RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01474
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20050715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cryptologic Technician, medically separated for “right shoulder pain” with a disability rating of 20%.  

CI CONTENTION:  “Review all conditions.”  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 - 20050615	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain (Major)	5099-5003	20%	No VA Exam in Evidence	
S/P Arthroscopy and Subacromial Decompression	Category 2		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Shoulder Pain (With S/P Arthroscopy and Subacromial Decompression).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right shoulder condition (major/dominant) began seven years prior to military service when he sustained a right shoulder dislocation.  The CI was right-hand dominant.  In January 2004, while in service, the CI sustained an injury to his right shoulder.  In February 2004, the right shoulder was reinjured.  After the two injuries, the CI complained of pain and instability.  Exam at that time showed “some” right shoulder anterior instability.  X-ray studies on 12 March 2004 showed no evidence of acute boney injury.  Magnetic Resonance Imaging (MRI) showed a possible SLAP tear (injury to the fibrocartilaginous rim attached of the shoulder joint; "superior labral tear from anterior to posterior").  The CI underwent extensive physical therapy without improvement.  On 23 September 2004, the CI underwent an arthroscopy.  Examination under anesthesia showed mild shoulder laxity, but no subluxation.  Arthroscopy showed no apparent Bankart lesions or SLAP lesion, however there was some fraying at the biceps insertion consistent with type I SLAP lesion.  A subacromial decompression and debridement was performed.  Follow-up MRI showed “what looked like” a partial under-surface tear of the rotator cuff.  The CI declined further surgery.  Despite treatment, the right 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 “other joint derangement, not elsewhere classified, shoulder region” for PEB adjudication.  

At the time of the 10 February 2005 orthopedic clinic appointment, examination showed range of motion (ROM) at 180 degrees forward flexion (normal 180 degrees) and abduction at 160 degrees (normal 180 degrees).  

The 31 May 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of pain over the anterior portion of the shoulder and weakness in the shoulder.  The CI reported he was unable to do more than five pushup and could not do any overhead with weights.  There were no complaints of subluxation or instability.  Physical examination showed ROM was flexion 180 degrees (normal 180 degrees), abduction at 160 degrees (normal 180 degrees).  Pain was present at 90 degrees and above in both forward flexion and abduction.  Strength below 90 degrees was 4 out of 5 (slight weakness) with his Neer test (exam for subacromial impingement) and Hawkins test (test for tendon damage) normal.  

The 9 June 2005 MEB NARSUM addendum examination, 1 month prior to separation, the CI’s strength below 90 degrees in both forward flexion and abduction remained at 4 of 5.  The CI had “pain in forward flexion and abduction over 90 degrees;” and the physician also recorded “(the CI) has 80 degrees of abduction and external rotation and 70 degrees of abduction and internal rotation.”  

There was no VA examination or rating determination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 20%, coded 5099-5003 (arthritis, degenerative).  The PEB additionally rated a Category 2 condition, “status post arthroscopy and subacromial depression” as contributing to the unfitting condition.  It is first clarified that the PEB’s Category II diagnosis (status post arthroscopy and subacromial decompression) is intrinsic to the rated condition and a separate rating cannot be supported without pyramiding (VASRD §4.14); thus, it is appropriately subsumed in the same rating.  

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).  Although ideal coding would be 5299-5202 (versus 5099-5003) at 20%, there was no benefit to the CI in recommending a coding change with the same disability rating as adjudicated by the PEB.  

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.   

BOARD FINDINGS:  In the matter of the right shoulder and category 2 conditions and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150616, w/atchs
Exhibit B.  Service Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS

Subj: PHYSICIU. DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDAT IONS 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 :

-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX ., XXX XX 6924, former USN
-	XXXXXXXXXXXXXXXXXX, XXX XX 9590, former USMC
-	
XXXXXXXXXXXXXXXXXX, XXX XX 3497, former USN