RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY  
SEPARATION DATE:  20031216 

 
NAME:  XXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1101003 
BOARD DATE:  20130130 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty PFC/E-4 (11B/Infantryman), medically separated for 
chronic  right  shoulder  pain.    He  injured  his  right  shoulder  during  a  field  training  exercise.  
Despite  surgical  repair  and  14  months  of  physical  therapy  he did not respond  adequately  to 
treatment  and  was  unable  to  perform  within  his  Military  Occupational  Specialty  or  meet 
physical  fitness  standards.    He  was  issued  a  permanent  U3/H2/E2  profile  and  underwent  a 
Medical Evaluation  Board  (MEB).    Chronic  right shoulder pain  was  forwarded  to  the  Physical 
Evaluation Board (PEB) as medically unacceptable IAW AR 40-501.  Total hearing loss, right ear  
status post (s/p) resection of acoustic neuroma, right facial paresis, s/p resection of acoustic 
neuroma, neuropathic keratitis right eye, post-surgical headaches, mild intermittent positional 
vertigo, and mild nerve root dysfunction right upper extremity as identified in the rating chart 
below, were forwarded on the MEB submission as medically acceptable conditions.  The PEB 
adjudicated the chronic right shoulder pain condition as unfitting, rated 10% with application of 
the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were 
determined to be not unfitting.  The CI made no appeals, and was medically separated with a 
10% combined disability rating.  
 
 
CI CONTENTION:  “All medical conditions have exacerbated.  I also feel that the rating I was 
given  is  incorrect.  I  gave  the  military  110%  and  they  gave  me  10%.    Everyone  from  the 
beginning told me to appeal but it could take 1-3 years.” 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44 Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.”  The ratings 
for  unfitting  conditions  will  be  reviewed  in  all  cases.    The  total  hearing  loss;  right  ear  s/p 
resection  of  acoustic  neuroma;  right  facial  paresis,  s/p  resection  of  acoustic  neuroma; 
neuropathic  keratitis  right  eye;  post-surgical  headaches;  mild  intermittent  positional  vertigo; 
and mild nerve root dysfunction right upper extremity conditions requested for consideration 
and the unfitting right shoulder pain condition meet the criteria prescribed in DoDI 6040.44 for 
Board  purview,  and  are  accordingly  addressed  below.    Any  conditions  or  contention  not 
requested in this application, or otherwise outside the Board’s defined scope of review, remain 
eligible for future consideration by the Army Board for Correction of Military Records.  
 
 
 
 
 
 
 

 
 
 
RATING COMPARISON:   
 
Service IPEB – Dated 20030827 
Code 
Condition 
Chronic Right Shoulder 
5099-5003 
Pain 
Mild 
Positional Vertigo 
Right Facial Paresis 

Intermittent 

Not Unfitting 
Not Unfitting 

Rating 
10% 

Nerve 

Surgical 

Post 
Headaches 
Mild 
Root 
Sensory  Dysfunction 
Right Upper Extremity 
Neurotrophic Keratitis, 
Right Eye, 

Not Unfitting 

Not Unfitting 

Not Unfitting 

Hearing Loss 

Not Unfitting 

30%* 

Persistent 

Code 
5203 

VA (3 Mo. Pre Separation) – All Effective Date 20031217 
Rating 
Condition 
Right  Shoulder  Acromioclavicular 
20% 
Separation Status Post Repair 
7th  Cranial  (facial)  Nerve  Palsy 
with 
Headache, 
Vertigo  and  Diminished  Sense  of 
Smell  on  the  Right  Side  of  the 
Nose  Associated  with  Right  Side 
Acoustic  Neuroma,  Status  Post 
Craniotomy  
Sensory  Dysfunction  Right  Upper 
Extremity  Associated  with  Right 
Shoulder Surgical Repair 
Neuropathic  Keratitis  Right  Eye 
Associated  with  Right 
Side 
Acoustic Neuroma 
Total  Hearing  Loss  Right  Ear 
Assoc.  w/  Right  Side  Acoustic 
Neuroma, 
Post 
Craniotomy 
0% x 1/Not Service Connected x 0 
Combined:  80%* 

6209-6100 

Status 

20% 

10% 

10% 

8207 

8510 

6001 

Exam 
20030923 

20030923 

20030923 

20030923 

20030923 

20030923 

↓No Additional MEB/PEB Entries↓ 
Combined:  10% 
*Separate 30% rating for headache added per VARD 20050107 effective 20031217. 
  
 
ANALYSIS SUMMARY:  The Disability Evaluation System (DES) is responsible for maintaining a fit 
and  vital  fighting  force.    While  the  DES  considers  all  of  the  member's  medical  conditions, 
compensation  can  only  be  offered  for  those  medical  conditions  that  cut  short  a  member’s 
career, and then only to the degree of severity present at the time of final disposition.  The DES 
has neither the role nor the authority to compensate members for anticipated future severity 
or  potential  complications  of  conditions  resulting  in  medical  separation  nor  for  conditions 
determined  to  be  service-connected  by  the  Department  of  Veterans  Affairs  (DVA)  but  not 
determined to be unfitting by the PEB.  However the DVA, operating under a different set of 
laws  (Title  38,  United  States  Code),  is  empowered  to  compensate  all  service-connected 
conditions  and  to  periodically  re-evaluate  said  conditions  for  the  purpose  of  adjusting  the 
Veteran’s disability rating should the degree of impairment vary over time.  The Board’s role is 
confined to the review of medical records and all evidence at hand to assess the fairness of PEB 
rating  determinations,  compared  to  VASRD  standards,  based  on  severity  at  the  time  of 
separation.  The Board has neither the jurisdiction nor authority to scrutinize or render opinions 
in reference to the CI’s statements in the application regarding suspected DES improprieties in 
the processing of his case.    
 
Chronic Right Shoulder Pain Condition.  The CI injured his right shoulder during training in July 
2001  incurring  an  acromioclavicular  (AC)  joint  separation  and  compression  fracture  of  the 
clavicle.  The CI experienced persisting right shoulder pain due to AC joint degenerative arthritis 
with impingement syndrome due to an AC joint osteophyte.  The CI subsequently underwent 
right shoulder surgery in March 2003 with resection of the distal end of the clavicle at the AC 
joint.  Following recovery from surgery, pain recurred with wearing his rucksack and when he 

was detailed to picking up trash.  He was unable to tolerate load bearing equipment, fire a rifle 
due to impact on the shoulder, or perform push-ups due to his shoulder pain condition.  The 
MEB  examination  performed  on  13  May  2003  was  remarkable  for  tenderness  of  the  right 
shoulder over the mid to distal two-thirds of the right clavicle without deformity, redness or 
warmth.  Range-of-motion (ROM) was flexion to 160 degrees, abduction 160 degrees, internal 
rotation  75  degrees  and  external  rotation  75  degrees.    Motor  strength  was  normal.    Deep 
tendon  reflexes  were  normal  and  symmetrical.    There  was  decreased  sensation  in  the  right 
upper extremity over ulnar hand, forearm and biceps considered a residual from surgery.  On 
the general VA Compensation and Pension (C&P) examination on 23 September 2003, 3 months 
before  separation,  the  musculoskeletal  system  examination  was  noted  as  unremarkable 
without detail referring to the MEB examination; “see medical evaluation board and claimant’s 
medical record for details of this problem and associated functional limitations.”  As a residual 
of the surgery it was noted that there was a mildly diminished sensation to simple touch and 
sharp over the right upper extremity from the biceps area to the proximal forearm.  Muscle 
strength of both upper extremities was normal.   
 
The Board directs attention to its rating recommendation based on the above evidence.  There 
was  no  ankylosis,  limitation  of  movement,  or  instability  to  warrant  a  minimum  compensable 
rating under respective VASRD diagnostic codes (5200, 5201 5202).  The condition correlated 
with  the  10%  rating  under  5202,  impairment  of  clavicle  or  scapular  malunion  or  non-union 
without  loose  movement.    Alternatively  a  10%  rating  was  supported  for  painful  motion  or 
functional impairment with application of §4.59 or §4.40.  The VA granted a 20% rating citing 
loose movement and sensory loss; however the Board noted that the MEB examination did not 
document loose movement, that strength was reported as normal, and sensory changes did not 
interfere  with  duties.    After due deliberation,  considering  all  of the  evidence  and  mindful  of 
VASRD §4.3 (Resolution of reasonable doubt), the Board concluded that there was insufficient 
cause to recommend a change in the PEB adjudication for the right shoulder pain condition.   
 
Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB 
were  total  hearing  loss,  right  ear  s/p  resection  of  acoustic  neuroma,  right  facial  paresis,  s/p 
resection of acoustic neuroma, neurotrophic keratitis right eye, post-surgical headaches, mild 
intermittent  positional  vertigo,  and  mild  nerve  root  dysfunction  right  upper  extremity.    The 
Board’s first charge with respect to these conditions is an assessment of the appropriateness of 
the PEB’s fitness adjudications.  The Board’s threshold for countering fitness determinations is 
higher  than  the  VASRD  §4.3  (Resolution  of  reasonable  doubt)  standard  used  for  its  rating 
recommendations,  but  remains  adherent to  the  DoDI  6040.44  “fair  and  equitable”  standard.  
During  the  MEB  examination  in  November  2002,  a  marked  right  sided  hearing  loss  was 
detected  leading  to  diagnosis  of  a  right  sided  acoustic  neuroma.    MEB  proceedings  were 
suspended pending evaluation and treatment.  The CI underwent surgical removal of the right 
sided acoustic neuroma on 5 February 2003 resulting in complete hearing loss in the right ear, 
right cranial nerves VII and VIII injury with right facial paralysis, decreased sense of taste and 
smell.  The total hearing loss of the right ear resulted in an H2 profile which is non-disqualifying 
for continued military service.  The residual right facial paresis (paralysis and loss of sensation), 
decreased sense of smell and taste also did not interfere with duty.  The CI developed chronic 
dry right eye with inflammation of the cornea secondary to incomplete closure of the right eye 
lid (neurotrophic keratitis) and underwent eye lid surgery in June 2003 to enable full closure.  
At the time of the MEB, his vision met retention standards and examination showed good eye 
closure.  At the VA Compensation and Pension (C&P) examination, visual acuity was unchanged, 
and examination of the cornea, lens, and retina was normal.  The CI experienced worsening of 
headaches  following  surgery.    The  MEB  narrative  summary  (NARSUM)  31  July  2003  noted 
intermittent headaches three times per day lasting up to an hour aggravated by wear of the 

helmet  or  bending  over.    The  headaches  required  restriction  from  Kevlar  and  head  gear, 
however the examiner noted the headaches were improving and expected to meet retention 
standards. The C&P examination, September 2003, recorded a similar history for the headaches 
without report of incapacitation.  The commander’s letter reported excellent performance of 
duties in an office setting.  The majority of the Board concluded the evidence was not sufficient 
to overcome the PEB not-unfit determination for the headache condition.  The NARSUM noted 
post-operative  episodes  of  vertigo  characterized  as  “mild  intermittent  positional  vertigo 
improving.”  The condition did not require medications.  The physician notes from the 13 May 
2003 MEB history and physical examination notes headache without any  mention of vertigo.  
The  otolaryngology  NARSUM,  dictated  21  May  2003  also  makes  no  mention  of  vertigo.    On 
examination, there was no eye nystagmus to suggest a vestibular problem.  At the time of the 
C&P  examination  in  September  2003,  tests  for  balance  and  coordination  were  all  normal.  
Board  members  concluded  the  evidence  was  not  sufficient  to  overcome  the  PEB  not-unfit 
determination for the vertigo condition.  Following right shoulder surgery the CI experienced 
decreased  sensation  of  the  right  upper  extremity  ulnar  hand/forearm  and  biceps  without 
weakness.    Examinations  documented  intact  strength  reflexes.    The  decreased  sensation  did 
not  interfere  with  performance  of  duties.    Board  members  concluded  the  evidence  was  not 
sufficient  to  overcome  the  PEB  not-unfit  determination  for  the  mild  nerve  root  dysfunction 
right upper extremity condition.  After due deliberation in consideration of the preponderance 
of the evidence, the Board concluded that there was insufficient cause to recommend a change 
in the PEB fitness determinations for the any of the contended conditions; and, therefore, no 
additional disability ratings can be recommended. 
 
 
BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or 
guidelines relied upon by the PEB will not be considered by the Board to the extent they were 
inconsistent with the VASRD in effect at the time of the adjudication.  In the matter of the right 
shoulder  pain  condition  and  IAW  VASRD  §4.71a,  the  Board  unanimously  recommends  no 
change in the PEB adjudication.  In the matter of the contended total hearing loss, right ear s/p 
resection  of  acoustic  neuroma,  right  facial  paresis,  s/p  resection  of  acoustic  neuroma, 
neurotrophic  keratitis  right  eye,  mild 
intermittent  positional  vertigo,  mild  nerve  root 
dysfunction right upper extremity conditions, the Board unanimously recommends no change 
from  the  PEB  determinations  as  not  unfitting.    In  the  matter  of  the  contended  post-surgical 
headaches, the Board by a vote of 2:1 recommends no change from the PEB determination as 
not unfitting.  The single voter for dissent (who recommended unfit with a 0% rating did not 
elect to submit a minority opinion.  There were no other conditions within the Board’s scope of 
review for consideration.   
 
 
RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows:   
 

VASRD CODE 
5099-5003 
RATING 

RATING 
10% 
10% 

UNFITTING CONDITION 
Chronic Right Shoulder Pain 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20111024, w/atchs 

Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 
 
 

  XXXXXXXXXXXXXXXXXX, DAF 
  Director 
  Physical Disability Board of Review 

 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXXXXXX, AR20130003090 (PD201101003) 
 
 
I have reviewed the enclosed Department of Defense Physical Disability Board of 
Review (DoD PDBR) recommendation and record of proceedings pertaining to the 
subject individual.  Under the authority of Title 10, United States Code, section 1554a,   
I accept the Board’s recommendation and hereby deny the individual’s application.   
This decision is final.  The individual concerned, counsel (if any), and any Members of 
Congress who have shown interest in this application have been notified of this decision 
by mail. 
 
 BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 
 
 
Encl 
 
 
 
 

     XXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)