RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2013-00165
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20140328
SEPARATION DATE:  20080623

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-6 (5811/Military Policeman) medically separated for a left shoulder condition.  After initially injuring his shoulder during a motor vehicle accident (MVA) in 1994, the CI reinjured the left shoulder after an improvised explosive device (IED) explosion while deployed and again while doing pull-ups.  Despite extensive physical therapy, the condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The shoulder condition, characterized as “osteoarthrosis, localized, secondary, involving shoulder region” with “other chronic pain” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The Informal PEB adjudicated “acromioclavicular joint degenerative joint disease, left shoulder” as unfitting, rated 10%, citing criteria of the VA Schedule for Rating Disabilities (VASRD).  Additionally, “joint pain, left shoulder (slap lesion by MRB), upper back pain (suprascapular), left shoulder, uncertain etiology” was determined to be Category II, contributing to the unfit condition.  The CI made no appeals and was medically separated.

CI CONTENTION:  “VA total disability rating is 100% as of date of discharge. The same condition(s) which deemed the Service member unfit for duty, received a disability rating of 30% with the VA, which is greater than the military's rating of only 10%.  Requesting that service member’s discharge reflect 30% versus 10%.”

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 shoulder 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 20070815	VA - (10 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Acromioclavicular Joint Degenerative Joint Disease, Left Shoulder	5003	10%	Left Shoulder AC Joint Degenerative Joint Disease With Slap Lesion 	5201	30%	20070816	
Joint Pain, Left Shoulder (Slap Lesion By MRA), Upper Back Pain (Suprascapular), Left Shoulder, Uncertain Etiology	Cat II					
No Additional MEB/PEB Entries	Other x 16	20070816	
Combined:  10%	Combined:  90%	
Derived from VA Rating Decision (VARD) dated 20080721 (most proximate to date of separation [DOS]).
ANALYSIS SUMMARY:

Left Shoulder Condition.  This left hand dominant CI sustained injury to his left shoulder in a 1994 MVA, during training.  He completed his recruit and MOS training without difficulty and was subsequently deployed to Iraq, April 2004 to May 2005.  During deployment he apparently reinjured the left shoulder when thrown against the turret of his vehicle during an IED occurrence.  This improved, but was again reinjured during physical therapy (PT) in November 2005.  On clinic evaluation in December 2005, movement of the left shoulder was painful with a reduced range-of-motion (ROM) of forward flexion (FF) of 100 degrees (FF defined as rising arm forward with stiff elbow from a position of attention to above head; normal 180 degrees) and abduction (ABD) of 80 degrees (ABD defined as raising the arm with a stiff elbow to the side from a position of attention to above head; normal 180 degrees).  With PT the condition improved to FF of 130 degrees and ABD of 140 degrees.  Radiographic studies (magnetic resonance arthrogram [MRA]) obtained in May 2006 revealed a small tear in the anterior joint shoulder cartilage with some evidence of degenerative change in the collar bone attachment area (AC joint).  On orthopedic evaluation on 3 May 2006, the surgeon noted some “laxity” of the left shoulder with both FF and ABD of 150 degrees with pain and opined that surgery was not indicated.  At PT evaluation in January 2007, ROM was improved (FF 160, ABD 110) but not pain.  A follow-up shoulder radiograph (MRI) March 2007, reported a small residual tear of the cartilage with an intact rotator cuff.  The tendon of the biceps muscle, attaching in the area, was normal.  The CI was begun on antidepressant medication at this time with some improvement in his symptoms of pain.  At the MEB narrative summary evaluation, on 30 May 2008, a month prior to separation, the CI reported continued left shoulder pain with motion.  On physical examination the shoulder was “stable” without “popping” or dislocation.  “Mild atrophy” of the muscles around the medial left scapula was noted.  Marked tenderness to palpation of the left upper scapula, deltoid muscles and AC joint was present.  ROM of the left shoulder was FF 170 degrees and ABD of 160 degrees, both with pain.  Strength, sensation and reflexes were normal.  X-rays of the scapula were negative.  At the VA Compensation and Pension (C&P) exam on 16 August 2008, the month of separation, the CI reported pain and weakness in the left shoulder with motion, but was able to function with anti-inflammatory and anti-depression medication.  He noted no difficulties with activities of daily living.  On physical examination no loss of “substance or impairment of tone of the upper extremity muscles” was noted.  Tenderness to palpation of the left shoulder was present.  ROM was FF of 130 degrees with pain starting at 80 degrees and ABD of 100 degrees with pain starting at 70 degrees.  No further reduction in ROM with repetition was recorded.  Motor strength was slightly decreased to 4/5 in the left shoulder but, this was not defined as during flexion or abduction.  Sensory examination was normal.  X-rays of the complete left shoulder were normal.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition as degenerative joint disease, 10% coded 5003, citing painful ROM.  The VA rated the left shoulder pain condition 30%, coded 5201 (arm, limitation of motion) citing decreased ROM.  The Board undertook to determine a rating for the condition under the ROM code 5201.  Under this code, for the dominant arm, the minimum rating of 20% requires FF or ABD of no greater than 90 degrees.  A higher rating of 30 degrees requires FF or ABD restricted to more than 45 degrees but less than 90 degrees.  A rating of 0% may be given for FF and ABD greater than 90 degrees IAW VASRD §4.31 (zero rating).  The Board noted the differences in ROM for the PEB and the C&P evaluations for which the record provided no explanation.  However, the Board unanimously agreed that the shoulder condition was not compensable for the ROM’s stated in either exam.  This was additionally supported by the preponderance of noncompensible ROM evidence in physical examinations in the 12-month period prior to separation.  The Board noted the slightly decreased motor strength of the left arm on the C&P examination.  In the absence of finding of muscle or tendon injury on radiographic examination and findings on exam of normal sensation, “no loss of deep fascia, muscle substance or impairment of muscle tone,” the Board opined this slight reduction was related to painful motion and not caused by a muscle or nerve pathology.  The Board was unable to recommend additional rating under VASRD §4.124 (diseases of nerves) or §4.73 (muscle injury).  The Board unanimously agreed the record of evidence supported a rating of 10% for painful motion, IAW VASRD §4.59, for the left shoulder condition.  The Board unanimously opined the left shoulder and scapular pain conditions, rated by the PEB as Category II conditions, were subsumed under the degenerative joint disease left shoulder condition and were not subject to separate rating IAW VASRD §4.14 (avoidance of pyramiding).  The Board was unable to find any other appropriate codes for consideration.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left shoulder 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 left 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 20130410, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 15 Dec 14

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandum, 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:

- XXXXXXXXXXXXXX, former USN    
- XXXXXXXXXXXXXX, former USMC  
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC