RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00881
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20080615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Hazardous Material Control Management Technician, medically separated for “bilateral multi-directional shoulder instability, left surgically treated,” rated at 20%.  The left shoulder and the right shoulder condition was found to exist prior to service (EPTS) without permanent service aggravation and therefore not compensable. 

CI CONTENTION:  He was given a higher rating for his condition by the VA.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 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 Military 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 based upon a 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 PEB - 20070613	VARD - 20081208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Multi-Directional Shoulder Instability, Left 	5099-5003-5201	20%	Left Shoulder Dislocation and Instability Status Post Arthroscopy 	5203-5201	20%	20080331	
			Scars on Left Shoulder Status Post Arthroscopic Surgery	7805	0%	20080331	
Bilateral Multi-Directional Shoulder Instability, Right	EPTS, NO PSA	Right Shoulder Dislocation and Instability	5203-5201	20%	20080331	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Bilateral Multi-Directional Shoulder Instability.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the left hand dominant CI injured his left shoulder in 2003.  The CI underwent left shoulder arthroscopic capsular shift and Bankart repair on 26 October 2006.  A sports medicine note dated 15 February 2007 noted a 2-month history of right shoulder instability and a diagnosis of bilateral shoulder instability.  

Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “other joint derangement, not otherwise classified, shoulder region” for PEB adjudication.

At the MEB NARSUM examination on 12 April 2007, 14 months prior to separation, the CI reported occasional left shoulder subluxation at rest and with forward flexion and abduction activities.  He reported right shoulder subluxation and dislocation.  Physical examination showed left shoulder limitation of motion without subluxation and right shoulder dislocation with relocation.  The neurovascular examination was normal.

At the 31 March 2008 VA Compensation and Pension (C&P) evaluation, performed 3 months before separation, the CI reported bilateral shoulder stiffness, swelling, giving way, locking, constant pain, and recurrent dislocation.  Physical examination showed easy subluxation and reduction of both shoulders during ROM testing.  

The range of motion (ROM) examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Shoulder ROM
(Degrees)	MEB ~14 Mo. Pre-Sep	VA C&P ~3 Mo. Pre-Sep	
	Left	Right	Left	Right	
Flexion (180 Normal)	90	120	90	90	
Abduction (180)	90	110	80	105	
Comments		Painful motion	
§4.71a Rating	20%	10%	20%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 20%, coded analogously to 5202 (humerus, other impairment of) and adjudicated the right shoulder condition as existing prior to service, not permanently service aggravated and not ratable.  The VA rated the each shoulder condition 20% coded 5203-5201 (clavicle impairment of-arm limitation of motion), based on the VA C&P examination 3 months before separation.   
  
The VASRD §4.71a threshold for compensable humerus impairment is infrequent dislocations with guarding at shoulder level as evidenced by examination findings.  The next higher 30% rating for the dominant arm requires frequent episodes of dislocation and guarding with all arm movements; however, examinations did not reflect frequent post-surgical dislocations with pain or guarding with all movement.  There was arm limitation of motion for a rating under the 5201 code (arm limitation of motion); however this would not have resulted in a higher than 20% rating.  Board members agreed that the preponderance of evidence did not support that the right shoulder was permanently service aggravated.  

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 left shoulder condition and no change in the PEB adjudication of the right shoulder as not permanently service aggravated is warranted.  

BOARD FINDINGS:  In the matter of the left shoulder condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the right shoulder condition, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  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 20140220, 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 11 Aug 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:

		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN

						XXXXXXXXXXXXXXXXXXXX
	     				Assistant General Counsel
(Manpower & Reserve Affairs)