RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01952
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020404

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Military Police, medically separated for “chronic pain, right shoulder,” with a disability rating of 10%.

CI CONTENTION:  The CI contends his disability rating should have been higher.  The 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 – 20020117	VARD - 20020424	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Shoulder…	5099-5003	10%	Status Post Ligament Reconstruction…	5203	10%	20011204	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Pain, Right Shoulder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI sustained a Grade III separation (a complete disruption of the ligament which joins the two bones) of the acromioclavicular joint (ACJ), the joint that collar bone and shoulder blade, on 27 September 2000. Conservative management including immobilization, physical therapy, and duty restrictions was not adequate and the CI then underwent right shoulder surgery on 25 April 2001 to stabilize the ACJ.  The CI was seen in physical therapy on 12 June 2001.  Forward flexion was 150 degrees and abduction was 110 degrees (normal 180 degrees each).  There were no signs of impingement or instability, but provocative testing was positive for pain in the ACJ.  Despite rehabilitation, he was not able to return to unrestricted duty.  In orthopedics on 23 October 2001, the CI was determined to fail retention standards for the ongoing shoulder pain and referred for an MEB.  

At the 4 December 2001 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported right shoulder pain, weakness, stiffness, swelling, inflammation, locking, fatigue, and lack of endurance.  He said the shoulder was constantly sore, the pain flared with most activities and was alleviated by Motrin and rest.  The physical examination showed no signs of inflammation or instability.  Forward flexion was 180 degrees and abduction 170 degrees.  There was some apparent weakness of the right shoulder, according to the examiner.  However the same examiner recorded that the neurological examination was normal.  The Board cannot explain this disparity.  An X-ray revealed some separation of the right AC joint.  The 17 December 2001MEB NARSUM evaluation, 3 months prior to separation, was dictated by a treating orthopedist.  The CI complained of ongoing right shoulder pain aggravated by activity.  Shoulder dislocations were not recorded.  Forward flexion was 180 degrees and abduction was 120 degrees.  The shoulder was stable.  X-rays showed that the ACJ was well aligned and restored.  The MEB forwarded “right shoulder pain, chronic, status post coracoclavicular ligament reconstruction using a semitendinosus graft” for PEB adjudication.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA also assigned a 10% rating, but used the 5203 code (impairment of clavicle or scapula).  A 10% rating is supported by limited and painful motion with X-ray evidence of arthritis.  Absent instability, malunion, or motion limited to the shoulder level, there was no route to a higher rating than that adjudicated by the PEB.  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.  

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 20150709, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005295, XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
						      					
Enclosure