RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00299
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20060430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E5, Ground Communications and Organizational Repairer, medically separated for “left shoulder pain status post rotator cuff repair, impingement” with a disability rating of 20%.

CI CONTENTION:  “Review all conditions.”  The CI’s 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 - 20060224	VARD - 20141107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain	5299-5003	20%	Impingement, left Shoulder	5201	0%	20140527	
			Scar, Left Shoulder…	7805	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Shoulder Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the left-dominant CI injured his left shoulder doing pull ups in August 2003.  An MRI arthrogram confirmed a rotator cuff injury, cartilage (labrum) damage, and degeneration of the acromio-clavicular joint (ACJ, the fibrous joint between the shoulder blade and collar bone).  He underwent left shoulder surgery on 26 April 2004 for subacromial decompression and distal clavicle resection.  He was released from active duty on 11 June 2004.  Despite rehabilitation, the CI did not improve sufficiently following surgery to meet full duty requirements.  An MRI on 13 April 2005 showed post-surgical changes as well as indications of an injury, but without a cartilage or tendon tear.  At a civilian orthopedic evaluation on 18 May 2005, atrophy was absent and the range of motion (ROM) was comparable to the unaffected right side.  Some signs of impingement were present.  The CI was not able to return to full duty and he was referred for an MEB.  The MEB NARSUM, dated on 25 August 2005, 8 months prior to separation, noted pain aggravated by overhead lifting and rotation.  On 10 February 2006, 3 months prior to separation, the CI was noted to have flexion limited to 65 degrees on the left.  However, it was also limited to 75 degrees on the normal right shoulder.  Previously, the ROM had been noted as normal or near normal.  

The VA Compensation and Pension (C&P) examination was not performed until approximately 8 years after separation and the findings from this evaluation as too distant from separation to provide any probative information to the panel.  However, the ROM of the right shoulder was full as expected and the left shoulder showed 160 degrees of abduction and 150 degrees of flexion, consistent with the measurements obtained 17 months pre-separation.  There were 3 sets of ROM evaluations in evidence which the panel weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized below.  

Left Shoulder ROM
(Degrees)	PCC ~17 Mos. Pre-Sep	PT~17 Mos. Pre-Sep	PCC ~3 Mos. Pre-Sep	
Flexion (180 Normal)	160	WNL	65	
Abduction (180)	170		145	
Comments		Painful Motion	75 degrees on the right side	
§4.71a Rating	0%	10%	20%	

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under an analogous 5003 code (degenerative arthritis).  The VA assigned a 0% rating using the 5201 code (arm limitation of motion) noting non-compensable limitation of motion.  The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) the next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level.”  This degree of limitation was not present.  There was no a higher rating under an alternate code.  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 shoulder 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 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 20160518, 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:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
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:

		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN