RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2017-04572 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20080601

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Shipboard Air Traffic Control Radar Technician, medically separated for “left greater than right shoulder multidirectional instability” 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 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 - 20071109	VARD - 20080922	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Greater Than Right Shoulder Multidirectional Instability	5202	20%	Left Shoulder Subluxation…	5201	20%	20081101	
			Right Shoulder Rotator Cuff…	5201-5024	10%	20081101	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Left Greater Than Right Shoulder Multidirectional Instability. The bilateral shoulder condition evidence is presented together with recommendations regarding a separate unfitting determination for each shoulder along with a separate rating if indicated. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right handed CI’s left shoulder dislocated in August 2004 while climbing an on-ship ladder. In November 2004, the CI underwent arthroscopic surgery for left shoulder labral repair and capsule plication. The CI underwent a second surgery in April 2005 due to persistent limitation of motion for manipulation under anesthesia and capsular release. He returned to full duty after the second surgery, however, he reported progressive instability symptoms.

The 23 October 2007 MEB NARSUM examination, 7 months prior to separation, noted complaints of left shoulder pain and dislocation occurring 2 to 3 times per month. The CI was able to self- reduce these dislocations. He reported he consciously avoided positions of near dislocation. He declined additional left shoulder surgery. Physical examination showed left shoulder flexion to

165 degrees (normal 180) and abduction was 165 (normal 180). Painful motion was not addressed. Right shoulder flexion was 170 degrees and abduction was 170. Painful motion was not addressed. Bilateral shoulder laxity testing (2+ sulcus) was positive. The CI was diagnosed with left and right shoulder multidirectional instability; however, there was no evidence of right shoulder medical treatment in the STR.

At the 1 November 2008 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported constant left shoulder pain that traveled down the arm and was elicited by physical activity and weather. The CI also reported right shoulder pain that occurred two times per day elicited by physical activity and shoulder pressure. Physical examination revealed left shoulder weakness, tenderness, and moderate subluxation without guarding of movement. The shoulder slid out of socket during active and passive maneuvers. Strength of shoulder flexion and abduction was graded 4/5. There was also right shoulder weakness, tenderness and slight subluxation without guarding of movement. The shoulder slid out of socket, slightly significant during active and passive maneuvers. Right shoulder strength in flexion and abduction was graded 3 to 4/5. Left shoulder flexion was normal and abduction was 70 degrees. Painful motion was elicited. Right shoulder flexion and abduction were normal, with painful motion. There was no additional left or right shoulder range of motion loss following repetitive motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left and right shoulder conditions 20%, coded 5202 (humerus, other impairment). The VA the rated the left shoulder condition 20%, coded 5201 (arm, limitation of motion), based on the C&P examination, citing limitation of arm motion. The VA also rated the right shoulder condition 10%, analogously coded 5201-5025 (arm, limitation of motion-tenosynovitis), based on the C&P examination, citing painful motion.

The panel first considered whether the left and right shoulder conditions remained separately unfitting, having been decoupled from each other as per the PEB adjudication. Although the limited duty form (LIMDU) and the MEB NARSUM both listed left greater than right multidirectional instability, the 5 November 2007 non-medical assessment (NMA) did not provide any specific information regarding the CI’s limiting medical condition and in fact requested that the CI remain in his current capacity within his Rating until the end of CI’s active obligated service date in May 2009, and also noted the CI could presently take physical fitness tests. The PEB’s Joint Disability Evaluation Tracking System form indicated the 20% rating coded 5202 was assigned for the left shoulder. The MEB NARSUM reviewed the course of treatment of the left shoulder and noted declination of further surgery on the left shoulder was reasonable and did not mention the right shoulder other than in the diagnosis of multidirectional instability. Only the left shoulder condition was medically treated during military service. The panel concluded the left shoulder condition was reasonably justified as separately unfitting and agreed there was a preponderance of evidence that the right shoulder condition was not reasonably justified as separately unfitting at separation. Accordingly, the panel recommends a separate service rating for the left shoulder condition.

A 20% rating was supported for infrequent dislocations with guarding at shoulder level as noted at the MEB NARSUM examination or for the limitation of left arm motion at shoulder level at the VA examination. There was no malunion with marked deformity of the humerus or frequent episodes of recurrent dislocation with guarding of all arm movements to warrant the next higher 30% rating. There was likewise no higher rating for limitation of motion (5201), nor under the 5203 code (clavicle or scapula, impairment). After unbundling the shoulders, the panel found that its rating recommendation of an unfit left shoulder, rated 20% and a not unfit right shoulder provides no ratings benefit to the CI and therefore no change to the PEB’s combined adjudication is recommended. 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 bilateral shoulder condition.

BOARD FINDINGS: In the matter of the left and right shoulder conditions 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.

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

IN REPLY REFER TO,
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:	XXXXXXXXXXXXX

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno 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.