RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-05646
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080328

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated for “left (dominant) shoulder injury” with a disability rating of 10%.

CI CONTENTION: "I would like for my rating to reflect the VASRD that was in effect in 2011. According to that VASRD my rating for the left shoulder status post AC repair (code 5201) should have been 20%. At the time of my MED board, my PTSD was not diagnosed. I am currently in treatment with the VA and would also like to be reviewed." 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 USPDA - 20080402	VARD - 20080506	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left (Dominant) Shoulder Injury	5099-5003	10%	Left Shoulder S/P AC Repair	5203	10%	20070925	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

Left (Dominant) Shoulder Injury. According to the service treatment record and MEB narrative summary (NARSUM), the CI dislocated his left shoulder in April 2006, and in January 2007, he underwent an arthroscopic subacromial decompression with debridement of labral tissue and open rotator cuff repair. He reinjured the shoulder and underwent another arthroscopic surgery in July/August 2007 (Mumford with subacromial decompression and type I superior labrum

anterior and posterior (SLAP) tear debridement with resection of the lateral clavicle). Post- surgery X-rays showed a healing rotator cuff tear as well as arthritic changes of the acromioclavicular (AC) joint and a type 1 SLAP tear, with no overt degenerative changes.

The 25 September 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of left shoulder pain that required narcotic pain medication. Physical examination showed well-healed scars, tenderness over the distal clavicle, and breakaway on strength testing due to pain (although strength was normal). There was pain with cross-arm testing and some impingement with Neer and Hawkins signs (painful motion and impingement). Apprehension and relocation tests were negative. Range of motion (ROM) showed forward flexion to 120 degrees (normal 180) and abduction to 110 degrees (normal 180).

At the VA Compensation and Pension (C&P) examination the same day, the CI reported left shoulder swelling and grinding, with pain rated at 6/10, and aggravated by exercise or walking, but alleviated by medication and ice. Physical examination showed left shoulder flexion of 128 degrees and abduction of 100 degrees. Muscle strength was normal, and there were no additional limitations from pain, fatigue, weakness or lack of endurance following repetitive use.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left shoulder condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing ROMs and chronic pain “rated as slight/constant” with likely application of the US Army Physical Disability Agency pain policy. The VA also rated the left shoulder condition 10%, but coded 5203 (clavicle or scapula, impairment of), based on the C&P examination, citing flexion to 128 degrees with no increased pain during repetition. The VASRD §4.71a threshold for rating for ROM impairment under 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. However, 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 humerus to justify a rating under code 5202 (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under code 5203. 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 §4.7, 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.

PD-2017-05646

ARXXXXXXXXXXX, XXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

	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.

Sincerely,					      

Enclosure

PD-2017-05646