RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03357
BRANCH OF SERVICE:  Army	SEPARATION DATE: 20090428

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Machinist, medically separated for “right shoulder pain,” with a disability rating of 20%.  

CI CONTENTION:  The applicant has asked for consideration of all conditions in his application.  The CI’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 – 20090210	VARD	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain…	5299-5202	20%	Residuals Of Fracture of Right  Corocoid Process with Right AC
Separation of the Right Shoulder	5201	20%	20090812	
Frequent Headaches	Not Unfitting	No VA Placement	
COMBINED RATING:  20%	COMPLETE COMBINED RATINGOF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  Shortly after accession, the right dominant CI fell onto his right elbow and jammed his upper arm into his shoulder.  He was treated conservatively with medications, physical therapy (PT) exercises and a week of duty restrictions.  He was able to complete training and deploy, but while deployed noted recurrent pain and was found to have a chronic separation of the acromio-clavicular joint ([ACJ] the joint between the collar bone and shoulder).  He was again treated conservatively, but his pain persisted and a surgical repair was accomplished on 5 June 2007.  He underwent rehabilitation in PT following his surgery with a reduction in symptoms, but was not able to return to full duty.  He then fell and reinjured the right shoulder, fracturing a different part of the shoulder bone (coracoid process).  This was treated conservatively, but his symptoms persisted and a computed tomography scan subsequently showed that the fracture had not properly healed (non-union).  A second operation was thought to not be beneficial.  He was not able to meet duty requirements and referred for a Medical Evaluation Board (MEB).  

At the MEB examination on/about 2 December 2008, the CI reported ongoing pain in the right shoulder and weakness.  The examiner noted decreased strength moving the arm from front to the side (ad- and abduction) and decreased range of motion (ROM) with internal rotation.  The CI was evaluated in PT for ROM measurements (charted below) on 12 December 2008, just over three months prior to separation.  The CI reported that he avoided overhead activity and heavy lifting.  Motion was painful throughout the range and crepitus (an audible or palpable grating noise/sensation) was present.  His strength was reduced in all planes.  The shoulder was tender to palpation and with abduction (away from the body) past 100 degrees.  The motor examination was normal and the shoulder was stable.  The narrative summary (NARSUM) was dated 22 December 2008.  On examination, his armswing while walking was normal and the CI was able to take off his shirt without difficulty.  

At the VA Compensation and Pension (C&P) examination performed on 12 August 2008, 4 months after separation, the CI reported shoulder problems since the initial injury, but that he had improved (with treatment).  On examination, his strength was normal and atrophy was absent.  The shoulder was stable.  X-rays showed post-surgical changes and some widening of the ACJ which did not change with weights (an increase in joint space with a load is an indication of laxity of the ligament).  The ROM was slightly reduced and painful.  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 ~4 Mo. Pre-Sep	VA C&P ~4 Mo. Post-Sep	
Flexion (180 Normal)	162	165	
Abduction (180)	131	165	
Comments	Motor loss; painful ROM	Nml motor; painful ROM	
§4.71a Rating	10% (4.59)	10%(4.59)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the shoulder at 20%, coded 5299-5202 (other impairment of the humerus) and 5201 (limitation of motion of the arm), respectively.  Both cited VASRD §4.10 (functional impairment) and VASRD §4.40 (functional loss).  The Board considered these codes and others applicable to the shoulder and found no route to a rating higher than the 20% adjudicated by the PEB.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder pain condition.  

Contended PEB Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that “frequent headaches” was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The headache condition profiled or implicated in the commander’s statement and was not judged to fail retention standards.  The CI was seen twice for headaches in the year prior to separation and returned to duty.  It was reviewed and considered by the Board.   There was no performance based evidence from the record that the headaches significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the headache condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the right shoulder pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended “frequent headaches” condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140628, with attachments
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 XXXXXXXXXXXXXXXXXXXX, AR20160007995 (PD201403357)

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:

Enclosure

CF:
( ) DoD PDBR
( ) DVA