RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02311
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20061201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty  E3, Infantry, Gun Crews, and Seamanship Specialists, medically separated for “status post resection of distal right clavicle with persistent pain,” with a disability rating of 20%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20061004	VARD - 20070414	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Resection of Distal Right Clavicle with Persistent Pain	5202	20%	Right Shoulder Tendonitis with Bursitis and AC Separation Status Post Arthroscopic Surgery	5024	10%	20070402	
Status Post Arthroscopic Debridement of Right Shoulder	Cat II					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Status Post Resection of Distal Right Clavicle with Persistent Pain.  The CI was right-handed (major/dominant).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right shoulder arthroscopic Mumford procedure in September 2005 and a second arthroscopic surgery in February 2006.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right clavicle pain status post arthroscopic debridement right shoulder” for PEB adjudication.  

According to the MEB NARSUM evaluation on 10 August 2006 (4 months prior to separation) the complained of persistent right shoulder pain that restricted his activities of daily living which require abduction greater than 90 degrees and inability to perform pushups.  Shoulder dislocations were not reported.  Physical examination showed evidence of instability with a positive apprehension test.  The right shoulder had full range of motion (ROM) with pain at the extremes of motion.  There was minimal tenderness over the distal end of the clavicle.  There was no atrophy and O’Brien test (for labral tears) was negative.  The distal neurovascular examination was normal.  

During the MEB examination (recorded on DD Forms 2807 and 2808) dated 23 August 2006, 3 months prior to separation, physical examination showed decreased strength of 4-5/5 (normal 5/5) and full ROM of the right shoulder.  

At the time of the Physical Therapy (PT) clinic appointment on 7 September 2006, 3 months prior to separation, the CI reported right shoulder pain and instability.  On examination pain was rated 6/10 at rest and increased with any movement.  There was tenderness of the anterior shoulder and the acromioclavicular (AC) joint.  ROM measurements showed a flexion of 165 degrees (normal 180) and an abduction of 165 degrees (normal 180).  Strength was decreased 3+/5, scapular stabilization was fair, sensation was normal, and there was pain with impingement and rotator cuff provocation tests.  

At the 2 April 2007 VA Compensation and Pension (C&P) examination, performed 4 months after separation, physical examination showed right shoulder tenderness.  ROM measurement showed a flexion of 160 degrees after a Deluca examination (repetition) and an abduction of 160 degrees; all movements during ROM measurements were with moderate pain, mild weakness and fatigue, but no incoordination.  The diagnosis was tendinitis and bursitis, AC separation, and previous nonunion right clavicle fracture.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 5202 code (humerus, other impairment of).  The Navy PEB also listed “status post arthroscopic debridement of right shoulder” as a related Category II condition (a condition that contributed to the primary unfitting condition but was not separately ratable).  The impairment from the “status post arthroscopic debridement of right shoulder” was properly subsumed under the overall rating for the “status post resection of distal right clavicle with persistent pain” IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA assigned a 10% rating using the 5024 code (tenosynovitis) for limited and painful motion.  

There was no route to a higher rating under code 5202 as there was no malunion with marked deformity of the humerus or frequent episodes of recurrent dislocation with guarding of all arm movements to warrant the next higher 30% rating.  There was no route to a higher rating for limitation of motion (5201) as 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.  Although the 5203 code was alternatively applicable in this case for dislocation of the clavicle, the maximum 20% rating under this pathway offered no advantage to the CI.  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 20150819, w/attachments
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 26 Apr 17

      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:

		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
						                				(Manpower & Reserve Affairs)