BVA9502770 DOCKET NO. 93-07 782 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUE Entitlement to an increased (compensable) evaluation for a recurrent dislocation of the left shoulder. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD John D. Nachmann, Associate Counsel INTRODUCTION The veteran had active military service from May 1968 to January 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of June 1992 by the Department of Veterans Affairs (VA) Roanoke, Virginia, Regional Office (RO). CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the RO was incorrect in not granting his claim of entitlement to a compensable evaluation for a recurrent dislocation of the left shoulder. He maintains that a 20 percent evaluation for this disability is warranted because it has interfered with his lifestyle and employment. Therefore, he requests a favorable determination by the Board. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the veteran's claim of entitlement to a compensable evaluation for a recurrent dislocation of the left shoulder. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The current manifestations of the veteran's recurrent dislocation of the left shoulder consist of complaints of pain without objective evidence of pathology. CONCLUSION OF LAW The criteria for a compensable evaluation for a recurrent dislocation of the left shoulder have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 4.1-4.14, 4.40- 4.46, 4.71a, Diagnostic Code 5202 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran has submitted a well-grounded claim within the meaning of 38 U.S.C.A. § 5107(a). See Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990); Gilbert v. Derwinski, 1 Vet.App. 49, 55 (1990). That is, the Board finds that he has submitted a claim which is plausible. The Board is also satisfied that all relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained and that no further assistance is required to comply with the duty to assist him mandated by 38 U.S.C.A. § 5107(a). The service medical records indicate that the veteran had an antero-inferior dislocation of his left humeral head in June 1969. Private medical records reveal that the veteran fell down a hill and dislocated his left shoulder in November 1971. A reduction of the veteran's left shoulder was performed under anesthesia. These records further show that the veteran dislocated his left shoulder and underwent a reduction under general anesthesia in July 1972. The report of an August 1972 VA examination demonstrates that the veteran's left shoulder was grossly normal. The examiner indicated that no attempt was made to have the veteran elevate his left arm above 90 degrees as the veteran reported that he would redislocate his shoulder. A diagnosis of a recurrent dislocation of the left shoulder was recorded. By decision in September 1972, the RO granted service connection for a recurrent dislocation of the left shoulder with guarded movement and assigned this disorder a 20 percent disability evaluation. A June 1975 letter from the Staley Clinic, Inc., indicates that the veteran experienced a recurrent dislocation of his left humerus in May 1975. The report of an August 1977 VA examination reveals that the veteran had no swelling, bony deformity, tenderness, or limitation of motion of his left shoulder. In addition, the veteran had a strong left-hand grip. X-rays indicated no fracture or dislocation of the shoulder and the acromioclavicular joint appeared to be preserved. A diagnosis of a recurrent dislocation of the left shoulder joint by history was recorded. By decision in September 1977, the evaluation assigned to the veteran's recurrent left shoulder dislocation was reduced from 20 percent to noncompensable. A February 1992 VA orthopedic record indicates that the veteran reported having experienced nine dislocations of his left shoulder, the most recent of which occurred "some years ago." This record further notes that the veteran went to the emergency room for an increase in his disability payments and not for treatment. No further visits were required. During a May 1992 VA examination, the veteran reported that it had been approximately ten years since he last dislocated his left shoulder. Flexion, abduction, internal rotation, and external rotation of the left shoulder were 160, 160, 80, and 80 degrees, respectively. Flexion of the left elbow was 140 degrees and extension was 0 degrees. X-rays of the left shoulder revealed that the joint space and the acromioclavicular joint were intact and that there were no soft tissue calcifications. There was, however, a small spur extending from the inferior lip of the glenoid fossa. The examiner noted that there were no residuals of a dislocation of the veteran's left shoulder as there was an adequate range of motion as well as adequate functioning of the left shoulder. Medical records from Larry G. Lipscomb, M.D., show that while the veteran may have had some mild inferior instability, there was no subluxation forward or posteriorly to any pathologic degree. Resistance to abduction did not cause any pain and the veteran had full elevation of his left arm. Abduction was 90 degrees and external rotation did not create any pain. The veteran had full external rotation and an impingement sign was negative. There was some mild anterior shoulder pain to direct palpation, but Dr. Lipscomb noted that the pain was minimal and not significant. In the supine position, the veteran's shoulder felt stable although some anterior subluxation was noted. Dr. Lipscomb felt that the veteran's subluxation was not pathognomonic. X-rays revealed that the left shoulder was not subluxed and that there were no tumors, degenerative changes, or lesions. An impression of left shoulder pain with probable anterior subluxation rather than a glenoid labrale injury was recorded. By decision in October 1992, the RO confirmed the noncompensable evaluation assigned to the veteran's recurrent dislocation of the left shoulder under the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5202. A compensable evaluation of 20 percent for recurrent dislocations of the humerus at the scapulohumeral joint requires infrequent episodes and guarding of movement only at the shoulder level. Based upon a thorough review of the evidence of record, the Board finds that the current noncompensable evaluation most accurately represents the veteran's disability picture. In this regard, the Board notes that the veteran indicated during the May 1992 VA examination that the most recent dislocation of his left shoulder occurred around 1982. In addition, no residuals of the dislocations were noted during the May 1992 VA examination and an adequate range of motion was noted by the examiner. Likewise, no significant residuals were noted during the examination conducted by Dr. Lipscomb. Lastly, while pain is an important disability factor that must be considered in the rating of a claimant's disabilities, See 38 C.F.R. §§ 4.40, 4.59 (1994); Voyles v. Brown, 5 Vet.App. 451, 453 (1993), the veteran's claims of left shoulder pain are not supported by adequate pathology or evidenced by the visible behavior of the veteran undertaking left shoulder motion. See 38 C.F.R. § 4.40. Therefore, the preponderance of the evidence is against a compensable evaluation. In reaching its decision, the Board has considered the complete history of the disability in question as well as the current clinical manifestations and the effect the disability may have on the earning capacity of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Further, the Board finds in this case that the disability picture is not so exceptional or unusual so as to warrant a compensable evaluation on an extra-schedular basis. It has not been shown that the veteran's recurrent left shoulder dislocation has caused marked interference with employment or necessitated frequent periods of hospitalization so as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). ORDER A compensable evaluation for a recurrent dislocation of the left shoulder is denied. CHARLES E. HOGEBOOM Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.