RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX		CASE: PD-2017-00913 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20070801

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Fire Control Technician, medically separated for “left shoulder adhesive capsulitis” with a disability rating of 20%.

CI CONTENTION: The condition continues to worsen and negatively affects daily activities. 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 - 20070510	VARD - 20080315	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Adhesive Capsulitis	5201	20%	Adhesive Capsulitis Left Shoulder	5201	0%	STR	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 0%	

ANALYSIS SUMMARY:

Left Shoulder Adhesive Capsulitis. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left (non-dominant) shoulder labral repair for instability (Bankart) in July 2006. The 4 January 2007 MEB NARSUM examination, 7 months prior to separation, noted complaints of pain at the extremes of motion with no significant improvement in range of motion (ROM) over the previous 2 months. Physical examination showed well-healed surgical portal sites and no shoulder tenderness. Left shoulder ROM tests, following repetition, showed flexion of 150 degrees (normal 180). External rotation was severely limited (0 degrees at side and 10 degrees with shoulder abducted to 90 degrees) and there was also limited internal

rotation. The CI had significant pain with extremes of motion, particularly external rotation with the arm at the side, but there was no evidence of instability or impingement. Motor strength with internal rotation, external rotation, forward elevation and abduction.

At the 1 May 2007 MEB NARSUM addendum examination, 3 months before separation, the CI reported residual left shoulder stiffness with some improvement in ROM and pain, but limited external rotation. On examination, left shoulder ROM following repetitive movement showed flexion of 160 degrees, abduction of 120 degrees (normal 180), external rotation of 0 degrees at the side, and “limited” internal rotation, with tenderness at the extremes of motion, especially with external rotation. The CI had good strength with external rotation and forward flexion. There was otherwise no change in the shoulder findings from the MEB NARSUM.

During the VA physical therapy goniometric ROM examination on 7 May 2008, 9 months after separation, left shoulder active ROM revealed flexion of 148 degrees, abduction of 110 degrees, external rotation of 30 degrees and internal rotation of 48 degrees. At the 29 May 2008 VA Compensation and Pension (C&P) examination, the CI reported constant, dull left shoulder pain but could use his arm for approximately 25 minutes before suffering a significant increase in pain. Weather also aggravated the shoulder pain, and during flare-ups his ROM was cut “in half.” Painful motion, tenderness and guarding of movement was noted, and the examiner highlighted normal ROM values for shoulder flexion and abduction on the VA examination template, but noted physical therapy should evaluate the degree limitations.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left shoulder condition 20%, coded 5201 (arm, limitation of motion of). The VA rated the left shoulder condition 0%, also coded 5201, based on the STR, citing no VA C&P examination. The VASRD §4.71a threshold for rating for ROM impairment under code 5201 is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level. Although panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion), this provided no rating benefit to the CI. There was no malunion or recurrent dislocation of the humerus to justify a rating under code 5202 (humerus, other impairment of), and the panel concluded there was no evidence to support a rating higher than the 20% adjudicated by the PEB. 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 left shoulder condition.

BOARD FINDINGS: In the matter of the left shoulder condition 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.

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY   REFER  TO,
20May20

From:

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 25 Apr 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate  action.

2.	On 20 March 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.