RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:	CASE: PD-2019-00175
BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20070813

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Support Equipment Maintenance Manager, medically separated for “left acromial fracture status post (s/p) arthroscopic decompression” with a disability rating of 10%.

CI CONTENTION: “I am requesting that all my service connected disabilities be taken into consideration. My combined disability rating upon discharge should have been at least 30% resulting in a medical retirement from service. My knee condition nor my shoulder was rated properly, my sleep apnea condition was not rated and I was issued a C-Pap machine that I was unable to use while deployed.” He also requested review of 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 - 20070425	VARD - 20071106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Acromial Fracture S/P
Arthroscopic Decompression	5099-5019	10%	Left Shoulder and Open Reduction Internal Fixation (ORIF) of Humerus Fracture	
5202	
20%	

20070606	
Left Humerus Fracture, S/P Open Reduction, Internal Fixation	Cat II					
Left Ulnar Fracture	Cat III	Left Wrist Ulnar Fracture	5211	10%		
Left Knee Medial Meniscus Tear	Cat III	Left Knee Meniscectomy with
Anterior Cruciate Ligament (ACL) Repair	
5259	
10%		
Left Knee Lateral Meniscus Tear	Cat III					
Left Knee Partial ACL Tear	Cat III					
Right Comminuted Clavicle Fracture	Cat III	Right Clavicle Fracture	5203	0%		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Left Acromial Fracture. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right-handed CI sustained fractures of the left acromion, left humerus mid-shaft, left ulna, and right clavicle after a motorcycle accident in August 2005. He underwent

ORIFs of the left humerus and left ulna on 23 August 2005, and on 29 March 2006 he had a left subacromial impingement procedure due to complaints of overhead pain and decreased shoulder range of motion (ROM).

The 15 March 2007 MEB NARSUM examination, 5 months prior to separation, noted CI complaints of persistent anterior left shoulder pain with any type of reaching or lifting movements to include normal activities of daily living. With extension above shoulder level, he experienced persistent shoulder pain and a mild sensation of subluxation. Physical examination showed both flexion and abduction to 160 degrees (normal 180), external rotation to 70 degrees and internal rotation to 45 degrees. Motor strength was 4/5 with abduction and internal rotation. The examiner restricted overhead and general lifting to no more than 35 pounds.

At the 6 June 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported constant stiffness and pain rated at 5/10. Physical findings showed no tenderness, guarding of movement, edema or effusion. Both flexion and abduction were to 180 degrees, but with pain at 90 degrees in both planes. After repetition, ROM was not further limited by fatigue, weakness, lack of endurance or incoordination. Shoulder X-rays showed no fracture or other significant bone, joint or soft tissue abnormality. The left humerus X-ray revealed a well-healed fracture.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left shoulder condition 10%, analogously coded 5099-5019 (bursitis), and listed “humerus fracture” as a Category II condition contributing to the disability in this case. The panel concluded this related diagnosis was not a separate condition which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD
§4.14 (avoidance of pyramiding). The VA rated the left shoulder condition 20%, coded 5202 (humerus, other impairment of) based on the C&P examination, citing malunion of the humeral head with marked or moderate deformity. Although there was insufficient limitation of motion to support a rating under code 5201, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion). Other VASRD shoulder and analogous codes were considered, 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.

Contended PEB Conditions: Left Ulnar Fracture, Left Knee Medial and Lateral Meniscal and Partial ACL Tears, and Right Clavicle Fracture. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The NARSUM indicated the left ulnar fracture and left knee failed retention standards, and the 11 October 2005 limited duty form included the left ulna and left clavicle fractures.

Left Ulna Fracture. The NARSUM was silent on the ulna fracture, but the C&P examination noted complaints of daily stiffness and pain rated at 7/10. Physical findings showed no tenderness, edema or deformity, and multiple X-rays revealed fixation hardware but no fracture or other abnormalities. The examiner stated that the wrist condition only minimally limited the CI’s ability to perform his usual occupation and daily activities.

Left Knee Meniscal and ACL Tears. At the NARSUM examination, he stated his knee was doing well with good strength, ROM, stability and decreased pain with strenuous activities and daily living. At the C&P examination, ROM was normal, as were X-rays, and the examiner stated the left knee condition minimally limited occupational and daily living activities.

Right Clavicle Fracture. On 20 August 2005, X-rays revealed a comminuted fracture of the distal one third of the right clavicle. Physical therapy notes on 15 November 2005 documented full

right shoulder ROM and normal strength. Neither the NARSUM nor the C&P examination addressed the right clavicle fracture.

There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the left shoulder condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended left ulna, left knee, and right clavicle conditions, the panel recommends no change from the PEB determinations as not unfitting. 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 nm NAVY COUNCIL OF REVIEW BOARDS
720 KENNON STREET SE STE 309 WASHINGTON NAVY YARD, DC 20374-5023

IN R EPLY REl' ER TO ,
1850
CORB: 003
10 Sep20

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.