RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1300056
BRANCH OF SERVICE:  army	BOARD DATE:  20130619
SEPARATION DATE:  20020526

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated active duty SPC/E-4 (25R/Broadcasting Engineer) medically separated for chronic right shoulder pain.  Onset of symptoms began in 2000 whenever he performed any activities.  He had surgery on his right shoulder but continued to have pain.  Injections in the shoulder and physical therapy brought no relief after surgery.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The right shoulder condition, characterized as “Right shoulder pain status post a distal clavicle excision.  Pain is frequent and slight” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated “chronic right shoulder pain, status post distal clavicle excision, and pain rated as slight, not requiring daily narcotic therapy and frequent” as unfitting, rated 10%, citing criteria of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals, and was medically separated.

CI CONTENTION:  “For the past 3 years my condition has gotten progressively worse.  I have been to the VA Hospital in Northport, N.Y., had x-rays, MRI’s, etc. performed and the doctors explained to me that my condition has no solution available, medically and that surgery would not alleviate the symptoms.  I am in constant pain and at times, the pain is debilitating.”

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.  Ratings for unfitting conditions will be reviewed in all cases.  The rated, unfitting right shoulder condition meets the criteria prescribed in DoDI 6040.44 for Board purview.  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 Military Records.

RATING COMPARISON:

Service IPEB – Dated 20020325	VA -  (3 Wks Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain, Status Post Distal Clavicle Excision	5099-5003	10%	S/P, Right Clavicle Excision With Chronic Right Shoulder Pain	5301-5303	20%	20020507	
No Additional MEB/PEB Entries	Other x 0	20020507	
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20020624 (most proximate to date of separation [DOS).

ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which his service-incurred condition continues to burden him.  The Board wishes to clarify that it is subject to the same laws for service disability entitlements as those under which the Disability Evaluation System (DES) operates.  The DES has neither the role nor the authority to compensate 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 Veterans Affairs (DVA), operating under a different set of laws (Title 38, United States Code).  The Board evaluates DVA evidence proximal to separation in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness decisions and rating determinations for disability at the time of separation.

Chronic Right Shoulder Pain Condition.  At the first visit for right shoulder pain in 1999, the right-handed CI reported that he was treated non-surgically after sustaining a shoulder injury from falling off a truck in 1995.  He complained of recurrent shoulder pain in March 1999 not associated with new trauma.  Based on radiologic and clinical examination findings, the initial injury was presumed to be an acromioclavicular (AC) joint separation.  Due to persistent pain, he underwent an uncomplicated arthroscopic Mumford procedure (distal clavicle resection) for AC arthrosis in December 2000.  At a physical therapy exam in October 2001 the CI complained of constant pain which had increased since the operation, rated generally at 6-7 out of 10 (on a 1-10 scale) and at a maximum of 10 out of 10.  The pain was increased by elevation of the arm greater than 90 degrees or by reaching behind his back.  At an orthopedic surgery exam in January 2002, the CI complained that in November 2001 his shoulder had dislocated while sleeping and spontaneously relocated.  Electrophysiologic studies performed in January 2002 to evaluate a complaint of intermittent positional numbness showed a conduction block of unknown significance across the forearm without electromyogram evidence of axonal (nerve) injury.  At the MEB exam on 23 January 2002 (4 months prior to separation), the CI reported pain at night, with overhead activities and throwing, and a grinding sensation in the shoulder.  On physical exam, there was a tender prominence over the distal clavicle (resection site).  Light touch sensation was intact in the bilateral upper extremities.  Tests for shoulder impingement (Hawkins, Neers) and AC pain (cross-arm) were negative.  Shoulder muscle strength was normal.  At the VA Compensation and Pension exam on 7 May 2002 (3 weeks prior to separation) the CI reported pain with heavy lifting, exercising and running, and overhead activities; and subjective weakness and occasional soreness of the shoulder muscles.  He described subluxation on awakening and dislocation once a month when he rolled over in his sleep.  He described a grinding sensation when he moved his shoulder.  He was not employed and was planning to become a teacher.  The examiner noted that the CI was able to use his dominant right hand in writing, eating, brushing teeth, and combing his hair.  On physical exam, there was a tender, bony prominence, but no tenderness of the surrounding shoulder.  No inflammation, abnormal movements, instability, or weakness was observed.  The examiner noted that range-of-motion (ROM) was limited by pain but not by fatigue, weakness, lack of endurance, or incoordination.  Strength was reported as 5/5 strength (normal) in muscle Groups II and IV; and 4/5 strength in muscle Groups I and III.  X-rays of the right shoulder showed good ROM and no fracture, subluxation, or dislocation; some ligament calcification was noted.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Shoulder ROM
(Degrees)	MEB ~ 1 Mo. Pre-Sep	VA C&P ~ 3 Mo. Post-Sep	
Flexion (180 Normal)	170	140	
Abduction (180)	180	140	
Comments	+Tenderness	+Tenderness, painful motion	
§4.71a Rating	10%	10% (VA 20%)	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (degenerative  arthritis).  The VA’s 20% rating was based on an assessment that muscle disability was “moderate” under code 5303 (muscle injuries; Group III).  There was no limitation of motion on any exam that justified a compensable rating under the 5200 code (scapulohumeral articulation, ankylosis of) or the 5201 code (arm, limitation of motion of), but the Board agreed that a 10% rating was reasonably conceded with application of  VASRD §4.59 (Painful motion).  Although the CI reported to the orthopedist that his shoulder dislocated once in his sleep and to the VA examiner that dislocations occurred monthly, there was no physical examination evidence of shoulder laxity, instability or subluxation to justify consideration of a rating under the 5202 code (humerus, other impairment of).  Under the 5203 code (clavicle or scapula, impairment of) the Board agreed that the next higher 20% rating (“non-union of, with loose movement”) was not supported.  Finally, rating under a muscle disability pathway was deliberated, but Board members agreed there was no history of compatible muscle injury to the shoulder girdle and arm to support a rating IAW VASRD §4.56 (Evaluation of muscle disabilities).  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 chronic right shoulder pain 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the chronic shoulder pain was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic right shoulder pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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	
Chronic Right Shoulder Pain, Status Post Distal Clavicle Excision  	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120808, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for AR20130016377 (PD201300056)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA