RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03071
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20060331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Aircraft Electrical Technician, medically separated for “failed left shoulder instability” rated at 20%.  

CI CONTENTION:  The CI requests that all conditions be considered.  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 - 20060202	VARD - 20060606	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Failed Left Shoulder Stabilization	5201	20%	Left Shoulder Dislocation Status Post Surgical Repair	5201-5024	10%	20060109	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Failed Left Shoulder Stabilization.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI underwent left shoulder surgery (arthroscopic Bankart repair) in January 2005 to repair a torn labrum (a cartilage disc in the shoulder).  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “other joint derangement….shoulder region” for PEB adjudication.  At the time of the orthopedic clinic appointment on 16 August 2005, 7 months prior to separation, the CI reported an inability to do push-ups, pull-ups, or overhead lifting.  He did “not trust his left shoulder” and felt like it was popping out of place, though shoulder dislocations were denied.  On examination, flexion and abduction were both recorded as 170 degrees (normal 180).  The examiner recorded a significant apprehension (relative to shoulder position), and testing for shoulder instability was positive (+ Jobes, decubitus, and apprehension testing), while a different test for instability (sulcus) was slightly positive (trace) to negative.  A later orthopedic examination on 22 November 2005 (4 months prior to separation) recorded significant shoulder instability (3+ on a scale of 0-3, or full dislocation testing) and apprehension.  Diagnostic imaging indicated a “sizable bony fragment that was displaced medially” by report, and the surgeon recommended revision open shoulder surgery.  There was no evidence in the record that a second shoulder was performed.  

According to the MEB NARSUM evaluation on 6 December 2005, the CI reported continued left shoulder instability.  Shoulder dislocations were not reported.  Physical examination showed “significant” anterior instability (3+) and significant apprehension.  The examiner indicated left shoulder ROM “…otherwise was pretty well preserved.”  Strength was normal.  The examiner also reported the left shoulder caused significant problems with his job and activities of daily living.  

At the 9 January 2006 VA Compensation and Pension (C&P) examination, performed 3 months before separation, the CI reported left shoulder pain rated 2-3/10 that increased to 4-5/10 with cold weather.  He indicated that he heard crepitation (popping or grinding noise) when he moved the shoulder and that the shoulder felt unstable.  Dislocation was not reported.  Physical examination showed no deformity, swelling, or fluid buildup.  There was pain with examination by touch.  Flexion of the left shoulder was 180 degrees with no pain, and abduction 103 degrees limited by pain.  With repetitive testing there was no additional loss of function due to pain, fatigue, weakness, lack of endurance, or incoordination.  Radiographic study (X-ray) indicated irregularity possibly due to surgery and no obvious fracture of the humeral head (the ball at the top of the upper arm that fits in the shoulder socket).  No instability testing was documented.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under an analogous 5201 code (arm, limitation of motion of), citing pain and instability.  The VA assigned a 10% rating using a 5201-5024 code (arm, limitation of motion of - tenosynovitis) for painful and limited motion.  The VA did not rate the left shoulder surgical scars.  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 limited above 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 (or record of post-surgical dislocation thereof) to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available under the 5203 code (clavicle or scapula, impairment of). 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 failed left shoulder stabilization.  

BOARD FINDINGS:  In the matter of the failed left shoulder stabilization 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 20140623, 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 1 Jun 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 USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN

						  	XXXXXXXXXXXXXXXXXXXX
	     				 		Assistant General Counsel
						  	(Manpower & Reserve Affairs)