RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00340
BRANCH OF SERVICE:  Army	BOARD DATE:  20150709
SEPARATION DATE:  20071210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Military Police) medically separated for right shoulder pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for an Medical Evaluation Board (MEB).  Status post right acromioclavicular joint arthroplasty was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded hyperlipidemia for PEB adjudication.  The Informal PEB adjudicated “right shoulder pain” as unfitting, rated 10% with cited application of the US Army Physical Disability Agency (USAPDA) pain policy.  The remaining hyperlipidemia was determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  Received two additional right shoulder surgeries due to military mistakes.  He was not evaluated for neck and back conditions.  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 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 20070830	VA* - (~3 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5099-5003	10%	Residuals, Status Post Surgery and History of Degenerative Joint Disease, Right Shoulder	5010	10%	20070920	
Other MEB/PEB Conditions x 1 (Not In Scope)	Other x 0 	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20080304 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Right Shoulder Pain Condition.  Review of the service treatment record (STR) found that the right hand dominant CI injured his right shoulder in 2005.  Ongoing pain led to arthroscopic removal of the distal clavicle in March 2005.  Persistent pain and the development of instability were surgically treated with acromioclavicular joint reconstruction in September 2006.  However, this procedure failed to adequately address the condition, so a third surgery (revision of the reconstruction) was performed in March 2007.

According to the MEB narrative summary (NARSUM) dated 25 May 2007 (2 months after surgery and 7 months prior to separation), the CI continued to complain of right shoulder pain.  There was no mention of shoulder instability or dislocations.  Examination showed mild shoulder tenderness and some painful motion.  Multiple tests for instability were normal.

At the VA Compensation and Pension (C&P) exam performed 3 months before separation, the CI reported right shoulder pain severity of 2/10.  Although he was able to perform activities of daily living, he noted difficulty with overhead activities and driving with his hand on top of the steering wheel.  He denied instability or giving way of the shoulder.  Examination showed mild right shoulder weakness.

The goniometric range-of-motion (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 ~5 Mos. Pre-Sep	VA C&P ~3 Mos. Post-Sep	
Flexion (180 Normal)	110/110/110	130	
Abduction (180)	100/105/105	120	
Comments	Pain limited ROM	+Tenderness, painful motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating analogously to VASRD code 5003 (degenerative arthritis), citing application of the USAPDA pain policy.  The VA also rated the condition at 10%, coded 5010 (arthritis due to trauma).  The VASRD §4.71a threshold for compensable ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion above this level.  Despite non-compensable limitation of motion, Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment of).  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 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 right shoulder pain was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140127, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150013429 (PD201400340)

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						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA