RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03570
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20050911

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Boatswain’s Mate, medically separated for “left shoulder joint separation,” with a disability rating of 20%.  

CI CONTENTION:  The applicant’s left shoulder was “locking up.”  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 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 - 20050606	VARD - 20061011	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Acromioclavicular Joint Separation	5201	20%	Residuals of Contusion of the Left Shoulder with Separation of the Left Acromioclavicular Joint	5099-5203	10%	20060821	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Shoulder Acromioclavicular Joint Separation.  The CI was right-handed per the entry physical and VA examination.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his left shoulder in January 2004 after falling.  The CI reported persistent pain and radiographic studies and neuromuscular tests were conducted.  An X-ray of his shoulder in January 2004 showed evidence of a left shoulder acromioclavicular (AC) joint separation.  An MRI performed in February 2004 indicated an AC joint separation and a possible tear of the coracoclavicular ligament.  A nerve conduction study in 2004 showed all muscles tested were normal.  X-ray studies on 19 January 2005 showed no fractures and a slight elevation (11 mm; deformity) of the collar bone in relation to the left shoulder joint.  Despite treatment, the left 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 “closed dislocation of acromioclavicular joint” for PEB adjudication.  

At the MEB NARSUM examination dated 2 February 2005, 7 months prior to separation, noted the CI had a “deformity” and tenderness over the left AC joint.  The upper arm was intact with no atrophy and his shoulder strength was: 3/5 (5/5 normal).  The arm was neurovascularly intact.  The CI’s left shoulder flexion was 90 degrees (normal 180 degrees) and abduction was 90 degrees (normal 180 degrees).  During the MEB examination (recorded on DD Forms 2807 and 2808) dated 03 March 2005, 6 months prior to separation, the CI reported sharp shoulder pain and arm numbness.  Physical examination indicated a “distal clavicle” and limited range of motion (ROM).  

At the 21 August 2006 VA Compensation and Pension (C&P) examination, performed 11 months after separation, the CI reported pain on elevation of his arm above shoulder level, and paresthesias with occasional numbness.  Physical examination showed the left shoulder had a “normal configuration.”  There was mild pain over the left AC joint.  The CI had painful but “full range of motion” in the left shoulder.  The CI’s left shoulder forward flexion and abduction were full with onset of pain at 140 degrees and 135 degrees respectively.  During repetitive motion, the CI complained of easy fatigability and lack of endurance, but had no decreasing ROM.  Electrodiagnostic testing was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 5201 code (arm, limitation of motion).  The VA assigned a 10% rating using an analogous 5099-5203 code (clavicle or scapula, impairment), for “limitation of motion caused by pain.”  The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the Service examination in evidence demonstrated motion limited to this level.  The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level;” however, examinations did not reflect this degree of limitation.  There were no nonunion or fibrous union of the humerus to justify a higher rating under the 5202 code (humerus, other impairment of), and no higher ratings available 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 left shoulder condition.  

BOARD FINDINGS:  In the matter of the left shoulder joint separation 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 20140725, 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 11 Aug 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:

		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN

						  	XXXXXXXXXXXXXXXXXXXX
	     				  		Assistant General Counsel
						  	(Manpower & Reserve Affairs)