From: To:

Subj: Ref:

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

Director, Secretary of the Navy Council of Review Boards 
PD-2017-02144

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(b)	PDBR ltr dtd 18 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:  XXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02144 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20070701

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Food Service Specialist, medically separated for “chronic right shoulder pain” with a disability rating of 10%.

CI CONTENTION: In addition to the right shoulder condition, 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 - 20070404	VARD - 20080531	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5099-5003	10%	Right Shoulder Rotator Cuff Tendinitis S/P Right Shoulder Surgery	
5203	
10%	
STR	
Right Shoulder Type 1 SLAP Tear with Proximal Biceps Tendinopathy Status Post (S/P) Arthroscopic Debridement	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	
	
ANALYSIS SUMMARY:

Chronic Right Shoulder Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right shoulder arthroscopic surgery in February 2006 with debridement of a labral tear. In spite of rehabilitation measures, the pain persisted and he remained unable to perform pull-ups, lift weights or lift heavy objects over his head.

The 19 June 2006 MEB NARSUM examination, 13 months prior to separation, noted complaints of pain with overhead activities and inability to complete the Marine fitness test as he was unable to complete even one pull up. The range of motion (ROM) evaluation showed 170 degrees each of flexion and abduction (normal 180). On examination, Hawkins and O’Brien’s tests were mildly positive (equivalent to painful motion), but there were no other signs of impingement. Neurologic and motor strength were normal. The 19 November 2007 physical therapy ROM evaluation, 5 months after separation, showed right upper extremity flexion of 120 degrees and abduction of 150 degrees. Muscle strength was rated at 3+/5 and right scapular muscular atrophy was noted.

At the 31 January 2008 VA Compensation and Pension (C&P) orthopedic examination, 6 months after separation, the CI reported sharp, stabbing pain with lifting and overhead motion (occasionally even resting) approximately three times per month. Physical examination showed normal right shoulder ROM for both flexion and abduction and motor strength of 5/5 in all planes of motion.  An MRI taken 6 days earlier showed right rotator cuff tendinitis.

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 adjudicated “right shoulder type 1 SLAP tear with proximal biceps tendinopathy S/P arthroscopic debridement” as a related diagnoses (Category II) contributing to the disability in this case. The panel concluded the Category II diagnosis was not a separate condition which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without pyramiding (VASRD §4.14). The VA rated the right shoulder condition 10%, coded 5203 (clavicle or scapula, impairment of: malunion of), based on the C&P examination, citing a malunion or nonunion of the clavicle or scapula.

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 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. 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.

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170227, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record