RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-04490 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080527

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Bradley Vehicle Mechanic, medically separated for “bilateral shoulder subluxation” with a disability rating of 20%.

CI CONTENTION:  No specific contention was made.  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 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 – 20090305	VARD - 20080619	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Bilateral Shoulder Subluxation…	
5299-5201	
20%	Shoulder Subluxation With Strain, Left (Non-Dominant)	5201	20%	
20080411	
			Shoulder Subluxation With Strain, Right (Dominant)	5201	20%		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Bilateral Shoulder Subluxation… The PEB listed bilateral shoulder subluxation rated 20%, but assigned a 10% rating for each unfitting shoulder for a combined 20% rating. The evidence for the right and left shoulder conditions is presented together below with attendant individual rating recommendations. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral shoulder condition began in early 2006 with no trauma or injury. The CI initially reported pain with use of the dominant right shoulder. Right shoulder X- rays showed degenerative changes and left shoulder X-rays were normal. Right shoulder MRI in October2007 showed degenerative changes with no evidence of injury of the humeral head due to dislocations. He was evaluated in October 2007 by orthopedics and diagnosed with multidirectional instability and shoulder sprain. Surgery was not recommended and would only be considered after several months of rehabilitation. After discussion with orthopedics, the CI opted for a P3 profile and initiation of an MEB.  The 4 January 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of bilateral shoulder pain at rest and increased pain when lifting objects greater than 35 pounds. Physical examination of the bilateral shoulders revealed  no  gross  abnormality  or  muscle  atrophy.    There  was  mild  tenderness  over  both

acromioclavicular (AC) joints. Hand grip was full (5/5) and symmetric. The shoulders were slightly hypermobile and the CI had pain with impingement tests, bilaterally. Shoulder ROM using a goniometer revealed left shoulder flexion of 158 degrees and abduction of 180 degrees with noted pain. Right shoulder flexion was 162 degrees with pain; abduction was 182 degrees with pain.

The VA Rating Decision summarized the 11 April 2008 VA Compensation and Pension (C&P) examination findings noting the CI reported bilateral shoulder subluxation for the past year. The VA examiner noted there was pain with subluxation during daily activities but no total dislocations. Physical examination revealed identical findings for the left and right shoulder. The examiner noted shoulder ROM was 110 degrees with abduction and forward flexion, with end range pain in all motion. There was no change in ROM or additional limitations with repetitive use and no muscle atrophy or shoulder joint ankylosis noted.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral shoulder conditions 10% each, analogously coded 5299-5201 (arm, limitation of motion). Using the same code, the VA rated the right and left shoulder conditions 20% each, based on the C&P general examination, citing arm motion limited at shoulder level. 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. There was insufficient limitation of motion to support a rating under the 5201 code, however, panel members agreed that a 10% rating for each shoulder was justified with application of VASRD §4.59 (painful motion), coded 5099-5003. Although the orthopedic specialist noted the CI could sublux his left shoulder voluntarily, there was no history or evidence of recurrent shoulder dislocations in the available record to justify a rating under the 5202 code (humerus, other impairment) for recurrent dislocations. There was no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment). Although the panel’s rating recommendations are based on a different code than that of the PEB, there is no ratings benefit to the CI and therefore no change to the PEB’s coding choice is recommended. 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 adjudications for the right and left (bilateral) shoulder conditions.

BOARD FINDINGS: In the matters of the right and left shoulder (bilateral) conditions and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudications. 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:

2	PD-2017-04490

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

AR20200000214, 

Dear XXXXXXXXXXXXXX:
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.