RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

injections 

into 

treatment,  nine 

 
NAME:  XXXXXXXXXXXX                                                                  BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1200850                                                          SEPARATION DATE:  20050426 
BOARD DATE:  20130116   
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty SGT/E-5 (19K/Armor Crewman), medically separated 
for right shoulder pain.  The CI initially entered active duty in February 1994, and remained on 
active duty until leaving active service with an honorable discharge in September of 1996.  He 
re-entered active service in March 1999.  In August of 1999 he reported a 2 month history of 
right  shoulder  pain  with  no  traumatic  event.    He  underwent  a  long  course  of  physiotherapy 
followed  by  orthopedic  evaluation  and 
the  right 
acromioclavicular  (AC--shoulder)  joint  with  no  real  improvement  of  the  symptoms.    He  then 
underwent  an  orthopedic  Mumford  procedure  (clavicle  resection)  in  December  of  2000.    In 
November of 2002 he deployed to Kosovo, but was later re-deployed due to his shoulder and 
his  inability  to  adequately  perform  his  duties.    He  then  underwent  a  Medical  Military 
Occupational Specialty (MOS) Retention Board and was going to be re-classified into the 42A 
Administrative  Specialist  MOS,  but  it  was  finally  determined  that  he  could  not  meet  the 
standards of that MOS or perform some required solider skills.  He was given a permanent U3 
profile  and  referred  for  a  Medical  Evaluation  Board  (MEB)  for  “Shoulder  pain,  secondary  to 
Mumford  procedure  as  a  result  of  A/C  joint  degenerative  disease  of  unknown  origin  on  the 
right.”    The  MEB  forwarded  no  other  conditions  for  Physical  Evaluation  Board  (PEB) 
adjudication.  The PEB adjudicated the right shoulder pain condition as unfitting, rated 0%, with 
cited 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:    “The  Shoulder  Impingement  also  called  bursitis  or  tendonitis,  shoulder 
impingement  refers  to  the  pain  in  the  shoulder  caused  by  the  rotator  cuff  tendons  being 
pinched or squeezed between the humerus (arm bone) and the scapula (shoulder blade) as the 
arm  is  raised.    This  may  be  due to  the natural shape  of  your  shoulder,  or  from  a  bone  spur 
rubbing (impinging) on the tendons as they move.  Experts consider this is the earliest stage of 
rotator  cuff  problems.    A  distal  clavicle  excision  is  a  surgical  procedure performed  to  relieve 
pain in the acromioclavicular (AC) joint, which often develops as a result of a fall or other type 
of  trauma.    AC  injuries  may  cause  the  two  bones  to  move  or  separate,  or  the  ligaments  to 
stretch or tear.  While conservative treatments are often used as initial treatment, surgery is 
needed in many cases to restore the position of the clavicle and allow the patient to resume 
normal functioning.  During the procedure, a small part of the clavicle is removed to create a 
space between the two bones.  I had this procedure complete on my right shoulder, while in 
military service.  Continuing to have pain in my right shoulder & left shoulder is showing the 
same symptoms of my right shoulder before surgery.”   
 
 
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 conditions “identified but not determined to be unfitting by the PEB.”  The ratings for 

Service PEB – Dated 20041220 
Condition 
Right Shoulder Pain  
↓No Additional MEB/PEB Entries↓ 
Combined:  0% 

Code 
5099-5003 

Rating 
0% 

VA (~3.5 Mos. Pre-Separation) – All Effective Date 20050426 
Condition 
Right 
Residuals 
Not Service-Connected x 3 
Combined:  10% 

Code 
5299-5024 

Rating 
10% 

Shoulder 

Surgery 

Exam 
20050105  
 

 
 
ANALYSIS SUMMARY:   
 
Right  Shoulder  Pain  Condition.    The  CI  was  right  hand dominant.    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.   
 

unfitting conditions will  be reviewed in all cases.  The  rated condition right shoulder pain as 
requested  for  consideration  is  the  only  condition  that  meets  the  criteria  prescribed  in  DoDI 
6040.44 for Board purview; and, is addressed below.  The requested left shoulder condition, 
and 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:   
 

Right Shoulder ROM 
(Degrees) 
Flexion (0-180⁰) 
Abduction (0-180⁰) 
Comments:    Surgery  >4 
yr. Pre-Sep 
§4.71a Rating 

NARSUM ~5 Mo. Pre-Sep 
130 
170 
Some 
and 
moderate  discomfort  with 
motion 
10% (PEB 0%) 

crepitus 

VA C&P ~3.5 Mo. Pre-Sep 
108 / 95* 
115 / 95* 
Pain  on  motion;  *After  5  reps 
(DeLuca) 
10%-20% (VA 10%) 

 
At the MEB exam, the CI reported persistent shoulder pain and weakness which was increased 
with activity and loading.  The MEB physical exam noted previous resection and reconstruction 
of  the  right  AC  joint  in  2000  for  AC  joint  pain  that  had  not  improved  post-surgery  or  with 
physical therapy.  There was tenderness at the right AC joint, 5/5 (normal) strength and limited 
ROMs with crepitus as summarized above.  Radiographs indicated postoperative Mumford on 
the  right  shoulder  and  the  narrative  summary  diagnosis  was  “Shoulder  pain,  secondary  to 
Mumford  procedure  as  a  result  of  A/C  joint  degenerative  disease  of  unknown  origin  on  the 
right.”    The  MEB  DD  Form  2808  noted  right  shoulder  pain  with  overhead  rotation  above  90 
degrees  and  positive  crepitus.    The  U3  profile  restriction  stated  “no  mandatory  overhead 
activities”  and  the  commander’s  statement  indicated  “even  individual  movement  techniques 
are particularly difficult and painful for (the CI).”   
 
At  the  VA  Compensation  and  Pension  (C&P)  exam  performed  prior  to  separation,  the  CI 
reported  he  could  not  wear  his  military  load  bearing  equipment  without  pain.    The  exam  is 
summarized  above  and  indicated  pain-limited  ROMs.    The  examiner’s  functional  assessment 
included a statement that “(the CI) has voluntarily switched performing several activities to his 
left nondominant, to include using the computer mouse, carrying heavy suitcases, and some 
overhead work.  The veteran otherwise can undertake all other activities of normal daily living.”   

 
The Board directs attention to its rating recommendation based on the above evidence.  The 
Board considered alternate coding under code 5203 (Clavicle or scapula), 5024 (Tenosynovitis) 
or 5201 (Arm, limitation of motion).  There was no mention of loose motion on either exam for 
coding above 10% under 5203.  The Board considered the probative values of the two exams in 
evidence  and  adjudged  the  VA  exam,  which  was  closer  to  separation  and  included  an 
assessment of repetitive motion (DeLuca criteria) had the highest probative value for rating at 
the  time  of  separation.    The  Board  deliberated  if  the  flexion  and  abduction  limitation  to  95 
degrees on the VA exam following repetition (DeLuca) with the CI’s described functional loss 
more closely approximated the 20% criteria under code 5201 for limitation “at shoulder level.”  
The VA rating determination specified the VA rating was for flexion limited to 108 degrees and 
did not mention DeLuca or the C&P-recorded more limited ROM following repetition.  After due 
deliberation,  considering  all  of  the  evidence  and  mindful  of  VASRD  §4.3  (Resolution  of 
reasonable doubt), §4.7 (Higher of two evaluations), §4.59 (Painful motion) and DeLuca criteria, 
the  Board  majority  recommends  a  disability  rating  of  20%  for  the  right  shoulder  condition 
coded 5003-5201.   
 
 
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 was operant in this case and 
the condition was adjudicated independently of that policy by the Board.  In the matter of the 
right  shoulder  condition,  the  Board,  by  a  vote  of  2:1  recommends  a  disability  rating of 20%, 
coded 5003-5201 IAW VASRD §4.71a.  The single voter for dissent (who recommended a 10% 
rating  coded  5099-5003)  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 recommends that the CI’s prior determination be modified as 
follows, effective as of the date of his prior medical separation:   
 

VASRD CODE  RATING 
5003-5201 
COMBINED 

20% 
20% 

UNFITTING CONDITION 
Right Shoulder Pain 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120606, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

           XXXXXXXXXXXXXXXXXXX, DAF 
           Director 
           Physical Disability Board of Review 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXX, AR20130002544 (PD201200850) 
 
 
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 20% 
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 
 
 
 
 

     XXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)