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AF | PDBR | CY2013 | PD-2013-02818
Original file (PD-2013-02818.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02818
BRANCH OF SERVICE: NAVY  BOARD DATE: 20140813
SEPARATION DATE: 20050310


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty CTR3/E-4 (Petty Officer 3rd Class, Cryptologic Technician Collection Operator,) medically separated for a right shoulder condition. The condition could not be adequately rehabilitated to meet the physical requirements of his rating or satisfy physical fitness standards and he was referred for a Medical Evaluation Board (MEB). The left shoulder condition characterized as “right shoulder glenohumeral instability with voluntary subluxation” by the MEB and was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated “right shoulder glenohumeral instability” as unfitting and rated it at 10%. The CI made no appeals and was medically separated.


CI CONTENTION: “ Pilar cysts are actually psoriasis and I think my arthritis is psoriatic.”


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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting right shoulder condition is addressed below and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 20050119
 VA - (3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Shoulder Glenohumeral Instability 5099-5003 10% Status Post Recurrent Subluxation, Postoperative with Scar 5202 30% 20050615
Other x 0 (Not in Scope)
 Other x 2 (Not in Scope) 20050615
Combined: 10%
 Combined: 60%
Derived from VA Rating Decision (VA RD ) dated 200 50907 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Right Shoulder Condition. The CI injured his right (dominant) shoulder in a fall in November 2002 associated with a “pop” and pain. Service treatment records (STRs) from the time of initial treatment for the injury stated there shoulder did not fully dislocate and spontaneously relocated back into place. However, the CI experienced persisting subluxation of the shoulder without full dislocations. According to orthopedic surgery notes from April 2003, a magnetic resonance imaging demonstrated deficient capsule and labrum (no tear of rotator cuff). In August 2003, the CI underwent right shoulder surgery to tighten the shoulder joint (capsular shift). The physical therapy appointment on 8 December 2003, 3 months after surgery, indicated active range-of-motion (ROM) as normal. At the 18 March 2004 orthopedic appointment, the CI reported 2 months of the right shoulder popping in and out when he extended or abducted arm with pain. On examination, active ROM of the right shoulder was similar to the left with flexion and abduction of 150 degrees. The orthopedic surgeon indicated there was no laxity but an equivocal sulcus sign for instability. Symptoms of persistent subluxation persisted and the CI was referred for MEB. The orthopedic MEB narrative summary (NARSUM) examination on 10 November 2004, reported continued right shoulder instability and subluxation with extension, abduction and overhead activity. On examination, the CI could voluntarily sublux the shoulder (move the shoulder partially out of place without dislocation) and the orthopedic surgeon noted examination maneuvers consistent with laxity. ROM included abduction and flexion to 175 degrees. The VA Compensation and Pension (C&P) examination on 15 June 2005, 3 months after separation, recorded CI report of residual ROM limitation due to pain as well as lifting limitations and inability to perform pushups due to recurrent subluxation. The CI reported recent acute worsening of symptoms but denied any recent trauma. The musculoskeletal examination revealed no atrophic findings (loss of muscle bulk) and strength of the extremities were normal. The examiner noted recurrent dislocation of the right shoulder, and range of motion limited to flexion of 70 degrees and abduction limited to 90 degrees. X-rays of the right shoulder were “negative.”

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the right shoulder glenohumeral instability 10% (coded 5099-5003). The VA rated the right shoulder condition (status post recurrent subluxation, right shoulder, postoperative with scar) 30% (coded 5202) citing recurrent dislocation recorded in the VA C&P examination. The right shoulder ROM recorded in the MEB NARSUM did not demonstrate limitation of motion that supported a minimum rating under diagnostic code 5201 (arm limitation of motion) while the post-separation VA C&P examination recorded limitation more nearly approximating limitation at shoulder level, supporting a 20% rating under the limitation of motion code. However, there was no reported history of a new injury to explain the marked changed between the two examinations. The Board considered the rating under diagnostic code 5202, other impairment of the humerus, used by the VA which includes recurrent dislocation of the glenohumeral joint in the rating guidance. The 30% rating stipulates frequent episodes of dislocation and guarding of all arm movements. The Board noted that the STRs documented recurrent subluxation, partial movement out of place, but not dislocation, movement completely out of place. The initial injury was not characterized as a dislocation and STRs are negative with regard to medical attention for treatment of an actual dislocation. The MEB orthopedic examination and preceding orthopedic and physical therapy examinations did not indicate there was guarding of all arm movements. The STRs indicated problems with abduction, extension and overhead use, not all directions. The Board therefore concluded the preponderance of evidence did not support the 30% rating under diagnostic code 5202. Although there were no full dislocations, subluxation was frequent and interfered with functioning in movements at or above shoulder level. Based on this the Board concluded the preponderance of evidence supported the 20% rating under diagnostic code 5202. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the right shoulder glenohumeral instability condition (coded 5202).


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. In the matter of the right shoulder glenohumeral instability condition, the Board unanimously recommends a disability rating of 20%, coded 5202 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Right Shoulder Glenohumeral Instability 5202 20%
COMBINED 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131031, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





                 
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review


 MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
                  DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
        
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) PDBR ltr dtd 25 Mar 15 XXXXXXXXXXXXXXX
         (c) PDBR ltr dtd 26 Feb 15 XXXXXXXXXXXXXXX
         (d) PDBR ltr dtd 25 Mar 15 XXXXXXXXXXXXXXX
         (e) PDBR ltr dtd 24 Mar 15 XXXXXXXXXXXXXXX

1. Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (e).

2. The official records of the following individuals are to be corrected to reflect the stated disposition:

a. XXXXXXXXXXXXXXX, former USMC : Entitlement to disability severance pay with a 10 percent (increased from 0 percent) disability rating effective date of discharge.

b. XXXXXXXXXXXXXXX, former USN : Entitlement to disability severance pay with a 20 percent (increased from 0 percent) disability rating effective date of discharge.

c. XXXXXXXXXXXXXXX, former USN : Entitlement to disability severance pay with a 20 percent (increased from 10 percent) disability rating effective date of discharge.

d. XXXXXXXXXXXXXXX, former USMC : Entitlement to disability severance pay with a 10 percent (increased from 0 percent) disability rating effective date of discharge.

3. Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are completed.



          XXXXXXXXXXXXXXX
         Assistant General Counsel
         (Manpower & Reserve Affairs)

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