RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05935
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20091020

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Military Policeman, medically separated for “limitation of motion of left (non-dominant) shoulder,” with a disability rating of 20%.  

CI CONTENTION:  “Review all conditions.”  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 - 20090710	VARD 20121121	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Limitation of Motion of Left (Non-Dominant) Shoulder	5201	20%	Left Shoulder Humeral Head	5202	20%	20100513	
Posttraumatic Stress Disorder (PTSD)	Not Unfitting	PTSD	9411	NSC	20100513	
Dysthymia	Not Unfitting	Chronic Mental Disability	9434	Treatment Only	20100513	
Attention Deficit Hyperactivity Disorder (ADHD)	Not Unfitting					
Lumbar Back Pain	Not Unfitting	Lumbar Degenerative Disc Disease	5243	10%	20100513	
Chronic Cough	Not Unfitting	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Limitation of Motion of Left (Non-Dominant) Shoulder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left shoulder arthroscopic repair of a SLAP (superior labrum anterior and posterior) lesion and a capsular shift in December 2004.  In July 2006, he underwent a second surgery to repair another capsular tear.  In December 2008, he underwent a third surgery to remove two loose sutures and debride the scar tissue.  The CI stated that his pain level did not reduce after the final surgery as it had in the previous arthroscopic surgeries.  

The 23 March 2009 MEB NARSUM examination, 7 months prior to separation, noted complaints of dull pain (6/10) around the shoulder with a sharp central pain in the glenohumeral joint.  He reported pain twice daily.  Pain increased to 8/10 with shoulder motion or above shoulder height activities.  The CI was unable to lie on his left shoulder because of the pain and reported numbness in the left hand (all fingers) in the morning.  Physical examination showed a normal left shoulder posture, except for a slightly lower resting position when compared to the right.  There was no obvious left upper extremity atrophy when compared to the right shoulder.  There was no tenderness or elicited pain upon palpation of the left shoulder.  There was pain with range of motion (ROM) testing, which became worse at the endpoints.  Flexion was 103 degrees (normal 180) and abduction was 90 degrees (normal 180).  There was normal sensation and reflexes, but the limitation in strength appeared to be associated with pain.  

The X-rays on 22 February 2010, 4 months after separation, showed bone mineralization was normal.  There was some flattening of the posterior superolateral humeral head consistent with the presence of a Hill-Sachs lesion.  The glenoid rim showed mild deficiency along the posteroinferior margin, but otherwise was intact.  The glenohumeral joint was intact and the acromioclavicular joint was unremarkable.  There were no significant subacromial spurs and the soft tissues were grossly unremarkable on a non-contrast computed tomography (CT) exam.  

At the 13 May 2010 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported constant pain (6/10) in the left shoulder.  He stated during “flares” (twice per month), the pain increased to 9/10, with limitation to reaching and lifting with the left arm.  Physical examination showed painful motion during ROM testing with crepitus present.  ROM showed flexion and abduction of 105 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 20%, coded 5201 (arm, limitation of motion of), citing limitation of motion at shoulder level.  The VA also rated the left shoulder condition 20%, coded 5202 (humerus, other impairment of), based on the C&P examination, citing limited motion of the arm above shoulder level.  The VASRD §4.71a threshold for rating for ROM impairment (code 5201) is “at shoulder level” (approximately 90 degrees from the side), and the MEB NARSUM examination in evidence demonstrated motion limited to this level.  The highest 30% rating for a non-dominant arm requires motion limited to “25 degrees from side,” but examinations did not reflect this degree of limitation.  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 shoulder condition.  

Contended PEB Condition:  PTSD.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Although the contended PTSD was profiled and judged to fail retention standards, the commander’s statement indicated that the CI “was a good Soldier and interacted well with others and had no issues with him other than shoulder limitations.”  The commander also stated that the CI had no difficulties completing tasks to standard, no difficulties with performance and had effective relationships with both supervisors and co-workers.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  

Contended PEB Conditions:  Dysthymia, ADHD, Chronic Cough and Lumbar Back Pain.  None of these conditions were profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  The panel also notes that, IAW DoDI 1332.38, ADHD is not a compensable condition because it does not constitute a physical disability.  Therefore, the panel has no basis for recommending it as unfitting.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended conditions and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left shoulder condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended PTSD, dysthymia, ADHD, chronic cough and lumbar back condition, the panel recommends no change from the PEB determinations as not unfitting.  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.  

AR20180008260, 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.