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:	Director, Secretary of the Navy Council of Review Boards To:	PD-2017-01261

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 6 Mar 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:  XXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-01261 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050429

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Logistics Vehicle System Operator, medically separated for “right shoulder SLAP [superior labrum anterior posterior] tear” with a disability rating of 10%.

CI CONTENTION: Review requested of shoulder condition as well as 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 - 20050321	VARD - 20050727	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder SLAP Tear	5299-5003	10%	Right Shoulder AC Arthrosis with Status Post Surgeries	5299-5201	10%	20050317	
Right Acromioclavicular Arthrosis	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	
	
ANALYSIS SUMMARY:

Right Shoulder SLAP Tear. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent right (dominant) shoulder surgeries in December 2003 for open resection of the distal clavicle, and in May 2004 for repair of a SLAP tear. At an orthopedic appointment on 3 November 2004, 6 months prior to separation, the CI reported persistent right shoulder pain, and the provider noted normal strength with no signs of impingement.   Right shoulder range of motion (ROM) showed flexion of    170 degrees (normal
180)  and  abduction  of  170  degrees  (normal  180).     The  13  January  2005  MEB     NARSUM

examination, 4 months before separation, noted CI complaints of right shoulder pain, weakness and difficulty with overhead activity. Physical examination revealed well-healed surgical scars, and ROM showed flexion of 170 degrees and abduction of 170 degrees; rotator cuff strength was normal.

At the 17 March 2005 VA Compensation and Pension (C&P) examination, 1 month prior to separation, the CI reported constant right shoulder pain with intermittent cracking and popping. Physical examination showed well-healed surgical scars and mild diffuse tenderness with limited ROM due to pain. Flexion was to 160 degrees and abduction to 140 degrees, with painful motion noted in all planes. There was no additional limitation of motion with repetition, and strength was normal throughout. Shoulder X-rays the same day revealed acromioclavicular joint widening with post-surgical changes, but were otherwise unremarkable.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right shoulder condition 10%, analogously coded 5003 (arthritis, degenerative). The PEB also listed right acromioclavicular arthrosis as a related Category II condition (contributes to the primary unfitting condition but not separately ratable), but members agreed the impairment from this condition was properly subsumed under the overall rating for the unfitting 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%, but analogously coded 5201 (arm, limitation of motion of), based on the C&P examination, citing objective evidence of painful motion of the dominant right shoulder.       The panel noted that the  VASRD
§4.71a threshold for rating 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. However, members agreed that a 10% rating, coded analogously to 5003, was justified with application of VASRD §4.59 (painful motion), based on the pre-separation VA examination. There was no malunion or recurrent dislocation of the humerus to justify a rating under code 5202 (humerus, other impairment of), and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under code 5203. There was therefore no rating higher than a 10% supported under any applicable VASRD shoulder code. 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.