RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02106
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Indirect Fire Infantryman, medically separated for “chronic right shoulder pain status post acromioclavicular [AC] separation” with a disability rating of 0%.  

CI CONTENTION:  The VA rated higher for the shoulder condition.   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 – 20070331	VARD - 20080130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain…	5099-5003	0%	Status Post Right Shoulder Reconstruction Surgery	5201	20%	20071128	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right (Dominant) Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI suffered an AC joint separation when he fell and landed on his right shoulder in July 2004.  He underwent AC reconstruction in October 2004, with hardware removal in April 2005, and a right distal clavicle excision in October 2005.  Post-operatively, he continued to have significant right shoulder pain.

The 3 November 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of constant right shoulder pain, rated 8/10 in severity, and aggravated by lifting, and moving or carrying most any weight; it also prevented him from doing housework or walking the dog.  Physical examination showed full range of motion (ROM) with “good strength…although, slightly decreases as compared to the left side…”  The examiner documented possible slight muscle atrophy over the right deltoid, but did not address painful motion.  The 17 November 2006 physical therapy ROM measurements for the MEB recorded flexion to 148 degrees (normal 180) and abduction to 166 degrees (normal 180), with no painful motion noted.  

At the 28 November 2007 VA Compensation and Pension (C&P) examination, 8 months after separation, the examiner documented “right shoulder normal, abduction complete, 0-90 deg, no pain, forward flexion 0-90 deg, no pain, int and ext rotation 0-90 deg, no pain.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing no significant loss of passive shoulder motion or evidence of joint instability.  The VA rated the right shoulder condition 20%, coded 5201 (limitation of arm motion), based on the C&P examination, citing arm motion limited at shoulder level.  Members first deliberated over the disparity between the MEB and C&P ROM measurements, and determined that the MEB NARSUM and PT examinations were more proximate to separation and thus carried the greatest probative value.  Additionally, the panel agreed that the C&P examiner’s confusing record of “ROM right shoulder normal” along with “0-90 deg” measurements made those findings less probative.  Members noted there was no shoulder limitation of motion to support a rating under diagnostic code 5201, or satisfactory evidence of painful motion or functional loss to support a 10% rating IAW VASRD §4.59, §4.40 or §4.45.  Likewise, there was no malunion, deformity, or recurrent dislocation of the humerus to justify a rating under code 5202 (humerus, other impairment of); and no nonunion or malunion of the clavicle or scapula to warrant any rating under code 5203 (clavicle or scapula, impairment of).   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 chronic right 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 20170209, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180016342, 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