RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01048
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20141112
Separation Date:  20020426

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SN/E-3 (0000/Undesignated Seaman) medically separated for a recurrent left shoulder condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Rating or satisfy physical fitness standards.  He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  The shoulder condition, characterized as “recurrent left shoulder pain” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “Recurrent Left Shoulder Pain Status Post (s/p) Scope Sub acromial Decompression with Reinjury” as unfitting, rated at 10%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Shoulder Injury.”

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 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 20020228	VA - (1 Mo. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Left Shoulder Pain	5299-5003	10%	Left Shoulder Impingement with Residual Scar	5201	20%*	20020312	
Other x 0 (Not in Scope)	Other x 2	
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20020918 (most proximate to date of separation)
VARD dated 20040714 continued left shoulder condition at 20%; added peripheral neuropathy left upper extremity coded 8615, rated 20% effective 20020427

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

Recurrent Left Shoulder Pain Condition.  The CI had a left shoulder injury prior to enlisting into the US Navy; however, his symptoms improved and the shoulder returned to normal.  He initially injured his left forearm in March 1999 while on ship.  He was evaluated for exquisite tenderness and guarding of left upper extremity and diffuse tenderness along the radius, ulna and flexor muscles.  He was seen by neurology and diagnosed with a probable neuropraxic injury to left arm.  An electromyelogram/nerve conduction velocity was normal.  Both Vascular Surgery and Neurology evaluated the CI on 17 May 1999 and ruled out thoracic outlet syndrome as well as a neurological cause of the symptoms.  The CI continued to report persistent left shoulder pain and was seen by Primary Care in May 2000 for left shoulder tendonitis.  Orthopedics reevaluated the CI for left shoulder pain and crepitus, painful motion and testing which was positive for impingement.  He was sent to physical therapy for evaluation and treatment of left shoulder pain.  He was placed on LIMDU status from 3 October 2000 to 2 June 2001 for chronic left shoulder pain, left upper extremity dysesthesia and weakness.  A left shoulder magnetic resonance imaging with arthrogram demonstrated a labral tear.  On 17 September 2001, the CI underwent an arthroscopic procedure where no labral tear was found; however, a sub-acromial decompression (to treat impingement) was performed.  A month after surgery, orthopedics noted that the CI had pain with sudden movements on lifting his arm over his head.  There were physical exam findings of limited range-of-motion (ROM) to 90 degrees forward flexion and 80 degrees abduction.  

The MEB narrative summary (NARSUM) examination (completed 4 months prior to separation) documented that the CI had persistent left shoulder pain and difficulty with overhead activities.  He was currently taking non-steroidal anti-inflammatory drugs and was extremely limited in his ability to perform his duties.  The CI completed two LIMDU stint without resolution of his symptoms.  The MEB documented that the recurrent left shoulder pain condition did not exist prior to enlistment.  The MEB NARSUM physical exam findings are summarized in the chart below.  The VA Compensation and Pension (C&P) examination (accomplished approximately 2 months prior to separation) documented that the CI still experienced clicking, cracking, and discomfort with overhead use and had some decreased overhead working ability with use of his left arm.  The VA C&P physical examination findings are also summarized below.

There were three ROM evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Left Shoulder ROM (Degrees)	MEB 4 Mo. Pre-Sep	PT ~3 Mo. Pre-Sep	VA C&P 1.5 Mo. Pre-Sep	
Flexion (180 Normal)	90	65 	180	
Abduction (180 Normal)	-	70 	180	
Comments:
Right Hand Dominant	Pos. impingement & painful motion; Normal strength	Four months post-surgical; Pos. Painful motion	Pos. painful motion & crepitus; Decreased overhead strength; No evidence of impingement	
Rating 4.71	10% (PEB 10%)	20%	10% (VA 20%)	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB coded the recurrent left shoulder pain condition as 5299 analogous to 5003 (degenerative arthritis), and rated at 10%.  The VA coded the left shoulder impingement with residual scar condition as 5201 (limitation of arm motion), and rated at 20% citing “chronic labral tear, significant crepitus and functional impairment of overhead lifting.”  The Board deliberated on the probative value of the three ROM containing exams closest to separation and members agreed that the VA exam was the most probative as it was closest to separation and farthest from the surgical procedure performed 7 months prior to separation.  That exam documented non-compensable ROM measurements with satisfactory evidence of painful motion.  VASRD §4.71a specifies for 5003 that “satisfactory evidence of painful motion constitutes limitation of motion and specifies application of a 10% rating “for each major joint or group of minor joints affected by limitation of motion.”  There was no evidence that would support using any shoulder specific VASRD codes for the Board’s rating recommendation.  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 Recurrent Left Shoulder Pain 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 Recurrent Left Shoulder Pain s/p Scope Subacromial Decompression with Re-injury 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 20130420, 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 8 Apr 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:

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