RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03803 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20091129

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Basic Avionics Marine, medically separated for “left shoulder posterior instability, existed prior to service (EPTS) but service aggravated” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made. 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 - 20090925	VARD - 20100910	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Posterior Instability…	5201	10%	Left Shoulder DJD with Reverse Bankart Injury	5010-5201	10%	20100803	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Left Shoulder Posterior Instability. According to the service treatment record and MEB narrative summary (NARSUM), the right-hand dominant CI’s left shoulder condition began with an injury while in high school. The pain resolved and the CI injured his shoulder again during basic training (approximately January 2009) when falling while traversing the obstacle course. X-rays showed a type 2 acromion and a possible Hill-Sachs lesion (bone notch sign of impingement). The 29 June 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of constant left shoulder pain and recurrent subluxation posteriorly especially with internal rotation, pull-ups, and overhead reaching and lifting.   Physical examination showed range of motion (ROM)   with

forward flexion and abduction each to 170 degrees (normal 180 for both). He had posterior load shift and a positive jerk test (posteroinferior instability of the glenohumeral join) with a palpable clunk when the shoulder relocated. The Neer and Hawkins signs (impingement and painful motion tests) and anterior apprehension and negative sulcus tests were negative. Strength was normal and there was no neurologic deficit.

At the 3 August 2010 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported pain in the anterior joint, worse with elevation of the extremity, lifting objects over 20 pounds, sleeping on the left side, and numbness in the upper arm. Physical examination showed left shoulder tenderness with ROM measurements of flexion and abduction each to 160 degrees with painful motion. There were no additional limitations after three ROM repetitions.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left shoulder condition 10%, coded 5201 (arm limitation of motion), citing service aggravation and being EPTS. The VA also rated the left shoulder condition 10%, dual coded 5010- 5201 (traumatic arthritis - arm limitation of motion) based on the C&P examination, citing painful motion. The VASRD §4.71a threshold for rating for ROM impairment (code 5201) 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 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). Although ideal coding would be analogous to 5203 at 10%, there would be no change in rating percentage or benefit to the CI. 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 posterior 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.

The following documentary evidence was considered:

2	PD-2017-04240

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 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.