RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00556
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090506

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for “chronic right (non-dominant) shoulder pain and weakness due to long thoracic nerve injury” with a disability rating of 20%.

CI CONTENTION:  No specific contention was made.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:

SERVICE PEB - 20090319	VARD - 20090930	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain and Weakness due to Long Thoracic Nerve Injury	8519	20%	Long Thoracic Nerve Injury	8519	20%	20090730	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Chronic Right Shoulder Pain and Weakness due to Long Thoracic Nerve Injury.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right shoulder condition began during the second week of basic training.  After performing pushups to exhaustion while wearing a fully loaded ruck sack and individual body armor, he experienced right shoulder pain and weakness.  He subsequently reported the inability to perform pushups, lift heavy objects, salute, or hold a weapon.  A 6 November 2008 electrodiagnostic study determined he had a right long thoracic nerve injury.  No surgery was indicated.

The 23 February 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of right shoulder pain and weakness.  Physical examination showed the CI had difficulty undressing and dressing for the examination due to right shoulder weakness and pain.  There was marked right scapula winging while attempting wall push-ups.  Right shoulder range of motion (ROM) of flexion and abduction was 30 degrees each (normal 180 each).  

At the 30 July 2009 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported right shoulder weakness, stiffness, giving way, lack of endurance, locking, fatigability, tenderness , pain, and a sense of dislocation.  Flare-ups occurred as often as 3 times per day lasting up to 3 hours each.  He denied incapacitation.  ROM was flexion and abduction to 55 degrees each with pain and weakness noted after repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 20%, coded 8519 (long thoracic nerve, paralysis of, complete; inability to raise arm above shoulder level, winged scapula deformity), citing pronounced winging of the scapula with flexion and abduction to 30 degrees.  The VA also rated the right shoulder condition 20%, coded 8519, based on the C&P examination, citing severe incomplete paralysis of arm movements.

The panel agreed there was no evidence of arm limitation of motion to 25 degrees or less to support a 30% rating under the criteria for code 5201 (arm, limitation of motion).  Additionally, the PEB adjudicated the maximum rating using code 8519 for the non-dominant shoulder.  There are no other applicable codes.  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.

BOARD FINDINGS:  In the matter of the right shoulder condition and IAW VASRD §4.71a and §4.124a, the panel recommends no change in the PEB adjudication.  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 20170124, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180004705, 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