RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-06117
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080720

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, UH-60 Helicopter Repairer, medically separated for “left (non-dominant) shoulder instability” with a disability rating of 20%.

CI CONTENTION: The left shoulder was rated higher by the VA. The CI also requested review of 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 - 20080423	VARD - 20080902	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left (Non-Dominant) Shoulder Instability	5202	20%	Left Shoulder S/P Surgical Repair	5299-5019	10%	20080620	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Left (Non-Dominant) Shoulder Instability. According to the service treatment record and MEB narrative summary (NARSUM), the right-hand dominant CI underwent left shoulder surgery in May 2006 for instability, but pain and instability continued. A post-surgical left shoulder MRI in July 2007 showed a small glenoid labrum tear, a humeral head cystic change and decreased shoulder joint fluid. The CI was offered, but reasonably declined a second surgery. An orthopedic examination on 10 August 2007, 12 months before separation, documented “abnormal” left shoulder range of motion (ROM). There was painful motion, instability and left shoulder weakness.

The 4 October 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 10 months before separation, showed left shoulder instability and weakness. The ROM study showed flexion of approximately 90 degrees (normal 180) and abduction of less than 90 degrees (normal 180). Painful motion was not addressed. During the 9 October 2007 MEB physical therapy (PT) ROM examination, 9 months prior to separation, left shoulder goniometric measured flexion was 155 degrees and abduction was 170; painful motion and instability were not addressed. At the  3 December 2007 MEB NARSUM examination, 8 months prior to separation, the CI reported chronic left shoulder pain and a history of multiple dislocations and subluxations in multiple directions. Physical examination revealed tenderness over the subacromial bursa with crepitus and palpable and audible subluxation that occurred during ROM testing. This was most noticeable with return from forward flexion at approximately 120 degrees. There was weakness in the left upper extremity due to pain, with scapular winging during ROM testing. Left shoulder flexion was 120 degrees and abduction was 130 degrees with painful motion. During a primary care visit on 21 April 2008, 3 months prior to separation, ROM testing showed crepitus and “full,” but “abnormal” left shoulder ROM without painful motion.

During the 20 June 2008 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported daily left shoulder pain that traveled to the left hand and was aggravated by physical activity. Symptoms included weakness, stiffness, swelling, giving way, lack of endurance, locking, fatigability, subluxation, grinding and numbness. Physical examination showed no left shoulder weakness, tenderness, subluxation or guarding of movement. Repetitive left shoulder flexion was 165 degrees and abduction was 130 degrees, with painful motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left (non-dominant) shoulder condition 20%, coded 5202 (humerus, other impairment), citing infrequent episodes of recurrent dislocation (subluxation). The VA rated the left shoulder condition 10%, analogously coded 5299-5019 (bursitis), based on the C&P examination, citing painful motion. The panel agreed there was no limitation of motion (5201), fibrous union or nonunion of the humerus (5202) or clavicle or scapula impairment (5203) to support a higher rating than the 20% rating adjudicated by the PEB. 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 §4.71a, 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-2017-06117

XXXXXXXXXXXXXXXX 

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.

		PD-2017-06117