RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01643
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080627

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

CI CONTENTION:  Review all 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 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 – 20080227	VARD – 20080912	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	10%	Left Shoulder Condition	5203	10%	20080506	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Left Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left (non-dominant) shoulder condition began in September 2006 following a fall.  Radiographs demonstrated a severely displaced clavicle consistent with a Grade-5 acromioclavicular (AC) separation he underwent clavicular ligament reconstruction on 20 June 2007 without complication.  However, he re-injured his shoulder after moving equipment in September 2007, and suffered a grade-3 AC separation.  He continued to experience shoulder pain but elected not to proceed with another operation and was eventually referred for an MEB.  

The 5 November 2007 MEB NARSUM examination, 7 months prior to separation, noted CI complaints of left shoulder pain.  Physical examination revealed well-healed surgical scars consistent with prior surgery and an obvious AC joint deformity, but no erythema or tenderness.  Left shoulder range of motion (ROM), measured with a goniometer, showed forward flexion to 180 degrees (normal), and abduction to 180 degrees (normal), which were equal to the unaffected side.  During the 19 November 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reported left shoulder pain with “a bone sticking out.”  The provider noted the left shoulder deformity as well as tenderness and ROM limited by pain.  

At the 5 May 2008 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported left shoulder pain exacerbated by cold exposure and upon waking up in the morning.  However, his activities of daily living were not affected and he was able to function during periods of pain.  Physical examination revealed both flexion and abduction to 180 degrees with evidence of painful motion.  There was no change or limitation of motion upon repeated resisted testing.  The examiner described the clavicle as jutting above the clavicular junction “indicating a distinct AC separation.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, analogously coded as 5003 (degenerative arthritis), citing painful motion.  The VA also rated the shoulder condition 10%, coded 5203 (impairment of clavicle or scapula), based on the C&P examination, citing a malunion or nonunion of the clavicle or scapula.  Panel members noted that the VASRD §4.71a threshold for rating for ROM impairment under code 5201 (arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level.  However, the panel agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under code 5202 (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under code 5203.  After due deliberation, considering all of 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 left shoulder condition.  

BOARD FINDINGS:  In the matter of the chronic left shoulder pain 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 20170224, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180011260, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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