RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX			          CASE:  PD-2014-03436
BRANCH OF SERVICE: Army		         SEPARATION DATE:  20060609

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Infantryman, medically separated for “chronic right (dominate) shoulder pain” with a disability rating of 10%.

CI CONTENTION:  “Please consider all conditions.”  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 based upon a 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 - 20060518	VARD - 20070214	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right (Dominant) Shoulder Pain	5099-5003	10%	Healed Clavicle Fracture Early Degenerative Joint
Disease of the Acromio Clavicular Joint	5010-5203	10%	20060923	
Chronic Neck & Back Pain	Not Unfitting	Chronic Strain and Degenerative Joint Disease Lumbar Spine	5010-5237	0%*	20060923	
		Moderate Traumatic Arthritis C-Spine with Chronic Cervical Strain	5010-5237	0%	20060923	
Hyperlipidemia	Not Unfitting	No VA Placement	
Adjustment Disorder	Not Unfitting	Adjustment Disorder	9440	NSC	20060828	
Hearing Loss	Not Unfitting	Left and Right Hearing Loss	6100	0%	20060923	
		Tinnitus	6260	10%	20060923	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Right (Dominant) Shoulder Pain.  The service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM) documented a shoulder injury after a HUMVEE rollover accident in June 2004.  Diagnostic imaging (MRI) in August 2005 documented a healed clavicle fracture, and findings suspicious for a full thickness tear of the anterior rotator cuff (supraspinatus tendon which initiates abduction).  Despite treatment, the shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “chronic shoulder pain, post fracture” for PEB adjudication.

At the MEB examination on 30 August 2005 (9 months pre-separation), the CI reported pain and numbness in the right arm after doing push-ups or any activity.  The examiner documented tenderness of the anterior shoulder and distal clavicle with painful motion; no limitation of movement.  Electrophysiologic testing in September 2005 for radiculopathy was negative.

The MEB NARSUM examination was written on 17 April 2006.  The CI reported chronic neck and shoulder pain, worsened by overhead or repetitive movement.  An orthopedic addendum, completed on the same day, documented a physical examination that showed range of motion (ROM) was forward flexion and abduction to 150 degrees (both normal 180), with atrophy of the rotator cuff musculature, evidence of supraspinatus tendon impingement, and 4/5 strength.  There was no evidence of other rotator cuff (labral or acromioclavicular) pathology.

At the VA Compensation and Pension (C&P) examination dated 23 September 2006 (3 months post-separation), the CI reported pain, weakness, and stiffness with occasional swelling.  The physical examination documented painful ROM with flexion and abduction to 170 degrees.  Radiographic evaluation documented a healed clavicle fracture and early degenerative joint disease of the acromioclavicular joint.

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10% analogously coded 5099-5003 (degenerative arthritis), citing flexion and abduction to 150 degrees with pain slight/constant.  The VA also rated the right shoulder condition 10% analogously coded 5010-5203 (arthritis due to trauma - clavicle or scapula, impairment) based on the VA C&P examination 3 months after separation, citing painful limitation of motion.

The Board considered the evidence for a higher than 10% rating.  The orthopedic addendum documented signs of impingement and limited motion.  The VASRD §4.71a (code 5201, arm limitation of motion) criteria for a 20% rating for limited motion is “at shoulder level,” and the ROM in evidence demonstrated motion above this level.  There was no evidence of recurrent dislocation at the scapulohumeral joint with guarding for a higher rating under 5202.  There was no evidence of impairment, dislocation or nonunion of the clavicle for a higher rating under 5203.  Therefore, Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  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.

Contended PEB Conditions:  Neck and Back Pain, Hyperlipidemia, Hearing Loss and Adjustment Disorder.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions, except hearing loss, were profiled.  None were implicated in the commander’s statement and none were judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.
The adjustment disorder is a condition not constituting a physical disability, IAW DoDI 1332.38; therefore, the Board has no basis for recommending it as unfitting.  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 any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  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.  In the matter of the contended adjustment disorder, neck and back pain, hyperlipidemia, hearing loss and adjustment disorder conditions, the Board unanimously recommends no change from the PEB determinations 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 20140719, 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 
XXXXXXXXXXXXXXXXXX, AR20160017187 (PD201403436)

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