RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01093
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20060620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Seaman Recruit, medically separated for “persistent right shoulder pain, status post right shoulder arthroscopy,” with a disability rating of 0%.

CI CONTENTION:  The CI’s condition continues to worsen and negatively affect daily activities.  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 - 20060426	VARD - 20060706	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Persistent Right Shoulder Pain, Status Post Right Shoulder Arthroscopy	5399-5003	0%	Right Shoulder (Major) Dislocation Status Post
Arthroscopy	5299-5203	10%	20060426	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Persistent Right Shoulder Pain, Status Post Right Shoulder Arthroscopy.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right (dominant) shoulder pain began on 9 September 2005 when he dislocated it while doing 8-count body builders (push-ups) during boot camp physical training.  Examination at that time revealed an anterior labral tear with recurrent instability.  The CI underwent surgery on 2 December 2005 for arthroscopic anterior stabilization, repair of a complex SLAP tear and debridement of undersurface rotator cuff tear.  Following surgery further treatment did not result in improvement sufficient to allow for boot camp completion.  The MEB forwarded “pain in joint, shoulder region” for PEB adjudication.  
The MEB examination (recorded on DD Forms 2807 and 2808) dated March 2006, 2 months prior to separation, was unremarkable other than noting the CI’s surgery and hardware.  The MEB NARSUM examination on 27 March 2006, 2 months prior to separation, noted complaints of 2/10 pain.  Physical examination of the right shoulder showed well healed arthroscopic portal incisions with no redness or edema.  Right shoulder range of motion (ROM) testing was recorded as “full and symmetric” with forward flexion and abduction to 180 degrees (normal).  There was no tenderness to palpation or laxity, however deep anterior pain with O'Brien's testing (test for superior labral tear) was noted.  

At the 26 April 2006 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported “throbbing shoulder pain” with “wrong way” or “certain angle” movements.  Physical examination of the right shoulder showed well healed and non-tender arthroscopic scars and mild shoulder tenderness with deep palpation.  ROM was recorded as “flexion and abduction restricted to 120 degrees” (180 normal) due to painful motion.  Lack of endurance upon repetitive use was noted, but there was no indication of increased pain, fatigue, weakness, in coordination, or loss of range of motion. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, analogously coded 5399-5003 (arthritis, degenerative (hypertrophic or osteoarthritis)), citing full ROM.  The VA rated the right shoulder dislocation 10% coded 5203 (clavicle or scapula, impairment of), based on the VA C&P examination 1 month before separation, citing painful motion.  There was no limitation of motion of the shoulder to support a rating under diagnostic code 5200 (scapulohumeral articulation, ankyloses of) or 5201 (arm, limitation of motion of).  There was no malunion, deformity, or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion or malunion of the clavicle or scapula to warrant any rating under the 5203 code (clavicle or scapula, impairment of).  The Board agreed that the VA C&P examination prior to separation did note a finding of painful motion beyond 90 degrees and functional loss to support a minimum compensable rating of 10% using analogous code 5201-5003 IAW VASRD §4.59.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right shoulder pain, coded 5201-5003.  

BOARD FINDINGS:  In the matter of the right shoulder pain, the Board unanimously recommends a disability rating of 10%, analogously coded 5201-5003 IAW VASRD §4.71a and §4.59.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Persistent Right Shoulder Pain, Status Post Right Shoulder Arthroscopy	5201-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150609, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 31 Jan 17 ICO XXXXXXXXXXXXXXXXXX      
	(c) PDBR ltr dtd 31 Mar 17 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 30 Jan 17 ICO XXXXXXXXXXXXXXXXXX 
	(e) PDBR ltr dtd 04 Apr 17 ICO XXXXXXXXXXXXXXXXXX 
	(f) PDBR ltr dtd 31 Jan 17 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 30 Jan 17 ICO XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 27 Feb 17 ICO XXXXXXXXXXXXXXXXXX
      	(i) PDBR ltr dtd 17 Jan 17 ICO XXXXXXXXXXXXXXXXXX 

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (i) are approved.  The official records of the following individuals are to be corrected to reflect the stated disposition below:

     a. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     d. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     f. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     g. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

     h. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.   
     
3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)