RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03050
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20080915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Scout Sniper, medically separated for “decreased range of motion of the shoulder status post a posterior dislocation and subsequent operation” with a disability rating of 20%.

CI CONTENTION:  The CI contended he is “still unable to use right arm at full capability.”  His 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 - 20080624	VARD - 20081106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Decreased Range of Motion Right Shoulder Status Post a Posterior Dislocation and Subsequent Operation 	5201	20%	Right Shoulder Osteoarthritis, Status Post Labral Repair	5010-5201	20%	20080812	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

Right Shoulder.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI underwent right shoulder surgery in March 2007 to repair posterior shoulder stability.  At the time of the surgery full thickness cartilage loss of the posterior shoulder was noted as well as a tear of the superior joint cartilage (labrum).  Following surgery the CI underwent physical therapy, but did not regain his previous range of motion (ROM), and did not improve sufficiently to allow unrestricted duty.  The MEB forwarded “recurrent dislocation of joint of shoulder region” for PEB adjudication.  At the MEB NARSUM evaluation on 24 January 2008, 8 months prior to separation, the CI reported decreased shoulder ROM.  The physical examination showed a normal appearing right shoulder.  The shoulder ROM was flexion of 165 degrees and abduction of 165 degrees (normal 180 degrees).  The right upper extremity strength was initially noted to be 5/5, but the CI rebutted the examination findings of normal strength and on repeat examination was found to have 4/5 strength with flexion and abduction of the shoulder.

At the 12 August 2008 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported constant right shoulder pain, aggravated by activity, with decreased ROM and weakness.  He reported having difficulty showering, climbing stairs, gardening, and driving a car due to the shoulder condition.  The examiner noted the CI was right hand dominant.  The physical examination of the right shoulder revealed well healed surgical scars that were not tender and did not cause limitation of motion.  There was TTP of the shoulder and guarding of movement.  The right shoulder ROM was flexion of 140 degrees (normal 180 degrees) and abduction of 130 degrees (normal 180 degrees).  Pain with motion was noted and there was pain, fatigue, weakness, lack of endurance and incoordination following repetitive use, with pain having the major functional impact, and there was no additional loss of ROM with repetition.  Right upper extremity strength was graded 4/5 and sensation and reflexes were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 5201 code (Arm, limitation of motion), citing limitation of motion.  The VA also assigned a 20% rating using an analogous 5201 code (Arm, limitation of motion) for pain, lack of endurance and dislocation, as well as weakness, tenderness to palpation, guarding of movement and limited motion.  The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level.  However, Board members agreed that a 20% rating was justified for functional loss (based on §4.40 and §4.45) as adjudicated by the PEB.  The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level” and, as noted, examinations did not reflect this degree of limitation.  There was no malunion with marked deformity of the humerus or frequent episodes of recurrent dislocation for higher rating for humerus impairment (5202) and no higher ratings available under the 5203 code (clavicle or scapula, impairment of).  The Board does not recommend disability rating for scars unless their presence imposes a direct functional limitation that renders the CI unfit.  The shoulder scars did not cause limitation of motion, interfere with military gear wear and were not tender.  There was insufficient evidence of duty-limiting impairment from the shoulder scars and therefore the Board concluded additional disability rating could not be recommended on this basis.  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 , 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 6 Jul 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 USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXXXX
	     				  	  Assistant General Counsel
						  (Manpower & Reserve Affairs)