Citation Nr: 0003249 Decision Date: 02/09/00 Archive Date: 02/15/00 DOCKET NO. 94-05 255 ) DATE ) ) On appeal from the Department of Veterans Affairs Medical and Regional Office Center in Fargo, North Dakota THE ISSUE Entitlement to an increased rating for a right acromioclavicular separation, currently evaluated as 20 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD D. J. Drucker, Associate Counsel INTRODUCTION The appellant had active military service from September 1984 to September 1987. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a September 1993 rating decision of the Department of Veterans Affairs (VA) Medical and Regional Office Center (M&ROC) in Fargo, North Dakota, that confirmed and continued a 10 percent disability rating for the appellant's right shoulder disability. In March 1996, the Board granted a 20 percent evaluation for the right shoulder disability that the appellant appealed to the U.S. Court of Appeals for Veterans Claims (known as the U.S. Court of Veterans Appeals prior to March 1, 1999). In October 1996, the Court granted a Joint Motion for Remand and issued an Order vacating and remanding that portion of the Board's decision denying an evaluation in excess of 20 percent for a right shoulder disability. [citation redacted]. Thereafter, pursuant to the Court's Order, in June 1997, the Board remanded the appellant's case to the M&ROC for further development. The Board remanded the appellant's case again in July 1998. The veteran has several orthopedic disabilities which have not been recognized as service connected, most notably a disorder diagnosed as a spondyloarthropathy or ankylosing spondylitis, bilateral carpal tunnel syndrome and fibromyalgia syndrome. A review of the record does not reveal any communications from the veteran which could be construed as claims for service connection for these disabilities, and no such issue was raised in the Joint Motion for Remand. In the absence of such claims, which would have to be recognized as intertwined issues, the Board may proceed with the resolution of the sole recognized appellate issue. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appellant's claim has been obtained by the M&ROC. 2. The appellant's service-connected right (major) acromioclavicular (AC) separation, is currently manifested by no more than mild right AC separation with slight limitation of motion on internal and external rotation and slight deformity of the AC joint, subjective complaints of pain and instability and no evidence of arthritis, atrophy, instability or dislocations. CONCLUSION OF LAW The criteria for an evaluation in excess of 20 percent for right acromioclavicular separation, grade II with spurring, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.20, 4.40, 4.45, 4.71a, Diagnostic Code 5299- 5202 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION The appellant's claim for an increased evaluation for his service-connected right shoulder disability is plausible and capable of substantiation and, thus, well grounded within the meaning of 38 U.S.C.A. § 5107(a); see Proscelle v. Derwinski, 2 Vet. App. 629 (1992) (a claim of entitlement to an increased evaluation of a service-connected disability generally is a well-grounded claim). When a veteran submits a well-grounded claim, VA must assist him in developing facts pertinent to that claim. 38 U.S.C.A. § 5107(a). The Board is satisfied that all relevant evidence has now been obtained regarding the appellant's claim. To that end, it remanded his claim in June 1997 and July 1998 to afford him the opportunity to submit additional evidence in support of his claim and to undergo further VA examination. The VA examination reports and new evidence submitted by the appellant are associated with the claims folders and no further assistance to the appellant with respect to his claim is required to comply with 38 U.S.C.A. § 5107(a). In accordance with 38 C.F.R. §§ 4.1, 4.2, 4.41 (1999) and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed the appellant's service medical records and all other evidence of record pertaining to the history of his service-connected right shoulder disability, and has found nothing in the historical record that would lead to a conclusion that the current evidence of record is inadequate for rating purposes. Factual Background The M&ROC granted service connection for right acromioclavicular separation in an August 1988 rating decision. That determination was based, in large measure, on service records that indicated that he sustained a right shoulder injury when he fell while roller skating and was assessed with a grade I AC sprain. The M&ROC also considered findings of a February 1988 VA examination that described the appellant's complaints of pain with activity, tenderness over the AC joint with a palpable deformity, normal range of motion and no evidence of rotator cuff injury. X-rays showed rounding of the clavicle consistent with an old type II AC separation. A 10 percent evaluation was assigned to the appellant's right shoulder disability. The M&ROC received the appellant's claim for an increased rating in December 1992. VA and private treatment records and examination reports, dated from 1990 to 1999, are associated with the claims files. According to a March 1990 VA examination report, the appellant, who was 26 years old and right handed, was placed in a sling after his 1986 shoulder injury. He continued to use it and had pain in the superior aspect of his right shoulder thereafter. The shoulder bothered him particularly when doing overhead work or heavy lifting. Findings on examination revealed that the appellant had a mildly prominent distal clavicle that was tender to the touch and somewhat unstable with normal range of motion. X-ray of the shoulder showed widening of the coracoacromial joint with some evidence of degenerative spurring at the inferior border. Very minimal proximal migration of the clavicle was noted, but the report also indicated no change since 1988. The appellant's right shoulder showed evidence of an old AC injury, superimposed secondary to degenerative change that was symptomatic. According to a July 1990 VA outpatient record, the appellant complained of shooting pain from his right shoulder to his elbow with numbness in his right thumb, index and point fingers. He had tenderness with full range of motion of his right shoulder. A February 1993 report from the Mayo Clinic, prepared by R. M., Valente, M.D., included diagnoses of severe HLA-B27 associated spondyloarthropathy, right greater than left, carpal tunnel syndrome and remote history of right shoulder separation with intact rotator cuff. Dr. Valente found that the appellant's right shoulder had a palpable hypertrophic spur at the acromioclavicular joint with slightly decreased external rotation. There was mild infraspinatus weakness, but otherwise strong intact rotator cuff musculature and no axillary nerve distribution, numbness or atrophy. The appellant also had developed left metatarsophalangeal pain and swelling and bilateral heel pain, as well as episodic numbness and tingling in the hands and increased right shoulder discomfort. Dr. Valente reported that the appellant had left sacroiliac joint sclerosis. The appellant was unable to stand for any period of time without his heel pain becoming intolerable. On examination, the appellant had swelling and tenderness that involved both ankles and was extremely tender at the Achilles' insertions and plantar fascial insertions of the calcaneus. There was also moderate synovitis and tenderness involving the metatarso-phalangeal joints of the left foot. He was tender over the left sacroiliac joint. X-rays of the right shoulder were negative, but documented sclerosis about the left sacroiliac joint and erosions at the right calcaneus, at the Achilles' tendon insertion, and at the plantar tendo insertion. These radiographic features were compatible with the enthesiopathy and sacroiliitis of an HLA-B27 associated spondyloarthropathy. A March 1993 Social Security Administration (SSA) disability determination record documents that the appellant was found to be totally disabled as of January 1993. His primary diagnosis was HLA-B 27 associated spondyloarthropathy; the secondary diagnosis was bilateral carpal tunnel syndrome. A July 1993 VA outpatient record describes the appellant's condition as somewhat improved but he continued to experience constant pain. The assessment was undifferentiated spondyloarthropathy. A September 1993 VA outpatient record indicates that the appellant had metatarsal-phalangeal and back pain and stiffness. The assessment was spondyloarthropic significant peripheral involvement. A September 1993 VA examination report reflects the appellant's history of right shoulder separation injury with clicking and stiffness and his diagnosis of ankylosing spondylitis at the Mayo Clinic the previous year. He complained of worsening and constant right shoulder pain and stiffness and problems lifting heaving objects with his right arm. The appellant denied recurring dislocation but had recurring right shoulder click coincident with pain. On examination, the appellant had some right shoulder discomfort, with no gross deformity, edema or discoloration, or muscular atrophy. Range of motion of elevation was to 180 degrees, abduction to 160 degrees, internal rotation to 90 degrees and external rotation to 80 degrees. X-rays showed asymmetrical AC joints, slightly widened on the right, tip of clavicle with a very slight elevation. The AC separation appeared to have stability from fibrous union. It was noted that there probably was an AC separation but it did not appear mobile or unstable. The final diagnosis was history of grade II AC separation of the right shoulder. At his December 1993 personal hearing at the M&ROC, the appellant testified that his service-connected right shoulder disability caused constant dull pain on the distal part of his shoulder that increased with overhead lifting and any physical activity. He was unable to do anything that required lifting his right arm above his head and, although he was right-handed, used his left hand for reaching, lifting, picking or pulling. The appellant stated that he put electric starters on equipment he operated to compensate for his disability. He further indicated that sometimes his leather jacket was too heavy to wear and his motorcycle riding was limited by his inability to hold the throttle. The appellant said he was fairly athletic before his shoulder disability forced him to limit his athletic activities. He testified that he had to leave a job that required he lift yeast bags because of his shoulder disability. He was a part-time farmer and missed out on income because his disability hindered his performing certain tasks, such as driving a tractor. When the appellant did anything that caused shoulder pain, the pain lasted for two or three hours while he relaxed. The appellant further stated that his shoulder was more painful in the past year than when it was initially injured and he had developed arthritis. He was never pain free and was unable to sleep on his right side, carry his son and hold his arm up or do things for which he had been trained in vocational rehabilitation. A December 1993 VA outpatient record reveals that the appellant's right shoulder distal motor and neurovascular status was intact, as were deep tendon reflexes and biceps and brachioradialis. He had a relatively negative compression syndrome of the neck for any radicular type syndrome. There was a significant amount of crepitance in his AC joint that seemed to be causing his pain. X-rays showed a mild amount of arthritis in the appellant's AC joint with some loose joint body present in the right AC joint. His bone scan did not show uptake in the SI (sacroiliac) joint or right shoulder. The assessment was degenerative joint disease of the right AC joint with a possible small loose joint body present within the AC joint. The appellant was given a steroid injection. A January 1994 VA outpatient record indicates that the appellant fell on the ice and experienced a subsequent back injury and some shoulder problems. He had had approximately one week's relief from the injection. VA hospitalized the appellant from January to February 1994 for evaluation and treatment of his spondyloarthropathy. According to the discharge summary, the appellant had a history of rheumatoid arthritis controlled with gold therapy and was admitted with a history of backache, tremulousness and proteinuria. The appellant had been diagnosed with rheumatoid arthritis more than four years prior. He was evalauted at the Mayo Clinic for what appeared to be an HLA-B 27 related spondyloarthropathy. The appellant had recently slipped and fallen on the ice after which he experienced severe backache. X-rays and a computed tomography (CT) scan of the lumbar spine were essentially negative except for a mild L2-3 disk protrusion. Final diagnoses were (questionable) gold encephalopathy and HLA-B 27 (human lymphocytic antigen) spondyloarthropathy. An October 1995 VA outpatient record indicates that the appellant was unable to sleep due to back and shoulder pain, assessed as ankylosing spondylitis. He had right shoulder pain without restriction of movement. In April 1996, the appellant was seen in the VA Arthritis Clinic and complained of radiating back pain and swelling of his right metacarpophalangeal joints and pain in the metatarsal phalangeal joints. In April 1996, the M & ROC effectuated the Board's March 1996 decision and assigned a 20 percent disability rating for right AC separation, grade II with spurring. An April 1996 SSA record indicates that the appellant's disability benefits were continued. His primary diagnosis was characterized as human lymphocytic antigen spondyloarthropathy. There was no secondary diagnosis. Pursuant to the Board's June 1997 remand, the appellant underwent VA orthopedic examination in September 1997 and said that in approximately 1991 his right shoulder problem worsened and, about that time, he was diagnosed with ankylosing spondylitis for which he took prescribed medication. The appellant had right shoulder discomfort with pushing, lifting overhead, carrying a heavy item or laying on his shoulder. In 1994, the appellant had some paresthesias in the right upper extremity that was treated with carpal tunnel release, which helped significantly. On examination, the appellant showed no atrophy, swelling, deformity, ecchymosis or erythema in the right upper extremity. He had good range of motion of his neck in all planes and Spurling's test was negative. Range of motion testing of his shoulder revealed full abduction, adduction, external rotation, forward flexion and extension. Internal rotation was about 15 degrees less on the right than on the left. The appellant had a slight decrease in strength in the right shoulder, especially flexion abduction, probably a grade less than the left shoulder and a grade less from expected. His biceps, triceps, brachial radials reflexes were +2/4. Sensation was intact and equal in all dermatomal areas with good radial pulses. Sensation was intact but the appellant had a little bit of Tinel's sign remaining yet of the right wrist and a mild Tinel's sign over the right cubital tunnel area. With palpation, there was moderate pain over the right AC joint and on palpation of the coracoacromial ligament there was discomfort. The empty water glass test was minimally positive and crossover test markedly positive. There was no sign of shoulder instability and some impingement testing was noted that caused pain. X- rays showed some widening at the AC joint thought to be possibly due to some osteolysis, either from direct trauma or a little osteolysis from the ankylosing spondylitis. The VA examiner commented that the appellant had a torn interarticular disk of the right, AC joint and some impingement and subacromial bursitis. The appellant also had a small amount of shoulder pain secondary to ankylosing spondylitis. In a September 1997 VA general medical examination report, the examiner noted that on range of motion examination, there was facial grimacing with no evidence of excessive fatigability or incoordination or further loss in range of motion with exercise. VA outpatient records dated in April 1998 indicate that the appellant was seen in the rheumatology clinic for follow up examination. All his joints bothered him, and he complained of a painful area under his right arm that hurt when the arm was lifted. It hurt to cough or lay on his left side. He had recent progressive, intense pain in the thorax both at the sternal and spinal areas and, in particular, around the right shoulder. The appellant had right AC pain and some radiation of pain to the intercostal area below the right axilla. He was unable to abduct the right shoulder without significant pain and had difficulty with flexion. He used his left arm to pull his right arm above his head to reduce the pain In an April 1998 statement, James E. Halvorson, M.D., said he had treated the appellant since October 1991 and last examined the appellant in March 1998. According to Dr. Halvorson, the appellant's daily activities were greatly limited by right shoulder pain with some degree of constant pain. The appellant had a continuous sense of clicking, pulling and a popping sensation of the shoulder with difficulty getting the arm above his head. Bicycle riding, use of his arm, daily childcare and sleep difficulties were attributed to chronic, nagging, aching shoulder disability. On examination, Dr. Halvorson found reproducible tenderness over the AC point, subacromial joint and coracoclavicular region. There was an appearance of some atrophy and tenderness over both the long and short head of the biceps. There was resistance and crepitation to range of motion and fatigability of the arm with general motion. With abduction maneuvering, the appellant often struggled to reach 90 degrees with his hands in the pronated position. Dr. Halvorson found there was significant intra-articular and extra-articular disease within the appellant's right shoulder. There appeared to be an ongoing, progressive impingement, a chronic subacromial bursitis, and the potential for a significant rotator cuff injury. The appellant also had ankylosing spondylitis of which his right shoulder had not been a primary involvement. Pursuant to the Board's July 1998 remand, the appellant underwent VA orthopedic examination in October 1998. According to a lengthy examination report that summarized the medical treatment for his right shoulder disability, essentially described above, the appellant currently complained that his right shoulder gave him problems. His shoulder problems worsened in approximately 1992 for no reason and he avoided water-skiing, bike riding and using an armrest or hand tool because of right should pain. He was unable to ride horses or bale hay and hired laborers for that work due to his shoulder condition. The appellant experienced pain when brushing his teeth, wearing heavy jackets or writing. He did not like having a heavy school bag on his right shoulder or wearing a seatbelt across his shoulder, was unable to lie on his right side at night and said his shoulder kept him awake. The pain worsened with weather change that also affected his low back and seat. Even taking a deep breath or coughing aggravated the pain. Medication eased the shoulder pain. The appellant said his pain was constant and aching and varied in intensity between 1 out of 10 and 6 out of 10 on a scale of 0 to 10, with 10 being unbearable excruciating pain. The pain was sharper when it was more severe but without radiation, numbness or tingling in the upper extremity. The appellant had right upper extremity weakness secondary to pain. The appellant had been diagnosed with ankylosing spondylitis in 1993 with a positive HLA-B27 antigen test. A bone scan was negative. Spondyloarthropathy was diagnosed at the Mayo Clinic. The appellant reported receiving SSA benefits due to foot pain. In 1993, he underwent carpal tunnel surgery with resolution of hand numbness. Two prior injections in the right shoulder did not help and the appellant declined surgery. On examination of the right shoulder, there was no evidence of muscle wasting. There was slight deformity of the right AC joint with increased step-down from the clavicle to the acromion when compared with the left shoulder. There was diffuse tenderness about the shoulder and the soft tissues just distal to the acromion. There was no added warmth of the right shoulder joint and no crepitus on passive ranging of the joint. Range of motion testing showed abduction was to 180 degrees (active and passive) and to 90 degrees following exercise; external rotation was to 90 degrees (active and passive) and to 70 degrees after exercise; internal rotation was to 90 degrees (active and passive) and to 55 degrees following exercise; and extension was to 70 degrees (active and passive) and to 40 degrees following exercise. There was no loss of coordination following exercise. Fatigability was demonstrated by decreased range of motion secondary to pain and the veteran reported that he did not wish to go any further. On palpation there was no tenderness of the AC joint and no glenohumeral instability, nor was there evidence of muscle spasm at the shoulder joint. A June 1996 bone scan was normal. The clinical impression was mild right AC separation with a need to rule out osteoid osteoma, since the veteran had a history of shoulder pain and relied on nonsteroidal antiinflammatory drugs, fibromyalgia syndrome and a history of spondyloarthropathy in remission. In a February 1999 addendum, the VA physician who examined the appellant in October 1998 said minimal residual impairment resulted from the service-connected AC separation. X-rays showed some mild separation of the AC joint without any evidence of interarticular fracture or loose body. There was no evidence of degenerative arthritis of the AC joint and, according to the VA physician, x-rays demonstrated no evidence of arthritis or degenerative changes at either the AC joint or the glenohumeral joint. Moreover, the February 1999 bone scan did not show evidence of an osteoid osteoma and the glenoid appearance was felt to be a bone cyst unrelated to previous trauma. There was no evidence of spondyloarthropathy involving the right glenohumeral joint, nor was there evidence, apart from the AC separation which was post-traumatic, of arthritis in the AC joint. The VA physician said an opinion regarding limitation of functional ability due to pain was highly subjective and, in the appellant's case, further complicated by the coexistence of fibromyalgia syndrome. As to the effects of the appellant's disability on ordinary activity, the physician said, typically in type II AC sprain, disability was mild and should not be functionally disabling to any significant extent with respect to ordinary activities. Analysis Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R. Part 4 (1999). The Board attempts to determine the extent to which the appellant's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.10 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1999). When an unlisted condition is encountered, it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but also the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. When entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). The U.S. Court of Appeals for Veterans Claims (known as the U.S. Court of Veterans Appeals prior to March 1, 1999) has held that diagnostic codes predicated on limitation of motion do not prohibit consideration of a higher rating based on functional loss due to pain or due to flare-ups under 38 C.F.R. §§ 4.40, 4.45 and 4.59. Johnson v. Brown, 9 Vet. App. 7 (1997); DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). The appellant's service-connected right acromioclavicular separation, grade II with spurring, is rated as 20 percent disabling, analogous with impairment of the humerus, under Diagnostic Code 5299-5202. See 38 C.F.R. §§ 4.20, 4.71a, Diagnostic Code 5202. The medical evidence documents that the appellant is right-handed, so his right arm is his major extremity. For the major upper extremity, a 20 percent rating is assigned when there is recurrent dislocation of the humerus at scapulohumeral joint with infrequent episodes and guarding of movement only at shoulder level. Id. A 20 percent rating is assigned for malunion with moderate deformity and 30 percent assigned for marked deformity. Id. A 30 percent rating is assigned for the major extremity with frequent episodes and guarding of all arm movements. Id. A 50 percent rating is warranted if there is fibrous union of the humerus. Id. A 60 percent evaluation requires nonunion of the humerus (a false flail joint). Id. A 80 percent evaluation, the maximum schedular rating involving impairment of the humerus of the major upper extremity, requires loss of the head of the humerus (flail shoulder). Id. The normal range of motion of the shoulder on forward elevation (flexion) is from zero degrees (arm at side) to 180 degrees (arm straight overhead); 90 degrees of flexion is achieved when the arm is parallel with the floor. 38 C.F.R. § 4.71, Plate I (1999). Normal abduction of the shoulder is from zero degrees to 180 degrees. Id. Normal internal or external rotation of the shoulder is from zero degrees to 90 degrees. Id. First, the Board concludes that the proper diagnostic code is Diagnostic Code 5202. There is no medical evidence of scapulohumeral ankylosis or limitation of motion to 25 degrees from the side such that the application of Diagnostic Code 5200 or Diagnostic Code 5201 would be proper or would yield a disability rating greater than the current assigned 20 percent, based on the evidence of record. Diagnostic Code 5203, impairment of the clavicle or scapula, permits a maximum 20 percent rating for dislocation or nonunion with loose movement. See Butts v. Brown, 5 Vet. App. 532, 538 (1993). The Board finds that the preponderance of the evidence is against a disability rating greater than 20 percent for the appellant's right acromioclavicular separation, under Diagnostic Code 5299-5202. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.20, 4.40, 4.45, 4.71a, Diagnostic Code 5299- 5202. Subjective complaints of pain and a feeling of instability that impacts his arm movement, particularly his ability to elevate his arm, manifest the right shoulder disability. However, the report of the most recent VA orthopedic examination, in October 1998, shows only slight limitation of motion and deformity of the AC joint. The Board notes that the appellant is able to flex and abduct the arm to well above shoulder level. There is no evidence of loss of strength or muscle tone, of any neurological involvement or of any dislocation or subluxation due to service-connected disability. There is no evidence of instability of the right shoulder. The appellant had nearly full range of motion of the right shoulder in all planes of excursion. 38 C.F.R. § 4.71a, Diagnostic Code 5201. Moreover, pain limited movement only on internal and external rotation, that was nearly full in any case, and the degree of functional impairment resulting from flare-ups of pain, due to service-connected right shoulder disability, was characterized by the examiner as mild. Under the provisions of 38 C.F.R. § 4.45, "[p]ain on movement, swelling, deformity or atrophy of disuse," as well as "[i]nstability of station, disturbance of locomotion, interference with sitting, standing and weight-bearing" are relevant considerations in evaluating joint disabilities. VAOPGCPREC 9-98. As indicated above, however, the VA examiners in 1997 and 1998 found that the appellant's service-connected right shoulder did not exhibit weakened movement, excess fatigability or incoordination, either on examination or by history. Thus, the factors considered in DeLuca v. Brown, 8 Vet. App. 202 (1995), that were felt to indicate the presence of greater disability in cases of joint impairment, are essentially absent in this case, except at the extremes of internal and external rotation. Moreover, the Board would note that in February 1999, the VA examiner commented that the appellant's limitation of functional ability due to pain was highly subjective and complicated by the coexistence of fibromyalgia syndrome. Additionally, the Board observes that the appellant has been variously diagnosed with other non-service-connected orthopedic disabilities and, while in September 1997, the VA examiner diagnosed a small amount of shoulder pain secondary to ankylosing spondylitis, in 1999, the VA doctor found no evidence of spondyloarthropathy involving the right glenohumeral joint. Further, while in April 1998, Dr. Halvorson diagnosed bursitis, ankylosing spondylitis, intra articular disease and atrophy of the biceps, these disorders were not found on recent VA orthopedic examinations in 1997 and 1998. In fact, in 1999, the VA physician stated that typically, in a type II AC sprain, the residual disability was mild and should not be functionally disabling to any significant extent with respect to ordinary activities. The Board, therefore, concludes that the 20 percent rating currently assigned accurately compensates the veteran for the actual degree of functional impairment currently produced under the ordinary conditions of life by his service- connected right shoulder disability. See 38 C.F.R. §§ 4.10, 4.40. Further, while earlier medical records described arthritis, the February 1999 VA Addendum reflects that recent x-ray and bone scans show no evidence of arthritis. Thus, the Board finds that a separate compensable evaluation is not warranted under 38 C.F.R. § 71a, Diagnostic Code 5010, for arthritis of the right shoulder. VAOPGCPREC 23-97, 62 Fed. Reg. 63,604 (1997); see VAOPGCPREC 9-98, 63 Fed. Reg. 56,703 (1998). Finally, the Board notes that a Social Security Administration (SSA) decision found the appellant suffering from HLA-B27 associated spondyloarthropathy and held him to be disabled since January 1993. While the Board recognizes the disabling nature of the appellant's spondyloarthropathy, the appellant has not asserted, and there is no medical evidence to indicate, that this disorder is related to active service or service-connected disability. Consequently, the SSA decision is not considered directly relevant to the limited issue before the Board. ORDER An increased evaluation for right acromioclavicular separation is not established. The appeal is denied. ROBERT D. PHILIPP Member, Board of Veterans' Appeals