RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00150
BRANCH OF SERVICE:  navy	SEPARATION DATE:  20030909

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Electrician’s Mate, medically separated for “[right] glenohumeral instability with impingement” with a disability rating of 20%.

CI CONTENTION:  Concurrent condition supports a higher 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 - 20030808	VARD - 20041129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
[Right] Glenohumeral Instability with Impingement	5299-5003	20%	Degenerative Arthritis, Right Shoulder…	5010-5201	20% 	20040915 	
[Right] Rotator Cuff and Biceps Tendinopathy	Cat II 					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

[Right] Glenohumeral Instability with Impingement.  The panel notes that the CI also had the related diagnosis of [right] rotator cuff and biceps tendinopathy which was adjudicated as a category II condition (a condition that contributed to the unfitting condition).  This condition was integral to the unfitting right shoulder condition listed above and IAW VASRD §4.14 (avoidance of pyramiding) is not eligible for an additional disability rating.

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI initially underwent right shoulder surgery in December 2000 for superior labral (cartilage rim) anterior and posterior (SLAP) tear reconstruction.  He reinjured his right shoulder while performing strengthening exercises in April 2001 and underwent an anterior capsular shift procedure to stabilize his right shoulder on 2 July 2001.  Following this second surgery further treatment did not result in improvement sufficient to allow unrestricted duty.

The 16 April 2003 MEB NARSUM examination, 5 months prior to separation, revealed that the CI had “full range of motion (ROM)” with abduction of 160 degrees (180 normal), internal rotation 65 degrees, and external rotation 95 degrees.  The CI was also noted to have mild scapular winging (scapula protrudes out rather than lying flat) that caused pain with stressing of the supraspinatus.  There was a positive apprehension test (indicative of instability), but there were no reports of shoulder dislocation.  Tests for impingement signs (equivalent to painful motion) were positive.

During the 2 June 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported limited use of the right arm with pain in the right shoulder, going down the biceps muscle with numbness in right arm and tingling in fingers.  Physical examination noted decreased ROM and strength in the right shoulder without quantification, with a positive cross arm test (suggestive of acromioclavicular joint arthritis, equivalent to painful motion).  The examiner did not include ROM measurements in the examination findings.

At the 15 September 2004 VA Compensation and Pension (C&P) examination, performed 12 months after separation, the CI reported pain and limited ROM in the right shoulder.  The examiner recorded that the CI could “not lift anything with right hand [or] do any work… above the head.”  Physical examination showed flexion to 105 degrees (180 normal) and abduction to 100 degrees (normal 180) with painful motion.  ROM was not additionally limited by fatigue, weakness, lack of endurance or incoordination.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the [right] glenohumeral condition 20%, analogously coded 5299-5003 (degenerative arthritis).  The VA also rated the [right] shoulder condition 20%, analogously coded 5010-5201 (arthritis, due to trauma-arm, limitation of motion), based on the C&P evaluation 12 months after separation, citing limitation of arm motion at shoulder level.

The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the VA examination in evidence demonstrated motion limited to this level.  The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level.”  However, the MEB NARSUM and VA examinations did not reflect this degree of limitation.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available 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 Board 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] glenohumeral instability with impingement 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 20160324, 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:

		- 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

		
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	     				  Acting