RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	     CASE:  PD-2014-02030
BRANCH OF SERVICE:  NAVY                                                                   SEPARATION DATE:  20080611

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Master-At-Arms, medically separated for “left shoulder pain and stiffness,” with a disability rating of 20%.

CI CONTENTION:  The CI requests the board consider all conditions.  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 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 PEB - 20080507	VARD - 20090518	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain and Stiffness	5299-5201	20%	Left Shoulder	5201	10%	STR	
Splenomegaly	Not Unfitting/Cat III	Splenomegaly	7799-7707	0%		
Dislocating Rib		Residuals, Fracture Ribs	5299-5297	NSC    		
Right Wrist Numbness		Cubital Tunnel, Right	8515	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:  

Left Shoulder Pain and Stiffness.  The CI is right hand dominant.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left shoulder surgery in August 2004 and again in May 2007 for diagnostic evaluation and repair of a cartilage tear respectively.  Following surgery, further rehabilitation treatment did not result in improvement sufficient to allow unrestricted duty and the CI was referred for a MEB.  
According to the MEB NARSUM evaluation on 19 March 2008 (3 months prior to separation), the CI complained of left shoulder pain when used against force.  Her focused physical examination (PE) showed no evidence of shoulder instability, painful motion, or the presence of physical guarding.  The VA Compensation and Pension (C&P) examination was temporally too remote from separation and therefore was not considered probative for deciding an impairment rating.  The goniometric 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.

Left Shoulder ROM
(Degrees)	Ortho ~4 Mos. Pre-Sep
(20080109) 	MEB ~3 Mos. Pre-Sep
(20080319) 	
Flexion (180 Normal)	160	130	
Abduction (180)	90	110	
§4.71a Rating	20%	0%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under an analogous code 5201 (Arm, limited motion), citing no specific reasoning whereas the VA assigned a 10% rating using the same primary code and citing X-ray findings.  The VASRD §4.71a code of 5201 threshold for rating ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated terminal motion at this level.  The highest 30% rating for a non-dominant arm requires motion limited to “25 degrees from side,” but examinations did not reflect this degree of limitation.  There was no fibrous union or nonunion of the humerus to justify a higher rating under code 5202 (Humerus, other impairment), and no higher ratings available under code 5203 (Impairment of clavicle or scapula).  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 non-dominant left shoulder condition. 

 Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the dislocating rib, right wrist numbness and splenomegaly conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  None of these conditions were permanently profiled or specifically implicated in the commander’s non-medical assessment.  All conditions were reviewed and considered by the Board.  There was no performance based evidence from the service treatment record that any of these conditions significantly interfered with satisfactory duty performance.  

BOARD FINDINGS:  In the matter of the shoulder condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended dislocating rib, right wrist numbness and splenomegaly conditions, the Board unanimously recommends no change from the PEB’s determination as Category III and therefore, not separately unfitting.  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 20140509, with attachments
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 18 Apr 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 USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN