RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04796
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060803

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Infantryman, medically separated for “left shoulder injury” with a disability rating of 20%. 

CI CONTENTION:  The condition continues to worsen and negatively affects 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 PEB - 20060628	VARD - 20061114	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Injury	5299-5202	20%	Left Shoulder Glenohumeral Arthrosis	5202	20%	20060801	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left (Non-Dominant) Shoulder Injury.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left shoulder pain began in 1998 after an initial dislocation, and he subsequently had recurrent dislocations which had to be reduced, and numerous subluxations which did not require reduction.  In October 2005, he underwent surgical repair for labral tears, and in February 2006 during physical therapy, he experienced a subluxation.  An MRI showed persistence of the posterior labral tear but healing of the anterior labral tear, as well as chondromalacia and developing arthritis.  

During the 30 March 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported constant left shoulder pain since his surgery.  Physical examination showed decreased “right” (presumed to be left shoulder) shoulder range of motion (ROM) with abduction limited to 90 degrees (normal 180).  The 19 April 2006 MEB NARSUM examination noted complaints of loss of motion, pain, and feelings of instability.  Left shoulder flexion was to 140 degrees (normal 180) and abduction to 110 degrees.  Provocative testing was positive for evidence of glenohumeral joint labral tears and impingement signs (equivalent to painful motion).  There was a positive apprehension relocation test (for instability) and an extensive amount of guarding, but negative anterior and posterior load shift tests (for instability). 

At the 1 August 2006 VA Compensation and Pension (C&P) examination, 2 days before separation, the CI reported constant left shoulder pain since surgery, decreased forward flexion and pain with abduction.  He related that in June 2006 he was trying to open a screen door and felt severe left shoulder pain but no sense of instability at that time.  Physical examination showed tenderness but no swelling, and the CI resisted provocative motions with abduction causing deep and diffuse pain.  Forward flexion was to 125 degrees, with pain, and abduction to 90 degrees, which was stopped due to pain and the sensation that the shoulder would pop out.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 20%, analogously coded 5299-5202 (impairment of the humerus), citing frequent guarding and shoulder subluxation.  The VA also rated the left shoulder condition 20%, coded 5202, based on the C&P examination, citing episodes of dislocation of the scapulohumeral joint with guarding of arm movements at shoulder level.  Members agreed that after surgery, there was documentation of recurrent, but infrequent episodes, of scapulohumeral joint dislocation and guarding of movement at shoulder level to support a 20% rating.  There was no evidence of frequent episodes of recurrent dislocation with guarding of all arm movements to warrant the next higher 30% rating.  Although code 5203 (impairment of clavicle or scapula), was applicable in this case for dislocation/nonunion with loose movement of the clavicle/scapula, the maximum 20% rating under this pathway offered no advantage to the CI.  Other VASRD shoulder codes were considered but all were less applicable and/or not advantageous for rating.  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 injury 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:

[AR NUMBER], 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.

					       

Enclosure