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AF | PDBR | CY2013 | PD-2013-02626
Original file (PD-2013-02626.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02626
BRANCH OF SERVICE: marine corps  BOARD DATE: 20150130
SEPARATION DATE: 20080531


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Intelligence Specialist) medically separated for left shoulder pain and left extremity nerve symptoms. The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was placed on limited duty and referred for a Medical Evaluation Board (MEB). The shoulder and nerve conditions, characterized as “pain in joint involving shoulder region” and “disturbance of skin sensation” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated “left shoulder pain” and “cubital tunnel syndrome” as unfitting, rated 10% and 10%. The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in his application.


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’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/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


RATING COMPARISON :

Service IPEB – Dated 20080319
 VA - ~3 Months Post-Separation
Condition
 Code Rating Condition Code Rating Exam
Left Shoulder Pain 5299-5003 10% Status Post Left Shoulder Distal Acromiocla Vicular Bursectomy, Mumford Procedure, With Residual
Impingement And Scar (Claimed As Radiculopathy, Left Upper Extremities And Left Shoulder Condition)		 5099-5024 10% 20080827
Cubital Tunnel Syndrome 8616 10%
Other x 0
 Other x 7
Rating: 20%
 Combined: 70%
Derived from VA Rating Decision (VA RD ) dated 200 90209 ( most proximate to date of separation [ DOS ] ).
ANALYSIS SUMMARY

Left Shoulder Pain. The narrative summary (NARSUM) notes the CI gradually developed pain of his non-dominant left shoulder, unresponsive to medication and physical therapy. Magnetic resonance imaging (MRI) on 22 September 2005 showed rotator cuff (RC) impingement syndrome. The CI had arthroscopic surgery performed by a civilian surgeon on 31 January 2006 for debridement, repair of a cartilage tear (labral tear) and acromioplasty to relieve impingement. Following the surgery the CI continued with decreased range-of-motion (ROM) and pain; repeat MRI on 9 March 2006 noted RC tendinitis and inflammatory changes. A neurological evaluation for numbness and tingling of the fingers noted normal left upper extremity (LUE) strength and reflexes with decreased sensation in the 4th and 5th fingers. Left shoulder ROM was reported as loss of 30 degrees of flexion, 10 degrees of external rotation, and 40 degrees of internal rotation. The CI was re-evaluated by a service orthopedic surgeon on 5 December 2006 and reported continued shoulder pain. The examination noted tenderness to palpation (TTP) about the shoulder and ROM of abduction of 170 degrees, full flexion, with painful motion and positive impingement signs. Strength was normal and a normal electromagnetic and nerve conduction studies (EMG/NCV) was noted. A second surgical procedure to revise the clavicle resection was recommended. According to the NARSUM the CI had surgery in March 2007 followed by physical therapy without full resolution of his symptoms. At the MEB examination on 3 December 2007, 6 months prior to separation, the CI reported left shoulder grinding sensation and pain with use, especially overhead or with rotation. The MEB physical exam was unchanged from the orthopedic and neurological examinations noted above, with shoulder abduction and flexion of 170 degrees.

At the VA Compensation and Pension (C&P) Joints examination on 27 August 2008, 3 months after separation, the CI reported constant left shoulder pain. On exam there was no TTP or crepitus of the shoulder with flexion of 155 degrees, abduction of 150 degrees, with no additional loss of ROM with repetition. Strength, sensation, and reflexes of the upper extremity (UE) were normal. X-rays on the left shoulder noted post-surgical changes without other abnormality.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the shoulder condition 10%, coded 5299-5003 (analogous to degenerative arthritis) and the VA rated it 10%, coded 5099-5024 (analogous to tenosynovitis). The shoulder ROM did not meet a compensable evaluation based on ROM criteria alone IAW the Veterans Schedule for Rating Disabilities (VASRD) §4.71a, but the evidence in the record supports a 10% rating of the shoulder for painful motion IAW VASRD §4.59 (painful motion). The Board reviewed to see if a higher evaluation was achieved with any alternative §4.71a coding but there was no evidence of shoulder ankylosis, impairment of the humerus, recurrent humeral dislocation, or nonunion of the clavicle or scapula, and there was no other ratable impairment of the shoulder. 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 left shoulder condition.

Cubital Tunnel Syndrome. The NARSUM notes the CI had numbness of his non-dominant left hand due to probable cubital tunnel syndrome. At a neurological evaluation for numbness and tingling of the fingers on 11 September 2006 the CI reported that, the numbness and tingling of the LUE began just prior to his first shoulder surgery. The examination noted the normal LUE strength and reflexes with decreased sensation in the 4th and 5th fingers. There was clinical evidence of nerve compression of the LUE at the wrist, but not the elbow. The neurology assessment was that the LUE numbness and tingling was probably related to the shoulder condition. EMG/NCS were ordered to evaluate for radiculopathy or neuropathy and notes in the service treatment record indicated that they were negative.
According to the NARSUM the CI also had a cervical MRI which provided no evidence of radiculopathy to explain the numbness and tingling symptoms. At the MEB examination on 3 December 2007, 6 months prior to separation, the CI reported tingling into the left 4th and 5th fingers. The MEB physical exam noted normal examination of the neck. Strength and reflexes of the LUE were normal, but there was decreased sensation in the distribution of the ulnar nerve, with positive evidence of nerve compression at the elbow.

At the VA C&P general examination on 26 August 2008, 3 months after separation, the CI reported numbness in the left 4th and 5th fingers, confirmed by examination. The VA C&P Joints exam, the next day, noted subjective symptoms consistent with cubital tunnel syndrome without an abnormal EMG/NCS and the examination noted normal UE strength, sensation, and reflexes.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the left cubital tunnel condition 10%, coded 8616 (neuritis of the ulnar nerve). The VA did not rate the claimed LUE radiculopathy separately from the shoulder condition. The characteristic findings of neuritis listed in VASRD §4.123 are “loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating.” IAW VASRD §4.124a, the 8616 rating criteria are subjective and described as mild for a 10%, moderate for a 20% , and severe for a 30% rating. The Board agreed that the LUE sensory abnormalities without motor deficit were best characterized as mild and did not rise to the next higher level of disability for moderate incomplete nerve paralysis. disability. 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 left cubital tunnel condition.


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 matters of the left shoulder condition, IAW VASRD §4.71a and the left cubital tunnel condition, IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudications. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131101, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record



                 
XXXXXXXXXXXXXXX
President
DoD 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 29 May 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their 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:

- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC



                           XXXXXXXXXXXXXXX
                          Assistant General Counsel
                           (Manpower & Reserve Affairs)

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