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AF | PDBR | CY2012 | PD2012 01562
Original file (PD2012 01562.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX       CASE : PD120 1562
BRANCH OF SERVICE: MARINE CORPS BOARD DATE: 201 4 0204
Separation Date: 20010915


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve GYSGT/E-7 (0193 / Personnel Chief) medically separated for a right shoulder condition. The CI developed idiopathic right shoulder pain. He underwent conservative treatment but eventually could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was referred for a Medical Evaluation Board (MEB). The MEB forwarded right shoulder tendonitis/bursitis; status post ( s / p ) removal of right accessory navicular bone; and posttraumatic left knee pain for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated “right shoulder tendonitis/bursitis” as unfitting, rated 10%. The remaining conditions were determined to be C ategory III, “conditions that are not separately unfitting and do not contribute to the unfitting conditions(s) . ” The CI made no appeals and was medically separated .


CI CONTENTION : “I’ve had continued issues with the injuries incurred on active duty to include the symptoms becoming worse.”


 SCOPE OF REVIEW : The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting right shoulder condition is add ressed below. In addition the B oard will consider the CI’s category III, not unfitting right foot and left knee conditions. No additional conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records.


RATING COMPARISON :
invalid font number 31502
Service IPEB – Dated 20010404
 VA - (9.75 years Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Shoulder Tendonitis/Bursitis 5299-5003 10% S/P Right Shoulder Acromioplasty for Rotator Cuff Bicipital Tendonitis and mild Sub deltoid Bursitis 5019 10% 20100630
Post Traumatic Left Knee Pain Cat III Left Knee Medial Meniscus Tear 5299-5259 10% 20100630
S/P Removal of Right Accessory Navicular Bone Cat III Scar, Residual of Removal of Accessory, Navicular Bone Right Foot 7805 0% 20100630
No Further Entries
 Other x19 20100630
Combined: 10%
 Combined: 40% 20100630
Derived from VA Rating Decision (VARD) dated 20101228 (most proximate to date of separation in the available records)
NOTE: No VA rating documentation available prior to VARD as stated above. VA rating for code 5019 was 0% from 20031003 (no VARD available), increased to 10% from 20100401. VA rating for codes 5299-5259 and 7805 from 20031003.
ANALYSIS SUMMARY : The Board acknowledges the CI’s sentiment regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veteran s Affairs, operating under a different set of laws. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

The Board notes that evidence from the service treatment record (STR) and the VA relating to both the unfitting and not unfitting conditions w as not available in evidence before the Board . There were five exhaustive attempts to obtain the relevant documentation which proved to be futile .

Right Shoulder Tendonitis/Bursitis Condition . There is minimal evidence in the STR regarding the right shoulder condition. A PEB working document ( JDETS ) noted that the right shoulder pain had worsened since playing softball. An Magnetic Resonance Image ( MRI ) of the right shoulder demonstrated supraspinatus tendonopathy and sub deltoid bursitis. The MEB narrative summary (NARSUM) exam completed approximately 7.5 months prior to separation documented that the CI was treated for right shoulder tendonitis and a rotator cuff tear ; however , there was no documentation of surgical intervention. The MEB NARSUM physical exam findings were shoulder range - of - motion (ROM) findings of flexion to 130 degrees (normal 180 degrees), abduction 160 degrees (normal 180 degrees) with crepitus ; tenderness to palpation (TTP) of the a cromioclavicular joint; s upraspinatus and subacromial impingement signs. There was no VA Compensation and Pension (C&P) exam done. The non-medical assessment (NMA) completed in February 2001 noted that the CI’s medical issues had not affected his work and that he could continue to make a positive contribution to the mission and the Marine Corps .

The Board directs attenti on to its rating recommendation based on the above evidence . The PEB coded the right shoulder tendonitis/bursitis as 5299 analogues to 5003 ( degenerative a rthritis ) and rated at 10%. The earliest VA Rating Decision (VA RD ) in the file was d ated 28 December 2010 and referenced a VA C&P exam performed on 16 April 2010 , over 8.5 years after separation. O nly VA evidence , which can be reasonably interpreted to reflect the CI’s disability at separation , is probative to the Board’s recommendations. The PEB worksheet noted worsening right shoulder pain. The MEB NARSUM noted TTP and limited , non-compensable ROM on both flexion and abduction of the shoulder . There was no evidence of shoulder instability or dislocation that would allow rating under a shoulder specific Veterans Affairs Schedule for Rating Disabilities (VASRD) code. There is a VASRD code for bursitis, 5019; however, that code is also rated under code 5003 and its utilization would confer no benefit to the CI. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder tendonitis/bursitis condition.

Contended PEB Conditions : The contended conditions that were adjudicated by the PEB as Category III (c onditions that are not separately unfitting and do not contribute to the unfitting condition) were post traumatic left knee pain and s/p removal of right accessory navicular bone. The Board’s first charge with respect to these conditions is an assessment of the appropriateness of the PEB’s fitness adjudications. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.

 Postt raumatic Left Knee Pain. The MEB NARSUM indicated that the left knee pain worsened in October 1999 and the CI underwent physical therapy. The CI was evaluated by Orthopedics and diagnosed with patellar tendonitis. An MRI (date unkn own) demonstrated numerous post traumatic changes which included a partial tear of the posterior cruciate ligament and a medial meniscal tear. The MEB physical exam showed TTP over the insertion of the patellar tendon and patellar crepitus on ROM . There was no evidence of painful motion on exam or evidence in the STR to support left knee painful motion.

 Status Post Removal of Right Accessory Navicular Bone. The MEB NARSUM exam indicated that the right foot pain was evaluated by podiatry in December 2000. The CI was found to have an accessory navicular bone and underwent surgery in January 2001. The MEB NARSUM physical exam findings were d orsiflexion 15 degrees ( normal 0-20 degrees ), plantar flexion 60 degrees (normal 0-45degrees); a well healed three inch scar on the medial foot; TTP anterior heel and numbness dorsal side great toe and first web space . The MEB N ARSUM Addendum completed approximately 6 months prior to separation noted that post-operatively, t he CI was non-weight bearing with crutches for 6 weeks then progressed to weight bearing with ROM exercises. At 2 months post-operative, the CI had full ROM, some pain along the incision, and the scar was healed. The examiner opined that it was expected that the CI should be physically able to return to full duty within 30 to 60 days. There was no additional evidence in the STR to support right foot pain or disability.
Neither t he left knee n or right foot conditions were profiled or implicated in the NMA . The NMA actually stated that “[applicant] has been under a physician's ca r e since summer 2000. His medical issues have not affected his work and he c a n continue to ma k e a positive contribution to the mission and the Marine Corps .” Neither condition was judged to fail retention standards. All were reviewed by the action officer and considered by the Board. There was no indication from the record that any of these conditions significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB Category III determination for the left knee and right foot contended conditions ; therefore, no additional disability ratings can be recommended.


 BOARD FINDINGS : IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the right shoulder tendonitis/bursitis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended post traumatic left knee pain and s/p removal of right accessory navicular bone conditions, the Board unanimously recommends no change from the PEB determinations as not unfit ting. There were no other conditions within the Board’s scope of review for consideration.


 RECOMMENDATION : The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Right Shoulder Tendonitis/Bursitis 5299-5003 1 0%
Post Traumatic Left Knee Pain Category III
S/P Removal of Right Accessory Navicular Bone Category III
COMBINED
 1 0%
invalid font number 31502

The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 120829 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans ’ Affairs Treatment Record




        
XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review












MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 9 Apr 14

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

 - XXXXXXXXXXXXXXXXXX , former USMC, XXX XX XXXX

                                                      XXXXXXXXXXXXXXXXXX
                                            Assistant General Counsel
                  (Manpower & Reserve Affairs)

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