RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01040
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070111

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated for “left axillary nerve palsy” with a disability rating of 10%.

CI CONTENTION:  “Review 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 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 - 20061213	VARD - 20071231	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Axillary Nerve Palsy	8518	10%	Residuals S/P Left Shoulder Axonal Nerve Injury	8518	10%	20070404	
			Residuals Status Post (S/P) Left Shoulder Rotator Cuff Tear	5201-5024	10%	20070404	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

Left Axillary Nerve Palsy.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left axillary nerve palsy condition began in December 2004 upon awakening with intense pain in his left shoulder (he was right-hand dominant) during his second deployment.  Several days later he was in a car accident, further injuring the shoulder and leaving him unable to lift it at all.  X-rays were negative but he was medically evacuated in February 2005.  Magnetic resonance imaging (MRI) showed a rotator cuff tear.  Physical therapy and surgery ensued followed by recovery.  He deployed again and in late November 2005 the pain returned while helping to move sandbags.  Limited duty and physical therapy did not resolve the pain.  A repeat MRI in June 2006 showed swelling in the deltoid and teres major muscles of the shoulder, possibly due to an axillary nerve injury.  An electromyelogram showed probable musculocutaneous neuropathy on the left side and left brachial plexus neuropathy could not be ruled out.  The MEB forwarded left axillary nerve palsy for PEB adjudication.  

The orthopedics NARSUM examination, dated 13 September 2006, 4 months pre-separation, showed the CI had atrophy of his anterior and lateral deltoid muscles compared to the right side with numbness in the axillary nerve distribution with 5/5 abduction and 4/5 forward flexion. At the October 2006 MEB examinations (recorded on DD Forms 2807 and 2808), 3 months prior to separation, the CI reported numbness in the left shoulder with pain all the time and difficulty using his left arm.    Physical examination showed left shoulder pain, decreased range of motion (ROM) and decreased strength.  The 27 October 2006 MEB NARSUM examination noted complaints that the left arm hurt all the time.  He could not drive a military vehicle.  Activity made it worse; resting made it better. The pain interfered with sleep.  The pain rating was moderate and constant.   

At the April 2007 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported pain 9 out of 10 days, up to 6-7/10 intensity and flare-ups most days of the week.  The more active he was, the more the pain increased.  He had burning, tingling and numbness over the entire shoulder cap that radiated into his neck.  Physical examination showed a 2cm by 5 mm scar on the right shoulder, with flexion to 125 degrees with pain, and abduction to 75 degrees with pain.  He had a mild decrease in muscle bulk in the anterior deltoid, and the lateral and posterior deltoid regions as compared to the right.  He had a very positive Hawkins Kennedy test (damage to the tendon of the supraspinatus muscle) and due to pain it was not possible to perform the Neer test for signs of impingement.  He had 4/5 strength on the left for abduction and flexion compared to 5/5 on the right.  Reflexes were equal bilaterally.  There was decreased sensation to light and sharp touch along the whole shoulder cap extending to the lateral neck and down to the proximal one-third of the shoulder.  There was mild atrophy of the left shoulder but the examiner was unsure if this was from direct injury to nerve innervation or disuse of the left shoulder.  X-ray of the left shoulder showed new degenerative change and evidence of prior rotator cuff repair.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left axillary nerve palsy condition 10%, coded 8518 (paralysis of, moderate), citing moderate, incomplete paralysis.  The VA also rated the residuals s/p left axonal nerve injury condition 10%, coded 8518 and s/p left rotator cuff tear 10%, coded 5201-5024 (arm, limitation of motion - tenosynovitis), based on the C&P examination 3 months after separation, citing painful or limited motion and incomplete paralysis of arm movements.  

The Board noted that the ROM found in the MEB DD Form 2808, 3 months pre-separation, and the VA C&P examination ROM, 3 months post-separation, each showed atrophy of the anterior shoulder muscles and decreased strength.  The EMG showed probable axillary nerve damage which likely extended into the collection of nerves in the axillary portion of the shoulder.   The examinations also documented an abduction ROM of 90 degrees and 75 degrees, respectively.  There was decreased sensation to touch, both light and sharp, to the proximal one-third of the shoulder.  The Board concluded the preponderance of evidence is consistent with a 20% disability rating under the 8518 code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the left axillary nerve palsy condition, coded 8518.  

BOARD FINDINGS:  In the matter of the left axillary nerve palsy  condition, the Board recommends a disability rating of 20%, coded 8518 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, effective as of the date of the prior medical separation:  
CONDITION	VASRD CODE	PERMANENT RATING	
Left Axillary Nerve Palsy	8518	20%	

The following documentary evidence was considered:

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

AR20170005668, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified to but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure