RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01121
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20050501

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Yard Patrol Craft Crew Member, medically separated for “left shoulder anterior labral tear,” with a disability rating of 20%.

CI CONTENTION:  The CI made no specific contention.  The 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 – 20050311	VA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Anterior Labral Tear 	5099-5003	20%	No VA Claim Filed	
Left Shoulder Impingement …	Cat II		
Left Shoulder Pigmented…Synovitis			
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Left Shoulder Anterior Labral Tear (Subsumes Left Shoulder Impingement and Pigmented Villonodular Synovitis).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left shoulder condition began in July 2003 while performing bench press.  Diagnostic imaging (MRI) revealed a torn labral.   Surgery was performed on 24 May 2004 that also diagnosed pigmented villonodular synovitis. Despite treatment, the left shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “left shoulder synovitis, anterior labral tear and impingement” for PEB adjudication.  An orthopedic examination on 14 June 2004, 11 months prior to separation, noted range of motion (ROM) of flexion 80 degrees (normal 180); painful motion was not addressed.  The physical therapy examination also performed on 17 June 2004, 11 months before separation noted ROM flexion 70 degrees and abduction 45 (normal 180); painful motion was not addressed.  An orthopedic examination on 30 July 2004, 9 months before separation, noted ROM flexion 130 degrees; painful motion was not addressed.  The physical therapy examination on 1 September 2004, 8 months before separation, noted positive Obrien’s testing (rotator cuff impingement) with ROM flexion 140 degrees and abduction 130; painful motion was not addressed.  The MEB NARSUM examination on 25 October 2004, 6 months prior to separation, noted complaints of chronic left shoulder pain.  Physical examination showed 5/5 motor strength in the supraspinatus (shoulder blade region) and external rotation with normal sensation.  Neer sign test (pain with passive flexion of the shoulder) and Hawkins sign tests (pain with internal rotation) were positive.  The ROM was flexion of 160 degrees and abduction to 85 degrees.  There was no VA disability claim proximate to separation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 20%, analogously coded 5099-5003 (degenerative arthritis).  The Navy PEB also listed left shoulder impingement status post subacromial decompression and left shoulder pigmented villonodular synovitis as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The impairment from these conditions were properly subsumed under the overall rating for the left shoulder anterior labral tear condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The Board agreed there was no ROM limitation proximate to separation that achieved a rating higher than 10%; and, there was no ankylosis, fracture (nonunion/malunion) or subluxation/instability that would support a rating higher than the 20% granted by the PEB.  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 left shoulder condition.

BOARD FINDINGS:  In the matter of the left shoulder anterior labral tear condition the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended left shoulder impingement and pigmented villonodular synovitis 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 recommends 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 20150615, w/atchs
Exhibit B.  Service 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