RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03589
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20090530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Small Arms Repairer/Technician, medically separated for “left joint shoulder pain, pectoralis minor tear, biceps tendonitis, 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 - 20090225	VARD - 20100927	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain	5099-5003	10%	Left Rotator Cuff Syndrome	5099-5024	10	20100119/29	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Joint Shoulder Pain, Pectoralis Minor Tear, Biceps Tendonitis, and Rotator Cuff Tendinitis.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right hand dominant CI injured his left shoulder in 2006.  The condition was not associated with a surgical indication.  A magnetic resonance imaging study and an X-ray, on 13 February 2008, indicated a normal left shoulder.  The CI continued to have left shoulder pain with reported tingling down to his fingertips.  Despite physical therapy and cortisone injections the CI’s shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for a MEB.  At the time of the physical therapy examination for the MEB Addendum, on 20 November 2008, the CI reported shooting pains into his left shoulder with just sitting activities aggravated by activities and weight bearing.  On examination the left shoulder range-of-motion (ROM) was within normal limits (and symmetric with the right shoulder) and there was minimal pain at the end range of flexion and adduction.  There was slight weakness (5-/5) in flexion and abduction, and pain with impingement testing and rotator cuff testing.  According to the MEB NARSUM evaluation on 9 January 2009 (5 months prior to separation) the examiner noted shoulder pain that caused the CI to be unable to lift greater than 40 pounds or complete overhead activities without pain.  On examination, testing for anterior instability, acromioclavicular joint degeneration, glenohumeral instability and bicep tendonitis were negative.  Muscle strength and reflexes were normal.  

At the VA Compensation and Pension (C&P) general medical examination on 19 June 2010, performed 13 months after separation, the CI reported pain with any physical activity and sometimes with no provocation.  The physical exam showed full range of motion (ROM) with no joint swelling, redness, increased warmth, popping, crepitus or pain on palpitation.  No left upper extremity neurologic deficits were noted.  At the C&P joint examination on 29 June 2010, performed 13 months after separation, the CI reported his left shoulder clicked and popped with shooting pain, numbness and tingling feelings.  The CI complained of the shoulder giving way, locking, and feeling unstable.  The physical exam showed crepitus, tenderness, and biceps tendon pain.  Tests for impingement were negative.  The ROM was flexion of 140 degrees (180 normal) and abduction 125 degrees (180 normal).  The diagnosis was left rotator cuff syndrome.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5099-5003 code (degenerative arthritis).  The VA assigned a 10% rating using an analogous 5099-5024 code (tenosynovitis) for painful or limited motion of a major joint or group of minor joints.  The VASRD §4.71a (code 5201, arm limitation of motion) threshold for a minimum rating for ROM impairment is “at shoulder level,” and the ROM in evidence demonstrated motion above this level.  Although the limitation of motion did not support a minimum rating (5201), Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating 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 pain condition.  

BOARD FINDINGS:  In the matter of the left shoulder pain 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 20140707, with attachments
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 9 May 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:

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