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AF | PDBR | CY2013 | PD-2013-01607
Original file (PD-2013-01607.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-01607
BRANCH OF SERVICE: NAVY  BOARD DATE: 20150325
SEPARATION DATE: 20041006


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Aviation Machinist’s Mate) medically separated for a right shoulder condition. This condition could not be adequately rehabilitated to meet the requirements of his Rating or physical fitness standards. He was placed on limited duty and referred to a Medical Evaluation Board (MEB). The “glenohumeral instability with scapular winging and scapular dyskinesis” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated “glenohumeral instability with scapular winging and scapular dyskinesis” as unfitting, rated 20%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “Please review and consider all my medical conditions found in my military MEB/PEB.”


SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’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/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. The Board 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, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


 RATING COMPARISON :

IPEB – Dated 20040621
 VA* – (~1 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Glenohumeral Instability… 5099-5003 20% Right Glenohumeral Instability… 5202 20% 20040823
Other x 0
Other x 7
RATING: 20%
 RATING: 40%
* Derived from VA Rating Decision (VA RD ) dated 200 41214 (most proximate to date of separation [ DOS ] ) .



ANALYSIS SUMMARY:

Right Shoulder Condition. In 1999, the CI injured his right shoulder while playing basketball. Shoulder X-rays were normal. It was determined that he was not a surgical candidate. He was treated on numerous occasions with physical therapy measures. In spite of all treatment efforts, his symptoms persisted and MEB was initiated. The MEB physical examination (PE) was in May 2004. The CI reported pain and instability of the right shoulder. PE of the right shoulder revealed mild winging of the scapula (shoulder blade). Anterior and posterior apprehension signs were positive. With flexion and abduction, there was subluxation of the humeral head. Range-of-motion (ROM) was measured and is summarized in the chart below. In the MEB narrative summary, the diagnosis was, “Glenohumeral instability with scapular winging and scapular dyskinesis.” The Navy PEB found the shoulder condition unfitting. (The glenohumeral joint is the “ball-and-socket” shoulder joint, scapular winging is abnormal protrusion of the shoulder blade from the back, and scapular dyskinesis is abnormal motion of the shoulder blade.)

The CI was separated from service on 6 October 2004. In August 2004, 6 weeks prior to separation, he had a VA Compensation and Pension (C&P) exam. At that exam, he reported being right-handed. He complained of pain and instability of the right shoulder. The shoulder problem was not incapacitating, but it did limit his ability to carry on normal physical work and daily activities. PE of the right shoulder revealed swelling of the right acromio-clavicular joint, and mild right scapular winging. Motion of the right shoulder was painful. The right shoulder showed no fatigue, weakness, lack of endurance, or incoordination. For a diagnosis, the C&P examiner wrote: “Right glenohumeral instability with impingement. The patient has chronic daily right shoulder discomfort with use, and decreased range of motion.”

The ROM evaluations which the Board weighed in arriving at its recommendation are summarized below.

“
“
Right Shoulder ROM
(Degrees)
 MEB ~10 mos . Pre-Sep
(20031216)		 MEB ~5 mos . Pre-Sep
(20040506)
 VA C&P ~ 6 weeks Pre-Sep
(20040823)
Flexion (180 Normal)
Full” 180 100
Abduction (180)
Full” 135 125

The Board directed attention to its rating recommendation based on the above evidence. The Navy PEB and the VA chose different coding options for the right shoulder condition, but both assigned a 20% disability rating. After thorough review of the evidence, the Board determined that a rating of 20% was appropriate. In the record, there was sufficient evidence for recurrent episodes of subluxation, with guarding of certain arm movements. The CI reported that subluxation occurred at least once per week. The Board tried to find a path to a higher rating, using other codes which could be applied to the shoulder condition. The other VASRD codes that were considered did not result in a higher rating, since the record did not show sufficient evidence of a seriously disabling shoulder abnormality which would justify a higher rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the unfitting right shoulder condition (Glenohumeral instability, with scapular winging and scapular dyskinesis). The Board preferred using VASRD code 5299-5202, instead of the code chosen by the PEB. However, since there would be no apparent benefit to the CI, the Board elected to leave the PEB code (5099-5003) intact.


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 right shoulder condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130926, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record







XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review
MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
Subj:    PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION
Ref:     (a) DoDI 6040.44
(b) CORB ltr dtd 25 Jun 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual's records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy' s Physical Evaluation Board:

-        XXXXXXXXXXXXXXXXXXXX, former USN
-        XXXXXXXXXXXXXXXXXXXX, former USN
-        XXXXXXXXXXXXXXXXXXXX , former USN
-        XXXXXXXXXXXXXXXXXXXX, former USN
-        XXXXXXXXXXXXXXXXXXXX, former USMC
-        XXXXXXXXXXXXXXXXXXXX, former USN
-        XXXXXXXXXXXXXXXXXXXX, former USN
-        XXXXXXXXXXXXXXXXXXXX, former USN
-        XXXXXXXXXXXXXXXXXXXX, former USMC
-        XXXXXXXXXXXXXXXXXXXX, former USN
-        XXXXXXXXXXXXXXXXXXXX, former USMC
-        XXXXXXXXXXXXXXXXXXXX, former USMC
-        XXXXXXXXXXXXXXXXXXXX, former USN
        




XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel
(Manpower & Reserve Affairs)

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