RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02389
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20030406

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Organizational Automotive Mechanic, medically separated for “bilateral voluntary posterior dislocation of shoulders” with a disability rating of 20%.

CI CONTENTION:  The CI contends for both shoulders as he has had no relief despite surgery and physical therapy.  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 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 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 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 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 - 20030221	VARD - 20040315	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Voluntary Dislocation of Shoulders	5299-5003	10%+10%=20%	Right Shoulder Strain

Left Shoulder Strain S/P Capulorrhaphy	5299-5201           0%         20040203

5299-520              0%        20040203	
Status Post Posterior Capsulorrhaphy, Left Shoulder with Poor Results	Cat II			
Moderately Server Retroscapular Bursitis, Bilateral	Cat II			
Hill-Sachs Lesion, Right Humeral Head, Associated with Old Anterior Labral Injury Suggestive of Previous Anterior Shoulder Dislocation	Cat II			
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

Bilateral Voluntary Posterior Dislocation of Shoulders

According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the left-hand dominant CI injured his left shoulder in early 2000.  He reported that his left shoulder pain began after a wrestling match.  In September 2001 he began complaining of pain in his right shoulder as well.  At the time he reported that his right shoulder made a clicking sound with movement and felt as if it might dislocate.  Initial radiographic studies showed a normal right shoulder.  A later MRI (August 2002) showed the right shoulder to have a Hills-Sachs lesion in the humeral head and an abnormal appearance to the labrum comparable with a partial tearing of scar tissue.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left shoulder capsulorhaphy surgery in November 2001.  Following the surgery the CI underwent physical therapy and was placed on limited duty (LIMDU).  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “bilateral posterior dislocation of shoulders,” “moderately severe retroscapular bursitis, bilateral” and “status post posterior capsulorhaphy, left shoulder with poor results” for PEB adjudication.  The range of motion (ROM) evaluations in evidence which the panel weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Bilateral Shoulder ROM
(Degrees)	Ortho~11 Mos. Pre-Sep	NARSUM~5 Mos. Pre-Sep	VA ~10 Mos. Post-Sep	
	Right 	Left	Right	Left	Right	Left	
Flexion (180 Normal)	“Normal range of motion”	No ROM measurements in STR	170	170	
Abduction (180)			170	170	
Comments	--	--	
Slight pain with movement. No tenderness/inflammation/erythema	
§4.71a Rating	0%	0%	0% (VA) 	

At the 24 October 2002 MEB NARSUM evaluation, 5 months prior to separation, the examiner simply reviewed the CI’s right and left shoulder history noting an evaluation done by orthopedics in June 2002 that the CI was still able to voluntarily dislocate both shoulders, further noting that the instability was greater in the right shoulder than the left (operated) shoulder.  An addendum to the NARSUM dated 29 January 2003 (3 months prior to separation) noted that the MRI done in August 2002 had revealed a Hills-Sachs lesion in the humeral head and an abnormal appearance to the labrum.  The addendum added the diagnosis of “Hill-Sachs lesion, right humeral head, associated with old anterior labral injury, strongly suggestive of previous anterior shoulder dislocation.  At the 3 February 2004 VA Compensation and Pension (C&P) examination, performed 10 months after separation, the CI reported that he continued to have pain in both shoulders with the left being 4/10 and the right shoulder 2/10.  He stated both shoulders are a 9/10 when exacerbated, which can happen with any movement at all.  The CI was not taking any medication and was not wearing a sling or other assistive device.  Physical examination showed no erythema, inflammation or tenderness but there was slight pain with movement.  Both shoulders had near normal ROM (see chart above).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20%% rating under an analogous 5299-5003 code (degenerative arthritis).  The PEB wrote 10% + 10% for each shoulder on the PEB form demonstrating that while the PEB bundled the shoulders together the final adjudication was to rate them each 10% (assumable for painful motion).  The VA assigned each right shoulder a 0% rating using an analogous 5299-5201 code (arm, limitation of motion of) stating “a non-compensable evaluation is assigned unless arm motion is limited at shoulder level or evidence shows malunion or nonunion of the clavicle or scapula.”  The panel agreed that the evidence did not show sufficient limitation of motion to support a rating under the 5201 code.  However, panel members agreed that a minimum 10% rating was justified for each shoulder with application of VASRD §4.59 (painful motion).  While there were recurrent infrequent episodes of dislocation of the humerus, the panel majority concluded that there was no evidence of guarding of movement at shoulder level to justify a rating under the 5202 code (humerus, other impairment of) with a rating of 20% for each shoulder.  There was no nonunion with loose movement of the clavicle to warrant a rating 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 majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral voluntary posterior dislocation of shoulders condition.  

BOARD FINDINGS:  In the matter of the bilateral shoulder condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommended re-characterization and did not elect to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150803, 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 USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN

		
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