RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04288
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20060815

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aircraft Electrical Systems Technician, medically for “chronic acromioclavicular separation, left 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 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 - 20060518	VARD - 20071115	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Acromioclavicular Separation	5299-
5201	20%	Left Shoulder Acromioclavicular Separation, S/P Reconstruction of Coraclavicular and Cromioclavicular Joint	
5203	
10%	
20070910	
Chronic Left Shoulder Pain	Cat II					
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Chronic Left Shoulder Acromioclavicular Separation. According to the service treatment record and the MEB narrative summary (NARSUM), the CI underwent four left shoulder surgeries (first one in 1999 due to a Grade 3 acromioclavicular joint separation 2 distal clavicle stabilization, last one in June 2005 was for revision due to recurrent clavicle separation). The CI developed an infection after surgery which was treated with intravenous antibiotics in the hospital for approximately one month. Radiograph imaging showed erosion and absence of the distal clavicle.

The 7 December 2005 orthopedics examination, 8 months prior to separation, noted the shoulder was popping out and there was tingling and numbness in the little and ring fingers. On examination the left shoulder range of motion (ROM) showed flexion of 150 degrees (normal
180)	with  pain  and  abduction  of  90  degrees  (normal  180).    Tenderness  was  present.  The
180)	
examiner did not comment regarding instability. The 15 March 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of constant pain and numbness at the lateral aspect of the shoulder as well as the fourth and fifth digits of the left hand.

At the 10 September 2007 VA Compensation and Pension (C&P) examination, 13 months after separation, the CI reported daily pain and loss of mobility to the shoulder. On examination the left shoulder showed painful motion with flexion of 115 degrees and abduction of 100 degrees. There was no effusion or impingement. There was no deltoid atrophy, and muscle strength was measured to be 5 out of 5.  There was no additional limitation following repetitive ROM.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic left shoulder acromioclavicular separation, 20%, analogously coded as 5201 (arm, limitation of motion). The PEB also listed chronic left shoulder pain as a related Category II condition that contributed to the primary unfitting condition but was not separately ratable. The impairment from the chronic left shoulder pain was properly subsumed under the overall rating for the chronic acromioclavicular separation, left shoulder IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA rated the left shoulder condition 10%, coded 5203 (clavicle or scapula, impairment), based on the C&P examination, citing painful motion, along with surgical resection of the distal clavicle.

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. The panel considered other VASRD shoulder and analogous codes, but all were less applicable and not advantageous for rating. 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 chronic, left shoulder acromioclavicular separation.

BOARD FINDINGS: In the matter of the chronic left shoulder acromioclavicular separation 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:

2	PD-2017-04288

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY   REFER  TO,
1850
CORB: 003 20May20

From:

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 2 Oct 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate  action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno 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.