RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00073
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20070206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Electronics Technician, medically separated for “right shoulder pain with periscapular muscle weakness” with a disability rating of 20%.

CI CONTENTION:  The CI requested consideration of 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 based upon a 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 - 20061024	VARD - 20070328	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain…	5299-5201	20%	Status Post Right Shoulder Rotator Cuff Repair and Capsular Release with Scar	5099-5019	10%	20061116	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI injured his right shoulder when a motor vehicle in which he was a passenger was involved in an accident and rolled over.  He underwent right shoulder surgery in April 2005 for rotator cuff repair and capsular release.  He continued to have shoulder and scapular region pain and an Magnetic resonance imaging study on 31 October 2005, 6 months after surgery, showed tendinosis (damage to the tendon at the cellular level) of the supraspinatus, a possible injury of the superior labrum (cartilage rim of the shoulder) and evidence of acromioplasty (removal of small piece acromion bone) changes.  Following surgery an orthopedic note in June 2006 indicated shoulder range of motion (ROM) and strength had improved with physical therapy but the CI re-injured the shoulder at work with return of pain.  The surgeon noted shoulder pain of unclear etiology and did not recommend any further surgery.  At the orthopedic clinic examination on 7 August 2006, 6 months prior to separation, the CI had regained full ROM but continued to have pain, although he reported a 90% decrease in pain level.  Physical examination showed no tenderness to palpation at the shoulder joint, no muscle atrophy and no instability.  Shoulder ROM measurements were recorded as 180 degrees flexion (normal) and 180 degrees abduction (normal).  There were positive impingement signs (positive Neer and Hawkins tests) demonstrating painful motion.  The MEB forwarded “pain in joint involving shoulder region” for PEB adjudication.

The MEB NARSUM examination on 16 September 2006, 5 months prior to separation, noted complaints of shoulder pain, worse with any activity, exacerbated by any movement.  Physical examination showed winging of the scapula on voluntary movement, accompanied by significant pain.  Bracing of the scapula decreased pain on movement.  The CI had a positive impingement sign, crossed arm test and positive O’Brien sign.  There was pain with internal and external rotation, with symmetric motion.  The CI’s right upper extremity was neurovascularly intact.  

At the MEB examination, 5 months prior to separation, the CI reported significant right shoulder pain which prevented him from eating and sleeping at times.  Physical examination showed limited right shoulder ROM with internal rotation.

At the 16 November 2006 VA Compensation and Pension (C&P) evaluation, performed 3 months before separation, the CI reported pain and weakness of the right shoulder joint, graded 4/10 in intensity, exacerbated by daily life activities which included washing dishes, vacuuming, dressing, and driving.  The pain precluded playing sports and swimming.  The CI used no assistive devices and lost no time from work due to his right shoulder condition.  Physical examination showed flexion and abduction ROM measurements to 180 degrees with pain beginning at 150 degrees.  Tenderness and crepitus were noted.  There was no loss of motion after repetitive testing, nor was ROM limited after repetitive testing by pain, fatigue, weakness, lack of endurance or incoordination (negative DeLuca factors).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder pain condition 20%, analogously coded 5299-5201 (arm, limitation of motion of).  The VA rated the right shoulder pain condition 10% analogously coded 5099-5019 (arthritis, degenerative), based on the VA C&P examination 3 months before separation, citing objective findings of tenderness and crepitus.  The Board reviewed to see if there was support for a higher rating than the 20% provided by the PEB.  The VASRD §4.71a threshold for 30% rating for ROM impairment of the dominant arm (code 5201, arm limitation of motion) requires motion limited to “midway between side and shoulder level.”  However, examinations did not reflect this degree of limitation.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available under the 5203 code (clavicle or scapula, impairment of).  The MEB NARSUM examination noted the CI had winging of the right scapular which is possibly related to injury to the long thoracic nerve (LTN).  However, coding the shoulder pain analogous to 8519 (long thoracic nerve) IAW VASRD 4.124a (neurological conditions) provides a maximum of 20% for “severe” incomplete paralysis of the LTN and there was no evidence of complete paralysis with inability to raise the arm above shoulder level for a 30% rating.  Therefore, there is no ratings benefit to the CI with this coding approach and the VARSD indicates that this rating is not to be combined with a rating based on limitation of shoulder motion.  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 pain condition.  
BOARD FINDINGS:  In the matter of the right 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 20150105, 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 20 Oct 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:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXXXXXX	     				  			  		  Assistant General Counsel
						  (Manpower & Reserve Affairs)