RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-01232 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20080831

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Combat Engineer, medically separated for “right shoulder instability” with a disability rating of 10%.

CI CONTENTION:  Review of all conditions requested.  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 - 20080604	VARD - 20090211	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Instability	5299-5003	10%	Post-Operative Right Shoulder Secondary to Martial Arts Training Injury with Residual Scars	
5201	
10%	
20080820	
Right Shoulder Stiffness	Cat II					
Status Post Right Shoulder Stabilization	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	
	
ANALYSIS SUMMARY:

Right Shoulder Instability. According to the service treatment record and the MEB narrative summary (NARSUM), the right-hand dominant CI underwent right shoulder stabilization surgery (Bankart repair)  in  July 2006.  X-rays taken  in  August  2008  showed  no  abnormalities.  The  18 December 2007 MEB NARSUM examination, 8 months prior to separation, noted complaints of right shoulder weakness but no numbness or tingling. Physical examination showed tests were negative for right shoulder symmetry, tenderness, and impingement, labrum and acromioclavicular joint impairment. Right shoulder strength and sensation testing were normal,

and flexion was 150 degrees (normal 180) and abduction was 80 degrees (normal 180) with painful motion.

At the 20 August 2008 VA Compensation and Pension (C&P) examination, 11 days before separation, the CI reported constant sticking right shoulder pain that radiated to the right arm. There was right shoulder weakness, stiffness, swelling, and lack of endurance. Physical examination showed right shoulder flexion and abduction to 120 degrees with painful motion. There was no range of motion (ROM) loss following 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). The Navy PEB also listed right shoulder stiffness and status post right shoulder stabilization as related Category II conditions (contributed to the primary unfitting condition but were not separately ratable). The impairment from the right shoulder stiffness and status post right shoulder stabilization were properly subsumed under the overall rating for the right shoulder instability condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA also rated the right shoulder condition 10%, coded 5201 (arm, limitation of motion), based on the C&P examination, citing functional loss due to pain/limitation of motion.

The panel deliberated and determined that that the C&P examination was closest to separation and best aligned with the underlying pathology and preponderance of evidence and therefore had the highest probative value for rating at separation. 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 VA ROM examination 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 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). 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 instability condition.

BOARD  FINDINGS:         In the matter of the right shoulder instability 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.

2	PD-2017-01232

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:
1850
CORB: 003 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 1 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 ofno 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.