RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-03134
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060630

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve O3, Meteorology/Oceanography Officer, medically separated for “chronic bilateral [right and left] shoulder pain,” rated 0% each, with a combined disability rating of 0%.

CI CONTENTION:  Review all conditions.  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 - 20060328	VARD - 20070119	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right and Left Shoulder Pain	5099-5003	0%	Right Shoulder Injury, Status Post [S/P] SLAP Repair with Tender Surgical Scars	5201-7804	10%	20061106	
	5099-5003	0%	Left Shoulder Injury, S/P SLAP Repair with Tender Surgical Scars	5201-7804	10%	20061106	
History of Multiple Labral Tears to Both	Cat II					
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Chronic Right and Left Shoulder Pain. The evidence for the right and left shoulder conditions is presented together with attendant separate rating recommendations. According to the service treatment record and MEB narrative summary (NARSUM), the CI had two shirt tacks placed in the right shoulder for a superior labral tear from anterior to posterior (SLAP) tear in 1997. In June 2002, she experienced right shoulder pain after increased demands of naval light training,   and

underwent a repair of a SLAP re-tear in September 2002. The CI’s left shoulder condition began in October 2003 associated with normal day-to-day activities, and an arthroscopic surgical SLAP repair was performed in March 2004, followed by rehabilitation.

In November 2004, she again experienced right shoulder pain after performing a physical readiness test, which resulted in a second arthroscopic surgery in March 2005 to repair a type 2 SLAP tear; glenoid arthrosis (shoulder osteoarthritis) was also noted. In September 2005, she had left shoulder pain without a specific precipitating event, and an MRI showed a questionable superior labral tear involving the biceps labral anchor, which resulted in a second left shoulder surgery in November 2005. Despite the surgeries and rehabilitative efforts, she continued to have pain in both shoulders.

The 14 March 2006 MEB NARSUM examination, less than 4 months prior to separation, noted CI complaints of continuous bilateral shoulder pain that affected her ability to physically train and caused significant discomfort during most daily activities. Physical examination showed painful, symmetric shoulder range of motion (ROM) “within normal limits.” Bilateral O’Brien’s (for glenohumeral joint labral tear) and a left Speed’s test (for superior labral tear or bicipital tendonitis) were positive, but there was no rotator cuff pathology, instability, or infection, and no further surgical recommendations.

At the 1 November 2006 VA Compensation and Pension (C&P) general examination, 4 months after separation, the CI reported bilateral shoulder pain aggravated by daily lifting, carrying, reaching, cooking, using a computer mouse, and sleeping, but she denied stiffness, giving way, instability, and locking. Physical examination showed no shoulder tenderness, and active bilateral shoulder flexion and abduction to 170 degrees each (normal 180), with painful motion, but no ROM loss following repetition.

During the 1 May 2007 C&P joint examination, 10 months after separation, the CI reported constant bilateral shoulder pain and mild ROM limitation, but denied any focal weakness. Physical examination revealed scars on the right and left shoulders. Bilateral shoulder flexion and abduction motions were 175 degrees each, with painful motion, and ROMs were additionally limited to 170 degrees following repetitive use.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right and left shoulder conditions 0% each, analogously coded 5099-5003 (degenerative arthritis). The PEB listed “history of multiple labral tears to both” as related diagnoses (Category II) contributing to the disability in this case, but the panel concluded that these were not conditions which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding). The VA rated the right and left shoulder conditions 10% each, dual coded 5201-7804 (arm, limitation of motion-scars, unstable or painful), based on the C&P general examination, citing a painful superficial scar on examination. 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 that the MEB NARSUM and VA ROM evidence demonstrated motion above this level. However, there was satisfactory evidence of painful motion (VASRD §4.59), as recorded  on the MEB NARSUM and VA examinations to support a 10% rating for each shoulder. The panel also agreed there was no fibrous union or nonunion of the humerus (5202), or clavicle or scapula impairment (5203) to support a higher rating. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right shoulder condition, and a disability rating of 10% for the left shoulder condition, each coded 5099-5003.

BOARD FINDINGS: In the matter of the right shoulder condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a. In the matter of the left shoulder condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Shoulder Pain	5099-5003	10%	
Chronic Left Shoulder Pain	5099-5003	10%	
	COMBINED	20%	

The following documentary evidence was considered:

IN REPLY REFER TO

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD DC 20374-5023

									                             1850
									                             CORB:003
                                                                                                                                                                             9 Jun 20 

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 of 14 Jun 19

1.  Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy for appropriate action.   

2.  On 4 June 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR.  Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEB) from 0% to 20% without re-characterization of your discharge. 

3.  For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation. 

4.  The Assistant Secretary’s determination, which represents final action in your case by the Department of the Navy, has been forwarded to the Navy Personnel Command for appropriate changes to your personnel records and notification to you upon completion.