RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01108
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20031124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aviation Electronics Technician, medically separated for “glenohumeral instability status post open rotator cuff repair,” with a disability rating of 20%.

CI CONTENTION:  The CI contends his shoulder and hearing 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 - 20030804	VARD - 20041027	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Glenohumeral Instability S/P Open Rotator Cuff Repair [Left]	5299-5003	20%	…Left Shoulder S/P Open Supraspinatus Rotator Cuff Repair	5202	20%	20040316	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Left Shoulder Instability.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left shoulder (non-dominant) instability condition began on 10 June 2000 after traumatic subluxation while carrying a heavy piece of radar equipment.  A diagnostic study (MRI) revealed a possible Bankart lesion and rotator cuff tendinosis.  Open left supraspinatus rotator cuff repair was performed on 12 December 2001.  Despite the operation and physical therapy the CI’s condition could not be adequately rehabilitated to allow for completion of all tasks associated with his rate.  The MEB forwarded “glenohumeral instability, status post rotator cuff repair” for PEB adjudication.
An orthopedics sports medicine examination on 11 February 2003, 10 months prior to separation, noted complaints of shoulder instability with lateral movement.  Physical examination revealed deltoid atrophy and a positive apprehension test (guarding).  Range of motion (ROM) was flexion 0 to 180 degrees and abduction 0 to 90 degrees (both normal 0 to 180); painful motion was not addressed.  Electrodiagnostic studies (NCV/EMG) performed on 6 March 2003, 9 months before separation, noted normal right suprascapular and bilateral axillary nerves and shoulder muscles revealed no electromyelogram abnormalities. The MEB NARSUM examination on 9 April 2003, 8 months prior to separation, noted complaints of left shoulder abduction and external rotation instability.  Physical examination revealed positive apprehension, relocation, and load shift (anterior and inferiorly) tests.  Radiographic imaging (X-ray) were within normal limits.  ROM was full abduction but flexion and painful motion were not addressed.  

The 16 March 2004 VA Compensation and Pension (C&P) shoulder examination, 4 months before separation, noted the CI was constantly worried his left shoulder might subluxate (partial dislocation).  He usually had discomfort in his left anterior deltoid without radiation.  Sensory to pinprick and motor strength examinations were normal in upper extremities.  ROM showed flexion 0 to 120 degrees with abduction 0 to 100 degrees.  The CI stated the limited motion was due to stiffness; painful motion was not addressed.  However, there was no additional loss of ROM, pain, weakness, incoordination or lack of endurance due to repetition.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 20%, analogously coded 5299-5003 (degenerative arthritis), citing continued pain and instability.  The VA also rated the left shoulder condition 20%, coded 5202 (humerus, other impairment) based on the C&P examination 4 months before separation, citing recurrent glenohumeral joint subluxation and limited ROM.  The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level”, or approximately 90 degrees of abduction.  The Board agreed the VA C&P examination most proximate to separation demonstrated an abduction ROM limited at the shoulder level to support a 20% rating using code 5201 but no more.  The Board further agreed the STR and VA evidence revealed the CI had recurrent subluxation (partial dislocation) with infrequent episodes and guarding of movements only at shoulder level to support a 20% rating coded 5202 (humerus, other impairment).  There was no fibrous union or nonunion of the humerus to justify a higher rating under code 5202.  The Board noted that neither of these provides a rating advantage to the CI.  There was likewise no route to a higher rating 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 Board concluded that although it would be more appropriate to code and rate the shoulder condition using either code 5201 or 5202 that neither provided a rating advantage to the CI and so concluded there was insufficient cause to recommend a change in the PEB adjudication for the left shoulder condition.

BOARD FINDINGS:  In the matter of the left shoulder 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 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
       (b) CORB ltr dtd 25 Apr 17

      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:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

						 XXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
						(Manpower & Reserve Affairs)