RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02407
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20060711

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Electronic Technician) medically separated for a left shoulder condition.  The left shoulder condition could not be adequately rehabilitated to meet the physical requirements of his Rating.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  “Other joint derangement, not elsewhere classified, shoulder region” and “stiffness of joint, not elsewhere classified, shoulder region” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “status post left shoulder anterior-inferior recurrent instability” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  Post-operative loss of motion was determined to be a Category II (contributing to unfit).  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI requests the Board consider all conditions.  His 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 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 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 20060407	VA* - (~3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
S/P Left Shoulder Anterior/Inferior Recurrent Instability	5299-5003	10%	S/P Arthroscopy of the Left Shoulder and Shoulder Blade Condition	5201	10%	20061004	
Post Op Loss of Motion	Cat II					
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 5 	
RATING:  10%	COMBINED RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20070212 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  The Navy PEB listed the “post-operative loss of motion” condition as a related diagnosis (Category II--contributing to the disability).  The Board concluded the Category II diagnoses was not a separate condition which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding).  

Left Shoulder with Post-Operative Loss of Motion and Instability.  The service treatment record (STR) and narrative summary (NARSUM) documented a traumatic dislocation of the non-dominant left shoulder in 2004.  In February 2005 (17 months before separation), shoulder reconstruction (anterior-inferior capsulolabral reconstruction and closure of the rotator cuff) was performed.  At a visit in October 2005 (9 months before separation), the CI reported the ability to perform his activities of daily living; however, he had discomfort with sleeping on the left shoulder and pain and stiffness after bench pressing in physical therapy.  The examiner documented tenderness in the left anterior shoulder, flexion and abduction of 160 degrees each (normal 180) with normal (5/5) strength in all planes.  At a visit in December 2005 (7 months before separation), the examiner documented initial abduction of 90 degrees, but increased to 170 degrees with a “hitch” maneuver (abnormal maneuver).  There was also mild discomfort with external rotation.  At an orthopedic clinic visit in January 2006 (6 months before separation), the CI reported shoulder stiffness.  The examiner documented flexion and abduction to 180 degrees each, and findings of shoulder instability (positive sulcus sign consistent with glenohumeral instability).  There was no other STR documentation of significant instability, guarding, loose movement or ankylosis.  

The MEB NARSUM exam was performed on 2 March 2006 (4 months before separation).  The CI reported decreased range-of-motion, tightness and the inability to lift anything greater than 5-10 pounds above his head as a result of slight laxity when lifting heavy objects.  The examiner documented flexion and abduction to 140 degrees each (normal 180) with slightly decreased strength (4-5/5) in all planes.  The examiner diagnosed “residual anterior tightness with inferior laxity” status-post surgery.  On the MEB DD Form 2697, Report of Medical Assessment, dated 13 March 2006, the CI reported “limited use of the left arm.”  On the MEB DD Form 2807-1, Report of Medical History, dated 13 March 2006, the CI reported impaired use of his arm and that he was “denied a job” due to decreased motion/strength in the left arm.  On the MEB DD Form 2808, Report of Medical Examination, dated 13 March 2006, the examiner documented no specific examination of the left shoulder and diagnosed left shoulder instability status-post surgery.  

At the VA Compensation and Pension (C&P) exam performed on 4 October 2006 (3 months after separation), the CI reported that lifting over 10 pounds was difficult, and that pain occurred three times per day (5/10 scale), without causing incapacitation.  The examiner documented flexion and abduction of 180 degrees each.  He further stated that the shoulder was additionally limited by pain and fatigue, after repetition, by 0 (zero) degrees.  Radiographs were normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the left shoulder with post-operative loss of motion and instability as unfitting, rated 10% coded analogously as 5299-5003 (traumatic arthritis).  The VA rated 10%, coded 5201 (arm, limitation of motion).  The Board first considered the evidence for a higher rating.  There was no evidence of ankylosis of the scapulohumeral articulation.  There was no evidence to support consideration of a higher rating under 5203 (impairment of clavicle or scapula) as there was no documentation of recurrent dislocation of the scapulohumeral joint, and no episodes of guarding at the shoulder level or otherwise.  All exams before and after separation documented near normal or normal range-of-motion for forward flexion and abduction (ranging from 140-180 degrees).  The range-of-motion in addition to the intermittent painful motion supported a 10% rating.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the left shoulder condition was appropriately recommended in this case.  

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 left 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 201340505, 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 8 Jan 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 USMC 
- XXXXXXXXXXXXXXX, former USN  
- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC 

				XXXXXXXXXXXXXXX
	     			Assistant General Counsel
				(Manpower & Reserve Affairs)