RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX						           CASE:  PD-2014-03151
BRANCH OF SERVICE:  AIR FORCE  	SEPARATION DATE:  20050310

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard E-5 (Supply Manage,” rated at 10%.  

CI CONTENTION:  The CI requests the Board consider all conditions.  His complete submission is at Exhibit A. 

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:  

FPEB – date unknown	VA* - (~6 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain s/p Rotator Cuff Repair x 2	5304	10%	Residuals Left Rotator Cuff Surgery Including Tendinitis	5201	20%	20040901	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 16 	
RATING:  10%	COMBINED RATING:  90%	
*Derived from VA Rating Decision (VARD) dated 20050526 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Left Shoulder Condition.  The CI is right hand/arm dominant.  In mid-2002, he injured his left shoulder while playing baseball.  Initially treated as tendonitis, radiographic follow-up revealed a torn rotator cuff tendon as well as a torn labrum.  In September 2002, he underwent surgical repair of the noted pathology and received subsequent physical therapy (PT).  The service treatment record (STR) noted a re-injury to the left shoulder in January 2003 which resulted in a second surgery being performed on 30 April 2003.  Despite aggressive PT and restrictions, his complaints of pain and limitation of motion continued throughout the remainder of his career.  He was last profiled in October 2004 and referred to a Medical Evaluation Board (MEB).  There were no STR entries that documented instability, subluxation or any positive neurovascular findings.  At the MEB narrative summary (NARSUM) exam performed on 2 July 2004 (8 months prior to separation), the CI offered no new or additional complaints other than those of prior history.  The physical examination (PE) revealed decreased left shoulder range-of-motion (ROM) with normal strength, motor control and sensation.  There was no comment IRT painful motion.  At the VA Compensation and Pension (C&P) examination performed on 1 September 2004 (6 months prior to separation), the CI endorsed constant left shoulder pain.  His PE revealed tenderness and decreased ROM about the left shoulder.  The goniometric 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.

Left Shoulder ROM
(Degrees)	MEB ~8 Mo. Pre-Sep	VA C&P ~6 Mo. Pre-Sep	
Flexion (180 Normal)	120	90	
Abduction (180)	100	90	
Comments	5/5 strength	tenderness	
§4.71a Rating	10% for painful motion	20%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA chose different coding options for the shoulder condition, but this did not bear on the rating and both were consistent with §4.73 Schedule of Ratings, muscle injuries and §4.71a musculoskeletal system, respectively.  The PEB adjudicated the left shoulder at 10% coded 5304 (moderate: group IV muscles) without specific citation.  The VA rated the left shoulder at 20% coded 5201 (arm; limitation of motion) citing limited motion.  The ROM values reported by the MEB and VA examiner (2 months apart) reflected a decrease in value coinciding to a different VASRD impairment rating.  Board members concluded that a greater value be placed upon the VA exam due to its nearer time reference to the separation date.  The shoulder limited ROM at 90 degrees supports the minimum rating under code 5201.  After due deliberation, considering the totality of evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the left shoulder condition.  There was no evidence of ratable peripheral nerve impairment which could provide for additional or higher rating.  Additionally, there was no further clinical or radiological evidence of the left shoulder joint that suggested non-union of, or mal-union of the clavicle or scapula.  Hence, no alternative shoulder code is supported in justification of a rating higher than that found in the limited ROM criteria of 5201.

BOARD FINDINGS:  In the matter of the left shoulder condition, the Board unanimously recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Left Shoulder Pain Condition	5201	20%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140612, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03151.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

Sincerely,

Attachments:
1.  Directive 
2.  Record of Proceedings

cc:
SAF/MRBR 
DFAS-IN