From: To:

IN   REPLY   REFER  TO:
1850
CORB:003
20 Feb 20

Director, Secretary of the Navy Council of Review Boards 
PD-2017-02361

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 27 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy.

2.	On 12 February 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02361 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20060115

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Field Artillery Cannoneer, medically separated for “mild AC [acromioclavicular] joint arthrosis” disability rating of 10%.

CI CONTENTION: Review requested of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20051109	VARD - 20070206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild AC Joint Arthrosis	5299-5003	10%	
Left Acromioclavicular Joint Status Post Dislocation	
5201	
0%	
20060710	
Status Post Left Upper Chest Wound	Cat II					
Chronic Left Shoulder Pain Status Post Motor Vehicle Accident	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 60%	
	
ANALYSIS SUMMARY:

Mild AC Joint Arthrosis. According to the service treatment record and MEB narrative summary (NARSUM), the CI was involved in a motor vehicle accident in July 2004 and sustained an open wound to the left upper chest area and left shoulder. He developed mild AC joint pain in August 2005, and X-rays revealed minimal AC joint arthroses and no fracture or dislocation.        An MRI

study was normal, and he was treated conservatively. At the 16 March 2005 orthopedic examination, left shoulder range of motion (ROM) showed flexion of 180 degrees (normal) and abduction of 180 degrees (normal). Pain increased with adduction and muscle strength was 5/5. The 3 August 2005 MEB NARSUM examination, 7 months before separation, noted complaints of left shoulder and upper chest wall pain. Physical examination showed “near normal bilateral shoulder ROM,” minimal tenderness, 5/5 muscle strength, and intact neurovascular function.

At the 10 July 2006 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported constant, sticking, sharp pain, rated at 8/10, that traveled up and down the left arm. However, he was able to function without medication. Physical examination showed a normal appearing shoulder, full flexion and abduction to 180 degrees, no pain, fatigue, weakness, lack of endurance, and incoordination after repetition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the mild AC joint arthrosis 10%, analogously coded 5299-5003 (arthritis, degenerative). The Navy PEB listed “status post left upper chest wound” and “chronic left shoulder pain and status post motor vehicle accident” conditions as related diagnoses (Category II) contributing to the disability in this case, but members concluded these diagnoses were not separate conditions which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding). The VA rated the left AC joint condition 0%, coded 5201 (arm, limitation of motion) based on the C&P examination, citing normal findings of both upper extremities without any evidence of ankylosis. The panel noted that the VASRD §4.71a threshold for rating ROM impairment under code 5201 is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level. However, 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 (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 AC joint condition.

BOARD FINDINGS:   In the matter of the mild acromioclavicular joint arthrosis and IAW    VASRD
§4.71, 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 20170227, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record