RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04503
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050623

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Military Policeman, medically separated for “chronic pain, left shoulder with malunion of clavicle” with a disability rating of 10%.

CI CONTENTION:  “Injury has caused an increase issue with range of motion [ROM] which has continued to decrease ROM and causes chronic pain and numbness.”  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 – 20050405	VARD – 20060907	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Shoulder	5203	10%	Left Shoulder Strain	5202	20%	20060124	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left (Non-Dominant) Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI fractured his collar bone in 2001 (prior to service) playing football.  This was noted at his entry physical, but he was asymptomatic and able to complete training.  In November 2004, he felt as though his shoulder popped out of place while doing push-ups, and in December 2004, an orthopedist diagnosed “malunion of fractured clavicle,” but noted full shoulder ROM and no surgical indication.  During a physical therapy (PT) visit on 16 December 2004, flexion was 112 degrees (normal 180) and abduction 75 degrees (normal 180).  On 11 January 2005, flexion was 125 degrees and abduction 120 degrees; the next day the CI was noted to have full ROM.  The 22 February 2005 MEB PT formal ROM measurements showed flexion of 100 degrees and abduction of 84 degrees, with painful motion.  

During the 11 March 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported numbness and tingling in his left shoulder down to his hand and finger tips.  Physical examination showed a marked left clavicle deformity with mildly decreased ROM and pain on movement, but no swelling or erythema.  The MEB NARSUM examination the same day noted complaints of constant pain aggravated by activity.  The examiner noted a marked mid clavicle deformity and repeated the MEB PT ROM measurements.  

At the 24 January 2006 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported persistent left shoulder pain after doing push-ups and with overhead motion.  Imaging revealed evidence of an old fracture involving the mid shaft of the left clavicle.  Physical examination showed a moderate mid clavicle deformity, flexion to 90 degrees and abduction to 100 degrees, with pain.  An additional 10-degree loss was estimated with repetition. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, coded 5203 (clavicle or scapula, impairment of), citing clavicle malunion and pain-limited abduction.  The VA rated the left shoulder condition 20%, coded 5202 (humerus, other impairment of), based on the C&P examination, citing moderate mid clavicle deformity.  The VASRD §4.71a threshold for a 20% rating for non-dominant ROM impairment under code 5201 (arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and examinations reflected this degree of limitation.  There was no fibrous union or nonunion of the humerus to justify a higher rating under code 5202, and no higher rating available under code 5203.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left shoulder condition, coded 5201.  

BOARD FINDINGS:  In the matter of the left shoulder condition, the panel recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Pain, Left Shoulder with Malunion of Clavicle	5201	20%	

The following documentary evidence was considered:

AR20190004849, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR)
reviewed your application and found that your disability rating should be modified but
not to the degree that would justify changing your separation for disability with
severance pay to a permanent retirement with disability. I have reviewed the Board’s
recommendation and record of proceedings (copy enclosed) and I accept its
recommendation. This will not result in any change to your separation document or the
amount of severance pay. A copy of this decision will be filed with your Physical
Evaluation Board records. I regret that the facts of the case did not provide you with the
outcome you may have desired.
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.
A copy of this decision has also been provided to the Department of Veterans Affairs.