RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01435
BRANCH OF SERVICE:  MArine CORPS	SEPARATION DATE:  20040831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Ammunition Technician and All-Marine Wrestler, medically separated for “right shoulder impingement syndrome” 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 - 20040709	VARD - 20041022	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Impingement Syndrome	5299-5003	10%	Residual Right Shoulder Dislocation	5299-5202	20%	20030908	
Right Shoulder Sternoclavicular Arthritis	Cat II	Status Post Resection of Right Sternal Clavicle (Collar Bone)	5299-5203	20%	20030908	
Left Shoulder Impingement	Cat III	Left Side Sternoclavicular Joint Separation 	5299-5202	0%	20030908	
Cervical Spine Facet Arthropathy	Cat III	Degenerative Arthritis of the Cervical Spine	5237-5242	10%	20030908	
Lumbar Spine Spondylolysis	Cat III	Arthritis of the Lower Back 	5010-5237	20%	20030908	
Left Knee Medial Meniscal Tear, Surgically Treated	Cat III	Residuals, Left Knee Meniscus Tear	5299-5259	0%	20030908	
Probable Muscle Tension Headaches	Cat III	No VA Placement	
Sleep Abnormality	Cat III		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Shoulder Impingement Syndrome.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI underwent right shoulder surgery in July 2003 for rotator cuff tear and anterior instability.  Following surgery, he had persistent pain, and in February 2004 the distal right sterno-clavicular joint (between the collar bone and breast bone) was resected.  

At the 8 September 2003 VA Compensation and Pension (C&P) evaluation, 11 months before separation and prior to the second surgery, the CI reported significant right shoulder pain, and could not raise his right arm above his head.  Physical examination showed dislocation of the right sternoclavicular joint with painful motion of the right arm.  Right shoulder range of motion (ROM) showed flexion of 90 degrees (normal 180) and abduction of 70 degrees (normal 180).  

During an orthopedic examination on 23 March 2004, 5 months prior to separation and 1 month after the sternoclavicular joint surgery (second operation), the CI complained of incisional pain and right shoulder pain with decreased ROM and strength.  ROM testing showed flexion of 90 degrees and abduction of 70 degrees.  There was tenderness, and testing for rotator cuff impingement and cross arm ROM was positive.  Overall, the CI was noted to be improving.  

At a physical therapy clinic visit on 28 April 2004, 4 months before separation, the CI reported his sternoclavicular joint pain had decreased, but that he had increased acromioclavicular joint pain; he was given a cortisone shot which helped.  He stated he still had limited ROM and was unable to put pressure on his right arm.  The examiner noted sternoclavicular joint tenderness, and ROM testing showed flexion of 120 degrees (abduction was not recorded).  While the CI’s ROM and pain were improving, he still had continued pain attributable to impingement.  

The 30 April 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of right shoulder impingement-like symptoms and sternoclavicular pain.  Physical examination showed well-healed surgical scars, pain over the anterolateral shoulder and sternoclavicular joint on palpation, and right acromioclavicular joint tenderness.  ROM testing showed flexion of 133 degrees and abduction of 128 degrees.  Rotator cuff impingement signs were positive and bicipital tendonitis testing was negative.  Muscle strength testing was 5/5 with the exception of the supraspinatus and infraspinatus which were 4/5.  Instability was not recorded.  Radiographs revealed excision of the distal clavicle of the right shoulder, but were otherwise normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, analogously coded 5299-5003 (arthritis, degenerative).  The PEB also listed right shoulder sternoclavicular arthritis as a related Category II condition (contributes to the primary unfitting condition but not separately ratable).  The impairment from the right shoulder sternoclavicular arthritis was properly subsumed under the overall rating for the right shoulder impingement syndrome.  The VA rated the right shoulder condition 20%, coded 5299-5202, (humerus, other impairment of), and 20% coded 5299-5203 (impairment of the scapula or clavicle), based on the C&P examination 11 months before separation and prior to the second surgery, citing infrequent episodes of dislocation of the scapula-humeral joint with guarding of arm movements only at the shoulder level.  The panel noted that this was based on the C&P done in the post-operative period shortly after the first procedure and prior to the second operation.  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 proximate to separation in evidence demonstrated motion above this level.  The panel assigned higher probative value to the ROM measurements at the time of the MEB NARSUM examination; it was closer to separation and followed the second surgery.  Although there was insufficient limitation of motion to support a rating under the 5201 code, the panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder condition.  

Contended PEB Conditions:  Left Shoulder Impingement, Cervical Spine Facet Arthropathy, Lumbar Spine Spondylosis, Left Knee Medial Meniscal Tear, Probable Muscle Tension Headaches, and Sleep Abnormality.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The commander noted that the CI had sustained injuries to his back, shoulder, and clavicle; however, the side for the shoulder and clavicle was not specified.  All were listed by the MEB.  While the CI continued to be symptomatic at separation, there was not sufficient performance-based evidence from the record to overcome the PEB adjudication.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right shoulder condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended left shoulder impingement, cervical spine facet arthropathy, lumbar spine spondylolysis, left knee medial meniscal tear, probable muscle tension headaches and sleep abnormality conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel 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 20160919, 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:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN