RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02589
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20060601

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Equipment Operator, medically separated for “continued right shoulder pain status post (S/P) SLAP repair” with a disability rating of 10%.  

CI CONTENTION:  “Member had multiple surgeries and was medically separated from the Navy with on a 10% rating.” 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 - 200604114	VARD - 20071127	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Continued Right Shoulder Pain Repair S/P SLAP Repair	5099-5003	10%	Degenerative Joint Disease (DJD), Right Shoulder 	5201-5010	10%	20071023	

ANALYSIS SUMMARY:  

Continued Right Shoulder Pain Status Post (S/P) SLAP Repair.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right hand dominant CI initially injured his right shoulder in 2000 while on ship duty.  He re-injured his right shoulder twice after that.  On 5 January 2005 the CI underwent arthroscopic labral repair and anterior stabilization (rotator cuff interval closure) surgery.  He continued to have problems with the shoulder and it was felt that he had a second labral tear.  On 26 April 2005 underwent a second arthroscopic stabilization and posterior labral tear repair.  His symptoms continued despite a long course of physical therapy.  His medical care was transferred to Naval Hospital Pensacola, FL.  On 31 October 2005 magnetic resonance imagining study (MRI) of the right shoulder done showed another posterior labral tear.  On 15 November 2005 he underwent a loose body suture removal times two with a repair of the tear.  His symptoms of instability improved but his pain persisted, localized to the posteroinferior aspect of his shoulder.  Five months of physical therapy did not significantly improve his shoulder pain.

According to the 8 March 2006 MEB NARSUM evaluation, 3 months prior to separation, the CI had continued right shoulder pain.  He was unable to perform push-ups, pull-ups or lift significantly heavy objects.  He also had difficulty doing sit-ups and running due to his right shoulder pain.  The examiner noted the CI had a range of motion (ROM) that was “intact with the exception of internal rotation to the approximate T10 level” (normal ~ T7).  Testing for shoulder impingement was negative.  The CI had significant pain with cross arm adduction as well as posterior capsular stretching techniques.  The neurovascular examination was normal.  Radiographs showed no significant abnormalities other than expected post-operative changes.  

At the 23 October 2007 VA Compensation and Pension (C&P) examination, 16 months after separation, the CI reported constant pain 3-8/10 during the day with increased pain at 4-6/10 with certain movements (i.e. reaching across his body).  He reported flare-ups that would occur at night while sleeping.  He stated he could wake up after sleeping on his shoulder with pain at 7-8/10.  There was no reported history of dislocation or inflammatory arthritis.  He denied any problems with activities of daily living or recreational activities.  He was working for the railroad inspecting and repairing cars.  He stated that he could perform his duties but his condition did slow him down.  He reported 3-4 days of lost work in the previous 12 months.  Physical examination noted the CI was right hand dominant and wrote with his right hand.  There were no deformities, swelling, or warmth of the shoulder joint.  There was no tenderness to palpation or crepitus of the shoulder with ROM.  There was no joint laxity or instability.  Right shoulder ROM was 165 degrees forward flexion (180 normal) with pain, 170 degrees abduction (180 normal) with pain.  He had 90 degrees of external and internal rotation respectively (90 normal).  Repetitive ROM testing did not increase the pain or limitation of motion.  There was no weakness, instability, incoordination or fatigue noted.  His strength was 5/5 and there was no scapular winging and no muscle spasms.  Grimacing was noted with forward flexion and abduction movements.  On 6 November 2006 right shoulder MRI showed advanced degenerative changes for the CI’s age.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, coded 5099-5003 (analogous to degenerative arthritis).  The VA also rated the right shoulder condition 10%, coded 5201-5010 (limitation of arm motion-traumatic arthritis) based on the C&P examination 16 months after separation, citing arthritis with limitation of motion.  

The PEB assigned a 10% rating, therefore the panel reviewed to see if a higher rating was supported with any applicable code.  There was no X-ray evidence of arthritis of two or more major joints for the next higher rating under 5003.  There was insufficient limitation of motion to support a rating under the 5201 code.  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 of).  There was therefore no higher rating than 10% available as adjudicated by the PEB.  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 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 20151102, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment 

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:

		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

		
						XXXXXXXXXXXXXXXXXXX
	     				  Acting