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AF | PDBR | CY2012 | PD2012 01072
Original file (PD2012 01072.rtf) Auto-classification: Approved

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXX     BRANCH OF SERVICE: Army
CASE NUMBER: PD1201072   SEPARATION DATE: 20021213
BOARD DATE: 20130108


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (13F/Fire Support Specialist [forward observer]), medically separated for painful motion-right shoulder (named Status post [s/p] distal clavicle excision times two). The CI first sought medical attention in June 2000 for his injured shoulder for which he received physical therapy at Fort Hood. In 2001, the CI re-aggravated the injury and had right shoulder arthroscopic Mumford surgery (distal clavicle excision) in October 2001. The surgery provided some relief; however, over the course of 5 months, he continued to have pain, and arthritic spurring was found on his X-rays. He underwent a repeat arthroscopic Mumford, but continued to have pain with rucking, overhead activities, wearing his TA50, push-ups and strenuous physical training, despite multiple trials of rest, physical profiling, nonsteroidal anti-inflammatory drugs, and physical therapy (PT). He was unable to do his job as a forward observer or satisfy physical fitness standards. He was issued a permanent U3 profile (131111) and referred for a Medical Evaluation Board (MEB). The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated his shoulder condition as unfitting, rated 0%, with application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals, and was medically separated with a 0% disability rating.


CI CONTENTION : I continue to have shoulder and ankle problems and pain. My hearing is worsening. My current VA % is 30%. Army awarded me 0%. (sic)


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 unfitting right shoulder condition as requested for consideration meets the criteria prescribed in DoDI 6040.44 for Board purview; and, is addressed below. The other requested conditions [left ankle condition, hearing loss and tinnitus] are not within the Board’s purview. 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 20020924
 VA (4 Mos. Post-Separation) – All Effective Date 20021214
Condition
 Code Rating Condition Code Rating Exam
Painful motion-right shoulder 5099-5003 0% Distal clavicle fracture with acromioclavicular arthritis s/p surgery times two 5203 10% 20030402
↓No Additional MEB/PEB Entries↓
 Chronic Instability, left ankle with degenerative joint disease 5003 10% 20030402
Tinnitus 6260 10% 20030411
0% X 1 / Not Service-Connected x 0 20030411
Combined: 0%
 Combined: 30%
* VARD 20030521 also awarded 0% for bilateral hearing loss. VARD 20110428 continued each rating at the rates established by the 2003 award.


ANALYSIS SUMMARY:

The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

DOS 20021213
“
Right Shoulder ROM
 MEB ~3.5 Mo. Pre-Sep
(20020826) 		VA C&P ~4 Mo. Post-Sep
 (20030402)
Flexion (0-180⁰)
 150⁰no ROM deficiencies”
Abduction (0-180⁰)
 140⁰
External rotation (0-90⁰)
 60⁰
Internal rotation (0-90⁰)
 To T7
Comments: 2 nd surgery 11 Mo. Pre-Sep
Contralateral arm is the same except for internal rotation to T5; O'Brien's test is mildly (+) [labral or AC jt] motor sensory and neuro exams normal (see text) Prominent dorsal AC joint; tenderness w/ overhead activities, but manifests no ROM deficiencies; increasing symptoms w/ crossed body adduction; impingement & supraspinatus maneuvers are (-)
§4.71a Rating
 10% (PEB 0%) 10%
invalid font number 31502
The CI is right hand dominant. At the MEB exam, the CI reported continued pain and functional limitations following healing of his two surgeries for clavicle fracture and resections. The narrative summary noted the CI “continued to have pain with rucking and continuous overhead activities including wearing his TA50 and rucksack.” In addition, long runs at higher paces would irritate his shoulder. The MEB physical exam noted the right shoulder ROM to be decreased but equal to the left, with the exception of internal rotation limited to T7 on the right compared with T5 on the left. Muscle strength was full. There was no shoulder instability. Pain was noted at the AC joint with some arm movements. The examiner stated doing push-ups exacerbated CI’s shoulder pain. Radiographs indicated post-surgical findings with no osteophytes. The MEB DD Form 2808 noted “R shoulder fracture/nonunion.” PT treatment notes indicated pain with overhead use. Prior radiographs indicated degenerative joint disease (DJD). The MEB diagnosis was s/p Mumford distal clavicle excision times two.

At the VA Compensation and Pension exam 4 months after separation, the CI reported similar complaints of pain to palpation of the AC joint, pain with overhead work or sleeping on the shoulder. The exam showed full ROM of the shoulder, pain to palpation of the AC joint, pain with overhead motion of the right arm, and pain was increased with cross body adduction of the right arm. X-rays showed persistent spurring about the AC joint. The VA diagnosis was distal clavicle fracture with acromioclavicular arthritis s/p surgery times two with persistent degenerative symptoms.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the condition of painful motion-right shoulder, 5099-5003, at 0%. The PEB stated “Rated for pain, moderate/intermittent.” The VA rated the shoulder as 5203 (Clavicle or scapula, impairment), at 10%. In April 2011 the VA continued the right shoulder rating at 10%. The Board considered all exams proximate to the date of separation: the treatment record supported painful motion, clavicle impairment, and tenderness to meet the 10% rating criteria of code 5203 (Clavicle or scapula, impairment). Alternatively, application of VASRD §4.59 (Painful motion) and use of codes 5003 or 5010 also provides a 10% rating. Clinically there may have been signs of loose motion, but the record did not provide sufficient objective findings to support a 20% rating under code 5203 for loose movement of the clavicle. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board recommends a disability rating of 10% for clavicle impairment, without loose movement, 5099-5203.


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. As discussed above, PEB reliance on the USAPDA pain policy for rating the right shoulder condition was operant in this case and the condition was adjudicated independently of that instruction by the Board. In the matter of the painful motion-right shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5203 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
Painful motion-right shoulder 5099-5203 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120612, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




                  xxxxxx
                  President

SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for AR20130001168 (PD201201072)


1. 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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                 
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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