RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03443
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20051216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Hospital Corpsman, medically separated for “chronic right shoulder pain,” with a disability rating of 10%.

CI CONTENTION:  The CI requests the Board consider all conditions.  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 based on 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 - 20051102	VARD - 20060510	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5299-5003	10%	Residuals of Right Shoulder Surgery	5299-5203	10%	20060228	
Postoperative Stiffness	Category II	Scar, Residual of Right Shoulder Surgery	7804	10%		
Obesity	Category IV	No VA Placement		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI initially injured his shoulder and underwent a right shoulder open Bankart repair in January 2000.   Post-operatively he had a sudden jerk on his arm and felt a definite grinding in his right shoulder and pain.  In November 2000 he underwent a revision Bankart repair and removal of a loose suture anchor.  In March 2004 the CI sustained an injury while doing martial arts training.  Magnetic resonance imaging demonstrated labral fraying anteriorly and posteriorly and a questionable Type II SLAP lesion (superior labral tear).  Surgery was performed on 31 January 2005 for persistent instability and pain despite physical therapy and consisted of anterior and posterior Bankart repairs, a SLAP repair, and a rotator interval closure.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “unspecified orthopedic aftercare” and “shoulder instability” for PEB adjudication.

At the time of the physical therapy clinic appointment on 12 September 2005, 3 months prior to separation and 7 months post the CI’s last surgery, the CI reported constant pain aggravated by any resistance, such as lifting a plate of food.  Physical examination showed the shoulder range of motion (ROM) equaled flexion of 125 degrees (180 normal) and abduction of 115 (180 normal) with tenderness to palpation over the biceps tendon, no shoulder swelling and strength 4-/5.  Capsulitis was diagnosed and the CI received a cortisone injection along with continued physical therapy.  According to the MEB NARSUM evaluation on 4 October 2005, 2 months prior to separation and 8 months post surgery, the CI complained of continued shoulder pain and stiffness.  The examiner noted mild tenderness to palpation and near normal gross motor strength.  ROM measurements revealed flexion of 120 degrees (180 normal) and abduction of 130 degrees (180 normal).  

At the 28 February 2006 VA Compensation and Pension (C&P) examination, performed 2 months after separation and 12 months after surgery, the CI reported constant pain, weakness, stiffness, swelling, locking and fatigability.  The pain was rated as a 6/10 (10 being the worst pain) and was elicited by lifting, raising arms or any physical activity.  Physical examination showed guarding with movement and no ankylosis.  The CI flexed his shoulder to 180 degrees (180 normal) and abducted to 90 degrees (180 normal).  ROM was limited by pain.  
 
The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis), citing right shoulder pain secondary to multiple surgical procedures.  The VA also assigned a 10% rating using an analogous 5203 code (impairment of clavicle or scapula) for painful motion.  The VA additionally rated the right shoulder surgical scars, which are not in the Board’s scope of review, at 10% under code 7804 (scar(s), unstable or painful).  Members agreed that the MEB NARSUM examination was more consistent with outpatient notes and more reflective of the anticipated severity based on the clinical pathology.  The Board placed higher probative value on the STR ROM measurements, which did not support a rating under the 5201 code at the time of separation.  

Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment of).   Board members discussed the probative value of the VA examination where abduction was 90 degrees.  However, that post-separation measurement is inconsistent with two proximate pre-separation measurements and there was no evidence of an intercurrent injury, accident, or surgical failure to account for the disparity of that single VA measurement, although the absence or diminution of continued physical therapy might provide a possible explanation, albeit speculative.  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.  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 interfere with wear of military gear and were not painful at the MEB examination.  There was insufficient evidence of duty-limiting impairment from the shoulder scars, thus the Board concluded that the scars could not be recommended for additional disability rating.  

The Navy PEB also listed postoperative stiffness as a related Category II condition that contributed to the primary unfitting condition but was not separately ratable.  The impairment from the postoperative stiffness was properly subsumed under the overall rating for the chronic right shoulder pain condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited) and is not separately unfitting and not ratable.  

Contended PEB Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that obesity, a Category IV condition, did not constitute a physical disability.  IAW DoDI 1332.38, obesity is a condition not constituting a physical disability; therefore, the Board has no basis for recommending it as unfitting.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination the contended condition; and so, no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the chronic right shoulder pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended obesity, a Navy Category IV condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140616, with attachments
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 21 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 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, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN

						 XXXXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
						(Manpower & Reserve Affairs)