RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01668
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20040219

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

CI CONTENTION:  The CI contended that his service rating should be changed for his left shoulder, genital herpes, lumbosacral sprain, right and left knee arthropathy, ulcerative colitis, depression with adjustment disorder, and hemorrhoids.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20031102	VARD - 20040223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Subacromial Bursitis   	5299-5003	10%	Left Shoulder Injury Status Post Reduction Arthroplasty of the Distal Clavicle (non-dominant)	5201	20%	20040112	
Left ACJ Osteoarthrosis	Cat II					
Left SLAP Tear	Cat II					
Chronic Left Shoulder Pain	Cat II					
Left Biceps Tendinitis	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Subacromial Bursitis with Impingement.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-handed CI was first evaluated for left shoulder pain in May 1999.  This was later aggravated in a fight.  The CI was referred to physical therapy for rehabilitation, but his pain persisted.  He was placed on LIMDU for 8 months beginning 28 February 2000.  He underwent surgery on 1 May 2000.  His pain continued and he was placed on a second 8 month period of LIMDU.  A second surgery (SLAP repair, Mumford (for a rotator cuff injury) and removal of part of the collar bone) was done on 22 January 2001.  He again entered rehabilitation, but was not able to return to full duty.  A third MEB referred him to a PEB which, on 19 July 2001, determined that he was fit to continue on active duty, but he continued to have pain with activity.  At a 15 March 2002 primary care evaluation he was noted to have full, but painful, range of motion (ROM) with a positive impingement sign.  In physical therapy on 2 April 2002, the ROM was slightly reduced for flexion and abduction at 165 degrees each (180 normal).  An X-ray on 16 August 2002 showed expected post-surgical changes.  In orthopedics on 10 September 2002, the ROM was full.  Impingement signs were present.  

The 4 April 2003 MEB NARSUM examination, 10 months prior to separation, noted that the CI continued to have pain despite surgical intervention and rehabilitation.  On examination atrophy was absent and strength was good, but impingement signs were present and the acromioclavicular joint (ACJ) was tender to palpation.  Neither flexion nor abduction values were recorded.  

At the 5 June 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, the CI reported ongoing left shoulder pain.  On examination abduction was noted to be reduced without quantification.  The neurological examination was normal.
 
At the 4 September 2003 orthopedic examination, 6 months prior to separation, the CI had flexion of 160 degrees and abduction of 120 degrees with impingement signs.  A few weeks later in physical therapy on 25 September 2003, the CI was noted to have left shoulder ROM within functional limits and continued signs of impingement.  At a physical therapy follow up on 23 October 2003, he had increased flexibility which was again noted on 11 December 2003.  Impingement signs were absent at the latter examination.  The next day in orthopedics, the examination was deferred, but it was recorded that both the ROM and strength were improving and pain was decreasing.  

At the 12 January 2004 VA Compensation and Pension (C&P) evaluation, 1 month before separation, no recent aggravation of the left shoulder was documented.  On examination, abduction was limited to 90 degrees and flexion to 120 degrees and a sign of ACJ irritation (cross chest maneuver) was positive.  

The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Shoulder ROM
Degrees	Ortho~6 Mo. Pre-Sep	PT ~5 Mo. Pre-Sep	VA C&P ~1 Mo. Pre-Sep	
	Left	Left	Left	
Flexion (0-180)	160	Within Functional Limits	120	
Abduction (0-180)	120		90	
Comments	+Impingement	+Impingement		
§4.71a Rating	10%	10%	20%	

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition at 10%, coded 5299-5003 (analogous to degenerative arthritis).  All of the Category 2 conditions were subsumed under the left shoulder for rating purposes.  The VA also rated the left shoulder as a single condition, but at 20%, coded 5201 (arm limitation in motion), based on the VA C&P examination 1 month prior to separation.  

The panel considered the evidence.  The ROM obtained on the VA examination supports a 20% rating for limitation in abduction.  The values obtained on the orthopedic examination in September 2003 are non-compensable other than for painful motion (implied with a positive impingement sign).  Three weeks later, the CI was noted to have a ROM within functional limits.  Two successive physical therapy notes and the orthopedic note, dated 12 December 2003, record that the CI was continuing to improve in ROM, strength, and pain.  The VA examination is an outlier from the preponderance of evidence and without an explanation for the decreased motion found.  The probative value of the VA examination is therefore reduced and it is not used for rating purposes.  The panel considered if the Category 2 conditions were separately unfitting and thereby separately ratable.  All pertained to the left shoulder and impacted the ROM and pain with movement.  The relative contributions of each to the impairment are not severable and the CI was rated on the total impairment.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel 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 subacromial bursitis with impingement condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150623, 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: PHYSICIU. DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDAT IONS Ref:	(a) DoDI 6040.44
In accordance with reference (a), I have reviewed the cases listed below and 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 :

-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX ., XXX XX 6924, former USN
-	XXXXXXXXXXXXXXXXXX, XXX XX 9590, former USMC
-	
XXXXXXXXXXXXXXXXXX, XXX XX 3497, former USN

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