RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2017-04021 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20070422

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Aviation Ordnanceman, medically separated for “left shoulder posttraumatic instability” with a disability rating of 10%.

CI CONTENTION: The severity of the left shoulder injury warrants medical retirement. 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 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 - 20070112	VARD - 20070713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Instability	5099-5003	10%	Acute Hill-Sacs Deformity, Left Shoulder	
5201	
20%	
20070316	
Left Shoulder Pain	Cat II					
Left Shoulder Adhesive Capsulitis	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 80%	

ANALYSIS SUMMARY:

Left Shoulder Instability. According to the service treatment record and MEB narrative summary (NARSUM), the right-handed CI’s left shoulder condition began in January 2006 after falling down a hatch aboard ship. Radiographic imaging revealed ligamentous injury within the shoulder joint and he underwent left shoulder surgery in August 2006. The 28 November 2006 MEB NARSUM examination, 5 months prior to separation and 3 months after surgery, noted complaints of stiffness and increased pain with instability symptoms. The CI was “unable to lift his left upper extremity away from his body without significant anterior shoulder pain. The pain [was] worsened with stiffness beyond shoulder level.” The physical examination (PE) noted mild weakness of the muscular complex of the left shoulder joint. Left shoulder range of motion (ROM) was documented as 90 degrees of abduction and flexion (normal 180 in each direction) with painful motion. Provocative clinical testing to elicit joint instability or ligamentous pathology was negative.

At the 16 March 2007 VA Compensation and Pension (C&P) examination, one month prior to separation, the CI reported the inability to lift, push or pull anything over 15 pounds and he could not lift anything overhead due to shoulder pain, weakness, stiffness, swelling, give way, lack of endurance, locking and dislocations of the left shoulder joint. The PE noted left shoulder ROM was unchanged, despite repetitive testing, from measurements obtained 4 months earlier at the NARSUM examination.

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 left shoulder pain and adhesive capsulitis as related Category II conditions. The panel agreed that these conditions were part and parcel of the unfitting left shoulder condition and any disability from either of these conditions was properly subsumed in the left shoulder rating to avoid pyramiding (VASRD §4.14). The VA rated the left shoulder condition 20%, coded 5201 (limitation of arm motion), based on the C&P examination, citing limitation of arm motion at shoulder level.

The VASRD §4.71a code of 5201 threshold for rating ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM measurements in evidence demonstrated terminal motion at this level. The highest 30% rating for a non-dominant arm requires motion limited to “25 degrees from side,” but examinations did not reflect this degree of limitation. The panel agreed the left non-dominant shoulder limitation at 90 degrees supported the maximum rating of 20% under code 5201. There was no fibrous union or nonunion of the humerus to justify a higher rating under the 5202 code (humerus, other impairment), and no higher ratings available under the 5203 code (impairment of clavicle or scapula). Additionally, there was no further clinical or radiographic evidence of the left shoulder joint that suggested non-union of, or mal-union of the clavicle or scapula. After due deliberation, considering all the evidence and mindful of VASRD
§4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left shoulder condition, coded 5201.

BOARD FINDINGS: In the matter of the left shoulder condition, the panel recommends a disability rating of 20%, coded 5201 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	
Left Shoulder Posttraumatic Instability	5201	20%	

2	PD-2017-04021

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 12 Oct 20

From: To:

Subj:

Ref:

Director, Secretary of the Navy Council of Review Boards 

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(b)	PDBR ltr of 21 May 20
(b)	

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 7 October 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 10% 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.