RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00167
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20021130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Helicopter Power Plant Mechanic, medically separated for “left shoulder rotation contracture, status post arthroscopic capsular plication, subacromial decompression and distal clavicle excision” with a disability rating of 10%.

CI CONTENTION:  The shoulder condition continues to hinder the CI’s ability to find stable work and interact with his children.  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 - 20020919	VARD - 20030711	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Surgical Residuals, Left Shoulder	5299-5003	10%	Residuals, Left Shoulder	5201-5010	10%	20030212	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Shoulder Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered a strain injury to his left (non-dominant) shoulder in January 2001.  Imaging (arthroscopic MRI) demonstrated arthrosis of the acromioclavicular joint with some impingement, and there was no notation of ligamental injury.  The CI’s symptoms continued; and, in January 2002 (11 months before separation) he underwent surgical intervention (arthroscopic subacromial decompression and distal clavicle excision [Mumford procedure]).  Post-operative STR entries documented progressive recovery of full (or nearly so) range of motion (ROM), but with residual painful motion.  There was no post-operative evidence of subluxation, instability or other VASRD ratable features.  Surgical results were insufficient to allow unrestricted duty and the CI was referred for an MEB, which in turn forwarded “left shoulder internal rotation contracture status-post arthroscopic [surgery]” to the PEB.  The NARSUM examination in July 2002 (4 months before separation) stated, “He has done fairly well post-operatively with his pain considered much improved...main limitation at this point is that he is unable to perform a standard pull-up...[as required by] Marine Corps...standards.”  The physical examination recorded negative signs of impingement without notation of instability.  The documented ROM was external rotation limited to 40 degrees (normal 90, not a VASRD rating criterion) and “full forward flexion” (no comment regarding abduction).  Formal ROM measurements by physical therapy two weeks after the NARSUM were forward flexion to 170 degrees (normal 180, 90 for minimum 20%), abduction to 170 degrees (same parameters), and improved external rotation to 50 degrees.

A VA Compensation and Pension (C&P) examination in February 2003 (3 months after separation) stated, “He currently has pain at the limits of his ROM and avoids working overhead.”  The physical examination recorded “well-healed and non-tender” surgical scars without notation of joint instability or impingement.  Measured ROM was forward flexion to 155 degrees and abduction to 145 degrees, specifying painful motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating analogous to 5003 (degenerative arthritis) was aligned with VASRD §4.71a criteria for the MEB findings and ROM evidence.  The VA assigned a 10% rating under code 5201-5010 (limitation of motion rated as traumatic arthritis [5003]) citing the C&P ROM measurements.  The ROM evidence did not support the minimum compensable rating, except by application of VASRD §4.59 (painful motion).  There was no ankylosis or fracture (nonunion/malunion) that would support a higher rating under any other joint code; and, there was no post-surgical history of dislocations or findings of instability that would support a higher rating under code 5202 (humerus, other impairment).  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 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 20150209, 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:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXXX	     				 			  Assistant General Counsel
						  (Manpower & Reserve Affairs)