RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-00163
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20081129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Field Artillery Cannoneer, medically separated for “right shoulder rotator cuff tendonitis, S/P SLAP repair and shoulder pain” with a disability rating of 20%.  

CI CONTENTION:  The CI submitted a lengthy contention stating that other related condition and aspects of his disability should have been taken into consideration.  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 - 20080721	VARD - 20090316	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Rotator Cuff Tendonitis…	5299-5201	20%	Right Shoulder Rotator Cuff Tendonitis and Osteoarthritis…	5010-5201	30%	20081028	
Right Wrist Numbness…	Cat II	S/P Right Wrist Fracture	5260-5024	10%	20081028	
Right Facial Numbness	Cat II	Right Facial Paresthesia	8207	0%	20081028	
Right Ankle Chronic Pain…	Cat II	Right Ankle Inversion Injury…	5271	20%	20081028	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Shoulder Rotator Cuff Tendonitis, Status Post (S/P) SLAP Repair and Shoulder Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right dominant CI injured his right shoulder in 2004.  Non-operative treatment was not successful and he underwent right shoulder surgery on 2 October 2007.  He then entered rehabilitation in physical therapy.  In a post-operative evaluation on 29 November 2007, 8 weeks after surgery, he was noted to have a stable shoulder.  Flexion was limited to 60 degrees by pain and abduction to 45 degrees, also by pain; this was improved from a physical therapy examination 2 weeks earlier (10 and 20 degrees, respectively).  Normal range of motion (ROM) is 180 degrees for each.  A post-operative arthrogram on 26 March 2008 showed a good surgical repair with some fraying of the rotator cuff.  

According to the 28 May 2008 MEB NARSUM evaluation, 6 months prior to separation, the CI continued to have right shoulder pain.  He could not do any pull-ups or wear a flak jacket.  He also reported trouble with any sort of weight bearing activities.  The examiner noted that the CI had a right shoulder range of motion (ROM) of 90 degrees forward flexion and 135 degrees of abduction.  He had increased pain with any resistance of external rotation for the rotator cuff musculature and 4/5 strength for internal rotation.  His deltoids were reduced at 4+/5.  The MEB 2808 dated 16 June 2008 noted decreased ROM of the right shoulder without quantification.  The neurological examination recorded a decrease in sensitivity to touch, but did not record a motor examination (implying that it was normal or near normal).  

At the 28 October 2008 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported daily pain which prevented him “from just about everything.”  The examiner noted that he could only perform a minimal examination due to the CI’s significant pain.  Forward flexion was 80 degrees with significant pain and no repetition due to pain.  He had abduction to 35 degrees limited by severe pain with the inability to do 3 repetitions due to pain.  His right shoulder external and internal rotation as 0 degrees again limited by pain.  Right shoulder x-rays done on 28 October 2008 shoulder showed post-surgical changes but were otherwise normal.  Neither atrophy nor strength was recorded.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under an analogous 5299-5201 code (limitation of arm motion).  The VA assigned a 30% rating using the dual 5010-5201 code (traumatic arthritis/limitation for arm motion) for limitation of arm motion midway between the side and shoulder level based on the VA C&P examination.  The VASRD §4.71a threshold for a 20% 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 limited to this level.  The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level.”  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available under the 5203 code (impairment of clavicle or scapula).  The panel considered the evidence.  The CI had surgery 14 months prior to separation.  The evidence leading up to the C&P examination showed that the CI was improving following surgery as expected including the ROM.  The DD 2808 did not quantify the ROM.  The VA C&P examination documented loss of motion for abduction much less than that recorded after the immediate post-operative period although the change in flexion was only 10 degrees.  No intervening injury was documented to explain the loss of motion.  The panel also noted that atrophy was not recorded.  While the loss seen in abduction on the VA C&P examination was not explained by the examiner, this evaluation was the most proximate to separation and is therefore accorded the highest probative value for rating.  A 30% rating is supported by this examination and is recommended at separation, coded 5201.  

Contended PEB Condition:  (Cat III conditions: Right Wrist, Right Facial Numbness, Right Ankle Chronic Pain Syndrome).  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  X-rays of the right wrist showed good alignment with a small amount of arthritis on one view.  Subjective numbness of the right side of the face was reported.  A neurological examination on 26 July 2005, for the right ankle, was normal for both the face and wrist.  While the CI had been placed on LIMDU for the right ankle, he had subsequently been returned to full duty.  No condition was implicated in the commander’s statement.  There were no clinical records in evidence specific for these conditions in the final 2 years of active duty.  There was no performance-based evidence from the record that the any significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for these conditions and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right shoulder condition, the panel unanimously recommends a disability rating of 30%, coded 5201 IAW VASRD §4.71a.  In the matter of the contended right facial numbness, wrist, and ankle conditions, the panel recommends no change from the PEB determinations as not unfitting.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Shoulder Pain…	5201	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment 

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs)
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 22 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(k) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(l) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(m) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(n) PDBR ltr dtd 21 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(o) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (o) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     c. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     d. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     e. XXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.

     f. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge. 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

     g. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     h. XXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     i. XXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.

     j. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     k. XXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     l. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     m. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     n. XXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.
     
3.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.

	XXXXXXXXXXXXXXXXXXX
	Acting