RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  MARINE CORPS 

 
NAME:  XXX                                              
CASE NUMBER:  PD1200823                                                  SEPARATION DATE:  20020131 
BOARD DATE:  20130115 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty,  LCPL/E-3,  (5537/Marine  Musician),  medically 
separated for bilateral shoulder condition.  The CI began experiencing spontaneous dislocations 
of his shoulders, right worse than left during recruit training.  He completed training but had 
difficulty carrying his saxophone in the Marine Corps Band; he was unable to meet the physical 
requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  
He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  The 
MEB forwarded multidirectional instability (MDI) of both shoulders and no other conditions for 
Physical Evaluation Board (PEB) adjudication.  The PEB adjudicated the multidirectional bilateral 
shoulder instability as unfitting, rated 10% for each shoulder, with application of the Veterans 
Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically 
separated with a combined 20% disability rating.   
 
 
CI CONTENTION:  “Unsure of original PEB findings (believed to be 0%) eventually each shoulder 
was rated as 20% after lengthy appeals process.  Condition has continued to worsen over the 
years (nearly constant discomfort/pain/numbness, etc.”    
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.”  The ratings 
for  unfitting  conditions  will  be  reviewed  in  all  cases.    The  rated  conditions  of  MDI  for  both 
shoulders  is  the  only  condition  that  meets  the  purview  of  the  Board  as  prescribed  in  DoDI 
6040.44  and  is  addressed  below.    Any  conditions  or  contention  not  requested  in  this 
application, or otherwise outside the Board’s defined scope of review, remain eligible for future 
consideration by the Board for Correction of Naval Records.   
 
 
RATING COMPARISON:   
 

Service IPEB – Dated 20011204 
Condition 

Multidirectional Instability 
both shoulders 

Code 
5299-5003 

Rating 
10% 

5299-5003 

10% 

VA (6 Mos. Post-Separation) – All Effective Date 20020201 
Condition 
Right Shoulder Joint Laxity 

Rating 
20%* 

Code 
5202 

5202 
6260 

Exam 
20020802 

20020802 
20020802 
 

20%* 
10% 

Left Shoulder Joint Laxity 
Tinnitus 
0% X 0 / Not Service-Connected x 3 
Combined:  50%* 

↓No Additional MEB/PEB Entries↓ 
Combined:  20% 
* VA originally rated shoulders combined at 20% using 5201, then separated at 10% each using 5203, then upon DRO review 
[including personal appearance, treatment notes and exam on 28 October 2003] increased to 20% each effective DOS using 
5202 for instability; Right shoulder increased to 30% effective 27 February 2008  
 
 
 

ANALYSIS SUMMARY:   
 
Multidirectional  Instability  of  Both  Shoulders.    The  narrative  summary  (NARSUM)  noted  the 
right hand dominant CI developed instability and pain in both shoulders, right worse than left 
with  spontaneous  bilateral  shoulder  dislocations  in  his  second  month  of  Marine  Recruit 
training.  None of the November 1999 prior to enlistment or enlistment physicals documented 
any  pre-existing  condition.    Over  the  next  year,  the  CI  experienced  episodes  of  shoulder 
dislocations including during Physical Fitness exercises, such as pull-ups, in February 2001 that 
prompted  orthopedic  and  physical  therapy  evaluations.    The  service  treatment  record  (STR) 
also references dislocation of his shoulder, while carrying his saxophone as a member of the 
Marine Corps Band.  At that time the record indicates that his right shoulder dislocations could 
happen  daily  and  he  could  self  sublux  each  shoulder  and  there  was  no  apprehension.  
Orthopedic evaluation in March 2001 referenced the CI felt shoulders slide out of socket, right 
more  often  than  left  and  spontaneously  reduce.    The  examiner  stated  right  shoulder  was 
positive sulcus test, mild apprehension, mild relocation test, and left shoulder less in degree, 
with diagnosis of shoulder laxity, subluxation/dislocation both shoulders, right greater than left.  
At orthopedic evaluation in May 2001, the CI was diagnosed with bilateral shoulder instability 
and physical therapy was extended 2 months with a limited duty (LIMDU) recommendation of 
no pushups, pull ups, or running for 6 months, due to up to 10 dislocations a day.  By May 2001, 
shoulder magnetic resonance imaging was reported as negative.  A second course of physical 
therapy  was  begun  in  June  2001.    In  September  2001,  the  member  was  at  sick  call  for  a 
transient  right  shoulder  dislocation/reduction  while  marching/drilling.    The  exam  showed  a 
limited  exam  due  to  pain  and  normal  neurological  exam.    Only  one  reference  to  proposed 
treatment by surgical repair was noted in the STR and that was in the commander’s statement.  
On 29 October 2001, the CI’s commander issued a non-medical assessment stating condition 
actually  prevents  him  from  performing  his  MOS  duties  as  a  Marine  Musician.    “The  medical 
advice  (the  CI)  has  received  is  that  his  condition  has  a  60%  chance  of  correction  through 
surgery.”    The  CI  declined  surgery  and  was  referred  to  the  MEB.    No  goniometric  range  of 
motion (ROM) evaluations are placed in evidence because rating was based on instability, not 
ROM, and full ROM was noted by MEB and VA exams.   
 
At  the  MEB  exam,  3  months  prior  to  separation,  the  CI  reported  “bilateral  shoulder 
subluxations”  on  the  DD  Form  2807.    On  the  MEB  physical  exam  DD  Form  2808,  dated 
05 November  2001,  the  examiner  recorded  “B  shoulder  subluxation,  popping  B  shoulder,  + 
sulcus  sign  L>R,  N/V  intact  distally.”    In  the  NARSUM,  4  months  prior  to  separation,  the 
examiner noted “he has minimal pain from this, but pretty much every time he tries to adduct, 
externally  rotate  the  arms,  he  dislocates  the  shoulders.    They  usually  easily  relocate.  
Occasionally he gets some numbness and tingling in the arms when this occurs.”  The NARSUM 
examiner noted “he has full range of motion in the joints.  He has capsular laxity inferiorly and 
posteriorly on both sides.  He can voluntarily dislocate the shoulder and it feels as if they are 
dislocating posteriorly, when he adducts, internally rotates the arms.”  The examiner also noted 
that  reversing  the  maneuver  usually  relocated  the  shoulder.    At  the  VA  Compensation  and 
Pension exam 6 months after separation, the CI reported that whenever he raises his arms over 
his head, he is at risk for his "shoulder dislocating.”  Per the examiner, the CI also stated that he 
“experienced  a  mild,  constant,  dull  throbbing,  particularly  of  his  right  shoulder,  which  is 
associated with some mild stiffness upon awakening.”  He also reports experiencing transient 
parasthesias in his hands which may persist for 2 or 3 hours following a “dislocation.”  The VA 
examiner found normal shoulder ROM and slight decrease in the CI’s ability to perform internal 
rotation posteriorly due to apprehension regarding possible subluxation of his shoulder joint.  
The  examiner  found  the  sulcus  test  negative.    The  examiner  opined  “Bilateral  shoulder  joint 
laxity, right greater than left, with history of recurrent, uncomplicated, anterior glenohumeral 
subluxations which easily relocate, and are most likely secondary to insufficient shoulder girdle 
muscular strength in this still developing young man.”  At the separation physical 2 weeks prior 
to  separation  the  examiner  documented,  “+  subluxation  with  ROM testing”  and  summarized 

   2                                                           PD1200823 
 

“B/L  shoulder  instability.”    Positive  sulcus  sign,  the  pathognomonic  sign  of  multidirectional 
shoulder instability, was found in multiple notes.  CI shoulder apprehension to testing ROM was 
noted twice in the service treatment record.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  rated  each  shoulder  8  weeks  prior  to  separation  at  10%  under  VASRD  code  5299-5003, 
analogous  to  Arthritis,  degenerative  (hypertrophic  or  osteoarthritis).    The  VA  rated  each 
shoulder 6 months after separation under code 5201, (Arm, limitation of motion), at 10% each.  
The  Board  debated  whether  the  CI’s  condition  was  laxity  with  subluxations  or  he  had  true 
shoulder dislocations due to instability, and noted both shoulders were coded separately from 
the PEB.  The Board directed its attention at coding the right shoulder, and found code 5202, 
(Humerus, other impairment of, recurrent dislocation of, at scapulohumeral joint), a better fit 
to the recurrent right shoulder condition, but felt that an analogous prefix should be attached 
to account for the lack of guarding of movement documented in the STR.  The Board considered 
the concept that the MDI as a syndrome of shoulder instability creates much more disability 
than the physical signs would suggest.  The Board felt the STR fit the level of frequent episodes 
for the right shoulder, but could not find sufficient documentation to make the same conclusion 
for the left shoulder.  In considering the right shoulder, the Board agreed that the apprehension 
documented  in  the  STR  in  ROM  testing  of  the  right  shoulder  represented  some  degree  of 
guarding at the shoulder level.  By considering §4.3, (Resolution of reasonable doubt) and §4.7 
(Higher  of  two  evaluations)  the  Board  opined  that  the  disability  best  fit  20%  for  the  right 
shoulder condition and did not rise to the level of 30% in the dominant shoulder since the STR 
did not support the next higher level of guarding of all arm movements for 30% disability of the 
dominant side.  The Board then turned attention to the matter of the left shoulder.  The Board 
noted that the left shoulder rarely, caused the CI to seek medical attention according to the 
STR.    The  Board  opined  that  the  original  PEB  coding  of  5299-5003  for  the  left  shoulder, 
analogous  to  arthritis,  degenerative,  best  fit  the  limitation  of  motion  due  to  the  risk  of 
dislocation as presented in the STR, and agreed with the 10% disability rating.   
 
After due deliberation, considering all of the evidence and mindful of VASRD §4.3, §4.7, §4.40 
and  §4.45;  the  Board  recommends  a  disability  rating  of  20%  for  the  right  shoulder  MDI 
condition under code 5299-5202, and no change to the PEB adjudication of 10% under code 
5299-5003 for the left shoulder MDI condition.   
 
 
BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or 
guidelines relied upon by the PEB will not be considered by the Board to the extent they were 
inconsistent  with  the  VASRD  in  effect  at  the  time  of  the  adjudication.    The  Board  did  not 
surmise  from  the  record  or  PEB  ruling  in  this  case  that  any  prerogatives  outside  the  VASRD 
were  exercised.    In  the  matter  of  the  MDI  both  shoulder  condition,  the  Board  unanimously 
recommends a disability rating of 20% for the right shoulder MDI condition coded 5299-5202.  
The Board recommends no change in the PEB determination of 10% for the left shoulder MDI 
condition coded 5299-5003, both IAW VASRD §4.71a.  There were no other conditions within 
the Board’s scope of review for consideration.   
 
 
 
 
 
 
 

   3                                                           PD1200823 
 

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as 
follows;  and,  that the discharge  with  severance pay  be  recharacterized to  reflect  permanent 
disability retirement, effective as of the date of his prior medical separation:   
 

UNFITTING CONDITION 
Multidirectional instability both shoulders condition 

VASRD CODE  RATING 
5299-5202 
Right 
Left 
5299-5003 
COMBINED (w/ BLF) 

20% 
10% 
30% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120611, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           xx 
           Director 
           Physical Disability Board of Review 

   4                                                           PD1200823 
 

      

             

                                       

b. former USMC:  Disability retirement with a final disability rating of 30 percent 

a. former USMC:  Disability separation with a final disability rating of ten (10) percent 

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS 
 
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS           
 
Ref:   (a) DoDI 6040.44 
          (b) PDBR ltr dtd 11 Feb 13 ICO 
          (c) PDBR ltr dtd 7 Feb 13 ICO   
          (d) PDBR ltr dtd 27 Feb 13 ICO   
          (e) PDBR ltr dtd 7 Mar 13 ICO   
                                         
1.  Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of 
Review set forth in references (b) through (d). 
 
2.  The official records of the following individuals are to be corrected to reflect the stated 
disposition: 
 
 
(increased from zero percent) with entitlement to disability severance pay effective 5 April 2002.  
 
 
(increased from 20 percent) with retroactive placement on the Permanent Disability Retired List 
effective 31 January 2002. 
 
 
c.  former USMC:  Disability separation with a final disability rating of ten (10) percent 
(increased from 0 percent) with entitlement to disability severance pay effective 15 July 2003. 
 
 
(increased from 20 percent) with retroactive placement on the Permanent Disability Retired List 
effective 31 July 2003. 
 
3.  Please ensure all necessary actions are taken, included the recoupment of disability severance 
pay if warranted, to implement these decisions and that subject members are notified once those 
actions are completed. 
 
 
 
 
 
 
 

  xx 
  Assistant General Counsel 
     (Manpower & Reserve Affairs) 

d. former USMC:  Disability separation with a final disability rating of 40 percent 

 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

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