RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01101
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20041031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman and Basic Security Guard, medically separated for “acromioclavicular arthrosis status post grade V acromioclavicular separation status post modified Weaver-Dunn procedure right acromioclavicular joint [right shoulder]” with a disability rating of 20%.

CI CONTENTION:  No specific contention was made.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:

SERVICE PEB - 20040902	VARD - 20050307	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Acromioclavicular Arthrosis…[Right Shoulder]	5201	20%	Right Shoulder Strain	5201	10%	20050207	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Acromioclavicular Arthrosis [Right Shoulder].  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right shoulder condition began in February 2003 when he was thrown to the ground and suffered a grade V acromioclavicular joint (AC joint) separation while participating in the Marine Corps Martial Arts Program.  He underwent a right shoulder modified Weaver-Dunn procedure to correct deformity and instability in April 2003.  Surgical hardware was removed from the right shoulder in October 2003.  Physical therapy improved the CI’s symptoms but he continued to have limited right shoulder range of motion (ROM) and some weakness. 

During 25 Jun 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, physical examination showed full range of motion (ROM) with pain at abduction to 110 degrees (normal 180); flexion was not addressed. The 22 July 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of right shoulder pain while performing pullups, pushups, lifting, and overhead activity.  Physical examination revealed marked deformity of the right AC joint which was elevated.  There was no atrophy, muscular wasting or swelling.  Flexion and abduction were both 90 degrees (normal 180) with pain-limited motion.  Strength testing was abduction 4/5 limited by pain; all other testing was normal.  

At the 7 February 2005 VA Compensation and Pension (C&P) joints examination, 3 months after separation, the CI reported right shoulder pain.  Physical examination showed flexion and abduction to 180 degrees.  The examiner noted painful motion was absent.  Upper extremity motor strength was 5/5. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 20%, coded 5201 (arm, limitation of motion).  The VA rated the right shoulder condition 10%, also coded 5201, based on the C&P joints examination.

The VASRD §4.71a threshold for the 20% rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side).  Although the MEB NARSUM demonstrated motion to shoulder level, all other examinations proximate to separation demonstrated motion above shoulder level.  Therefore, panel members agreed, a higher rating was not justified under the 5201 code.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment), and no higher ratings available under the 5203 code (clavicle or scapula, impairment).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded 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 panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160930, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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

      In accordance with reference (a), I have reviewed the cases listed below and 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:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

							XXXXXXXXXXXXXXXXXX
	     				                        Assistant General Counsel
						        (Manpower and Reserve Affairs)