RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02324
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Infantryman, medically separated for “chronic pain, due to right sternoclavicular joint (shoulder) instability” with a disability rating of 10%.  

CI CONTENTION:  His sternoclavicular condition continues to worsen.  Also, he contends his not unfitting opioid and benzodiazepine abuse conditions.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20060413	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, due to Right Sternoclavicular Joint Instability	5099-5003	10%	No VA Exam in Evidence	
Opioid Abuse	Not Unfitting		
Benzodiazepine Abuse	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Pain, due to Right Sternoclavicular Joint Instability.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right hand dominant CI’s right sternoclavicular joint instability condition began in June 2005 after falling.  The CI had continued recurrent instability and pain treated with narcotic pain medication.  Orthopedic specialist indicated surgery was not recommended.  The MEB forwarded “sternoclavicular joint instability” for PEB adjudication.  

The 9 November 2005 MEB examination (recorded on DD Forms 2807 and 2808), 7 months prior to separation, referenced the VA dictation for history, complaints and physical examination.  At the 9 November 2005 VA Compensation and Pension (C&P) evaluation (VA dictation), performed 7 months before separation, the right-handed CI reported sternoclavicular dislocation and torn ligaments with pain on lifting and raising his arm above his head as well as daily flares of 7/10 pain lasting for hours.  Physical exam showed right arm flexion to 80 degrees (normal 180) abduction to 180 degrees (normal) and normal internal and external rotation.  Strength was normal (5/5).  There was visible (2 cm forward) dislocation of the sternoclavicular joint at 80 degrees of flexion.  There were no neurovascular deficits noted.  

The 29 November 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of right shoulder pain.  The cited orthopedic physical examination from 10 August 2005 (10 months prior to separation) showed tenderness and swelling at the sternoclavicular joint with a positive posterior drawer (for laxity).  The CI could perform spontaneous dislocations, and strength was normal.  Right arm flexion was 80 degrees (normal 180), and abduction, internal rotation and external rotation were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right sternoclavicular joint instability condition 10%, coded analogously as 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  There was no evidence of any VA rating of any condition despite the presence of the VA C&P examination 7 months before separation and the first page of a VA claim form (VA Form 21-526).  

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 examinations 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 was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus and guarding of all arm movement 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 panel recommends a disability rating of 20% for the right sternoclavicular joint instability condition, coded 5202-5201.  

Contended PEB Conditions:  Opioid Abuse and Benzodiazepine Abuse.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel 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 right sternoclavicular joint instability condition, the panel unanimously recommends a disability rating of 20%, coded 5202-5201 IAW VASRD §4.71a.  In the matter of the contended opioid abuse and benzodiazepine abuse conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Sternoclavicular Joint Instability	5202-5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150830, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012486, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,