RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01759
BRANCH OF SERVICE:  Navy 	SEPARATION DATE: 20030602  

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E3, Seaman, medically separated for “right shoulder pain” with a disability rating of 10%.   

CI CONTENTION:  The CI made no specific contention.  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 – 20030116	VARD - 20040512	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5299-5003	10%	Right Shoulder Strain	5202	0%	20030826	
			Right Arm Neuropathy	5252-8715	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Shoulder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI dislocated his right (dominant) shoulder in March 2001 (over 2 years before separation).  This was reduced in a civilian emergency department, and further details were not in evidence.  There was an orthopedic entry two months later that noted a reported self-reduced dislocation.  There were no STR entries over the balance of the clinical course that documented any recurrent dislocations or subluxations, or that documented any subjective complaints or objective findings for instability.  Imaging (MRI) was normal and surgery was not recommended.

The STR evidence probative to range of motion (ROM) was variable in the early clinical course with measurements of forward flexion and abduction ranging from 90 degrees to 160 degrees (for both planes, normal is 180), but the most temporally probative measurements (2 weeks before the NARSUM) recorded forward flexion and abduction of 130 degrees each.  There were no STR entries that documented any additional VASRD-ratable criteria (excluding painful motion), although there was note of some impingement (not a ratable criterion).  

There was STR documentation of associated pain radiation and intermittent sensory symptoms of the right upper extremity (RUE).  An STR entry attributed this to cervical disc disease demonstrated by MRI, although the NARSUM reported a normal cervical MRI.  There was no service provider who attributed a neuropathy to shoulder pathology, and there was ample STR documentation of normal RUE strength (5/5). 

The 25 September 2002 NARSUM examination, 9 months prior to separation, documented constant shoulder pain without elaborating severity or specific functional limitations.  There was no report of any concurrent complaint of instability or subluxation.  The physical examination recorded “full [ROM] with no deformities … diffusely tender … [and] pain with provocative maneuvers.”  There was no note of instability or impingement, and motor strength and reflexes were normal.  Conversely the MEB’s DD Form 2808, Report of Medical Examination, on 10 October (2 weeks after the NARSUM) recorded abduction to 90 degrees (unclear if measured or estimated).  

The 26 August 2003 VA Compensation and Pension (C&P) evaluation, 3 months after separation, documented constant “shooting pains” without elaborating severity or specific functional limitations, but specified that there had been no work.  There was no reported history (past or present) of dislocation or complaint of instability.  The physical examination made no note of tenderness, deformity, impingement, or instability.  The ROM evidence was not straightforward.  The examiner stated that forward flexion was limited to 90 degrees and abduction to 80 degrees, by the onset of pain and the CI’s resistance to further active motion (would permit passive motion to 120 degrees in each plane).   The examiner specifically opined “this pain that he supposedly experiences … appears to be markedly feigned … looks to see how high he is getting the arm as compared to the one on the left.”  The formally recorded ROM was 120 degrees for each plane.  The VA examiner separately addressed the RUE neurological symptoms and opined that they did not constitute a diagnosable condition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5299-5003 (analogous to degenerative arthritis [correct prefix is 5099]) did not cite a rationale, but was consistent with VASRD §4.71a criteria for the NARSUM evidence (conceding painful motion).  The VA’s 0% rating was under code 5202 (humerus, other impairment) that provides ratings for fracture complications and recurrent dislocation, and cited failure to meet any of the criteria.  

The VA conferred a 10% rating for a right arm neuropathy attributed to the shoulder condition, although the basis for that association was not established.   That notwithstanding, members agreed that there was insufficient evidence to identify a separate related condition within the panel’s scope of review (as above); and, even if that were conceded, there was not a link to fitness to justify service rating (no motor deficit or significant functional impairment).

With regard to the shoulder joint rating, members agreed that there was no evidence at the time of separation for instability that would support any analogously rated criterion of code 5202 (see above).  Members considered if a higher rating could be supported under code 5201 (limitation of motion) for forward flexion or abduction limited to 90 degrees or less.  Members agreed, however, that a recommendation to that effect was not justified.  The NARSUM and the preponderance of the service evidence indicated that there was not ROM limitation to that extent; and, the probative value mitigation documented by the C&P examiner precluded concession of the 90-degree threshold based on the VA evidence.  

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 of the right shoulder condition.  

BOARD FINDINGS:  In the matter of the right shoulder 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 20150529, 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

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

		
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	     				  Acting