RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-05197
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090212

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cargo Specialist, medically separated for “chronic left shoulder pain” and “chronic right shoulder pain,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION: Review requested of the bilateral shoulders and additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20081022	VARD - 20091201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	10%	Right Upper Extremity Shoulder Ligament Instability (Dominant)	5299-5202	20%	20090530	
Chronic Right Shoulder Pain	5099-5003	10%	Left Upper Extremity Shoulder Ligament Instability	5299-5202	20%	20090530	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	
	
ANALYSIS SUMMARY:

Left Shoulder Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s non-dominant left shoulder condition began during deployment in June 2005, while loading and unloading cargo. The left shoulder dislocated, and through November 2005, subluxated weekly with spontaneous relocations.      On 9 May 2006, the CI underwent an open

repair of the left shoulder for instability. At an MEB orthopedic consult on 21 August 2007, the CI reported difficulty doing anything overhead or lifting anything of significant weight due to his shoulder. He was diagnosed with adhesive capsulitis after surgical repair of shoulder instability. The CI was evaluated by a civilian orthopedic surgeon in November 2007 and the physical examination showed flexion to approximately 120 to 130 degrees (normal 180) with minor instability. He underwent arthroscopic surgery on 28 December 2007 with debridement of fibroarthrosis (frozen shoulder) and repair of a torn labrum (SLAP lesion). Following surgery, he regained a significant amount of range of motion (ROM) with PT, but continued to have pain. At the 25 May 2008 orthopedic examination, 9 months prior to separation, physical examination described ROM as “through the impingement range of 90 to 160 degrees with moderate discomfort.” During the 6 June 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, physical examination documented “good” ROM with pain on abduction and forward elevation with ROM greater than 100 degrees of flexion or abduction (normal 180 degrees for both). Strength was intact. The MEB NARSUM examination on the same day noted complaints of chronic daily left shoulder pain, much worse with pushing, pulling, reaching, or lifting greater than 20 pounds. Physical examination showed mild deltoid atrophy. Muscle strength and neurological examination were intact. Left shoulder ROM was decreased and shoulder instability was noted as improved with no further anterior subluxation. At the PT ROM examination 4 days later, left shoulder flexion, after four repetitions, was flexion of 145 degrees and abduction of 130 degrees, with increased pain following repetitions.

The 30 May 2009 VA Compensation and Pension (C&P) orthopedic examination, 4 months after separation, was not in record. However, the original VA Rating Decision (VARD) cited the examination findings. At the VA examination there was guarding of shoulder movements at shoulder level. Shoulder ROM was flexion of 150 degrees and abduction of 160 degrees with no additional loss of motion with repetitive use. Left shoulder X-rays did not show any bony or joint abnormalities.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic left shoulder pain condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing non-compensable limitation of ROM with functional loss due to pain, including pain on repeated use and painful motion, fatigability, incoordination, and weakness with repetitive use and flare-ups. The VA rated the left and right shoulder ligament instability condition 20% each, analogously coded 5299-5202 (humerus, other impairment) based on the C&P examination, citing episodes of dislocation of the left and right scapulohumeral joint with guarding of arm movement at the 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. Although there was insufficient limitation of motion to support a rating under the 5201 code, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion). There was no malunion or recurrent dislocation of the left humerus after surgery as detailed in the NARSUM to justify a rating under the 5202 code; and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment). 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 chronic left shoulder pain.

Right Shoulder Pain. According to the STR and MEB NARSUM, the CI’s dominant right shoulder condition also began during deployment when the right shoulder dislocated in July 2005 and spontaneously reduced, with reoccurrence approximately five times. In February 2007, the CI underwent arthroscopy of the right shoulder for instability repair. Following the surgery the CI had poor ROM and pain. At an MEB orthopedic consult on 21 August 2007, the CI reported difficulty doing anything overhead or lifting anything of significant weight due to his shoulder. He was diagnosed with adhesive capsulitis after surgical repair of shoulder instability. The CI was

evaluated by a civilian orthopedic surgeon on 20 November 2007 and the physical examination showed the right shoulder was stable, with flexion to approximately 120 to 130 degrees. He underwent arthroscopic surgery on 22 February 2008 for debridement of fibroarthrosis (frozen shoulder). Following surgery, strength and motion improved with physical therapy (PT), but he continued to have pain.

At the 25 May 2008 orthopedic examination physical examination described ROM as “through the impingement range of 90 to 160 degrees with moderate discomfort.” The 6 June 2008 MEB physical examination revealed “good” ROM with pain on abduction and forward elevation with ROM greater than 100 degrees. Strength was normal. The same-day MEB NARSUM examination noted complaints of chronic daily right shoulder pain, much worse with pushing, pulling, reaching or lifting greater than 20 lbs. Physical examination showed mild deltoid atrophy. Strength was normal and ROM was decreased. Shoulder instability was noted as improved with no further anterior subluxation. Four days later at the PT ROM examination, right shoulder flexion after four repetitions was 135 degrees and abduction was 145 degrees, with increased pain following active ROM.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic right shoulder pain condition 10%, analogously coded 5099-5003, citing non-compensable limitation of ROM with functional loss due to pain, including pain on repeated use; additionally there was painful motion, fatigability, incoordination, and weakness with repetitive use and flare-ups. The VA rated the right upper extremity shoulder ligament instability condition 20%, analogously coded 5299-5202 based on the C&P examination, citing episodes of dislocation of the right scapulohumeral joint with guarding of arm movement at the shoulder level. The examinations in evidence demonstrated motion above the VASRD §4.71a “at shoulder level” threshold for rating for ROM impairment. Although there was insufficient limitation of motion to support a rating under the 5201 code, panel members agreed that a 10% rating was justified with application of VASRD §4.59. There was no malunion or recurrent dislocation of the right humerus after surgery as detailed in the NARSUM to justify a rating under the 5202 code; and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code. 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 chronic right shoulder pain.

BOARD FINDINGS:         In the matter of the chronic left and right shoulder pain 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.

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.