RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02451
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20051117

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E6, Master at Arms, medically separated for “left shoulder impingement syndrome/rotator cuff tendinitis” with a disability rating of 10%.

CI CONTENTION:  “Please consider all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 Veterans Affairs Schedule for Rating Disabilities (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:  

SERVICE PEB – 20050907	VARD - 20060223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Impingement Syndrome/Rotator Cuff Tendinitis, Status Post Sub Acromial Decompression with Worsening Of Symptomatology	5299-5003	10%	Status Post Arthroscopy, Left Shoulder, with Impingement and Degenerative Joint Disease, and Scar 	5203	10%	20050926	
Acromioclavicular Arthritis - Status Post
Distal Clavicle Resection without Improvement	Not Unfitting / Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left Shoulder Impingement Syndrome/Rotator Cuff Tendonitis.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right hand- dominant CI injured his left shoulder in a motor vehicle accident in 1989.  He reinjured the shoulder after being recalled to active duty in March 2003 when opening a heavy gate while wearing body armor.  A magnetic resonance imaging (MRI) study on 22 January 2005 showed partial thickness articular surface tear of the posterior fibers of the supraspinatus tendon near its insertion.  There was tendonosis (chronic tendon degeneration without inflammation) of the supraspinatus tendon at the musculotendinous junction and of the infraspinatus tendon.  Ongoing pain led to arthroscopic subacromial decompression and an open Mumford procedure (distal clavicle excision/resection to ameliorate shoulder pain) in 16 May 2005.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “unspecified disorders of bursae and tendons in shoulder region,” and “localized osteoarthritis not specified whether primary or secondary, shoulder region” for PEB adjudication.

At the 3 August 2005 MEB examination, 4 months prior to separation, the CI reported left shoulder pain.  The pain prevented him from doing push-ups, pull-ups, overhead activity, lifting heavy objects above his shoulder, lifting more than 2.5 pounds above his waist, or from performing any type of restraint activities or weapons handling.  Physical examination showed diffuse left shoulder tenderness to palpation.  Pain was noted on provocative shoulder maneuvers, specifically the O’ Briens and Speeds tests (suggestive of bicipital tendon issue, suggests painful motion).  The left shoulder ROM was limited in forward flexion to 125 degrees (normal 180) and an abduction ROM was not measured.  

At the 26 September 2005 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported daily left shoulder pain rated at 5/10 with associated weakness, stiffness, limitation of motion, fatigability, and lack of endurance.  There was no reported instability and the pain was aggravated by lifting and sleeping on his left side.  Physical examination showed weakness of the left shoulder which increased with repetition.  The Neer test rotator cuff impingement signs (equivalent to painful motion) were positive.  The left shoulder ROM was 0-125 degrees of flexion and 0-115 degrees of abduction (normal 180) after repetition.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (arthritis, degenerative).  The PEB also listed acromioclavicular arthritis as a related Category II condition (contributes to the primary unfitting condition but not separately ratable).  The impairment from the acromioclavicular arthritis was subsumed under the overall rating for the left shoulder impingement syndrome/rotator cuff tendonitis (§4.14 avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA also assigned a 10% rating under the 5203 code (clavicle or scapula, impairment of) based on the VA C&P examination 2 months after separation, citing slightly limited and painful motion.  The MEB examination did not report ROM values for abduction and therefore the Board placed greater probative value on the more proximate, and comprehensive, VA C&P examination.  The VASRD §4.71a (code 5201, arm limitation of motion) threshold for a rating for ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion above this level.  Although there was insufficient limitation of motion to support a rating under 5201, Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no fibrous union or nonunion of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher rating available under the 5203 code (clavicle or scapula, impairment of).  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:  In the matter of the left shoulder impingement syndrome/rotator cuff tendonitis 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.  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 20140519, 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 24 Jun 16

      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:

		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC 

						 XXXXXXXXXXXXXXXXXXXX
	     				  	 Assistant General Counsel
						 (Manpower & Reserve Affairs)