RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2017-05788 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060223

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Bradley Fighting Vehicle System Maintainer, medically separated for “left shoulder pain status post modified Weaver-Dunn procedure” with a 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 - 20060126	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain…	5009-5003	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Left Shoulder (Non-Dominant). According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent a left shoulder Weaver- Dunn surgical procedure in June 2005 for stabilization of the AC joint. Despite surgery, physical therapy and oral pain medications the pain persisted with activity, particularly overhead activities. At the 27 July 2005 orthopedic follow-up, 6 weeks post-operative, the CI reported pain with active movement and increased pain with raising the arm above shoulder level or moving the arm across the chest.  On physical examination there was no swelling, erythema, deformity,

or atrophy. There was tenderness at the acromioclavicular tip. Forward flexion was reported as decreased, but without measurement.  Cross flexion was also decreased.

The 7 November 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of persistent symptoms especially with activities, particularly overhead activities. Physical examination showed positive Neer and Hawkins (impingement, painful motion), mild external rotational weakness, 4+/5, and no guarding noted. X-rays of the left shoulder demonstrated evidence of the modified Weaver-Dunn to include resected left distal clavicle as well as a mildly elevated distal clavicle. Left shoulder range of motion (ROM) showed flexion of 140 degrees (normal 180) and abduction of 140 degrees (normal 180). AMA pain rating was noted as slight and frequent. During the 5 December 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported continued pain, weakness, and lack of motion. Physical examination revealed tenderness of the anterior aspect and AC joint. Pain was elicited by forward flexion and abduction. Left clavicle deformity was noted. Motor strength was 5/5. A 2005 MRI showed slight superior migration of the distal right clavicle. There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left shoulder condition 10%, analogously coded 5003 (degenerative arthritis), citing application of the US Army Physical Disability Agency pain policy. 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 above this level. Although there was insufficient limitation of motion to support a rating under the 5201 code, panel members 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 the 5202 code (humerus, other impairment); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment). There was clinical and X-ray evidence of malunion of the clavicle to warrant a 10% rating, but this provides no greater benefit to the CI than the rating for painful motion. 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 left shoulder condition 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.

2	PD-2017-05788

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.