RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2018-00194
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20040715

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Tactical Air Controller, medically separated for “right shoulder AC arthrosis” and “status post [s/p]…left…foot…surgeries…,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION: He continues to have difficulties due to pain in his arm and foot. 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 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 - 20040330	VARD - 20040827	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder AC arthrosis	5299-5003	10%	Right Shoulder Condition	5201	20%	
20040602	
S/P…Left…Foot…Surgeries…	5299-5284	10%	Post-Op…Left Foot	5284	10%		
Residual Scar…Nerve Entrapment	Cat II	Surgical Scars Left Foot...	7804	10%		
4th & 5th RA numbness…		No VA Placement	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

Right Shoulder AC Arthrosis. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the left-handed CI’s right shoulder condition began in April 2002 with no precipitating injury or trauma identified. MRI showed acromioclavicular (AC) degeneration and tendinopathy. During the 10 April 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 15 months prior to separation, the CI reported right shoulder pain and numbness radiating to the right arm. Physical examination revealed right shoulder range of motion (ROM) with flexion to 90 degrees (normal 180) and abduction to 90 degrees (normal 180).

The 6 May 2003 MEB NARSUM examination, 14 months prior to separation, noted complaints of right shoulder pain with abduction, and especially worse with overhead work, pushups, and bench pressing. He had mild occasional radiations down his arm. He had a history of several subacromial injections in the emergency department with mild to minimal relief. The examiner indicated that on the CI’s most recent examination he had an AC injection which relieved nearly

all of his symptoms. Physical examination showed point tenderness over his AC joint, a “very positive” cross arm test; mildly positive Hawkins and Neer's tests (equivalent to painful motion), and mildly positive impingement signs. O'Brien's, Clunk and Apprehension tests were negative. ROM was not addressed. The 5 June 2003 MEB orthopedic addendum indicated the CI’s right shoulder condition had worsened and that surgery might improve the CI’s function, however, likely not to a full duty status.

At the 2 June 2004 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported a diagnosis of osteoarthritic change with right shoulder pain exacerbated by ROM activities and weather. He used medication of “Flexeril, Valium, and steroid injections with short-term benefit without long-term amelioration.” Physical examination showed right shoulder ROM with flexion and abduction both limited to 90 degrees, with painful motion on ROM. There was no further limitation by fatigue, weakness, lack of endurance, or incoordination.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right shoulder at 10%, coded 5299-5003 (analogous to degenerative arthritis). The VA rated the right shoulder at 20%, coded 5201 (arm, limitation of motion), based on the C&P examination, citing limitation of arm motion at shoulder level.

The 20% rating for the non-dominant arm requires motion limited to “at shoulder level / 25 degrees from side” and the MEB, C&P, and post-separation physical medicine examinations reflected this degree of limitation. There was no fibrous union or nonunion of the humerus to justify a higher rating under the 5202 code (humerus, other impairment), and no higher rating 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 right shoulder AC arthrosis, coded 5201.

S/P Left Foot Surgeries (S/P Numerous Lateral Left Mid Foot Surgeries Secondary to Ganglionic Cyst Requiring Excisions and Exostectomies, also Tendon Transfer of the Peroneus Brevis Tendon). According to the STR and MEB NARSUM, the CI underwent multiple surgeries on his left foot to remove a ganglion cyst, with the most recent surgery in July 1997. The 6 October 2003 NARSUM podiatry addendum, 9 months prior to separation, noted chronic complaints of left lateral mid-foot pain and discomfort secondary to multiple surgeries, exostosis, ganglionic cyst, and soft tissue mass. “Physical examination is consistent with the past information.” The examiner indicated the CI had discomfort with nerve entrapment scar tissue, and decreased subcutaneous tissue substance, consistent with four or five surgical attempts that were only moderately successful in removing exostosis and ganglionic cyst, but these were left with daily scar tissue, numbness, and nerve entrapment pain.

At the C&P examination, the CI reported recurrent left foot ganglion cysts with surgeries, associated tendon surgical migration due to the location of the cyst formation, decreased ROM of the toes on plantar flexion, and discomfort on plantar flexion of the digits 4 and 5 of the left side. Physical examination showed a normal posture and gait with no limitations of standing or walking. There were no abnormal weight-bearing signs. Mild bilateral pes planus without valgus deformity of the Achilles tendons was noted. Left ankle ROM was to VASRD normal limits without painful motion. There were two left lateral foot region and dorsal aspect longitudinal scars measuring 3 cm x 0.6 cm and 4 cm x 0.5 cm, with mild hyperpigmentation, associated tenderness, and minimal keloid formation. There was some underlying tissue loss with mild depression without adherence to underlying structures. There was decreased sensation to pinprick and light touch of the distal 4th and 5th toes of the left foot. Left foot X-rays were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left foot at 10%, coded 5299-5284 (analogous to foot injuries, other). The PEB also listed “residual scar formation…with accompanied nerve entrapment” and “4th and 5th RA

(metatarsal area) numbness…” as Category II related diagnoses contributing to the disability in this case. These diagnoses and symptom residuals are intrinsic to the unfitting condition, when rated analogous to 5284, and a separate unfit painful scar or numbness determination and/or rating for the diagnoses cannot be supported without pyramiding (VASRD §4.14); thus, they are appropriately subsumed under the same 5284 rating. The VA also rated the left foot at 10%, but used a non-analogous 5284 code, based on the C&P examination, citing moderate symptoms. The VA additionally rated left foot scars with nerve entrapment at 10%, coded 7804 (scars, superficial, painful on examination), also based on the C&P examination, citing a superficial scar that is painful on examination.

The panel considered that the scar and sensory deficits were not separately unfitting, but contributed to the overall foot disability. The panel deliberated if the combination of foot symptoms, including the residuals of the scar and nerve entrapment, more nearly supported the 20% (moderately severe) criteria under code 5284. Given the CI’s normal gait and documentation of moderate symptoms on examinations proximate to separation, the panel adjudged that the overall left foot symptoms did not more nearly approximate the next higher moderately severe rating criteria. 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 foot condition.

BOARD FINDINGS: In the matter of the right shoulder acromioclavicular arthrosis, the panel recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a. In the matter of the status post left foot surgeries 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.

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Shoulder Acromioclavicular Arthrosis	5201	20%	
Status Post Left…Foot…Surgeries…	5299-5284	10%	
	COMBINED	30%	

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
12 Oct 20

From: To:
Subj:

Ref:

Director, Secretary of the Navy Council of Review Boards 

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
(a) DoDI 6040.44
(b)	PDBR ltr of 28 Mar 20
(b)	

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

2.	On 7 October 2020, the Assistant Secretary of the Navy took action in your case by accepting the correct recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Physical Evaluation Board from 20 to 30 percent with assignment to the Permanent Disability Retired List.

3.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the Navy Personnel Command, for correction of your records as stated above.	You will be notified once those changes are complete.