RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01689
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030627

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Light Wheeled Vehicle Mechanic, medically separated for “chronic right (dominant) shoulder pain,” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 - 20030421	VARD - 20030730	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	8519	10%	Right Long Thoracic Nerve Palsy, P/O Right Shoulder…	8519	20%	20030612	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Shoulder.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right hand dominant CI injured his shoulder in November 2001 after a motorcycle accident.  Electromyogram and nerve conduction studies (EMG, NCV) showed a long thoracic nerve injury.  A magnetic resonance imaging (MRI) study revealed some degenerative changes of the right shoulder.  The CI underwent a right shoulder arthroscopic acromioplasty and open distal clavicle resection in September 2002.  The 22 January 2003 physical medicine rehabilitation consult, 5 months prior to separation, confirmed the CI’s right shoulder injury and noted there was no evidence of cervical radiculopathy or plexopathy involving the right upper extremity, but there was nerve damage to the right long thoracic nerve with signs of nerve re-innervation.  
The 27 January 2003 MEB NARSUM examination, 5 months prior to separation, noted complaints of right shoulder pain and weakness.  The physical examination showed a right shoulder range of motion (ROM) of 150 degrees of flexion, 150 degrees of abduction and 0 degrees of external and internal rotation “to T4.”  The CI had mild weakness of both his triceps and deltoid functions secondary to pain with no other motor deficits noted.  Sensory function was intact and moderate winging of his right scapula was noted particularly during shoulder elevation between 50-100 degrees.

At the 12 June 2003 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported right shoulder pain aggravated by lifting.  He reported that he had about 80% of the strength that he used to have.  His pain was relieved by ice and non-steroidal anti-inflammatory medication.  He also reported weakness and scapular winging.  The physical examination showed decreased ROM with painful motion.  The examiner noted a diagnosis of scapular winging due to right thoracic nerve damage and confirmed a continuation of this condition. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition as moderate, 10%, coded 8519 (incomplete paralysis of the long thoracic nerve), citing scapular winging, 150 degrees of abduction, mild triceps and deltoid weakness secondary to pain, and no sensory or motor deficits.  The VA rated the right shoulder condition as severe, 20%, coded 8519, based on the C&P examination 6 months after separation, citing incomplete paralysis of arm movements characterized as severe.  

Panel members carefully considered the NARSUM and C&P examinations.  Both recorded the complaint of pain and weakness.  Physical examination at the NARSUM demonstrated mild weakness in the muscles supplied by the long thoracic nerve, and this finding was duplicated by the C&P examiner who recorded muscle strength 4/5, also mild.  All panel members agreed, the 10% rating and no higher was justified under the nerve code.  The panel also considered other routes to a higher rating.  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.  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).  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 right shoulder condition.  

BOARD FINDINGS:  In the matter of the right shoulder condition and IAW VASRD §4.124a, 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150625, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170008714, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					       
						      					
Enclosure