RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-05754 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050430

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Warehouse Clerk, medically separated for “right shoulder- symptomatic os acromiale status post [s/p] open reduction internal fixation [ORIF],” and “left shoulder-instability s/p arthroscopy capsulorrhaphy,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION: Review requested of shoulder conditions as well as additional conditions not identified by the Medical Evaluation Board (MEB) and/or 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 - 20050207	VARD - 20051006	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder-Symptomatic Os
Acromiale S/P ORIF	5099-5003	10%	Os Acromiale, Right
Shoulder, S/P ORIF	5203	10%	200	
Left Shoulder-Instability S/P Arthroscopy and Capsulorrhaphy	5099-5003	10%	Left Shoulder Instability, S/P Arthroscopy and
Capsulorrhaphy	5010-5203	10%	STR	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Right Shoulder Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent surgery on 22 July 2003 consisting of an ORIF of the right os acromiale (failure of the distal acromion to fuse) with an iliac crest bone graft. During recovery, he complained of left shoulder pain and unimproved right shoulder pain. A CT scan in December 2003 showed evidence of bridging bone indicative of healing, and a civilian orthopedic surgeon noted that the shoulders were “loose.” Further right shoulder surgery (capsular plication or capsulorrhaphy) was considered but not carried out due to the significant amount of postoperative rehabilitation necessary to achieve a satisfactory outcome. At the 12 May 2004 MEB physical therapy (PT) examination, right shoulder range of motion (ROM) measurements

revealed flexion to 170 degrees (normal 180) and abduction to 170 degrees (normal 180), with pain during resisted movement. The 15 December 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of right shoulder pain, and the examiner found well-healed scars, no swelling or tenderness, normal strength, and pain with resisted movement. Neer’s (to determine subacromial impingement) and impingement tests were positive, but O'Brien’s testing (to determine a potential labral tear or acromioclavicular joint pathology) was negative. Right shoulder ROM following repetition showed both flexion and abduction to 130 degrees.

At the 16 August 2005 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported chronic right shoulder pain, rated at 5-6/10, and decreased ROM. Physical examination showed right shoulder flexion to 180 degrees and abduction to 110 degrees with limited movements, but not due to pain. An X-ray showed post-surgical changes of the right acromioclavicular joint, but was otherwise unremarkable.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right shoulder condition 10%, analogously coded 5099-5003 (arthritis, degenerative). The VA also rated the right shoulder condition 10%, analogously coded 5299- 5203 (clavicle or scapula, impairment of), based on the C&P examination, citing subjective symptoms of pain with decreased ROM. Panel members noted that the VASRD §4.71a threshold for rating ROM impairment under code 5201 (arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side). While the evidence demonstrated motion above this level, 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 right shoulder condition.

Left Shoulder Pain. According to the STR and MEB NARSUM, the CI’s left shoulder pain began in September 2003 and a bone scan showed a possible os acromiale. Orthopedic evaluation in December 2003 revealed mildly positive impingement signs, no acromion tenderness, and “good” left shoulder ROM. The provider opined the symptoms were due to multi-directional instability, and on 22 January 2004, the CI underwent an arthroscopic capsulorrhaphy, at which time subacromial bursitis was noted, but not further addressed. At the MEB PT examination, left shoulder flexion was to 160 degrees and abduction to 140 degrees, with ROM limited by capsular tightness. There was pain with resisted motion, but no swelling or tenderness. Empty can (to determine tear to the supraspinatus tendon or muscle or neuropathy of the suprascapular nerve) and active compression tests were negative. The MEB NARSUM noted complaints of continued left shoulder pain, and physical findings showed no swelling or tenderness, normal strength, and pain with resisted movement. Impingement and Neer’s tests were positive, O'Brien’s testing was negative. Left shoulder ROM following repetition showed flexion and abduction to 130 degrees.

At the VA C&P examination, the CI reported left shoulder pain when raising his arm. Physical examination revealed a transverse, 10-cm scar that was non-tender, but slightly deforming. Left shoulder flexion was to 180 degrees and abduction to 170 degrees. All movements were pain- free, and there was no additional ROM limitation due to pain, fatigue, weakness, or lack of endurance. Left shoulder X-rays revealed mild degenerative joint disease.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left shoulder condition 10%, analogously coded 5099-5003 (arthritis, degenerative). The VA also rated the left shoulder condition 10%, but dual coded 5010-5203 (arthritis, due to trauma clavicle, substantiated by X-rays-clavicle or scapula, impairment of), based on the C&P examination, citing subjective pain with decreased ROM. As with the right shoulder, panel members agreed that while there was no compensable limitation of motion under code 5201, a 10% rating was justified with application of VASRD §4.59. 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 right shoulder condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. 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.

DEPARrnENT OF THE NAVY
SECRETARY OF TIIE 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:	XXXXXXXXXXX

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.