RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00159
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20080630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aircraft Maintenance Administration Specialist, medically separated for “left shoulder pain,” with a disability rating of 10%. 

CI CONTENTION:  He continues to have left shoulder pain, limited range of motion, and can’t perform normal activities.  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 - 20080409	VARD - 20090609	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain	5299-5003	10%	Postoperative Glenohumeral Joint Osteoarthritis and Instability, Left Shoulder	5201-5010	10%	20090509	
Postsurgical State	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:  

Left Shoulder Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-handed dominant CI’s left shoulder condition began in fall of 2006 when he began experiencing multiple shoulder subluxations (partial dislocations).  No trauma or injury was reported.  Radiographic studies showed a Hill-Sachs deformity (occurs from a shoulder dislocation) and an anterior/inferior labrum lesion and probable bony fragments.  In November 2006, the CI underwent left shoulder arthroscopy for stabilization and in early 2007 he underwent left shoulder reconstruction.  Electro-diagnostic studies were performed in March 2007 for neck pain that radiated to the hands bilaterally worse on the left than the right and showed cervical radiculopathy, worse on the left.  A cervical MRI in December 2007 showed degenerative disc disease without cord compression or obvious neural compression and physical therapy was recommended.  Despite treatment, the left shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “pain in joint involving shoulder region” and “unspecified orthopedic aftercare” for PEB adjudication.

The MEB NARSUM examination on 23 January 2008, 5 months prior to separation, noted complaints of pain in his left shoulder with numbness and tingling radiating to his hand.  Physical examination showed decreased range of motion, 5/5 strength, no asymmetry or deformity with sensation intact.  At the MEB examination on February 2008, 4 months prior to separation, the CI reported tingling and numbness in his left hand.  The CI detailed he was unable to lift or hold his left arm up for any amount of time nor could he “straighten it out properly.”

The 9 May 2009 VA Compensation and Pension (C&P) evaluation, performed 11 months after separation, noted that following his surgeries, the CI was told he had moderate degenerative changes of the shoulder joint.  The CI reported the left shoulder appeared more stable following the surgeries.  However, he reported pain, for which he did not take pain medications, and significant loss of motion in the left arm compared to the right.  Physical examination showed cervical spine ROM of 40 degrees flexion (normal 45 degrees) and 45 degrees extension (normal 45 degrees), without pain.  There was “mild” discomfort noted with right and left lateral bending and rotation.  There was no radiating pain to either upper extremity and there were no radicular symptoms.  Left shoulder forward flexion was 130 degrees (normal 180 degrees) and abduction was 120 degrees (normal 180 degrees).  There was no pain with any ROM> Left shoulder X-rays showed post –surgical changes with intact screws and moderate degenerative changes. 
 
The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, coded 5299-5003 (arthritis, degenerative).  The PEB also listed postsurgical state as a related Category II condition (a condition that contributed to the primary unfitting condition but was not separately ratable).  The impairment from the postsurgical state was properly subsumed under the overall rating for the Category I unfitting condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited.  The VA also rated the left shoulder condition 10% coded 5201-5010 (arm, limitation of motion-arthritis, due to trauma, substantiated by X-ray findings), based on the VA C&P examination 11 months after separation, citing range of motion with no episodes of recurrent dislocation.  

The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level.  Although there was insufficient limitation of motion to support a rating under the 5201 code, Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion) coded according to 5003 criteria.  There was no malunion or recurrent dislocation of the humerus after his surgeries 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 shoulder condition.  

BOARD FINDINGS:  In the matter of the 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.  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 20141022, 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 21 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:

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

						  XXXXXXXXXXXXXXXXXXXX
	     				 	 Assistant General Counsel
						 (Manpower & Reserve Affairs)