RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02154
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20021231

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Tracked Vehicle Repairman, medically separated for “right shoulder instability, status post (s/p) reconstructive procedure,” 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 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 - 20021022	VARD - 20030203	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Instability	5299-5003	10%	S/P Right Shoulder Dislocation w/ORIF	5201	20%	20021003	
Right Shoulder Pain	Category II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Shoulder Instability.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right shoulder surgery in June 2001 for repeated dislocations.  During the operation a “significant Hill-Sachs lesion” was discovered.  Surgery improved the instability, but postoperatively he continued to report persistent pain.  The 28 March 2002 MEB NARSUM examination, 9 months prior to separation, noted complaints of persistent pain and a “feeling of instability inferiorly,” but no shoulder dislocation.  Physical examination showed full range of motion (ROM), with pain on rotation.  He had a negative sulcus sign (test for inferior instability of the shoulder/glenohumeral joint).  The examiner stated “there was no significant anterior/posterior laxity with load shift testing and he was intact to light touch in the upper extremity.”  On 1 August 2002, the CI presented to the emergency room with complaints of posterior scapular and cervical pain.  Physical examination demonstrated full right shoulder ROM. There was minimal impingement and a positive Spurling’s test for reproduction of pain.  Radiographic evidence showed the presence of previous surgical anchors used to repair the shoulder defect.  The examiner diagnosed cervical strain and discharged the CI with a referral to physical therapy and prescription pain medications.  At the 3 October 2002 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported continued right shoulder pain.  On examination, following repetitive movement, the right shoulder ROM showed flexion of 155 degrees (normal 180) and abduction of 145 degrees (normal 180).  The examiner noted the ROM was limited by pain and the major functional impact was mild incoordination with pain.  There was no instability.  X-rays of the right shoulder showed no significant degenerative changes or impingement syndrome.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder instability 10%, coded 5299-5003 (analogous to degenerative arthritis) citing painful motion.  The PEB also listed right shoulder pain as a related Category II condition that contributed to the primary unfitting condition but was not separately ratable.  The impairment from the right shoulder pain was properly subsumed under the overall rating for the right shoulder instability, s/p reconstructive procedure IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated “s/p right shoulder dislocation with ORIF with residuals” 20%, coded 5201 (arm, limitation of motion), based on the C&P examination 2 months before separation, citing surgery with residuals of mild incoordination, and painful limited motion.  Although there was insufficient limitation of motion to support a rating under the 5201 code, the Board agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder instability condition.    

BOARD FINDINGS:  In the matter of the right shoulder instability condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends 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 20150701, 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
       (b) CORB ltr dtd 26 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:

		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
						                				(Manpower & Reserve Affairs)