RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00869
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050520

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E2, Intelligence Analyst, medically separated for “right shoulder weakness,” rated 10%.

CI CONTENTION:  The CI made no specific contention.  The complete submission is 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 on 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 – 20050506	VARD - 20051006	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Weakness Secondary to Idiopathic Long Thoracic Nerve	8519	10%	Idiopathic Long Thoracic Neuropathy, Right Shoulder…	5203-8519	10%	20050820	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Shoulder Weakness Secondary to Idiopathic Long Thoracic Nerve.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right shoulder condition began while participating in basic training activities in March 2005.  Absent a history of direct injury or trauma to the upper extremity, the CI’s diagnosis was listed as a neurologic palsy probably attributed to the use of a shoulder rucksack.   Despite normal electro-diagnostic studies, the CI’s symptoms of pain and weakness continued causing an inability of the CI to perform unrestricted duty.  The MEB forwarded “long thoracic nerve palsy” for PEB adjudication.  

At the MEB NARSUM examination on 31 March 2005, 2 months prior to separation, the CI had continued complaints of right shoulder pain, numbness, and right forearm weakness.  His physical examination (PE) revealed un-quantified weakness of the right shoulder/upper extremity as well as “winging” of the right shoulder blade (indicative of muscular weakness secondary to a nerve abnormality).

At the VA Compensation and Pension (C&P) evaluation on 20 August 2005, 3 months after separation, the CI reported constant pain and numbness in the right forearm, protruding right shoulder blade, associated weakness and paralysis of his right arm.  He reported the inability to lift his right arm above his head and denied any lost time from work.  His PE revealed right shoulder range of motion (ROM) of 90 degrees of flexion and abduction (normal 180 for both).  Repetitive motion included additional findings of incoordination, lack of endurance, and weakness.  Winging of the right shoulder blade remained.    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition at 10%, coded 8519 (incomplete and moderate paralysis of the long thoracic nerve), citing moderate impairment.  The VA also rated the condition at 10%, coded 5203-8519 (impairment of clavicle or scapula-incomplete and moderate paralysis of the long thoracic nerve) based on the VA C&P examination 3 months after separation.  Board members considered the various coding options in this case and agreed the best coding schemes were limited to either the identified nerve code 8519 or a ROM code of 5201 (arm; limitation of motion).  The threshold for a shoulder ROM rating is motion to approximately 90 degrees for 20%; which is supported at the VA examination.  Additionally, the definitive diagnosis of “long thoracic nerve palsy” with objective symptoms was appropriately identified under the nerve code of 8519.  The nerve code has two categories of either complete paralysis (maximum of 30%) or incomplete paralysis with further sub-categories of mild (0%), moderate (10%), or severe (20%) impairment ratings.  Under “complete paralysis,” the VASRD criteria is, “…the inability to raise arm above shoulder level, winged scapula deformity.”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), all Board members agreed that such evidence of 90 degrees of ROM coupled with the scapular winging was supported under the 30% rating of the dominant shoulder under VASRD 8519. 

BOARD FINDINGS:  In the matter of the right shoulder condition, the Board unanimously recommends a disability rating of 30%, coded 8519 IAW VASRD §4.124a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Shoulder Weakness…	8519	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150607, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB																		

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170000689 (PD201500869)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

			       
						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA