RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2018-00168
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20040630

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aviation Supply Clerk, medically separated for “left shoulder instability status post (s/p) surgery x5 including bone graft from left hip to glenoid” with a disability rating of 10% and “right shoulder ligamentous laxity” which was determined to have existed prior to service (EPTS) and was not rated.

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 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 - 20040401	VARD - 20050214	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Left Shoulder Instability…	
5099-5003	
20%
-10%
10%	
Chronic Left Shoulder Dislocation, Post-Operative	
5201	
20%	

20041022	
Right Shoulder Ligamentous Laxity	EPTS	Right Shoulder Disability	5201	NSC		
Hyperlipidemia	Cat III	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Left Shoulder Instability. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI injured his left shoulder while doing pull ups in May 2001. His military enlistment physical in 1997 did not note any shoulder symptoms and upper extremity examination was checked “normal.” Following aggressive physical therapy (PT), he continued to have intermittent left glenohumeral dislocations with spontaneous reductions, and an MRI on 22 October 2001 showed an anterior labral tear and inferior labral fraying; a fluoroscopy (live X- rays with contrast) with motion showed posterior dislocation and reduction. He subsequently had five left shoulder surgeries with the last being a posterior glenohumeral reconstruction with iliac crest bone graft in April 2003.

During the 26 September 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, the CI reported left shoulder pain, and the examiner found that his shoulder could be dislocated. The 3 November 2003 MEB NARSUM examination, noted complaints of recurrent dislocations and physical findings revealed a dislocating left shoulder.

At an orthopedic second opinion examination on 4 March 2004, 4 months before separation, the CI reported an episode of acute subluxation approximately 3 weeks earlier when removing his shirt with his arm positioned in abduction/extension. The shoulder popped posteriorly and he experienced more numbness of the upper extremity than ever before, along with pain, weakness and instability. Physical examination showed left shoulder flexion to 106 degrees (normal 180) with posterior-inferior slide of the humerus, and decreased external and internal rotation compared to the right arm. Testing for instability was moderately to markedly positive, both posteriorly and anteriorly, and posterior load-and-shift testing produced a significant “clunk” and reproduced most of the CI’s normal symptoms. There was significant shoulder joint crepitus but no evidence of rotator cuff injury or biceps tendinopathy. Shoulder X-rays showed surgical hardware and degenerative changes, and the provider presented three treatment options to include: do nothing, or attempt an allograft reconstruction or fusion. Additional imaging was planned with further discussion to follow.

At the 22 October 2004 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported left shoulder discomfort, decreased range of motion (ROM), and fatigability with physical activity. Pain increased and ROM decreased with driving or even prolonged walking. Physical examination showed well-healed surgical incisions with no abnormal scarring or loss of muscle tissue. The examiner noted markedly decreased ROM, primarily in external rotation, and “then abduction only to 30 degrees.” Motion in the remaining planes was within normal limits, but painful motion was not addressed. The CI could bring his hands over his head (flexion) and behind his back (Internal rotation) without difficulty.

The panel directed attention to its rating recommendation based on the above evidence. The PEB adjudicated the left shoulder condition as EPTS and rated 20%, with an EPTS deduction of 10% for a final 10% rating, analogously coded 5099-5003 (arthritis, degenerative). The VA rated the left shoulder condition 20%, coded 5201 (arm, limitation of motion of), based on the C&P examination, citing limitation of arm motion midway between side and shoulder level or at shoulder level. The VASRD §4.71a threshold for rating ROM impairment under code 5201 is “at shoulder level” (approximately 90 degrees from the side), and while the examinations in evidence demonstrated motion limited to this level, the highest 30% rating for non-dominant arm motion limited to “25 degrees from side” was not warranted. The panel considered other VASRD shoulder and analogous codes, but all were less applicable and/or not advantageous for rating. The panel found no evidence upon which to base an EPTS rating deduction and therefore no deduction is recommended. 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.

Contended PEB Conditions: Right Shoulder Ligamentous Laxity and Hyperlipidemia. The panel’s main charge is to assess the fairness of the PEB determinations that the contended condition were not unfitting. The CI was diagnosed with bilateral multidirectional shoulder instability (left much greater than right) in July 2002. The PEB adjudicated the right shoulder laxity as EPTS, and the VA did not service connect the condition. Panel members considered whether there was evidence of service aggravation of the right shoulder condition, noting that a presumption of service aggravation may only be overcome by a preponderance of competent medical evidence and accepted medical principles that the natural progression of a pre-existing condition was clearly unaltered by any consequence of military service. The panel found no evidence in the STR of the CI reporting right shoulder symptoms or being treated for instability during active duty. After due deliberation, considering all the evidence, panel members concluded the right shoulder

condition was not permanently aggravated by service beyond the natural progression of the condition and therefore recommends no change in the PEB’s adjudication. The hyperlipidemia, as an asymptomatic laboratory finding, had no impact on fitness and is not a VASRD-ratable condition, and thus the panel has no basis for recommending it as unfitting.

BOARD FINDINGS: In the matter of the left shoulder condition, the panel recommends a disability rating of 20% coded 5201 IAW VASRD §4.71a. In the matter of the right shoulder condition, and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended hyperlipidemia, the panel agrees it cannot recommend it for additional disability rating. 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 Instability S/P Surgery (x5)	5201	20%	
Right Shoulder Ligamentous Laxity	5201	EPTS	
	COMBINED	20%	

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

rn 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 27 Apr 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 office of the Deputy Commandant, Manpower and Reserve Affairs, for appropriate changes to your personnel records and notification to you upon completion.