RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX		 CASE:  PD-2014-00371
BRANCH OF SERVICE:  NAVY	 	SEPARATION DATE: 20060731

 SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Advanced Laboratory Technician) medically separated for a right shoulder condition rated at 10%.  

CI CONTENTION:  The CI contends that his rating was too low given his life changing discomfort.  The complete submission is at Exhibit A. 

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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 Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  
   
Service Recon IPEB – Dated 20060417	VA - (3 1/2 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder SLAP Tear	5299-5003	10%	Osteoarthritis Rt Acromioclavicular Joint w/ Impingement Syndrome	5201-5010	10%	20061213	
Bicipital Tendonitis	Category II					
Other MEB/PEB Conditions x 2  (Not in Scope)	Other x 7 	
Rating:  10%	Combined:  50%	
Derived from VA Rating Decision (VARD) dated 20070419 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:  

Right Shoulder SLAP Tear Condition.  According to service treatment records and the MEB narrative summary (NARSUM), the left hand dominant CI injured his right shoulder in February 2000.  Ongoing pain led to a right shoulder arthroscopy with superior labrum (rim of cartilage on the socket side of the joint) anterior and posterior (SLAP) repair surgery in March 2004.  Postoperatively he continued chronic right shoulder pain, bicipital pain and stiffness.  After extensive physical therapy and conservative treatment he underwent a second surgery to release the biceps tendon and debridement of the superior labrum with an arthroscopic biceps tenodesis in April 2005.  A physical therapy examination 8 July 2005, approximately 10 weeks after surgery, recorded active right shoulder flexion to 160 degrees and abduction to 144 degrees with mild weakness of the rotator cuff muscle action.  The CI’s shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for a Medical Evaluation Board (MEB).  The range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Shoulder ROM
(Degrees)	MEB ~ 9 Mo. Pre-Sep	VA C&P ~ 4 Mo. Post-Sep	
Flexion (180 Normal)	130	120	
Abduction (180)	120	90	
Comments	Active motion
Pain with palpation
 4+/5 rotator cuff /deltoid / pectoralis strength	No change after repetition.
Pain w/ abduction; neg drop arm sign & pos Speed test
No arm muscle atrophy	
§4.71a Rating	10%*	10%*	
*Based on painful motion 

According to the MEB NARSUM dated 26 October 2005 the examiner noted the CI had pain with palpation of the bicipital groove on the right as well as 4+/5 rotator cuff strength, deltoid strength and pectoralis strength.  He also experienced pain with rotator cuff and bicep muscle testing.  His shoulder pain caused him to be unable to swim, work overhead or lift more than 10 pounds.  Physical examination showed no evidence of instability.  At the VA C&P exam on 13 December 2006, approximately 4 months after separation, the CI reported popping, crepitus and pain over the anterior aspect of the right shoulder.  He also reported three episodes of incapacitating right shoulder pain that required placing his right in a sling for a 2-3 day period over the previous year.  The examiner recorded negative drop arm sign and positive Speed test and moderate subacromial crepitus with abduction and external rotation.  The CI experienced pain at the glenohumeral joint and the acromioclavicular (A/C) joint with active and passive range of motion.  There was no muscle atrophy (biceps circumference 39 centimeters both arms).  There was no change in limitation of motion after repetition.  X-ray impressions from 13 December 2006 reflected early osteoarthritis A/C joint, right shoulder and radiographic changes consistent with impingement syndrome.  The examiner noted that the CI’s osteoarthritis of the A/C joint with impingement syndrome and loss of range of motion of his right shoulder would make it difficult for him to do any overhead lifting in excess of 10 pounds.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating for the right shoulder under the analogous 5299-5003 code (degenerative arthritis) citing painful motion.  The Navy PEB also listed bicipital tendonitis of the right shoulder as a related Category II condition (a condition that contributes the primary unfitting condition but are not separately ratable).  Impairment from the bicipital tendonitis was subsumed under the overall rating for the right shoulder (§4.14 avoidance of pyramiding;   more than one rating based on the same impairment is prohibited).  The VA assigned a 10% rating using 5201-5010 codes (arm, limitation of motion and traumatic arthritis) citing painful of motion.  The VASRD §4.71a threshold for compensable ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion above this level.  Although the limitation of motion did not support a minimum rating (5201), Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion) and functional loss (§4.40).  The Board noted the post-separation VA C&P examination showed abduction limited to 90 degrees which supported consideration of the next higher rating of 20%.  However the evidence of the MEB examination and examinations leading into the time of referral for the MEB did not more nearly approximate the 20% rating than the 10% rating adjudicated by the PEB and the VA.  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment of).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  In the matter of the right shoulder condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration. 

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140105, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 1 Feb 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN   
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC 

			XXXXXXXXXXXXXXX
	     		Assistant General Counsel
			(Manpower & Reserve Affairs)