RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01870
BRANCH OF SERVICE:  Army	BOARD DATE:  20150417
SEPARATION DATE:  20051115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (M1 Armor Crewman) medically separated for a chronic right shoulder pain condition.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The right shoulder condition, characterized as “incompetent coracoclavicular ligaments right shoulder, status post acromioclavicular (AC) joint separation,” “complete disruption of the right AC ligaments,” and “chronic right shoulder pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic right shoulder pain,” as unfitting, rated 20%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  An admin correction by the Army Physical Disability Agency changed the disability code, but maintained the rating.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions and any information acted to the Serviceman’s connected disability.”

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 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:

Admin Corr IPEB – Dated 20051020	VA* - (~13 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain 	5299-5202	20%	Acromioclavicular Separation of the R/Shoulder w/Tendinitis, Bursitis, and Impingement	5201	20%	20061218	
Other x 0 (Not In Scope)	Other x 9	
RATING:  20%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20080904 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Right Shoulder Pain Condition.  Treatment records evidence that the CI sustained a right shoulder injury in October 2004.  He was diagnosed with right AC separation which was surgically repaired.  The CI continued to experience post-surgical shoulder pain and limitation of motion.  An X-ray dated 29 October 2004 demonstrated mild widening of the AC joint compatible with separation and a fixation screw of the clavicle to the acromion.  The CI was referred to physical therapy (PT).  Throughout the course of PT the CI reported sleep disturbance due to right shoulder pain, decrease range-of-motion (ROM), and difficultly lifting greater than 50 pounds.  The PT noted documented improving ROM from 70 to 110 degrees of abduction from 24 November 2004 to 16 December 2004.  Despite PT the CI continued to report that he was unable to extend his right shoulder without pain and pain with direct pressure.  A PT note dated 5 April 2005 noted that the CI had a right shoulder injection.  The therapist noted that the right clavicle was slightly more prominent that the left, but that there was no instability.  The narrative summary (NARSUM) noted that the CI had the fixation screw removed in December 2004 with decreased pain from 7-8/10 to 4-5/10.  The examiner noted that surgical options were available, but that the CI was declined surgery based on his past experience.  The shoulder examination demonstrated deformity with moderate prominence of the distal right clavicle, displacement of the humeral head, atrophy of the deltoid and supraspinatus muscles, and marked tenderness to palpation of the distal clavicle and acromion.  Diagnoses of incompetent coracoclavicular ligaments right shoulder, complete disruption of the right AC ligaments, and chronic right shoulder pain were rendered.

At the VA Compensation and Pension examination performed 13 months after separation, the CI reported constant right shoulder pain with flare-up during cold weather.  He reported that he could not life greater than 50 pounds.  The shoulder examination demonstrated mild to moderate weakness and fatigue with repetitive movement and painful motion beginning at 110 degrees with forward flexion and abduction.  The examiner noted that the CI was right hand dominant.  Radiographic evaluation dated 9 August 2006 noted mild widening of the acromioclavicular joint space with scarring at from the glenoid to proximal shaft of the humerus.

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 ~3 Mo. Pre-Sep
(20050823) 	VA C&P ~13 Mo. Post-Sep
(20061218) 	
Flexion (180 Normal)	140,142,140 	180	
Abduction (180)	147.145.146 	150	
Comments	Painful motion, muscle atrophy, humeral head displacement.	Painful motion	
§4.71a Rating	20%	(20%- VA)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the chronic right shoulder pain secondary to a shoulder dislocation as unfitting. Both the PEB (5299-5202, humerus other impairment of) and VA (5201, arm limitation of motion) rated the condition at 20%.  The Board considered whether the evidence supported a higher than 20% rating.  The PEB stated that the ROM was limited by tissue limits to 170 degrees of passive abduction and rated equal to marked deformity of malunion.  The Board noted that the VASRD rates active range of motion.  The Board determined that the CI’s active range of motion of abduction to 150 degrees was above shoulder level and did not meet the criterion of arm limitation of motion between the side and shoulder level for higher rating.  The Board also noted that the PEB stated the shoulder condition was rated equal to marked deformity of malunion and that marked deformity of the humerus of the dominant (major) extremity, IAW VASRD code 5202 is rated at 30%.  The Board then deliberated if the right shoulder deformity rose to the level of marked shoulder deformity.  The NARSUM noted inferior displacement of the humeral head, muscle atrophy, and moderate prominence of the distal clavicle; however, there was no loss of muscle strength, the pain was reported as 2-3/10, and there was no impact on activities of daily living.  Radiographic evaluation demonstrated mild widening of the AC joint and scarring at the humeral head and upper shaft.  Board members agreed, mindful of VASRD § 4.7 (the higher of two evaluations), that the right humerus deformity most closely approximated moderate deformity.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board members agreed that a disability rating of 20% for the chronic right shoulder pain condition was appropriately recommended in this case.

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 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140428, 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, AR20150013653 (PD201401870)

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