RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01250
BRANCH OF SERVICE:  Navy                                                                   SEPARATION DATE:  20070309	

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Machinist Mate, medically separated for “a right shoulder condition” with a disability rating of 10%.  

CI CONTENTION: The applicant contends for his unfitting shoulder and a condition not identified by either the MEB or PEB.  The applicant’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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:  

SERVICE PEB - 20061227	VARD - 20070807	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Impingement	5299-5003	10%	
Degenerative Joint Disease Right Shoulder	5201-5010	10%	20070420	
Right AC Joint Arthritis	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Shoulder Impingement.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right (dominant) shoulder surgery in February 2006 for acromioclavicular (AC) joint arthritis and mild impingement.  The CI continued to have shoulder pain and radiographs of the AC joint did not show any separation.  The CI was evaluated by orthopedic and physical medicine specialists and diagnosed with chronic right shoulder pain status post distal clavicle resection and no additional treatment was recommended.  At an orthopedic second opinion on 18 September 2006 the examination showed “good range of motion of the shoulders” with pain with use.  There was TTP of the clavicle.  There was no evidence of instability with testing, but the glenohumeral joint (shoulder) was “very loose”.  Radiographs from 2006 showed some “new bone formation” at the site of the clavicle resection.  The examiner recommended continued home exercises with consideration of a shoulder capsule tightening procedure if there was no improvement, but no surgery was recommended at the time.  Despite treatment, the right shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “unspecified arthropathy [arthritis] involving shoulder region,” “pain in joint involving shoulder region,” and “other affections of shoulder region, not elsewhere specified” for PEB adjudication.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated October 2006, 6 months prior to separation, the CI reported right shoulder problems.  Physical examination showed a palpable gap between the clavicle and the acromion with scar tissue noted at the site of the clavicle excision.  Shoulder ROM was 135 degrees abduction and otherwise full ROM with significant pain.  There was a positive test for impingement noted (Neer’s test).  Neurological examination was normal.  The MEB NARSUM examination, written in November 2006, 5 months prior to separation, used the data from the October MEB examination above.  The MEB examination (recorded on DD Form 2807 and 2808) was repeated on 11 January 2007, 2 months before separation.  The CI reported limited right shoulder ROM due to pain with arthritis.  The noted “limited ROM, some pain [with} rotation.”

At the VA Compensation and Pension (C&P) examination in April 2007, performed 1 month after separation, the CI reported aching, sharp pain, weakness, and difficulty working above his head; however, he could function without medication and the condition did not cause incapacitation.  The physical examination noted the CI was right hand dominant.  There was tenderness noted.  Shoulder forward flexion and abduction were both 180 degrees and there was no additional loss of ROM with repetition.  Strength and sensation were normal.  Right shoulder X-rays showed surgical changes and degenerative arthritis.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5299-5003 code (arthritis, degenerative), citing painful motion.  The VA also assigned a 10% rating using an analogous 5201-5010 code (arm, limitation of motion of, and arthritis due to trauma, substantiated by X-ray findings) based on the VA C&P examination a month after separation, citing pain and degenerative changes.  The VASRD §4.71a (code 5201, arm limitation of motion) threshold for a rating for ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion above this level.  Although there was no limitation of motion to support a rating under 5201, 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).  The Board noted that the PEB also adjudicated “right acromioclavicular arthritis” as a related Category II condition.  In this case the unfitting Category I condition of “residual right shoulder pain” and the Category II condition reflect the same disability and more than one rating cannot be assigned IAW VASRD 4.14 (Avoidance of pyramiding).  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 condition.  

BOARD FINDINGS:  In the matter of the right shoulder 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.  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 20140103, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 May 16

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