Citation Nr: 0006428 Decision Date: 03/09/00 Archive Date: 03/17/00 DOCKET NO. 97-27 743 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUE Entitlement to an increased evaluation for recurrent dislocation, left shoulder, with post-operative capsulorrhaphy, currently evaluated as 10 percent disabling. ATTORNEY FOR THE BOARD M.G. Mazzucchelli, Counsel INTRODUCTION The veteran served on active duty from February 1983 to February 1987. This appeal arises from a June 1997 rating decision of the Department of Veterans Affairs (VA), Jackson, Mississippi, regional office (RO). In July 1999, the Board of Veterans' Appeals (Board) remanded the case for additional development. Subsequently, a rating action of December 1999 continued the prior denial. FINDINGS OF FACT 1. The RO has obtained all relevant evidence necessary to an equitable disposition of the veteran's claim. 2. The appellant's service-connected left shoulder disorder is manifested by X-ray evidence of degenerative chagnes and limitation of motion with possible functional loss. CONCLUSIONS OF LAW 1. The schedular criteria for a disability evaluation in excess of 10 percent for recurrent dislocation, left shoulder, with post-operative capsulorrhaphy, based on dislocation, nonunion or malunion of the clavicle or scapula, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, Diagnostic Codes 5200, 5202, 5203 (1999). 2. The criteria for a separate evaluation of 10 percent for recurrent dislocation, left shoulder, with post-operative capsulorrhaphy, based on limitation of motion, have been met. 38 U.S.C.A. §§ 1155, 5107(b)(West 1991); 38 C.F.R. Part 4, Code 5003 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim is well-grounded, within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, he has presented a claim which is plausible. All relevant facts have been properly developed and no further assistance is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a) (West 1991). Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1999). Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1999). The disability ratings evaluate the ability of the body to function as a whole under the ordinary conditions of daily life including employment. As such, the ratings take into account such factors as pain, discomfort, and weakness in the individual rating. 38 C.F.R. §§ 4.10, 4.59 (1999). Evaluations are based on the amount of functional impairment; that is, the lack of usefulness of the rated part or system in self-support of the individual. 38 C.F.R. § 4.10 (1999). In November 1987, the RO granted service connection for recurrent dislocation, left shoulder, with post-operative capsulorrhaphy. A 10 percent evaluation was assigned from February 1987. That evaluation has been continued in subsequent rating actions. The veteran contends that he is entitled to a higher evaluation. The veteran's left shoulder disability has been rated pursuant to Diagnostic Code 5203. Under Diagnostic Code 5203, impairment of the clavicle or scapula manifested by malunion warrants a 10 percent disability evaluation. Where there is nonunion without loose movement, a 10 percent disability evaluation is warranted. Where there is nonunion with loose movement, a 20 percent disability evaluation is warranted. A 20 percent disability evaluation is also warranted for impairment manifested by dislocation of the clavicle or scapula. 38 C.F.R. Part 4, Diagnostic Code 5203 (1999). A left shoulder arthroscopy with Bankart reconstruction, posterior capsulorrhaphy and extensive debridement was performed on April 21, 1997. A follow-up medical report dated April 30, 1997, reported that the veteran was doing very well. He had very little pain and no excessive tightness in the shoulder. He was allowed some circumduction and pendulum and lap slides and lap rotations. On May 21, 1997, the veteran was again evaluated. He was "doing very well, nice and stable." He was directed in easy, gentle, active range of motion. A VA examination was conducted in December 1999. The veteran reported that he was working in a paper mill. His job involved driving an end loader and lifting objects, as well as work in a water treatment plant. The veteran stated that he was back to his pre-surgery work and did not take any medications for his left shoulder condition. He indicated that his shoulder was much improved since prior to the surgery in 1997, but he still had to take intermittent rest periods to stretch and perform range of motion exercises when the shoulder became painful on the job. At extreme ranges of motion, the veteran reported hearing noises like subluxation, but these were not as bad as they had been prior to surgery. The veteran denied any shoulder swelling or weakness. On examination, the veteran was able to don and doff his shirt without discomfort. Examination showed old healed nontender scar on the anterior aspect of the shoulder. Range of left shoulder abduction was noted as 150 degrees, active, and 160 degrees, passive. (For comparison, right shoulder ranges were 170 and 180). Flexion was 150 degrees, active, and 160 degrees passive. (Right was 170 and 180). Extension was to 30 degrees both active and passive, with moderate discomfort during and at 30 degrees of extension. (Right extension was 45 active and 50 passive). Internal rotation was to 40 degrees, and external rotation was to 45 degrees, active and passive. (Right was 80 and 80). The veteran had some difficulty reaching the back of the neck and back pocket with the left upper extremity. Sensory function was intact, and manual muscle strength within the available range of motion was normal. There was no atrophy of the muscles. X- rays indicated mild degenerative changes and post surgical changes. The impression was degenerative joint disease of the left shoulder (as result of shoulder subluxation), and status post Bankart procedure on left shoulder. The examiner noted that there was some limitation of motion, especially when compared to the right shoulder, and some discomfort at the extreme ranges of motion available. It was possible that during acute exacerbations, the veteran may have some limitations of function or limitations in ranges of motion, however this could not be stated with any medical certainty. There was no evidence of incoordination or weakness noted. The record does not document findings which approximate nonunion of the scapula and clavicle with loose movement or dislocation such to provide a basis for an increased disability evaluation under Diagnostic Code 5203. Nor has there been any showing of ankylosis or impairment of the humerus for evaluation under Codes 5200 or 5202. However, the veteran has X-ray evidence of degenerative joint disease of the left shoulder and his left shoulder motion was limited. This limitation of motion was confirmed by satisfactory evidence of painful motion. When the limitation of motion is noncompensable under the appropriate diagnostic code, a rating of 10 percent is for application for each such major joint group affected by limitation of motion. Thus, the veteran is also entitled to a separate 10 percent evaluation under code 5003. See VAOPGPREC 23-97; 38 C.F.R. Part 4, Diagnostic Codes 5003, 5201 (1999). However, the veteran is not entitled to higher ratings under Codes 5201 since arm motion in not limited at shoulder level. 38 C.F.R. Part 4, Diagnostic Codes 5201 (1999). The veteran's complaints of shoulder discomfort and pain on extreme range of motion are contemplated by the current 10 percent evaluation under code 5203 and the separate 10 percent evaluation under code 5003. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.40, 4.45, 4.59 (1999). (CONTINUED ON NEXT PAGE) ORDER An evaluation in excess of 10 percent, for recurrent dislocation, left shoulder, with post-operative capsulorrhaphy, based on dislocation, nonunion or malunion of the clavicle or scapula, is denied. A separate evaluation of 10 percent for recurrent dislocation, left shoulder, with post-operative capsulorrhaphy, based on limitation of motion, is granted. BETTINA S. CALLAWAY Member, Board of Veterans' Appeals