RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02334
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050909

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Cannon Fire Direction Specialist, medically separated for “chronic left neck and shoulder pain” with a disability rating of 10%.  

CI CONTENTION:  “Nerve damage in my upper back and neck that has caused permanent numbness and pain in my left arm.”  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 - 20050712	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Neck and Shoulder Pain	8519	10%	No VA Claim	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Left Neck and Shoulder Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s “chronic left neck and shoulder pain” condition began in August or September 2003 after a gradual onset of symptoms.  The CI noted numbness and tingling, stating, “My entire left arm would fall asleep,” after wearing load-bearing equipment, body armor and a rucksack on a daily basis.  There was no surgical indication and after an adequate period of physical therapy the CI’s condition could not be rehabilitated to allow for unrestricted activity and completion of all tasks required of his military specialty.  
An 18 November 2003 MRI of the cervical spine, 22 months prior to separation, demonstrated normal vertebral bodies and disc thicknesses and a very slight posterior bulge of the C3/C4 disc that did not touch any of the nerves in the neck.  

A 27 January 2004 electro-diagnostic nerve study, 20 months prior to separation, showed a left long thoracic neuropathy.  A repeat study performed 7 February 2005, 7 months prior to separation, showed improvement in the left long thoracic neuropathy but no resolution and a new left dorsal scapular neuropathy.  

The 6 April 2005 orthopedics consult examination for the MEB, 5 months prior to separation, recorded complaints of constant left shoulder pain that was worse with wearing a book bag or lifting more than 40 pounds with the left arm.  The physical examination revealed full range of motion (ROM) of both shoulders with normal muscle strength and sensation in the arms.  The examiner noted significant scapular winging (paralysis of the subscapularis muscle – innervated by the long thoracic nerve) and atrophy of the serratus anterior muscle (innervated by the dorsal scapular nerve).  

During the 27 January 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, the CI reported pain in his back that caused numbness and tingling in his left arm and shoulder.  The physical examination showed the neck had full ROM.  There was tenderness of the neck muscles on the left side but no tenderness of the bones.  The left shoulder also demonstrated full ROM and there was no tenderness.  

The 5 May 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of an aching pain overlying the left scapular region.  His pain was aggravated by wearing a backpack or a heavy coat lying on the left scapular area and by running.  The CI speculated that the bouncing motion caused an increase in his symptoms.  At its worst, the aching and then tingling would radiate into the left armpit and down the inner aspect of the left arm and into his whole hand.  Pain was rated 3-4/10 constantly and increased to 6-7/10 with activity.  The physical examination showed a winged scapula on the left and full active ROM of the neck.  A physical examination technique to induce nerve pain associated with the cervical spine was negative.  No neurological deficits of the left arm were found.  The examiner recorded that the CI was right-handed.  The CI did not file a VA Compensation and Pension claim.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left neck and shoulder pain condition 10%, coded 8519 (incomplete paralysis of the long thoracic nerve, moderate), citing the electro-diagnostic studies’ results, winged scapula, and serratus and rhomboid muscle atrophy.  

In accordance with VASRD §4.123, neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis.  Panel members noted that with the long thoracic nerve there is not a corresponding reflex but that all of the other features listed were present in this case.  The presence of all other features validates a rating of 20% under code 8519, severe.  There is not a higher rating under code 8519 for the non-dominant side.  There was no loss of ROM in the shoulder or neck to support ratings in the respective codes.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the chronic left neck and shoulder pain condition, coded 8519.  

BOARD FINDINGS:  In the matter of the “chronic left neck and shoulder pain” condition, the panel unanimously recommends a disability rating of 20%, coded 8519 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel 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	
Chronic Left Neck and Shoulder Pain	8519	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150907, w/atchs
Exhibit B.  Service Treatment Record

AR20170011809, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified 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,