RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01022
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20061114

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

CI CONTENTION:  “Right shoulder surgery.”  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 - 20060922	VARD - 20070322	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Persistent Right Shoulder Pain	5099-5003	10%	Right Shoulder Posterior SLAP (Superior Labrum Anterior and Posterior) Injury and SLAP Repair by Arthroscopy	5099-5203	10%	20061025	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Persistent Right Shoulder Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right shoulder surgery in October 2005 for SLAP and posterior labral repair.  At the time of the orthopedic clinic appointment on 11 April 2006, 7 months prior to separation, the CI reported continued shoulder pain that wakes him up at night.  Physical examination showed range of motion (ROM) measurements of a normal forward flexion (180 degrees) and abduction of 175 degrees (180 normal).  There was a positive O’Brien, positive Kim test, and tenderness with push-ups.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “pain in joint involving shoulder region” for PEB adjudication.  

According to the MEB NARSUM evaluation on 17 August 2006 (3 months prior to separation) the CI complained of persistent right shoulder pain that caused functional limitations of unable to perform push-ups, pull-ups or significant lifting.  Shoulder dislocations were not reported.  Physical examination showed ROM measurements of forward flexion to 165 degrees and abduction of 165 degrees.  There was tenderness to palpation over the posterior aspect of the scapula, inferior to the scapula spine at the supraspinatus area.  There was a positive O’Brien, positive Speed test, and no impingement signs.  There was pain with cross arm and resisted external rotation, consistent with infraspinatus tenderness to palpation.  

At the 25 October 2006 VA Compensation and Pension (C&P) examination, performed a month before separation, the CI reported daily shoulder pain that prevents him to do any shoulder level or above shoulder level work because of the right shoulder.  Physical examination revealed ROM measurement of flexion of 150 degrees and abduction 130 degrees.  There was a positive Neer test, positive impingement test, and no change in ROM after repetitive motion.  The CI reported 2 days of incapacitation in the past 12 months.  
 
The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (arthritis, degenerative).  The VA also assigned a 10% rating using an analogous 5203 code (clavicle or scapula, impairment of) citing evidence of limited motion.  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 no 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 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 right shoulder condition.  

BOARD FINDINGS:  In the matter of the persistent right shoulder pain 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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150608, w/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 14 Nov 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:

		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)