RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01026
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20030213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Information Systems Technician, medically separated for “persistent left shoulder pain,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 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 - 20021003	VARD - 20030530	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Persistent Left Shoulder Pain	5299-5003	10%	Biceps Tendon Laxity, Left Shoulder, Status Post Surgical Repair	5201	30%	20021007	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Persistent Left Shoulder Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left shoulder surgery on 7 June 2001 for left bicipital tenodesis condition, coracoacromial ligament release and subacromial decompression.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “persistent left shoulder pain” for PEB adjudication.  

At the time of the MEB NARSUM examination on 4 January 2002, 13 months prior to separation, the CI reported persistent pain.  Physical examination range of motion ROM forward flexion of 170 degrees (normal 180) and abduction of 160 degrees (normal 180).  Strength was 5/5; however, subjectively weaker than it was on the right side.  The MEB recommend the CI be placed on a second period of 8 months of limited duty with limitations of no push-ups, no pull-ups, and no lifting greater than 15 pounds.  According to the MEB NARSUM evaluation on 8 July 2002 (7 months prior to separation) the CI complained of shoulder pain prevents him from performing enough pushups required to pass the Navy Physical Readiness Test.  Shoulder dislocations were not reported.  Physical examination showed no evidence of instability; bicep tension test/speed test was negative, impingement tests were negative, and apprehension test was negative.  Left shoulder flexion was normal at 180 degrees and abduction was normal at 180 degrees.  The examiner stated there was “no further surgical or nonsurgical options at this point.”  

At the 7 October 2002 VA Compensation and Pension (C&P) examination, performed 4 months prior to separation, the CI reported shoulder pain with activities such as driving an automobile and extending his shoulder.  He has pain rated a 5/10 associated with limitation of motion and he is unable to do pushups.  Physical examination showed asymmetrical contour to the left deltoid from the anterior view compared to the right.  The ROM measurement of abduction at 120 degrees and flexion of 160 degrees.  The Neers test was negative, impingement test was negative for pain, and strength was on 2/4, the general strength of the shoulder was decreased with the loss of ROM and loss of function.  The examiner characterized the condition as severely dysfunctional.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating, analogously code 5003 (degenerative arthritis).  The VA assigned a 30% rating using the 5201 code (arm, limitation of motion), citing symptoms of limited motion, muscle atrophy, and muscle weakness with 2/4 strength determined to represent moderately severe impairment.  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 no 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).  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).  Atrophy of the left deltoid muscle and left shoulder weakness was noted on examinations and considered under the muscle group code 5303 (Elevation and abduction of arm to level of shoulder).  Although the CI was able to raise his arm above shoulder level, Board members agreed that a 20% rating was justified for atrophy of the left deltoid muscle and left shoulder weakness base on application of VASRD §4.56 (Evaluation of muscle disabilities).  There was no palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side to justify a higher rating under the 5303 code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 20% for the left shoulder condition.  

BOARD FINDINGS:  In the matter of the left shoulder pain condition, the Board unanimously recommends a disability rating of 20%, coded 5303 IAW VASRD §4.71a.  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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Shoulder Pain	5303	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150608, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 25 Nov 16 ICO XXXXXXXXXXXXXXXXXX    
	(c) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 17 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 25 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 17 Nov 16 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (i) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:
     
     a. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, retroactive placement on the Temporary Disability Retired List with a 50 percent disability rating for six months, followed by a final disability rating of 10 percent. 

     b. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 20 percent) effective date of discharge.  

     c. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 60 percent disability rating (increased from 10 percent) effective date of discharge.  

     d. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.  

     e. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, entitlement to disability severance pay with a 20 percent disability rating (increased from 10 percent).   

     f. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, entitlement to disability severance pay with a 20 percent disability rating (increased from 10 percent).  

     g. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, entitlement to disability severance pay with a 20 percent disability rating (increased from 0 percent).

     h. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.     

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)