RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX	CASE:  PD-2014-01922
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20150210
SEPARATION DATE:  20051130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Basic Trainee) medically separated for a right (dominant) shoulder condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “right shoulder multi-directional instability,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The Informal PEB adjudicated the right shoulder condition as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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 Military/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:

IPEB – Dated 20050930	VA* - (~2 Mo. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Multi-Directional Instability	5299-5003	10%	Tendinitis/Multidirectional
Instability, Right Shoulder	5201-5024	10%	20050922	
Other x 0 (Not In Scope)	Other x 2	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20080404 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:

Right Shoulder Condition.  The CI developed right shoulder issues early in basic training (history of rotator cuff injury prior to enlistment), and there are early entries in the service treatment record (STR) noting pain with pull-ups, push-ups, and other training requirements.  Initial entries note improvement with conservative measures and full range-of-motion (ROM).  The symptoms persisted with attempts at further training, however, and did not improve with further treatment.  Imaging (magnetic resonance imaging and arthrogram) demonstrated a partial tendon tear (supraspinatus) and inflammation of tendons and the joint capsule (infraspinatus tendinosis, inferior labrum without discrete tear).  Surgery was deferred.  The STR documents complaints of pain, “popping,” and subjective impingement, specifically with overhead activities; but, there is no mention of subjective instability until a late orthopedic entry (9 August 2005, 4 months pre-separation) which states, “The shoulder joint feels unstable and the shoulder feels like it will slip out of joint ... [but] ... does not seem 'out of place'....”  There is no STR evidence of significant ROM impairment, dislocation/subluxation, or objective signs of joint laxity or instability.

An orthopedic narrative summary (NARSUM) was conducted on 2 September 2005 (3 months prior to separation), and documents “pain [rated 5/10] with push-ups, overhead activity, and a sensation of his anterior shoulder popping and subluxing with pull-ups and cross-body stretching. ... He feels that his shoulder flips out of place, however, he is unable to voluntarily make it dislocate.”  The physical exam noted 5/5 strength (except 4/5 external rotation) and measured ROM to 180 degrees forward flexion and 170 degrees abduction (180 degrees normal for both, minimal compensable 90 degrees).  There are detailed exam signs for impingement and instability, which are consistent with some degree of joint laxity (“mild” anterior and posterior drawer signs and a “2+” sulcus sign), but not with objective subluxation (negative apprehension and relocation signs).  The NARSUM provided the PEB diagnosis of multi-directional instability.

A VA Compensation and Pension examination conducted on 22 September 2005 (2 months prior to separation), did not specify the severity or frequency of shoulder pain; but did state, “He currently avoids lifting objects greater than 20 pounds, overhead activity, push-ups and pull ups.”  The VA physical exam provided no findings other than measured ROM (forward flexion and abduction 170 degrees each), commenting on complaints of “weakness and fatigability” with repetitive motion.  The VA diagnosis was “right shoulder supraspinatus tendinitis with evidence of multidirectional instability,” although there was no history or physical finding for instability in the exam itself.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating analogous to 5003 (degenerative arthritis) was compliant with VASRD §4.71a for the criteria of that code.  The VA’s 10% rating under 5024 (tenosynovitis) also defaults to 5003 criteria.  With the lack of any ratable ROM limitation, ankylosis, or bone injury there is no §4.71a route to a rating higher than 10%; other than consideration of an analogous rating under 5299-5202 (humerus, other impairment of).  Members agreed, however, that, although there was some mild joint laxity and subjective instability in evidence, this would not reasonably comport (even analogously) with the criteria for “recurrent dislocation of the scapulohumeral joint” as rated under code 5202.  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 of 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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  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 20140430, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX 
President 
DoD Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION 
Ref:	(a) DoDI 6040.44
(b) CORB ltr dtd 25 Jun 15

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

XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel 
(Manpower & Reserve Affairs)