RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00844
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20050814

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Miniature/Microminiature Module Test and Repair Technician, medically separated for a “right shoulder superior labral tear, recurrent status post revision repair,” with a disability rating of 20%.  

CI CONTENTION:  The CI contends his right shoulder condition continues to worsen and negatively impacts his daily activities.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20050506	VARD – Not Dated	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Superior Labral Tear, Recurrent	5201	20%	Right Shoulder Injury Status Post Superior Labrum Anterior and Posterior (SLAP) Repair	5203	10%	20051110	
Neck Pain Secondary to Cervical Impingement	Cat II	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Shoulder (Dominant) Superior Labral Tear, Recurrent.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right shoulder arthroscopic superior labrum anterior and posterior (SLAP) repair in December 2001.  He was able to return to full duty, but in May 2004 the CI returned for care due to increasing right shoulder pain and complaints of clicking and catching.  On 17 November 2004, he underwent an arthroscopic revision of his previous SLAP repair.  At the orthopedic clinic appointment on 18 January 2005, the CI reported decreasing pain, less instability and fewer locking episodes.  On examination range of motion (ROM) was noted to be improving with flexion of 160 degrees (180 normal) and abduction of 150 degrees (180 normal).  Continued physical therapy was recommended.  At the Medical Board LIMDU [limited duty] examination on 18 January 2005, 7 months prior to separation and 2 months post-op, the CI reported continued pain in the right shoulder, which was noted to be expected.  An additional 6 months of limited duty was recommended.  However, it was also noted that the CI had already had over 12 months of LIMDU for this condition and did not desire to remain in the military.  He was then referred for PEB adjudication.  

At the physical therapy (PT) appointment on 7 March 2005, right shoulder ROM was flexion of 150 degrees and abduction of 130 degrees.  At the PT evaluation on 28 April 2005, right shoulder ROM showed flexion of 170 degrees and abduction of 170 degrees.  The CI also complained of neck pain for several weeks which limited his shoulder therapy.  The therapist commented “unable to lift above shoulder.”  X-rays of the neck were normal.  He was thought to have an acute exacerbation of a cervical impingement (not previously found in the records).  

At the VA Compensation and Pension (C&P) evaluation performed on 10 November 2005, 3 months after separation, the CI denied ROM issues, but had pain with lifting objects heavier than 25-30 pounds.  The CI denied flares or incapacitation.  The examination showed slight pain on deep palpation of the AC (acromio-clavicular) joints bilaterally.  Abduction and flexion were both full, but the former was painful.  Repetitive motion caused pain, weakness, fatigue, and lack of endurance or coordination, but without a decrease in ROM.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the dominant right shoulder condition 20%, coded 5201 (arm, limitation of motion).  The JDETS form recorded the CI’s inability to lift above shoulder height as the basis or their rating.  The VA rated the right shoulder condition 10%, coded 5203 (clavicle or scapula, impairment of), based on the VA C&P examination 3 months after separation, citing malunion or nonunion of the clavicle or scapula.  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 PT examination in evidence demonstrated functional loss above shoulder height.  The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level.” However, examinations did not reflect this degree of limitation.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder condition.  

Contended PEB Condition:  Neck Pain Secondary to Cervical Impingement.  The PEB listed the neck pain secondary to cervical impingement condition as a Category II condition, a condition that is related to the primary unfitting condition and contributes to the primary unfitting condition.  The panel’s first charge for this Navy PEB Category II condition is to assess whether it can be reasonably justified as separately unfitting for rating consideration.  The panel’s threshold for such determinations is reasonably unfitting and remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The MEB NARSUM examination on 18 January 2005 did not address a cervical condition.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated March 2005, 5 months prior to separation, there were no complaints regarding neck pain.  The LIMDU did not include a cervical condition.  The MEB did not forward a cervical condition for PEB adjudication.  A treatment note dated 20 April 2005 noted recent upper back pain for 2-3 weeks which prevented him from doing therapy for his shoulder.  The CI was unable to turn his head.  Cervical ROM was listed as left rotation 30 degrees, right rotation 60 degrees, left tilt 20 degrees and right tilt 45 degrees.  Positive Spurling was noted.  No acute injuries were noted on cervical spine X-rays.  The CI did not claim a neck condition with the VA.  Members concluded that a preponderance of evidence indicates that the Category II neck pain condition was not reasonably justified as separately unfitting at separation.  There was no performance based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the neck pain condition as a Category II condition, and therefore no additional rating is recommended.  

BOARD FINDINGS:  In the matter of the right shoulder condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the Category II neck pain condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150604, 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

      In accordance with reference (a), I have reviewed the cases listed below and 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:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

		
							XXXXXXXXXXXXXXXXXXX
	     				Principal Deputy, Assistant 
						Secretary of the Navy
						(Manpower and Reserve Affairs)
						Performing the Duties of the 
						Assistant Secretary of the Navy
						              (Manpower and Reserve Affairs)