RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01545
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20040630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Aviation Structural Mechanic, medically separated for “chronic right shoulder pain” with a disability rating of 10%.  

CI CONTENTION:  “Not sure if it was accurately done to begin with…the shoulder.”  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 - 20040331	VARD - 20050104	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5299-5003	10%	Status Post Right Shoulder Rotator Cuff Surgery	5201	20%	20040311	
Chronic Recurrent Postoperative Subluxations, Right Shoulder	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60% 	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the left-handed CI experienced a right shoulder subluxation in September 2000 after he was rolled to the ground.  On 29 March 2002, his right shoulder was immobilized after experiencing several subluxations.  X-rays showed some fragmentation in the inferior aspect of the glenoid, while magnetic resonance imaging (MRI) revealed a bony Bankart lesion (pocket formed by a small bone fragment knocked off at the front of the glenoid allowing humeral head dislocation).
The CI underwent an open Bankart procedure on 21 May 2002 but continued to have pain afterwards.  On 8 July 2002, he was noted to have neuropraxia (a mild nerve injury) of the right shoulder axillary nerve manifested by numbness over the lateral aspect of the shoulder and pain in the right hand.  Electrodiagnostic studies on 13 August 2002 revealed cervical, brachial, and mixed neuropathy.  

By November 2002, the CI had diminished sensation over the lateral aspect of the right shoulder in an area supplied by the axillary nerve.  For the next 8 months, he reported generalized right shoulder pain as well as a sensation of subluxation.  An MRI in October 2003 revealed a suspected Bankart lesion as well as tendonitis in the supraspinatus tendon, but no tearing of the supraspinatus tendon or rotator cuff.  The CI subsequently underwent surgery for recurrent instability on 13 January 2004, which consisted of a right shoulder arthroscopy with a revision Bankart reconstruction.  At the 27 January 2004 emergency room visit, 10 days post-surgery, he complained of a stinging sensation and pain but denied any trauma since suture removal a day prior.  No numbness or tingling was noted, but a mild wound infection was irrigated and treated with antibiotics.  

At the 3 February 2004 MEB NARSUM examination, 4 months prior to separation, the CI reported right shoulder pain.  Physical examination revealed a well-healed surgical incision on the anterior aspect of the right shoulder with no swelling, deformity or atrophy.  He had mild limitation of motion as well as apprehension with shoulder abduction beyond 90 degrees and when combined with external rotation.  Neurocirculatory status of the shoulder was noted to be intact with no crepitus or swelling and normal skin temperature.  

On 23 February 2004, 6 weeks post-surgery, physical therapy (PT) range of motion (ROM) measurements showed flexion to 85 degrees (normal 180) and abduction to 50 degrees (normal 180) with decreased strength.  At the 2 March 2004 PT appointment, the CI reported pain with an intensity of 7/10, and still wore a sling except when sitting on a couch.  ROM measurements were flexion to 85 degrees and abduction to 60 degrees.  

At the 11 March 2004 VA Compensation and Pension (C&P) evaluation, 3 months before separation, the CI reported chronic right shoulder pain, limited motion, and an inability to fully rotate his shoulder.  Physical examination showed normal posture and gait, and a normal appearing right shoulder with no heat, redness, swelling, effusion, or drainage.  The joints were stable and there was no tenderness or crepitus.   The examiner did not conduct ROM tests noting the CI “just had surgery.”  X-rays on 22 March 2004 showed post-surgical changes without dislocations or fractures.  

During the 25 March 2004 PT evaluation, 3 months prior to separation, the CI reported pain rated at 3/10 when not moving and 7/10 when elevating the right shoulder.  Measured ROM showed flexion to 90 degrees and abduction to 90 degrees with muscle guarding.  The therapist noted that 10 weeks post-surgery, the CI had not regained full ROM on his own. 

At the 3 November 2004, C&P joint evaluation, 4 months after separation, the CI complained of right shoulder pain, rated at 5/10, with any type of activity.  He report both sharp and dull pain but denied any swelling, redness or fatigue.  Any activity above the head aggravated the pain and he could lift objects, but not pull them.  Flare-ups occurred once every 2 weeks and lasted one day with a pain intensity of 8-9/10.  Pain was alleviated by rest and massage, and he continued to take large amounts of opiates for relief.  Physical examination showed well-healed scars that were mildly reddish-purple and elevated approximately 2 mm.  There was tenderness over the anterior portion of the rotator cuff which extended from the humerus head distally.  Shoulder girdle, clavicle, and supraspinatus muscle contours were normal and ROM measurements showed flexion to 140 degrees and abduction to 100 degrees, with painful motion.  X-rays the same day showed post-operative changes in the glenohumeral joint with good articulation at the shoulder joint.  The scapula, clavicle and humerus were all within normal limits.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, coded 5299-5003 (arthritis, degenerative).  The PEB also listed chronic, recurrent right shoulder postoperative subluxations as a related Category II condition (contributes to the primary unfitting condition but not separately ratable).  The impairment from this condition was properly subsumed under the overall rating for the chronic right shoulder pain IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the right shoulder condition 20%, coded 5201 (arm, limitation of motion), based on the C&P evaluation, citing 100 degrees abduction with pain and functional loss due to pain after repetition.  The VASRD §4.71a threshold for a 20% rating for the non-dominant arm under code 5201 is “at shoulder level” (approximately 90 degrees from the side), and PT examinations proximate to separation reflected this degree of limitation.  There was no fibrous union or nonunion of the humerus to justify a higher rating under code 5202 (humerus, other impairment of), and no higher rating available under code 5203 (clavicle or scapula, impairment of) or under code 5200 (scapulohumeral articulation, ankylosis of).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the chronic right shoulder pain condition, coded 5201.  

BOARD FINDINGS:  In the matter of the chronic right shoulder pain condition, the panel recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Shoulder Pain	5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161012, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs} COMMANDER, NAVY PERSONNEL COMMAND

Subj:		PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS 
Ref:	(a)	DoDI 6040.44

1.	Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (h) are approved.	The official records of the following individuals are to be corrected as follows:

a.	XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.

b.	XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from
10 percent) effective date of discharge.

c.	XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

d.	XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

e.	XXXXXXXXXXXXXXXXXX, former USN: Entitlement to  disability separation pay with a 20 percent disability rating (increased from
10 percent) effective date of discharge.

f.	XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from
10 percent) effective date of discharge.

g.	XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from
10 percent) effective date of discharge.

3.	Please take action to implement these decisions and provide notification
to the above individuals once thoseact

XXXXXXXXXXXXXXXXXX 
Acting