RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX		CASE: PD-2017-04347 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20081020

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Machinist Mate, medically separated for “right shoulder adhesive capsulitis” with a disability rating of 20%.

CI CONTENTION:  Review of all conditions requested.  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 - 20080908	VARD - 20080718	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Adhesive Capsulitis	5299-5201	20%	Right Shoulder Glenoid Labrum Tear Status Post Arthroscopic Surgery	5201	20%	20080423	
Recurrent Instability, Right Shoulder	Category II					
Migraine Headaches	Category III	Common Migraines	8100	0%	20080423	
Obstructive Sleep Apnea	Not Adjudicated	Sleep Apnea	6847	50%	20080423	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

Adhesive Capsulitis Right Shoulder (Non-Dominant). According to the service treatment record and MEB narrative summary (NARSUM), the left-hand dominant CI sustained a right shoulder dislocation while playing basketball in January 2007. An MRI demonstrated a nearly circumferential labral tear with inferior labral detachment and a small Hill-Sachs deformity of the posterolateral humeral head consistent with the recent dislocation. He subsequently underwent

a right shoulder arthroscopy with a superior labral repair, anterior Bankart repair, and capsular labral reconstruction in May 2007. An MRI of the right shoulder post arthrogram injection, dated 21 February 2008, demonstrated a markedly abnormal glenoid labrum with a SLAP (superior labrum anterior posterior) tear extending posteriorly behind the biceps anchor and anteriorly/inferiorly. The findings were consistent with a re-tear. In April 2008, because of inability to abduct his shoulder greater than 80 degrees despite extensive physical therapy (PT), he underwent arthroscopic evaluation and a limited capsular release was performed. Postoperatively, abduction improved to 160 degrees.

At the 23 April 2008 VA Compensation and Pension (C&P) examination, 6 months before separation, the CI reported weakness, stiffness, swelling, giving way, lack of endurance, locking, fatigability, and dislocation. Pain was reported to be constant. Physical examination of the right shoulder showed tenderness anteriorly, superiorly, and posteriorly with guarding of movement. There was no edema or effusion, but there was mild weakness. There was no subluxation. ROM showed flexion of 100 degrees (normal 180) and abduction of 60 degrees (normal 180), both with pain. External rotation was 40 degrees (normal 90) and internal rotation was 0 degrees (normal 90), both with pain. After repetitive use there was an additional 20 degrees limitation specifically in flexion and internal rotation. The CI tripped and fell on 10 July 2008, 3 months prior to separation, and dislocated his right shoulder. He then underwent a reduction of the right shoulder.  Post reduction X-rays and a CT scan were reported to be normal.

The 22 July 2008 MEB NARSUM examination, 3 months prior to separation, noted the complaints of right shoulder pain, instability, and tightness. Physical examination showed the CI wore a sling. There was a well-healed surgical incision and no atrophy. Both forward elevation and abduction were limited to approximately 45 degrees. External rotation was to 30 degrees and internal rotation was to his belt, all limited by pain. X-rays a week earlier showed the shoulder was reduced. There was evidence of some osteolysis (resorption of bone) at the points of the anchor placement on the bony labrum. A small Hill-Sachs lesion (a cortical depression in the posterolateral head of the humerus) existed, but was otherwise unremarkable. The final diagnoses were recurrent instability of the right shoulder and adhesive capsulitis.

During the 7 August 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported dislocation of his right shoulder, surgeries, and re-dislocation. There was no physical examination of the shoulder due to instability. The diagnosis was right shoulder dislocation, unstable. The MEB orthopedic addendum a week later noted the CI’s history and indicated he developed recurrent instability with daily subluxations and dislocations as well as significant muscle spasms. Physical examination noted significant spasms of the trapezius and deltoid muscles. Right shoulder forward elevation (flexion) was 50 degrees and abduction was 45 degrees, limited secondary to guarding and pain as well as apprehension. The CI elected non-operative treatment and was managed in a sling. PT was stopped due to increased shoulder pain and risk for subluxation or dislocation.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right shoulder adhesive capsulitis condition 20%, analogously coded 5299-5201 (arm, limitation of motion). The PEB listed recurrent instability of the right shoulder as a Category II condition (related to and contributing to the primary unfitting condition).

The panel’s first charge for this Category II condition is to assess whether it can be reasonably justified as separately unfitting for rating consideration. Of interest, the CI was diagnosed with adhesive capsulitis and underwent successful surgery to ameliorate the problem; however, as a result of a fall with dislocation of the right shoulder, he developed instability and pain with decreased ROMs as noted on the MEB orthopedic addendum. His second limited duty (LIMDU) dated 15 February 2008, 5 months before his fall, actually listed right shoulder instability first and right  shoulder  adhesive  capsulitis  second.   Nevertheless, at  the  time  of  separation, the  CI’s

primary issue was instability. Therefore, the panel determined the instability was separately unfitting and could be rated using code 5202 (humerus, other impairment: recurrent dislocation of at scapulohumeral joint with frequent or infrequent episodes and guarding of all arm movements) at 20%, and no higher. However, a separate rating for an additional disability rating for the right shoulder movement impairment would invoke VASRD §4.14 (avoidance of pyramiding), which is to be avoided. Therefore, an additional rating for the recurrent instability, right shoulder cannot be assigned. The VA also rated the right shoulder condition 20%, coded 5201, based on the C&P examination, citing arm motion limited at shoulder level. 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, albeit the recurrent instability of the right shoulder was unfitting, but not ratable.

Contended PEB Conditions: Migraine without Aura and Obstructive Sleep Apnea (OSA). The panel’s main charge is to assess the fairness of the PEB determination that the migraines were not unfitting. The PEB did not adjudicate OSA. Neither of the conditions were noted on LIMDUs or implicated in the non-medical assessment. There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the adhesive capsulitis right shoulder condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the Navy Category II recurrent instability, right shoulder condition, the panel agrees it was unfitting, but recommends no additional disability rating IAW VASRD §4.14. In the matter of the contended migraine without aura and obstructive sleep apnea conditions, the panel recommends no change from the PEB determinations as not unfitting. 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:

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 

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 21 Aug 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.