RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03461
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090920

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

CI CONTENTION:  The VA rated the left shoulder and other conditions.  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 - 20090724	VARD - 20100920	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right (Dominant) Shoulder Limitation of Motion 	5099-5003-5201	20%	Right Shoulder Pain	5299-5202	0%	STR	
Left Shoulder Instability	Not Unfitting	Left Shoulder Pain	5299-5202	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Right (Dominant) Shoulder Limitation of Motion.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI dislocated his right shoulder in February 2006 while doing pull-ups, and subsequently underwent a closed right shoulder relocation.  He finished advance individual training with a temporary profile but continued to experience multiple bilateral shoulder subluxation episodes (partial dislocations).

Bilateral shoulder X-rays on 3 June 2009 showed 1 cm of inferior shoulder displacement with the addition of weights.  A right shoulder MRI on 11 June 2009 showed a tear of the superior labrum, an anterior labrum with cartilaginous Bankart lesion, and inferior glenohumeral ligament thickening.  Surgery was recommended, but CI reasonably declined.

The 16 June 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of bilateral shoulder pain and weakness, right greater than left, aggravated by overhead motion or work.  Physical examination showed no right shoulder tenderness.  Range of motion was “normal,” with crepitus present throughout motion.  Instability tests were positive and shoulder resistance produced subluxation.  Deep tendon reflexes were 2+ bilaterally.  X-rays showed no fracture, dislocation, arthritic changes or soft tissue swelling.  The physical therapy ROM examination on 25 June 2009 showed right shoulder flexion to 100 degrees (normal 180) and abduction to 90 degrees (normal 180); painful motion was present.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 20%, analogously coded 5099-5003-5201 (arthritis, degenerative-arm, limitation of motion), citing limitation of motion.  The VA rated the right shoulder condition 0%, analogously coded 5299-5202 (humerus, other impairment), citing STR documentation of painful, limited motion.  Members agreed there was no evidence of right shoulder limitation of motion (5201), fibrous union or nonunion of the humerus (5202), or clavicle or scapula impairment (5203) to support a rating higher than the 20% rating adjudicated by the PEB.  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 right shoulder condition.

Contended PEB Condition: Left Shoulder Instability.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The left shoulder was permanently profiled, and while the MEB NARSUM documented left shoulder instability as failing retention standards, the MEB proceedings only listed “recurrent shoulder dislocation.”  The commander’s statement did not specially mention a specific condition.  The CI performed 82 pushups during a physical fitness test on 9 May 2009, 1 month prior to the permanent U3 profile.  He also wrote a memo to the PEB President, dated 14 July 2009 and 2 months before separation, which did not implicate his left shoulder condition.  The STR showed the right shoulder was the primary focus of the CI’s medical treatment, and the panel determined there was no performance based evidence from the record that the left shoulder condition significantly interfered with satisfactory duty performance.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the P EB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the right shoulder limitation of motion condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  In the matter of the contended left shoulder instability condition, the panel recommends no change from the PEB determination as not unfitting.  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 20170401, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180010013, 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