RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01544
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20061211

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

CI CONTENTION:  “My condition has become worse.”  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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20060808	VARD - 20150923	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5299-5201	20%	Right Shoulder Condition	5201	NSC	20150921	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right shoulder surgery in February 2005 to repair of Superior Labrum Anterior and Posterior (SLAP) lesion.  The CI continued to have right shoulder pain and a second surgery was performed in September 2005 to repair of recurrent SLAP tear.   

The 15 December 2005 MEB NARSUM examination, 12 months prior to separation, noted complaints of intermittent right shoulder pain, weakness, giving way, locking and decreased range of motion. The pain improved with ice and worsened with movement of the shoulder joint.  He was taking no medications for the pain since it did not help.  However, he used electro stimulation.  He did not use any assistive devices but admitted to dislocating his shoulder 2 weeks previously.  Physical examination showed no evidence of instability.  Right shoulder flexion was 145 degrees (normal 180) and abduction was 170 degrees (normal 180), with pain.  There was decreased motor strength 3/5 compared to the left upper extremity at 5/5.  The examiner listed the following limitations:  no lifting with the right shoulder, no throwing, no working overhead, no calisthenics using the right upper extremity and no running or jogging.   

The 23 May 2006 NARSUM ADDENDUM evaluation, 7 months prior to separation, noted complaints of the same symptoms as listed in the December NARSUM exam.  A shoulder dislocation was reported in December 2005.  The CI was taking one over the counter pain medication three times per day, took another pain medication as needed (with some improvement), and continued to use electrical stimulation.  He was unable to perform his job as he was unable to work over his head, change tires and perform other duties involving the right shoulder.  He came to work daily, but others performed his duties.  Although the CI could not perform his duties as an air framer, he was manning the soda mess since November 2005.  He had been on convalescent leave for 5 months of 2006 for the shoulder surgeries.  Physical examination showed no evidence of instability.  Right shoulder flexion was 145 degrees and abduction was 130 degrees with pain.  There was no tenderness reported, but painful motion was present and crepitus was reported through range of motion.  The examiner listed the following limitations:  no lifting with the right shoulder, no throwing, no working overhead, no calisthenics using the right upper extremity, and no running or jogging.  There was no VA Compensation and Pension (C&P) examination in evidence proximate to separation.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the analogous 5299-5201 code (arm, limitation of motion of).  The 23 September 2015 VA Rating Decision showed that the right shoulder condition was not service connected, citing no medical evidence of a current diagnosis.  

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 to this level.  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 mal union 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). 

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 pain condition.  

BOARD FINDINGS:  In the matter of the right shoulder pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20150623, 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

      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

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

		
	
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	     				  Acting