RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01130
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020926

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Attack Helicopter Repairer, medically separated for “right shoulder pain due to sternoclavicular joint sprain,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends his shoulder condition continues to worsen and negatively impact his daily activities.  His 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 on 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 - 20020702	VARD – 20070216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic R Shoulder Pain	5099-5003	10%	Impingement Syndrome, R Shoulder	5299-5203	10%	20070110	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Shoulder (Dominant) Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI fell on his dominant right shoulder after a motorcycle accident on 23 September 2001.  X-rays of the shoulder and clavicle (collarbone) were normal.  He was noted to have painful but full range of motion (ROM) of the shoulder.  He was treated with limited duty, medications, and physical therapy (PT).  In PT on 15 January 2002, he was noted to have full ROM and strength without pain.  He was referred to orthopedics and advised to continue the home exercise program.  At the time of the orthopedic clinic appointment on 27 February 2002, 7 months prior to separation, the examiner recorded tenderness, swelling, and moderate bruising about the joint.  There were no impingements signs. Tenderness was present over the sternoclavicular joint (chest bone and collar bone junction) and a CT scan was requested.  It was normal.  Despite treatment, the right shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “chronic right sternoclavicular joint sprain” and “right shoulder impingement syndrome” for PEB adjudication.  The commander’s letter dated 2 May 2002 noted that the CI’s immediate supervisor had testified, on behalf of the CI at an Article 15 proceeding, that the work performance of the CI had been outstanding the previous 3 months.  It was noted that the CI was capable of performing his job.  It was also noted that the CI was projected to transfer to Korea in July 2002 and that he did “not appear to enjoy the idea of a PCS move to Korea.”  

At the MEB examination (recorded on DD Forms 2807 and 2808) done the same day in May which was also 5 months prior to separation, the physical examination noted normal rotation, but decreased right shoulder abduction and forward flexion without quantification.  Good strength was noted.  The MEB NARSUM examination on 7 June 2002, 4 months prior to separation and accomplished by an orthopedic surgeon, noted complaints of persistent pain in the right sternoclavicular area as well as impingement signs.  The physical examination showed moderate swelling and persistent discoloration about the sternoclavicular joint and tenderness to palpation.  There was free ROM, but positive signs of impingement.  Motor, strength and sensation were normal.  The VA Compensation and Pension (C&P) evaluation was not performed until 10 January 2007, over 5 years after separation and well outside the normal 12-month window after separation to be assigned higher probative value for rating purposes.  The CI reported intolerance of working overhead and had an impaired ability to reach, lift, and throw.  The CI denied pain when not working overhead. The physical examination documented limited ROM recorded as flexion of 158 degrees (180 normal) with pain starting at 102 degrees.  Abduction was 167 degrees (180 normal) with pain starting at 105 degrees.  External and internal ROM was full without pain.  After repetition, flexion was 153 degrees and abduction was 142 degrees.  There was no anterior shoulder tenderness, however there was tenderness of the right sternoclavicular joint.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing application of the US Army Physical Disability Agency pain policy.  The VA also rated the right shoulder condition 10%, coded 5299-5203 (clavicle or scapula, impairment of), based on the C&P examination conducted more than 5 years after separation, citing painful motion.  The MEB forwarded both a right sternoclavicular joint sprain and right shoulder impingement as failing retention standards.  It considered if separately unfitting conditions were present.  The CT of the sternoclavicular joint was normal as were X-rays of the right shoulder.  The commander noted that the performance of the CI in the months leading up to separation had been outstanding and the orthopedic evaluation for the MEB noted normal motor function and ROM.  The evidence does not support a finding that separately unfitting conditions were present at separation.  The Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  No route to a higher rating was found.  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 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

08 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002610 (PD201501130)

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