approximately 90 degrees from the side), and the MEB NARSUM examination demonstrated motion limited to this level.  The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level.”  However, examinations did not reflect this degree of limitation.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available under the 5203 code (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 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 20170417, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005911, 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