RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2017-04123
BRANCH OF SERVICE:  army	SEPARATION DATE:  20090127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “arm limitation of motion between the side and shoulder level due to gunshot injury to the left (non-dominant) shoulder” with a disability rating of 20%.

CI CONTENTION:  Review of all conditions requested.  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 - 20081209	VARD - 20090506	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Limitation … 	5201	20%	Left Shoulder (Minor) Gunshot Wound	5303	30%	20090318	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:

Left Shoulder Limitation of Motion.  According to the service treatment record and MEB narrative summary (NARSUM), the CI sustained a left shoulder gunshot wound while deployed to Iraq in May 2007.  The CI underwent multiple surgeries to include primary washout procedures, wound debridements, and wound vacuum-assisted closures.  The initial surgical intervention noted that the CI’s injuries were limited to the soft tissues of the outer aspect of his left arm with metallic fragments in the deltoid muscle.  Eventually, the CI underwent primary surgical closure of the wound by means of adjacent skin flaps on 5 July 2007 which was 20 months prior to separation.
The 7 October 2008 MEB NARSUM, 4 months prior to separation, noted complaints of painful left shoulder flare-ups occurring two to three times per week with exacerbations due to extreme range of motion  and lifting.  Physical examination (PE) revealed global tenderness about the left shoulder.  Left shoulder flexion was 90 degrees (normal 180) and abduction to 30 degrees (normal 180).  Painful motion was present.  Distal [arm] sensation was intact. 

At the 18 March 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported left shoulder pain with weekly flare-ups precipitated by activity. The PE revealed left shoulder flexion and abduction to 90 degrees with painful motion. The peripheral neuro-sensory examination was normal.  There was no sign of peripheral motor strength loss. 

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 limitation of flexion and abduction.  The VA rated the left shoulder condition 30%, coded 5303 (Group III, muscle disability), based on the C&P examination, citing severe muscle disability for a non-dominant arm.  The panel agreed the highest 30% rating for a non-dominant arm requires motion limited to “25 degrees from side,” and the MEB NARSUM and VA ROM examinations did not reflect this degree of limitation.  There was no fibrous union or nonunion of the humerus to justify a higher rating under the 5202 code (humerus, other impairment), and no higher ratings available under the 5203 code (clavicle or scapula, impairment). 

Panel members additionally considered alternate VASRD muscle codes whereby four categories of disability exist:  slight, moderate, moderately severe, and severe.  This case did not reveal evidence of either ‘prolonged infection’ or ‘the sloughing of soft parts’ to support a level of “moderate severe” muscle disability.  However, this case did support a muscle disability greater than “slight” due to its debridement surgery.  Therefore, in the presence of ‘cardinal symptoms’ (loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement), the greatest support under a muscle code would be that of a “moderate” disability.  The appropriate muscle group in this case is Group III, which affects the elevation and abduction of the arm to shoulder level.  The sole rating (either arm) under Group III moderate impairment is 20%.  This rating scheme, being the same as the PEB’s rating provides no additional benefit to the CI.  Therefore, 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 left shoulder condition and IAW VASRD §§4.71a and 4.73, 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:

	PD-2017-04123

AR20190011674, XXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXX

	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.

	PD-2017-04123