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

From:
To:   

Director, Secretary of the Navy Council of Review Boards
PD-2017-03812

IN REPLY R(FER TO

1850
CORB:003
27 Feb 20

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
Ref:	(a) DoDI 6040.44
(b) PDBR ltr of 3 Jul 19

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

2,	On, the Assistant General Counsel of the Navy (Manpower & Reserve  Affairs) took  action  in  your case by    accepting  the recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEB) from 10% to 20% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents  final action in  your case by the Department of the Navy, has been forwarded to the Deputy Commandant, Manpower and Reserve Affairs, for appropriate changes to  your personnel records and notification to you upon completion.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-03812
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20081129

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Flight Equipment Technician, medically separated for “left rotator cuff tendinopathy” with a disability rating of 10%.

CI CONTENTION: CI requested review of all conditions and review of additional conditions 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’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 - 20080904	VARD - 20081223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Rotator Cuff Tendinopathy	5299-5003	10%	Left Shoulder Tendinitis and Anterior Labral Tear	5203	10%	20081022	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Left Rotator Cuff Tendinopathy. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right-handed CI’s left shoulder pain began in January 2007 after a forced abduction external rotation mechanism injury. Treatment included prolonged physical therapy and two subacromial space injections which provided no sustained relief. On 12 March 2007, an MRI of the left shoulder showed signal changes at the articular surface of the supraspinatus tendon consistent with a minimal low grade articular surface type tear. Radiographic images on 20 May 2008 showed no obvious bony or soft tissue pathology. The CI’s

left rotator cuff symptomatic tendinopathy was considered unresponsive to prolonged conservative treatment.  Surgical options were considered weak.

The 23 May 2008 MEB NARSUM examination, 6 months prior to separation, noted the CI denied left upper extremity numbness or tingling distally. Physical examination showed no atrophy or obvious deformity. Left shoulder range of motion (ROM) was forward flexion to 140 degrees (normal 180) and abduction to 90 degrees (normal 180). Tenderness was noted. Impingement signs were positive (Hawkins and Neer). Pain was noted with cross-arm adduction. Discomfort and guarding were noted with load shift test. No instability was noted. Sulcus sign, apprehension, and Jobe’s relocation signs were negative. The translation (integrity of the cruciate ligament), anterior and posterior, was 1+.  Neurovascular and reflexes were intact.

During 14 August 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, physical examination revealed no shoulder deformity. The CI was unable to extend the arm past 90 degrees (normal 180). Supraspinatus strength was 4/5, and deltoid and subscapular strength were normal. Neer’s test was positive; apprehension test was negative.

At the 22 October 2008 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported constant pain, ranging from 7-9/10 with pain increasing with extension and overhead movement. Physical examination showed no evidence of erythema, warmth, swelling, tenderness, or muscle atrophy. ROM was flexion to 115 degrees with pain reported at 90 degrees, and abduction was 110 degrees with pain. With repetitive ROM there was evidence of increased pain with some weakness, fatigability, lack of endurance, and some additional limitation of function.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left rotator cuff tendinopathy condition 10%, analogously coded 5299-5003 (degenerative arthritis). The VA also rated the left shoulder tendinitis and anterior labral tear condition 10%, coded 5203 (clavicle or scapula impairment), based on the C&P examination, citing painful ROM and impairment of joint function.

The panel deliberated on the probative value of the examinations in evidence. Although the VA examination was closest to and prior to separation, it lacked any indication of special shoulder tests for instability, was not as detailed as the STR evidence, and also noted additional functional loss on repetition. The NARSUM and MEB examinations were proximate to separation, more detailed including provocative tests, and both documented greater limitation of left shoulder motion than the single VA examination. The panel adjudged that the NARSUM and MEB examinations best depicted the CI’s condition and had the highest probative value for rating.

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 most probative 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.” However, examinations did not reflect this degree of limitation. 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), and no higher ratings available under the 5203 code (clavicle or scapula, impairment). After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left shoulder condition, coded 5201.

BOARD FINDINGS: In the matter of the left shoulder condition, the panel recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Left Rotator Cuff Tendinopathy	5201	20%	

The following documentary evidence was considered: