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

From: To:

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

Director, Secretary of the Navy Council of Review Boards 
PD-2017-00936

Subj: Ref:

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(b)	PDBR ltr dtd 9 Dec 18

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:  XXXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-00936
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20071130

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Special Communications Collection Operator/Analyst, medically separated for “right shoulder posterior instability” with a disability rating of 10%.

CI CONTENTION: “Right shoulder injury resulting in 3 surgeries and limited strength and range of motion; …” The CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20070904	VARD - 20080111	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Posterior Instability	5201	10%	Status Post (S/P) Right Shoulder Dislocation	5203-5024	10%	20071003	
Posterior capsule Labral Placation	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	
	
ANALYSIS SUMMARY:

Right Shoulder Posterior Instability. According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI injured his right shoulder in 2005 while carrying two heavy bunks. He experienced a right shoulder dislocation during the initial incident and reported that it occurred daily after that. Radiographic studies were normal. MRI done on 7 February 2006 showed a slight prominence of the acromioclavicular (A/C)  joint  but  was otherwise negative.   In May 2006 he  underwent    right

shoulder arthroscopic debridement, in November 2006 he underwent posterior capsule/labral plication surgery, and in May 2007 (6 months prior to separation) he underwent a revision surgery. Following surgery, he reinjured his right shoulder and again began experiencing shoulder pain and instability symptoms.

At the time of the physical therapy clinic appointment on 9 July 2007, 5 months prior to separation, the CI reported continued right shoulder pain at 2-4/10 at rest and 4-6/10 with movement. His right shoulder range of motion (ROM) was measured with a goniometer with flexion of 150 degrees (normal 180), abduction of 143 degrees (normal 180) and external rotation of 78 degrees (normal 90). Right shoulder strength showed weakness with infraspinatus 3+/5, Teres minor 3+/5, supraspinatus 3+/5, subscapularis 4/5, serratus anterior 3+/5, lower trapezius 3+/5, middle trapezius 3+/5, upper trapezius 4/5 deltoid 3+/5 and long head biceps 4/5. There was some moderate scapular winging.

According to the 19 July 2007 MEB NARSUM evaluation, 4 months prior to separation, the CI complained of continued right shoulder pain and instability. Physical examination showed right shoulder ROM measured at 160 degrees of forward flexion. His rotator cuff strength was normal (5/5) and his deltoid “fired with good strength.” There was tenderness posteriorly with apprehension upon forward flexion and some pain posteriorly.

During the 20 July 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the examiner noted mild atrophy of the right deltoid with reduced strength and reduced right shoulder ROM in abduction, internal rotation, flexion and extension. There was increased pain in ROM as well. There were not specific right shoulder ROM measurements recorded.

At the 3 October 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported continued right shoulder pain associated with weakness, giving way, fatigability and dislocation. The pain was constant and did not radiate. He characterized the pain as aching and sharp which mostly occurred with physical activities. He had difficulty with pushing and pulling, pull-ups and push-ups, and heavy lifting and carrying. He denied any periods of incapacitation. Physical examination showed the CI was in no apparent distress. There was a tender hyper-pigmented 1 x 0 cm scar, less than 6 square inches on the right shoulder. The CI was had normal hand strength. Examination of the right shoulder revealed evidence of limited and painful motion. There was no swelling, inflammation, heat, redness, effusion, drainage, abnormal movement, instability, or weakness. The right shoulder ROM was measured in degrees as flexion to 160, abduction 125, external rotation 80 and internal rotation 70, all with pain. With repetition the right shoulder ROM was limited by pain but not limited by fatigue, weakness, lack of endurance, or incoordination. There were no significant findings based on the radiographic studies.

The panel directed attention to its rating recommendation based on the above evidence. The PEB assigned a 10% rating under the 5201 code (arm, limitation of motion). The VA also assigned a 10% rating dual coded 5203-5024 (clavicle or scapula impairment - tenosynovitis) for painful or limited motion. The PEB’s Category II diagnosis (posterior capsule labral placation) is intrinsic to the rated condition and a separate rating  cannot  be supported     without  pyramiding  (VASRD
§4.14); thus, it is appropriately subsumed under the same rating.

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. Although there was insufficient limitation of motion to support a rating under the 5201 code, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion). There was no malunion or recurrent dislocation of the humerus with deformity or guarding of movement at shoulder level to  justify

a rating under the 5202 code (humerus, other impairment); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment). Although code 5201 does not have a 10% rating level, and ideal coding would be 5203-5024, the rating would remain 10% and this coding change would offer no benefit to the CI. 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 right shoulder condition.

BOARD FINDINGS: In the matter of the right 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.