DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374

IN   REPLY   REFER  TO:
1850
CORB:003
20 Feb 20

From: To:

Director, Secretary of the Navy Council of Review Boards 
PD-2017-00566

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a). DoDI 6040.44
(b) PDBR ltr dtd 7 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy.

2.	On 12 February 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXX	CASE: PD-2017-00566
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20090220

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E3, Seaman Apprentice, medically separated for “right shoulder instability” with a disability rating of 10%. However, the PEB determined the condition existed prior to service (EPTS) and reduced the rating by 10% for a disability rating of 0%.

CI CONTENTION: “Lower back pain still hurts since separation. Knee pain is still there since separation.”  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 - 20081008	VARD - 20090318	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Instability Status Post Bankart Repair	5299-5003	10%
-10%
0%	Right Shoulder Internal Derangement	5203	10%	20081204	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Right Shoulder Instability. According to the service treatment record and MEB narrative summary (NARSUM), the orthopedic examiner on 19 February 2008 recorded that the CI had a 3-year history of anterior right shoulder instability following a skateboard injury prior to enlistment. However, the 30 May 2007 induction physical indicated a normal upper extremity evaluation.  The right-handed CI underwent right shoulder surgery for anterior instability repair

on 21 February 2008. Six months after surgery, the CI had no recurrent instability issues, but did have some shoulder pain and physical limitations.

The 21 August 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of right shoulder pain. The CI reported he could not perform the overhead and lifting tasks of his military duties. Physical examination showed no tenderness of the acromioclavicular joint, biceps tendon of rotator cuff, and impingement signs were negative. Right shoulder and hand strength were normal. Active shoulder range of motion (ROM) testing showed forward flexion and abduction of 170 degrees (normal 180). There was no apprehension with instability testing.

At the 4 December 2008 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported post-surgical right shoulder pain. Physical examination showed some shoulder discomfort to pressure over the labral repair site without crepitus. Impingement testing was negative. Right shoulder ROM was 180 degrees flexion and 160 degrees abduction. There was no further loss in functional capacity from pain, fatigue, weakness or lack of endurance after repetitive use.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right shoulder condition 10%, analogously coded 5299-5003 (degenerative arthritis), but subsequently reduced the rating to 0%, citing an EPTS deduction. The VA also rated the right shoulder condition 10%, coded 5203 (impairment of clavicle or scapula) based on the C&P examination, citing malunion or nonunion of the clavicle or scapula.

The PEB determined the right shoulder condition was EPTS based on the CI’s report to an orthopedic examiner that he injured the shoulder during a skate-boarding accident prior to entering military service. The panel found no evidence to indicate this was incorrect. The panel noted that at the CI’s MEPS examination he did not report any shoulder problems and there was no evidence of shoulder limitation of motion, painful motion, or recurrent dislocations documented on the physical examination to support a 10% EPTS deduction at the time of enlistment.  Therefore, the panel does not recommend an EPTS deduction.

There was no limitation of motion of the shoulder to support a rating under diagnostic code 5201 (limitation of arm motion). The MEB NARSUM and C&P examinations did not note findings such as swelling, muscle spasm, satisfactory evidence of painful motion, or other evidence of functional loss to support a 10% rating IAW VASRD §§4.59, 4.40 or 4.45. There was no malunion, deformity or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment); and no nonunion or malunion of the clavicle or scapula to warrant any rating under the 5203 code. The panel found that no higher than a 0% rating was supported for the right shoulder at separation under any applicable VASRD code. However, IAW DoDI 6040.44, the panel may not recommend a lower combined rating than that assigned by the PEB and therefore, no change to the 10% PEB adjudication is recommended. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right shoulder condition.

BOARD FINDINGS: In the matter of the right shoulder condition and IAW VASRD §4.71a, the panel recommends a disability rating of 10%, coded 5003 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 the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Shoulder Condition	5003	10%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170215 w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record