RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02611 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20090603

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Aviation Boatswains Mate, medically separated for “chronic left shoulder pain” with a disability rating of 10%.

CI CONTENTION: Review requested of the left shoulder as well as an additional condition 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 - 20090409	VARD - 20090803	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	10%	Left Shoulder Status Post Surgery	
5201-5003	
10%	
20090715	
Loss of Motion	Cat II					
Left Shoulder Instability						
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Chronic Left Shoulder Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI had a history of several left (non-dominant) shoulder dislocations that were self-reduced prior to Service entry. In April 2007, he injured his left shoulder while lifting weights, and despite physical therapy (PT) and restricted activity, he eventually underwent surgical reconstruction of the left shoulder ligaments on 10 September 2008. On 3 February 2009, 5 months after surgery, left shoulder range of motion (ROM), measured by PT, noted

forward flexion to 140 degrees (normal 180) and abduction to 115 degrees (normal 180). One month later, left shoulder flexion and abduction were both to 119 degrees.

The 12 March 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of left shoulder pain and decreased ROM. The physical examination (PE) noted left shoulder ROM to 115 degrees of forward flexion and 110 degrees of abduction. Peripheral motor strength was noted as being within normal limits. Painful motion was not addressed or documented. During the 16 March 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reported constant left shoulder pain, aggravated with any movement, as well as shoulder weakness. The PE revealed 110 degrees of abduction and 90 degrees of forward flexion.

At the 15 July 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported chronic episodic left shoulder pain and stiffness. The PE revealed good grip and 5/5 motor strength of both upper extremities. Post-repetitive left shoulder ROM was painful to 150 degrees in both forward flexion and abduction.  Left shoulder X-rays were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left shoulder condition 10%, analogously coded 5099-5003 (degenerative arthritis). The PEB also listed “loss of motion” and “recurrent left shoulder instability” as related Category II diagnoses, but the panel noted these diagnoses were part and parcel of the unfitting left shoulder condition, and cannot be separately rated without pyramiding (VASRD §4.14). The VA also rated the left shoulder condition 10%, but dual coded 5201-5003 (limitation of arm motion due to degenerative arthritis), based on the C&P examination, citing painful or limited motion of a major joint. Panel members 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 vast majority of examinations in evidence demonstrated motion above this level. However, the panel 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 (clavicle or scapula, impairment of). 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.

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170315, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

2	PD-2017-02611

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 24 Jul 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.