RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01802
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20150106
SEPARATION DATE:  20040914

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-6 (7011/Expeditionary Airfield Systems Technician) medically separated for arthrofibrosis left shoulder status post left shoulder manipulation under anesthesia and capsular release.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The arthrofibrosis left shoulder status post left shoulder condition, characterized as “arthrofibrosis left shoulder status post left shoulder manipulation under anesthesia and capsular release” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB also identified and forwarded one other condition, chronic left shoulder pain, status post motor vehicle accident.  The Informal PEB adjudicated “arthrofibrosis left shoulder status post left shoulder manipulation under anesthesia and capsular release” as unfitting, rated 20%.  The remaining condition was determined to be Category II (a condition which contributes to the unfitting condition but is not separately ratable).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions”

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 arthrofibrosis left shoulder status post left shoulder manipulation under anesthesia and capsular release condition is addressed below along with the Category II chronic left shoulder pain condition; 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 20040315	VA - (13 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arthrofibrosis Left Shoulder Status Post Left Shoulder Manipulation Under Anesthesia and Capsular Release	5099-5003	20%	Left Shoulder Arthrofibrosis	5299-5203	10%	20051017	
Chronic Left Shoulder Pain, Status Post Motor Vehicle Accident	CAT II					
Other x 0 (Not in Scope)	Other x 2		
Combined:  20%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20060110 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Arthrofibrosis Left Shoulder Condition.  The narrative summary noted that the CI had chronic left shoulder pain following a motor vehicle accident (MVA).  Notes in the service treatment record (STR) indicated the CI reported pain and intermittent numbness in his non-dominant left upper extremity following the MVA on 8 December 2001.  Radiographs noted acromioclavicular (AC) arthritis.  Magnetic resonance imaging on 6 March 2002 suggested a partial rotator cuff (RC) tear and degenerative changes of the acromion.  Conservative treatment was not effective and the CI had arthroscopy on 8 August 2002 with repair of two labral tears and subacromial decompression/AC resection to reduce RC impingement.  The CI continued to have significant limited, painful range-of-motion (ROM) despite physical therapy (PT) due to adhesive capsulitis.  The CI had shoulder manipulation and a second arthroscopic surgery to release scarring (capsular release) 31 January 2003.  Following the procedure X-rays noted no abnormalities of the humeral head or shoulder joint.  Following the surgical release the CI did have improved, but still limited and painful ROM of the shoulder.  Orthopedic evaluation on 21 May 2003 noted “full overhead ROM” but also indicated abduction of 90 degrees (normal 180 degrees) and flexion of 110 degrees (normal 180 degrees).  PT visits in April and June 2003 noted active ROM of abduction and flexion of 150 degrees-160 degrees.  Orthopedic evaluation on 28 August 2003 noted continued pain and stiffness but did not recommend any further surgery because the “shoulder needs time to recover.”

At the MEB examination on 13 January 2004, approximately 8 months prior to separation, the CI reported left shoulder pain.  The MEB physical exam noted ROM of flexion described as “full 90 degrees of passive abduction limited by pain” and “forward flexion to 90 degrees limited by pain,” with RC strength graded 4+/5 on the left compared to the right.  Orthopedic evaluation on 28 April 2004 3 months after the MEB noted ROM of abduction of 90 degrees and flexion of 110 degrees, with painful motion.  The examiner also indicated that with full overhead motion the CI experienced pain and muscle spasms coming down.  Orthopedic re-evaluation on 12 May 2004 reiterated the same findings noting, “He is able to get his arms overhead slowly with significant pain in the left shoulder at approximately 110 degrees of abduction on the left.”  He has to manipulate the shoulder slightly to bring it overhead and has spasms and pain bringing the arm down to his side.

At the VA Compensation and Pension (C&P) examination on 17 October 2005, performed 13 months after separation, the CI reported left shoulder pain, stiffness, with limited motion, but no dislocations, or giving way.  Active shoulder ROM was noted as forward flexion of 180 degrees with pain and no additional loss of ROM with repetition.  Shoulder X-rays on 2 February 2005 noted post-surgical changes but were otherwise normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 20%, coded 5099-5003 (analogous to degenerative arthritis) with chronic left shoulder pain as a Category II condition.  The CI requested a Reconsideration PEB and the findings are not in the record, but notes indicated it resulted in no change, (31, 29, 489) and the CI waived a Formal PEB.  The VA rated the left shoulder 10%, coded 5299-5203 (analogous code for rotator cuff injury).  The Board noted that the ROM evidence was not documented in a clear and consistent fashion in the STR, including at the MEB examination.  However, the Board surmised from context that near the DOS, the CI was able to reach overhead, but would experience functionally limiting symptoms of pain and muscle spasms doing so.  The orthopedic evaluation noted after the MEB indicated that the ROM at which symptoms became limiting was improving and the post-separation C&P examination supported continued improvement, with residual painful motion.  Members agreed that the evidence at separation did not support a higher evaluation than the 20% conferred by the PEB; there was no evidence of for limited arm motion midway between the side and shoulder level or nonunion or fibrous union of the humerus.  
The Category II condition of chronic left shoulder pain noted by the PEB constituted a component of the CI’s left shoulder condition, already captured by the 5099-5003 code, and would therefore not be considered separately ratable.  The disability due to shoulder pain and limited motion from multiple factors such as degenerative joint disease, inflammation, and scarring is subsumed in the §4.71a rating of the left shoulder arthrofibrosis condition because painful and/or limited ROM of the shoulder can only be provided one disability rating IAW §4.14 (avoidance of pyramiding).  The Board noted that the PEB coding choice of 5099-5003 was not ideal as the rating criteria for 20% rating specifies involvement of two or more major joints, however, a recommendation to change the VA Schedule for Rating Disabilities (VASRD) code would not provide any benefit to the member.  Therefore, 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.  In the matter of the left shoulder arthrofibrosis 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 20140425, 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) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
         (b) CORB ltr dtd 18 May 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:

- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC

			  XXXXXXXXXXXXXXX
	     		  Assistant General Counsel
			  (Manpower & Reserve Affairs)