RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05457
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20070731

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Field Artillery Cannoneer, medically separated for “left shoulder pain and weakness and subtle findings consistent with long thoracic nerve injury” with a disability rating of 20%.

CI CONTENTION: Review of all conditions requested. 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 - 20070126	VARD - 20180518	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Left Shoulder Pain and Weakness …	
8619	
20%	Impingement Syndrome to Include Strain, Left Shoulder	5099-5024	10%	20070830	
			Strain, Upper Thoracolumbar
Spine	5237	10%	20070830	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Left Shoulder Pain and Weakness. According to the service treatment record and MEB narrative summary (NARSUM), the right-hand dominant CI’s left shoulder condition began in January 2006 after hiking with a broken ruck (back pack). The CI was treated conservatively for left shoulder strain until October 2006 when he complained of increased pain. He was referred to neurology for evaluation of the left brachial plexus/serratus nerves, with signs and symptoms consistent with a traction injury of the left brachial plexus, and possible lesion of innervation to the serratus anterior. A January 2007 examination noted the left shoulder was higher than the right, left scapula winging was present, and there was tenderness along the rhomboids resulting in a diagnosis of long thoracic nerve palsy. The shoulder injury was attributed to compression of the nerve due to the hiking. Time for healing was recommended. A neurology consult from February 2007 also noted weakness with abduction above 90 degrees (deltoid and marked weakness in the left rhomboid). An MRI showed a normal cervical spine but EMG nerve conduction studies

showed mild irritation of the C5-C6 innervated muscles on the left side. There was no surgical indication.

The 9 May 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of pain which kept him awake at night. The CI was not taking any medication. Physical examination showed motor strength was 5/5 throughout. The left arm had weakness with abduction above 90 degrees “probably” involving the deltoid muscle. There was also marked weakness in the left rhomboid muscle. Sensation was intact to light touch, vibration, and pinprick. There was also scoliosis of the thoracic spine with the left shoulder higher than the right and some winging of the left shoulder. The examiner opined the history and examination were most consistent with a possible long thoracic nerve injury, causing pain in the left shoulder and preventing him from carrying his back pack. During the 11 July 2007 MEB examination (recorded on DD Forms 2807- 1 and 2808), 3 weeks prior to separation, the examiner noted the CI had extreme trouble with neck motion due to his neck hitting the tailgate upon falling off a 7-ton truck. The CI had severe pain and swelling in the scapula and he had lost some and abilities on his left arm to include the inability to carry much. He noted thoracic nerve injuries on his spine prevented lifting and sleeping well.

At the 30 August 2007 VA Compensation and Pension (C&P) examination, one month after separation, the CI reported discomfort in the left shoulder and that the left shoulder blade was aggravated by lifting any heavy weight and doing above-shoulder activity. There was no evidence of adverse effect on activities of daily living, personal grooming, or transportation. Physical examination revealed no localized tenderness or instability of the left shoulder blade or joint. Range of motion (ROM) measured in degrees showed forward flexion and abduction were 140 respectively, external rotation was 16, and internal rotation was 60, with no pain and no loss of motion with three repetitions. Motor power was 5/5 in left shoulder external and internal rotators and abductor/adductors.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left shoulder condition 20%, coded 8619 (neuritis, long thoracic nerve). The VA rated the left shoulder impingement syndrome 10%, analogously coded 5099-5024 (tenosynovitis). The EMG studies showed irritation of C5 and C6 nerves which help to form the long thoracic nerve. The February 2007 neurology examination documented the left shoulder was higher than the right, there was winging, and the left deltoid and rhomboid muscle weakness was consistent with long thoracic or other peripheral nerve injury. The panel noted winging of the scapula (due to a weakened serratus anterior muscle, whose innervation is the long thoracic nerve), is the hallmark of long thoracic nerve damage. Shoulder pain and reduced overhead activity are also symptoms of long thoracic nerve injury. Time was recommended for healing. The September 2007 C&P neurological examination was essentially normal. Under the 8619 code, there is no higher rating than 20% for severe, non-dominant incomplete disability to the long thoracic nerve. 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 pain and weakness and subtle findings consistent with long thoracic nerve injury and IAW VASRD §4.124, 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:

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
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:	

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 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.