RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03053 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050801

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Military Policeman, medically separated for “left shoulder pain” with a disability rating of 10%.

CI CONTENTION: Review requested of the left shoulder condition as well as additional conditions (back, knee, right shoulder, scars) not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 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 - 20050609	VARD - 20060120	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain	5299-5003	10%	Left Shoulder Status Post Injury, Postoperative Resection of Distal Clavicle, Subacromial Decompression, Rotator Cuff Repair, with Surgical Scars	
5201	
20%	
20050104	
Mild Decrease in Strength Bilaterally and Globally…	Cat II					
Acromiale to the Left Shoulder	Cat II					
Resolved Impingement…	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Left Shoulder Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI was diagnosed with a left shoulder impingement and os acromial (developmental failure of distal acromial fusion) in 2001 and underwent an arthroscopic bursectomy and subacromial decompression in January 2003, and a repeat subacromial decompression with distal clavicle resection and rotator cuff debridement on 7 July 2004. He developed a post-operative infection resulting in an arthroscopic wound irrigation and debridement on 21 July 2004. Despite some improvement, his pain persisted and prevented physical training. Left shoulder X-rays on 1 October 2004 showed post-operative changes with absence of the distal clavicle but otherwise normal glenoid and humeral head.

At the 4 January 2005 VA Compensation and Pension (C&P) examination, 7 months before separation, the CI reported daily left shoulder discomfort and flare ups with shoulder movements. He was unable to perform throwing motions, push-ups, pull-ups or overhead work. Physical examination showed slight deltoid muscle atrophy with a palpable defect of the lateral aspect of the clavicle at the acromioclavicular joint. There was no crepitus or instability, and both flexion and abduction were to 170 degrees (normal 180), with painful motion.

At the 1 March 2005 MEB NARSUM examination, 5 months prior to separation, the CI reported constant pain rated at 2/10, with severe pain during any attempted physical training such as pull- ups or weight lifting. Physical examination showed left shoulder flexion to 170 degrees, with mild tenderness during internal rotation. There was bilateral symmetric movement of the scapulae with strength at 4+/5. Clinical examination for impingement, instability, labral injury and tendonitis was negative.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left shoulder condition 10%, analogously coded 5299-5003 (degenerative arthritis), and listed “mild decrease in strength bilaterally and global to his upper extremities, very mild,” “acromiale to the left shoulder,” and “resolved impingement examination findings to the affected left shoulder” as Category II conditions (contribute to the primary unfitting condition, but not separately ratable). Panel members agreed that these diagnoses were intrinsic to the rated condition and a separate rating could not be supported without pyramiding (VASRD §4.14); thus, the conditions were appropriately subsumed under the same rating. The VA rated the left shoulder condition 20%, coded 5201 (limitation of arm motion), based on the C&P examination, citing limitation of arm motion midway between side and shoulder level, or at shoulder level. The panel noted that while the examinations in evidence did not meet the VASRD §4.71a threshold for rating ROM impairment under code 5201 “at shoulder level” (approximately 90 degrees from the side), a 10% rating was justified with application of VASRD §4.59 (painful motion). The panel considered other VASRD shoulder and analogous codes, but all were less applicable and/or not advantageous for rating. After due deliberation, considering all 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 left shoulder condition.

BOARD FINDINGS: In the matter of the left shoulder condition and IAW VASRD §4.71a, 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:

	

2	PD-2017-03053

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY   REFER TO:
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY  BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr <ltd 29 Oct 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

Copy to: PDBR