RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00198
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060802

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Light-Wheel Vehicle Mechanic) medically separated for left shoulder pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic left acromioclavicular joint pain status post excision of distal clavicle with significant residual pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded five other conditions (post-traumatic stress disorder, attention deficit disorder, right ankle pain, myopia, and dyslipidemia) for PEB adjudication.  The Informal PEB (IPEB) adjudicated the left shoulder pain condition as unfitting, rated 0% for slight and occasional pain.  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated. 

CI CONTENTION:  “The applicant contends his left shoulder condition.  His complete submission is at Exhibit A.”

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:  

IPEB – Dated 20060718	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Painful Left Shoulder…	5099-5003	0%	Residuals, Left Shoulder Injury…	5201	20%	20061003	
Other MEB/PEB Conditions x 5 (Not In Scope)	Other x 5 (equals SC, NSC & deferred)	
RATING:  0%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20070117 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Left Shoulder Condition.  The record shows that the right-hand dominant CI injured his left shoulder when he fell onto it during a morning run on 11 January 2005.  X-rays that day showed a Grade II separation of the acromio-clavicular joint (ACJ, the joint between the collar bone and the shoulder none [scapula]).  Rehabilitation was not successful and he had surgical excision of the end of the clavicle on 19 October 2005.  An orthopedic examination on 13 March 2006, 5 months prior to separation and 5 months after surgery, recorded pain with overhead activity, but normal strength.  The orthopedist also recorded that the CI could carry up to 25 pounds.  His range-of-motion (ROM) was full and symmetric to the right side albeit painful above 70-80 degrees of flexion and abduction.  Despite rehabilitation, he was unable to return to full duty and entered into the MEB process.  At the narrative summary (NARSUM), dictated on 6 June 2006, 2 months prior to separation, the CI reported painful motion and pain even at rest.  His ROM was slightly reduced as noted below.  A VA outpatient note dated 14 September 2006 documented that the CI had a normal motor examination.  At the VA Compensation and Pension (C&P) examination performed on 3 October 2006, 2 months after separation and almost 1 year after the surgery, the CI reported ongoing pain and difficulty with overhead activities.  He did not use a sling or brace.  He had no difficulty changing positions on the examination table.  On examination, the scar was well healed and muscle atrophy absent.  The ROM, charted below, was reduced and painful.  Repetition resulted in a further loss of motion, but it was accomplished with a 5-pound weight, reducing the probative value of this finding.  An orthopedic evaluation on 29 November 2007, 16 months after separation, noted that flexion was 170 degrees and abduction 120 degrees, consistent with pre-separation measurements.  
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.

Left Shoulder ROM
(Degrees)	PT ~9 Mo. Pre-Sep (20051114) 	MEB 2808 ~4 Mo. Pre-Sep
(20060404) 	MEB ~2 Mo. Pre-Sep
(20060605) 	VA C&P ~2 Mo. Post-Sep
(20061003) 	VA Ortho ~3 and 6 Mo. Post-Sep
(20061116) 	
Flexion (180 Normal)	160	155 (150, 150, 155)	140	120	90	
Abduction (180)	130	105 (100, 102, 105)	108	90	90	
Comments	1 month post-op; painful motion	6 month post-op; painful motion not recorded	6 month post-op; painful motion not recorded	No atrophy		
§4.71a Rating	10%	0%	0%	20%	20%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder at 0%, coded 5099-5003 (analogous to degenerative arthritis), with probable utilization of the pain policy.  The VA rated the shoulder at 20%, coded 5201 (limitation of motion of the arm).  The Board considered the evidence.  The Board noted that while three ROM measurements obtained after separation showed limitation at the shoulder, all those obtained after surgery and prior to separation were above the shoulder level and one evaluation, by an orthopedic surgeon, was normal.  One orthopedic appointment 16 months after separation also had values well above the shoulder.  The Board reviewed the record for evidence to support a significant limitation in motion and noted that atrophy was not documented and that the strength, when recorded, was normal.  The Board determined that the totality of evidence did not support a limitation of motion at the arm level at separation.  Painful motion was recorded and supports a disability rating of 10%, retaining the 5099-5003 code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left shoulder 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the left shoulder was probably operant in this case and the condition was adjudicated independently of that policy/ by this Board.  In the matter of the left shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Left Shoulder Pain 	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131231, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXX, AR20160000155 (PD201400198)

1.  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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA