RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05943
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20071115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Basic Trainee, medically separated for “chronic right shoulder pain and anterior laxity” with a disability rating of 10%.  

CI CONTENTION:  Shoulder should be rated higher.  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 - 20071005	VARD –20090312	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain and Anterior Laxity	5009-5003	10%	Chronic Right Shoulder Pain with Anterior Laxity	5201	 20%	20081125	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain and Anterior Laxity.  According to the service treatment record and MEB narrative summary (NARSUM), the right-hand dominant CI underwent arthroscopic anterior labrum (Bankart) repair and anterior capsular shift in December 2006.  The orthopedic evaluation on 16 July 2007 showed tenderness and decreased active range of motion (ROM) due to pain with abduction to 110 degrees (normal 180).  There was cog-wheeling (guarding with give way attributed to pain) and pain on impingement testing.  Instability testing was positive (grade 2A).  The 27 August 2017 orthopedic examination noted abnormal right shoulder motion (unmeasured) with muscle atrophy of the anterior deltoid fibers and the pectoralis major muscle, and 4-/5 motor strength in right bicep flexion and forearm supination.  At the 14 September 2007 MEB physical therapy (PT) ROM study, 2 months before separation, right shoulder flexion and abduction were painful and limited to 105 degrees (normal 180).  Measurements were taken with an inclinometer.  

During the 18 September 2007 MEB NARSUM examination, the CI reported chronic right shoulder pain and instability.  Physical examination showed guarded limited ROM.  Pain was reproduced with overhead reaching, lifting, shoulder abduction, flexion, and internal and external rotation.  The CI was able to abduct to 110 degrees, but flexion and repetition were not addressed.  There was pain with impingement and instability tests (Hawkins, Kennedy, Neer’s and Speed’s), and there was a grade 2 anterior load shift (laxity).  There was no weakness.  The diagnosis was traumatic subluxation of the right shoulder joint with evidence of multidirectional instability.  

At the 25 November 2008 VA Compensation and Pension (C&P) examination, 12 months after separation, the CI reported constant right shoulder pain with weakness, swelling, heat and give way.  Physical examination revealed right shoulder edema, weakness, tenderness, redness and heat.  There was no subluxation.  ROM was guarded with flexion to 95 degrees and abduction to 90 degrees; painful motion was elicited and there was lack of endurance with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, analogously coded 5009-5003 (arthritis, other types - arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated the right shoulder condition 20%, coded 5201 (shoulder, limitation of motion), based on the C&P examination, citing limitation of motion.  

The panel agreed that the orthopedic, PT and NARSUM examinations had the highest probative value for rating at separation, as the VA examination was 12 months remote from separation.  The VASRD §4.71a threshold for rating for ROM impairment (code 5201) is “at shoulder level.” Code 5202 (humerus, other impairment of) uses guarding of movement “at shoulder level” for rating instability.  “At shoulder level” is approximately 90 degrees, and the panel deliberated if the CI’s disability picture at separation more nearly approximated the 20% rating.  

Given the CI’s right shoulder ROM limitations with guarding, impingement findings, multidirectional instability and functional impairment, the panel majority adjudged that the CI’s disability picture more nearly reflected guarding of motion at shoulder level.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under the 5202 code.  Although an alternative 20% disability rating analogous to the 5203 code (clavicle or scapula, impairment of) was considered for loose movement that would provide no benefit to the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 20% for the right shoulder condition, coded 5299-5202.  

BOARD FINDINGS:  In the matter of the right shoulder condition, the panel majority recommends a disability rating of 20%, coded 5299-5202 IAW VASRD §4.71a.  The single voter for dissent recommends no change and elected not to submit a minority opinion.  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	
Chronic Right Shoulder Pain and Anterior Laxity	5299-5202	20%	
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170919, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008266, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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.

Sincerely,					      
Enclosure