RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03817
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20050714

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Systems Organizational Initial Maintenance Technician, medically separated for “post bilateral shoulder anterior reconstruction for dislocation disorder” rated 10% for each shoulder, with a combined disability rating of 20%.

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 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 - 20050328	VARD - 20050721	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Bilateral Shoulder Anterior Reconstruction for Dislocating Disorder	5299-5003	10%	Left Shoulder Status Post Bankart Procedure	5201-5203	10%	20050524	
	5299-5003	10%					
Post Bankart Procedure	Category  II					
Post Anterior Capsule Shift Right Shoulder						
Persistent Anterior Area Tendinitis Capsulitis Left Shoulder with Chronic Subluxation		Right Shoulder Status Post-Surgical Inferior Capsular Shift	5201-5203	10%	20050524	
Persistent Recurrent Posterior Dislocation in Right Shoulder with Tendonitis						
Seasonal Allergies	Category III	Sinusitis	6510	10%	20050524	
Obsessive-Compulsive Disorder/Anxiety		Obsessive Compulsive Disorder with Mood Disorder (Also claimed as Depression)	9404	50%	20050524	
Depressive Disorder, Not Otherwise Specified						
Mild Bilateral Ulnar Nerve Dysfunction Manifested by Diminished Sensation Ulnar Aspect Both Hands		Carpal Tunnel Syndrome, Right Wrist	8515	10%	20050521	
		Carpal Tunnel Syndrome, Left Wrist	8515	10%	20050521	
Mild Chronic Triggering Left Ring Finger		Left Ring Finger Status Post Tendon Repair	5230	0%	20050521	
Hypercholesterolemia	Cat IV	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Post Bilateral Shoulder Anterior Reconstruction for Dislocating Disorder.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent a left shoulder Bankart procedure in November 2001 to repair a torn labrum (fibrocartilage attached to the rim of the shoulder socket).  The CI also underwent right shoulder inferior capsular shift surgery in July 2003 for instability.  Following the surgeries further treatment did not result in improvement sufficient to allow unrestricted duty; and, the CI was referred for an MEB.  

The range of motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below. 

Bilateral Shoulder ROM
(Degrees)	PT ~12 Mos. Pre-Sep
	VA C&P ~2 Mos. Pre-Sep
	
	Left	Right	Left	Right	
Flexion (180 Normal)	180	170	180	180	
Abduction (180)	180	180	155	160	
Comment	Minimal pain; no instability	Painful motion	DeLuca positive	DeLuca positive	
§4.71a Rating	PEB 10%	PEB 10%	VA 10%	VA 10%	

At a physical therapy clinic appointment on 30 June 2004, 12 months prior to separation, the CI reported shoulder pain and subluxation.  On examination scapulothoracic motion was abnormal and shoulder pain was elicited at the end of the ROMs.  Left shoulder ROM measurements were normal and right shoulder flexion was 170 degrees (180 normal) and abduction was 180 degrees.  Motor strength was normal; the sulcus sign (to evaluate glenohumeral instability) was observed with subluxation of the left shoulder; and an apprehension (Crank) test was positive.  During the MEB examination (recorded on DD Forms 2807 and 2808) in October 2004, 9 months prior to separation, the CI reported painful shoulders.  Physical examination revealed full ROMs of both shoulders with tenderness and popping of the shoulders bilaterally.  

At the 24 May 2005 VA Compensation and Pension (C&P) examination, performed 2 months before separation, the CI reported left shoulder symptoms for 5½ to 6 years from a torn socket including dislocation, pain, swelling, popping and grinding which occurred constantly.  Right shoulder symptoms included pain, swelling and popping also which also occurred constantly.  However, there were no incapacitating episodes.  Physical examination revealed no heat, redness, swelling, effusion, drainage or tenderness.  The joints were stable and ROM measurements for the right shoulder were flexion of 180 degrees and abduction of 160 degrees; left shoulder ROM measurements were normal flexion and abduction of 155 degrees, limited by pain, with weakness, fatigue, lack of endurance, and incoordination after repetitive use.  On 25 May 2005 X-rays of the right shoulder were normal and X-rays of the left shoulder demonstrated postoperative changes, but no acute disease.  
 
The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating for each shoulder under an analogous 5003 code (arthritis, degenerative).  The Navy PEB listed the “post Bankart procedure left shoulder,” “post anterior capsule shift right shoulder,” “persistent anterior area tendinitis capsulitis left shoulder with chronic subluxation,” and “persistent recurrent posterior dislocation in right shoulder with tendonitis,” conditions as a related diagnoses (Category II) that contributed to the disability of the bilateral shoulders in this case.  The Board agreed that the conditions were the underlying diagnoses causing the “post bilateral shoulder anterior reconstruction for dislocation disorder” and were not separate conditions which could be separately rated IAW §4.14 (avoidance of pyramiding since more than one rating based on the same impairment is prohibited).  The VA also assigned a 10% rating for each shoulder using the 5201-5203 code (arm, limitation of motion-clavicle or scapula, impairment of) for mildly limited motion with pain.  

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.  Although there was insufficient limitation of motion to support a rating under the 5201 code, 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).   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 bilateral shoulder condition.

Contended Conditions:  Seasonal allergies, obsessive compulsive disorder/anxiety, depressive disorder, mild bilateral ulnar nerve dysfunction, mild chronic triggering left ring finger, and the hypercholesterolemia.  None of the conditions were granted limited duty (LIMDU) and no non-medical assessment was available for review.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral shoulder condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended seasonal allergies, obsessive compulsive disorder/anxiety, depressive disorder, mild bilateral ulnar nerve dysfunction, mild chronic triggering left ring finger, and hypercholesterolemia conditions, the Board unanimously recommends no change from the PEB determinations 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 20140820, 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 11 Aug 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
	     				  		Assistant General Counsel
						  	(Manpower & Reserve Affairs)