RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02337
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20090629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Machinist's Mate, medically separated for “superior labral tear, right shoulder, status post SLAP repair [‘superior labrum anterior and posterior’ which is the ring of cartilage that surrounds the socket of the shoulder joint],” with a disability rating of 10%.  

CI CONTENTION:  The CI asserts that his condition has continued to worsen and impacts his everyday life.  Additionally, he contends the 10% rating from the Service did not and does not reflect the severity of his condition.  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 - 20090115	VARD - 20090827	
Condition	Code	Rating	Condition	Code	Rating	Exam	
SLAP Repair, Right Shoulder	5099-5003	10%	SLAP Repair, Right Shoulder	5299-5203	10%	20090514	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Right Shoulder Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI experienced an atraumatic onset of right (dominant) shoulder pain in 2005, and underwent an arthroscopic SLAP repair in May 2007 (2 years prior to separation).  There were post-operative STR entries noting significant limitation of range of motion (ROM) which responded favorably to physical therapy over time.  The last ROM measurements preceding the NARSUM are charted below, along with all ROM measurements in evidence for the 12 months preceding separation.  There was some STR evidence of joint impingement which improved over time, but no evidence of instability or other significant functional impairment.  Post-operative imaging (MRI) demonstrated expected surgical changes with no evidence of rotator cuff or other internal pathology.  Shoulder pain and disability persisted, however, and further treatment did not result in improvement sufficient to allow unrestricted duty.  The Medical Evaluation Board (MEB) forwarded “pain in joint involving shoulder region” to the Physical Evaluation Board (PEB). 

The MEB NARSUM evaluation on 29 July 2008, preformed 11 months prior to separation, noted “pain at rest ... click, popping” which interfered with overhead activities and prohibited push-ups or pull-ups.  The physical examination recorded tenderness and painful motion without instability.  The ROM measurements are charted below.  The MEB’s later DD Form 2808 physical examination provided additional ROM measurements as charted below.

At the VA Compensation and Pension (C&P) examination on 14 May 2009, performed 2 months before separation, the CI reported constant pain rated 10/10 “elicited by physical activity.”  The physical examination recorded the absence of tenderness, locking, or instability.  The ROM measurements are charted below, and specified painful motion but no change with repetition.   

The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation are summarized in the chart below. 
Right Shoulder ROM
(Degrees)	Ortho ~12 Mos.
Pre-Sep	NARSUM ~11 Mos. Pre-Sep	DD 2808 ~9 Mos. Pre-Sep	VA ~2 Mos.
Pre-Sep	
Flexion (180 Normal)	175	175	100	175	
Abduction (180)	165	165	130	165	
§4.71a Rating*	10%	10%	10%	10%	
             * Conceding painful motion.
The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under analogous code 5300 (arthritis, degenerative), and listed “right shoulder pain” as a related Category II condition (contributing to the primary unfitting condition but not separately ratable).  Members agreed that the latter was intrinsic to the rated condition and not eligible for a separate rating in compliance with VASRD §4.14 (avoidance of pyramiding).  The VA’s 10% rating was analogous to 5303 (clavicle or scapula, impairment of), and cited painful motion.  There was no ROM limitation which would achieve a rating higher than 10%; and, there was no ankylosis, fracture (nonunion/malunion) or subluxation/instability that would support a higher rating under any other joint code.  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:  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. 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 20140519, 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 31 May 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)