RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2016-01016
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20050501

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Telephone/Personal Computer Repairer, medically separated for “multidirectional atraumatic shoulder instability bilaterally” with each shoulder rated 10%, for a combined disability rating of 20%.   

CI CONTENTION:  He believes he received 0% for each of his shoulders but should have been medically retired.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040617	VARD - 20050511	
Condition	Code	Rating	Condition	Code	Rating	Exam	
…Atraumatic Shoulder Instability Bilaterally	5299-5003	10%	L Shoulder…Instability	5299-5202	0%*	20050224	
	5299-5003	10%	R Shoulder…Instability	5299-5202	0%*		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	
* Increased by 20061103 VARD to 10% for each shoulder effective the day after separation 

ANALYSIS SUMMARY:  

Multidirectional Atraumatic Shoulder Instability Bilaterally.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right-hand dominant CI started having bilateral shoulder instability in February 2002 with no specific injury or trauma identified.  

The 3 March 2004 MEB NARSUM examination, 14 months prior to separation, noted complaints of continued bilateral shoulder instability when performing military duties.  Physical examination showed full active range of motion ((ROM); normal is 180 degrees for both flexion and abduction).  Testing for possible shoulder instability was positive (Sulcus sign, apprehension, and relocation) bilaterally.  Testing (O’Brien’s) for possible labral tears and (Speed’s) bicep tendinitis was negative bilaterally.  The examiner rated shoulder muscle strength as 5/5 bilaterally.  During the 11 May 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 12 months prior to separation, the CI reported painful shoulders, chronic subluxation (incomplete dislocation of the joint), and loss of mobility of the shoulder when dislocated.  Physical examination revealed full ROM, with positive testing for instability (apprehension & Sulcus).  Testing for labral tears was again negative via O’Brien’s test.  

At the 24 February 2005 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI complained of loss of shoulder strength and repeated bilateral shoulder subluxation and dislocation, left worse than right.  Physical examination showed normal-looking shoulders bilaterally, with normal strength and “some slight increase of mobility” in both shoulders.  ROM was measured as 0-180 degrees for both flexion and abduction (normal 180), with painful motion noted on the left but not the right shoulder.  Neurologic examination of the upper extremities was normal bilaterally.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral shoulder instability 10% for each shoulder, coded analogously as 5003 (degenerative arthritis).  The VA also rated each shoulder 10%, coded analogously as 5203 code (clavicle or scapula impairment), based on the C&P examination.  

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 examinations in evidence demonstrated motion above this level.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of either humerus to justify a higher rating under the 5202 code (humerus, other impairment), and no higher ratings available under the 5203 code (clavicle or scapula, impairment).  Therefore, there was no higher rating than the assigned PEB ratings of 10% for the right shoulder and 10% for the left shoulder under any applicable codes.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the bilateral shoulder instability.  

BOARD FINDINGS:  In the matter of the shoulder instability bilaterally and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

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: