RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00659
BRANCH OF SERVICE:  coast Guard	SEPARATION DATE:  20061018

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Operations Specialist) medically separated for a right (dominant) shoulder disability.   The CI’s 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 MEB forwarded “other joint derangement, not elsewhere classified, shoulder region” to the Physical Evaluation Board (PEB) for fitness determination.  The MEB documented the condition as “aggravated by service - EPTE” (existed prior to enlistment).  No other condition was submitted by the MEB.  The Informal PEB adjudicated “shoulder impingement syndrome analogous to arthritis, degenerative; painful range of motion” as unfit, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  In making its finding, the PEB found the condition at enlistment rated 0%, with subsequent service aggravation rated 10%.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI contends that his right shoulder condition has worsened.  The complete submission is at Exhibit A.  

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 20060606	VA* - (~4 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Shoulder Impingement Syndrome Analogous to Arthritis, Degenerative	5099-5003	10%	Right Shoulder Impingement Syndrome with Rotator Cuff Tendonitis (Major)	5099-5024	10%	20070317	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 4	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20070622 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Right (Dominant) Shoulder Impingement Syndrome.  The narrative summary (NARSUM) and treatment record noted the CI was right hand dominate.  The CI had a pre-service right shoulder injury with strain with resolution of symptoms and a waiver for Service entry.  The CI had onset of right shoulder pain in August 2005 and in November 2005 was diagnosed with right shoulder impingement syndrome with bursitis.  Treatment with physical therapy and injections did not alleviate symptoms and the CI declined recommended surgery (adjudged reasonable).  At the MEB exam, the CI reported taking narcotic pain medication and nonsteroidal anti-inflammatory (NSAIDs) medication without relief, and had continued shoulder pain, difficulty sleeping due to pain, and pain with carrying weights.  The exam performed in December 2005 documented “satisfactory” range-of-motion (ROM), shoulder tenderness, positive impingement signs.  There was normal and symmetric upper extremity and grip strength and peripheral pulses.  The MEB physical exam performed April 2006 (6 months prior to separation) documented a full ROM with positive impingement signs (Hawkins and Neer).  MRI showed subacromial bursitis with no definitive rotator cuff tear or labral pathology while the examiner specified that the “physical exam may be consistent with a SLAP lesion” (a tear in the shoulder joint; superior labrum anterior and posterior lesion).  The examiner stated “(the CI) is unable to lift or do the overhead activities needed for active duty.”  

At the VA Compensation and Pension (C&P) exam performed 5 months after separation, the CI reported improvement in his shoulder due to decreased activities.  He was no longer taking medications, but continued to have stiffness and occasional difficulty sleeping.  The CI denied swelling, subluxation, dislocations or instability or giving-way.  He avoided heavy activities requiring lifting high up or repetitive overhead work.  Flare-ups were “not severe and do not occur now that he is not using it in repetitive activity.”  Exam documented tenderness with positive Hawkins impingement test.  There was painful ROM to VASRD normal limits and no motor weakness.  

The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Right Shoulder ROM
(Degrees)	MEB ~6 Mo. Pre-Sep	VA C&P ~5 Mo. Post-Sep	
Flexion (180 Normal)	FROM	180	
Abduction (180)	FROM	180	
Comments	Impingement; tender; “unable to work overhead”	Painful motion; tender, impingement -improved	
§4.71a Rating	10%-20% (PEB 10%)	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the shoulder condition at 10% coded analogously to 5003 (arthritis, degenerative [hypertrophic or osteoarthritis] citing analogy to arthritis with painful motion.  The PEB did not make any deduction for EPTS (shoulder injury Existing Prior To Service).  The VA rated the shoulder at 10% analogous to 5024 (tenosynovitis) which uses the same rating criteria as code 5003.  The Board deliberated if the CI’s shoulder symptoms and restrictions proximate to separation were equivalent to, or closer to, limited motion at shoulder level code 5201 (arm, limitation of motion) or 5202 (humerus impairment with recurrent dislocation) with guarding of motion at shoulder level.  The VA exam indicated post-separation improvement, while the CI’s contention indicated post-separation worsening.  The Board therefore adjudged that the MEB exam had the highest probative value for rating.  

Although the CI’s contention indicated frequent right shoulder dislocations, there was no evidence proximate to separation that the shoulder had recurrent subluxations or dislocations.  The NARSUM indicated that the CI was unable to work overhead, but also documented full ROM.  The record did not document sufficient evidence of either “guarding of movement only at shoulder level” or limited motion approximating a “limit at shoulder level” to support any rating higher than 10%.  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 right shoulder (dominant) 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 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 20140128, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

								   

Dear XXXXXXXXXX
I am the Designated Decision Authority for the Coast Guard on applications submitted to the Department of Defense Physical Disability Board of Review (PDBR).  Under the authority of Title 10, United States Code, section 1554a, I accept the PDBR’s recommendation in your case (Case Number PD-2014-00659) and decline to modify your findings. 

Enclosed for your information are a copy of the PDBR’s recommendation and a copy of the record of proceedings. 

A copy of this decision has also been provided to Coast Guard Enlisted Personnel Management Branch, the PDBR, and the Department of Veterans Affairs. 

If you have any further questions, please contact the Coast Guard Personnel Service Center at (202) 795-6628. 
	Sincerely,

2 Enclosures		
	
Copy:	CG Personnel Service Center (EPM-1)
DoD Physical Disability Board of Review
Department of Veterans Affairs