RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03174
BRANCH OF SERVICE:  NAVY  	SEPARATION DATE:  20030320

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1, Seaman Recruit medically separated for a right shoulder condition, rated 20%.

CI CONTENTION:  His condition continues to worsen and impact his daily activities.  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 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 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 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 20030211	VA* - (5 Wk. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Right Shoulder Dislocation	5202	20%	Recurrent R Shoulder Dislocation	5202	20%	20030211	
Other x 0 (Not In Scope)	Other x 3	
RATING:  20%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20030402 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  

Right Shoulder Condition.    The service treatment record (STR) corroborates the history in the narrative summary (NARSUM) that the CI had a pre-enlistment history of a right (dominant) shoulder dislocation in 1999 (football), which was managed non-operatively and asymptomatic at service entry.  He suffered a recurrent injury during recruit training in August 2002 (2 months after enlistment, 7 months pre-separation).  This resulted in a dislocation (anterior) which was emergently reduced (post-reduction X-rays with good position and no fracture).  The pain persisted; magnetic resonance imaging (arthrogram) demonstrated a labral tear (the labrum is the attachment for joint capsule); and, arthroscopic repair was recommended.  The CI refused the surgery and it was determined that his shoulder was too unstable to continue recruit training and Naval service.  There were several STR entries documenting normal (or nearly so) measured range-of-motion (ROM), but persistent laxity (2+ anterior translation, sulcus sign, positive apprehension).  There was no STR documentation of any recurrent dislocation, joint impingement, specific functional limitations, or incapacitation; and, no STR entries contrary to any of the above evidence.

The NARSUM was conducted 9 December 2002 (3 months pre-separation) and documented persistent pain and instability prohibiting heavy lifting and “overhead activities.”  The NARSUM physical examination recorded “full” ROM and strength, “marked anterior translation” (abnormally loose movement within the joint), “positive apprehension and load-shift sign” (guarding to prevent stress of an unstable joint), and negative signs of impingement.

A VA Compensation and Pension (C&P) examination was conducted 11 February 2003 (5 weeks pre-separation) and documented persistent pain and instability with “restriction of overhead reaching and lifting.”  The VA physical examination recorded the absence of weakness and noted no positive findings except for “significant laxity.”  The VA measured ROM was forward flexion and abduction of 180 degrees each (normal), noting pain at the extremes.  

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and the VA rated under code 5202 (humerus, other impairment of) which confers rating for instability and recurrent dislocations.  The 20% rating conferred by both is for “infrequent episodes [dislocation], and guarding of movement only at shoulder level.”  The maximum achievable rating is 30% (major) for “frequent episodes and guarding of all arm movements.”  The NARSUM and C&P indicated that limitations were overhead (e.g., shoulder level) and records document only the 1999 and 2002 dislocations from above.  Members thus agreed that the 30% criteria of 5202 were not satisfied by the evidence.  There was no compensable ROM impairment, ankylosis, deformity, fracture complication or other ratable feature which would support a rating higher than 10% under any alternative VASRD §4.71a 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 of 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. 

Exhibit A.  DD Form 294, dated 20140702, 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 5 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:

		- XXXXXXXXXXX, former USN
		- XXXXXXXXXXX, former USN
		- XXXXXXXXXXX, former USN
		- XXXXXXXXXXX, former USN
		- XXXXXXXXXXX, former USN
		- XXXXXXXXXXX, former USN