RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05506
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070816

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Signal Support Systems Specialist, medically separated for “recurrent left shoulder” [subluxation] with a disability rating of 0%.  

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 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 - 20070621	VARD - 20080128	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Left Shoulder…	5099-5003	0%	Left Shoulder Instability…	5202	30%	20071022	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Recurrent Left Shoulder.  According to the service treatment record and MEB narrative summary (NARSUM), the right-hand dominant CI underwent multiple left shoulder surgeries, the last in October 2006, to repair chronic instability.  Despite physical therapy, he was unable to continue serving in his military specialty.  At the 7 May 2007 physical therapy appointment, 7 months after surgery and 3 months prior to separation, the CI complained of left shoulder pain and instability.  The physical examination (PE) revealed painful left shoulder range of motion (ROM) as flexion to 140 degrees (normal 180) and abduction to 143 degrees (normal 180). At the 1 June 2007 MEB NARSUM examination, 3 months prior to separation, the CI endorsed continued dislocations of the left shoulder, with occurrences 2-3 times per month.  The detailed PE noted shoulder flexion and abduction to 170 degrees.  Joint instability tests were mildly positive.  There was no areas of tenderness and upper extremity strength was normal.  

At the 22 October 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported continuous left shoulder pain that limited reaching and stretching with the left arm.  The PE showed an unstable left shoulder with popping and the humerus head gliding over the glenoid with any movements.  There was modest atrophy of the deltoid muscle, and ROM was recorded after repetition as flexion to 90 degrees and abduction to 95 degrees with the examiner noting “discomfort, fatigue, lack of endurance, and dis-coordinated motions.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder at 0%, coded 5099-5003 (degenerative arthritis).  The VA awarded the left shoulder a non-scheduler rating at 30%, coded 5202 (humerus, other impairment), based on the C&P examination, citing 10% for pain on repetition added onto what would normally have been a 20% rating for “…episodes of dislocation of the scapula-humeral joint.”  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 vast majority of examinations in pre-separation evidence demonstrated motion above this level.  However, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  Although some clinical tests revealed a ‘mild’ amount of joint instability, the VASRD criteria of having recurrent dislocations of the shoulder with guarding of all arm movements was not supported for the higher 20% rating.  Therefore, after due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left shoulder condition, analogously coded 5099-5003.    

BOARD FINDINGS:  In the matter of the left shoulder condition, the panel recommends a disability rating of 10% analogously coded under 5003 IAW VASRD §4.71a.    There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Recurrent Left Shoulder Subluxation	5099-5003	10%	

The following documentary evidence was considered:

AR20200004274

Dear XXXXXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.