RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01893
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20051118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Damage Control Man, medically separated for “left shoulder posterior instability,” with a disability rating of 10%.  

CI CONTENTION:  “Review all 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 - 20050920	VARD - N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Posterior Instability	5299-5003	10%	No VA Examination in Evidence	
Capsular Labral Reconstruction with Persistent Pain and Sensation of Instability	Cat II		
Status Post Left Shoulder Arthroscopic			
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Left Shoulder Posterior Instability.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left shoulder surgery (posterior capsular labral reconstruction) in November 2004 for instability following a shoulder dislocation.  Following surgery the maximum benefits of outpatient care was obtained and treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “other joint derangement, not elsewhere classified, shoulder region” for PEB adjudication.  

The 2 August 2005 MEB NARSUM examination, 3 months prior to separation, the examiner noted that the CI was 8 months status-post surgery and continued to have activity-limiting pain in the left shoulder.  The CI could not elevate his shoulder without significant discomfort, had difficulty sleeping, was unable to perform heavy lifting, and was unable to do push-ups.  He was requiring periodic narcotic use at night for pain and was unable to perform the tasks assigned to him given his Navy rate.  The CI had feelings of shoulder instability, but post-surgical dislocations were not reported.  The physical examination showed positive apprehension, positive relocation, and pain with O’Brien’s testing.  The CI’s range of motion (ROM) showed a forward flexion of 160 degrees (normal 180) and an abduction of 110 degrees (normal 180).  These were all decreased compared to the contralateral side and the CI had pain with posterior load shift testing.  

During the August 2005 MEB examination (recorded on DD Forms 2807 and 2808) 3 months prior to separation, the CI reported a painful left shoulder with numbness with certain sleeping positions and recurrent dislocations.  The physical examination showed left shoulder point tenderness and painful ROM with flexion of 85 degrees and abduction of 85 degrees.  There was no VA Compensation and Pension (C&P) examination in evidence.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, analogously coded 5003 (arthritis, degenerative).  The Navy PEB also listed “capsular labral reconstruction with persistent pain and sensation of instability” and “status-post left shoulder arthroscopic” as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable). The impairment from the Category II conditions were properly subsumed under the overall rating for the “left shoulder posterior instability” condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  There was no VA rating in evidence.  

The CI’s principle disability was painful limited motion and instability of the left shoulder.  The record did not indicate the CI’s dominant/major arm, and the left arm was adjudged as major. The Board considered the probative value of the NARSUM and MEB DD From 2808 exams.  The NARSUM examination best supported rating for instability while the MEB DD Form 2808 examination best supported ROM-based rating.  The VASRD §4.71a threshold for rating for ROM shoulder impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the MEB DD Form 2808 exam demonstrated motion limited to this level to warrant the next higher 20% rating under the 5201 code.  The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level.” However, no examinations reflected this degree of limitation.  

There was no malunion with marked deformity of the humerus; however, there was evidence of instability after surgery to justify a 20% rating analogously to the 5202 code (humerus, other impairment of) for infrequent episodes (of instability), and guarding of movement only at shoulder level, and/or a 20% rating available under the analogous 5203 code (clavicle or scapula, impairment of).  Although there is no rating higher than 20% under the 5203 code, the Board considered other routes to a higher rating.  There were however no such pathways using coding options for limitation of motion (5201) or malunion or recurrent dislocation of the humerus (5202).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the left shoulder condition, coded 5299-5202.  

BOARD FINDINGS:  In the matter of the left shoulder posterior instability condition, the Board unanimously recommends a disability rating of 20%, coded 5299-5202 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  
The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Shoulder Posterior Instability	5299-5202	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150709, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 31 Jan 17 ICO XXXXXXXXXXXXXXXXXX      
	(c) PDBR ltr dtd 31 Mar 17 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 30 Jan 17 ICO XXXXXXXXXXXXXXXXXX 
	(e) PDBR ltr dtd 04 Apr 17 ICO XXXXXXXXXXXXXXXXXX 
	(f) PDBR ltr dtd 31 Jan 17 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 30 Jan 17 ICO XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 27 Feb 17 ICO XXXXXXXXXXXXXXXXXX
      	(i) PDBR ltr dtd 17 Jan 17 ICO XXXXXXXXXXXXXXXXXX 

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (i) are approved.  The official records of the following individuals are to be corrected to reflect the stated disposition below:

     a. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     d. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     f. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     g. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     h. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.   
     
3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)