RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03982 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20080630

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Airframes Mechanic, medically separated for “status post tendon transfer for a long thoracic nerve palsy” with a disability rating of 20%.

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 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 - 20080418	VARD - 20080911	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Tendon Transfer for a Long Thoracic Nerve Palsy	5399-5302	20%	Right Upper Extremity Paresthesias/Nerve Injury	8599-8516	10%	20080829	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Status Post Tendon Transfer for a Long Thoracic Nerve Palsy. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a right (non-dominant) acromioclavicular (AC) joint reconstruction surgery in March 2006 after sustaining a grade II AC separation. He continued to complain of stiffness, pain, popping, and intermittent hand numbness and weakness, and an EMG study was consistent with a thoracic nerve and sensory branch lesion at the musculocutaneous nerve. In November 2007, he had a right shoulder pectoralis transfer with an autologous hamstring graft. During the 21 February 2008 MEB NARSUM examination, 4 months prior to separation, the CI reported doing well since the second

surgery, with some continued weakness, but the ability to reach over his head without any pain or difficulty. The examiner noted that prior to the November 2007 surgery, the CI had significant right scapular winging with weakness of serratus anterior muscle (supplied by the long thoracic nerve), as well all of the shoulder muscle groups. Physical examination showed 4/5 shoulder girdle strength, and no winging, even when the CI performed a pushup on the wall. Painful motion was absent and range of motion (ROM) revealed both flexion and abduction to 180 degrees (normal). The 18 April 2008 physical therapy (PT) visit, 2 months before separation, noted complaints of continued numbness and pain with prolonged use, but improved strength, function and ROM.  Right shoulder flexion was to 170 degrees and abduction to 162 degrees.

During the 29 August 2008 VA Compensation and Pension (C&P) peripheral nerve examination, 2 months after separation, the CI reported numbness, cold sensation and right arm/hand paresthesias. The examiner found decreased sensation to pain, light touch, and temperature. Serratus anterior muscle strength was 4/5. At the C&P joint examination the same day, the CI complained of shoulder stiffness and deformity, but no instability or giving way. Physical examination showed flexion to 115 degrees and abduction to 110 degrees, with painful motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right upper extremity condition 20%, analogously coded 5399-5302 (Group II- depression of arm). The VA rated the right upper extremity condition 10%, analogously coded 8599-8516 (ulnar nerve, paralysis of, mild) based on the C&P examination, citing mild incomplete paralysis. Panel members noted that the 30% rating under code 5302 is for “severe” disability, and that evidence of scapular winging after the tendon transfer surgery was absent, and the serratus anterior muscle showed only mild-moderate decrease in motor strength (4/5). The NARSUM recorded full flexion and abduction, and the PT examination, 2 months before separation, documented 170 degrees of flexion and abduction to 162 degrees. At the C&P examination, flexion was to 115 degrees and abduction to 110 degrees. The panel agreed that a 20% rating, but no higher was justified for the right upper extremity condition based on demonstration of moderate muscle disability. A higher rating was not justified under any other applicable VASRD code. 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 right upper extremity condition.

BOARD FINDINGS: In the matter of the status post tendon transfer for a long thoracic nerve palsy condition and IAW VASRD §4.73, 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.

	

2	PD-2017-03982

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) PDBRltr

I. 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 ofno 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.