RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-03386
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150609
SEPARATION DATE:  20090820

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Combat Control Helper) medically separated for right shoulder pain.  The right shoulder condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was issued a temporary U4 profile and referred for a Medical Evaluation Board (MEB).  “Chronic right shoulder pain status post SLAP surgery,” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “right shoulder pain, chronic, status post SLAP surgery” as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  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/Naval 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 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:

IPEB – Dated 20090730	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain …	5304	10%	Right Shoulder Strain Status Post SLAP Surgery	5203	10%	20091020	
			Scar Status Post Right SLAP Surgery	7805	0%		
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 5	
RATING:  10%	COMBINED RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20100414 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Shoulder Condition.  On 3 November 2008, the CI presented with a history of long standing right (dominant) shoulder pain aggravated by “working out” over the prior week.  He was found to have a tear of the cartilage of the shoulder “socket” (labrum) and underwent surgical repair (SLAP) on 20 January 2009.  He did well in rehabilitation other than some discomfort related to early resumption of some activities (pull-ups and push-ups) as noted at the 6 May 2009 follow-up.  A 5 June 2009 note documented that he had been disruptive in the orthopedic clinic and was frustrated with his progress.  He was also pending possible administrative separation for academic failure.  At a physical therapy appointment 2 weeks later there was concern that he was exaggerating his symptoms and further treatment was discontinued pending re-evaluation in orthopedics.  The narrative summary was dated 29 June 2009, 2 months prior to separation.  It noted that the CI was pending separation for unrelated academic and behavior issues.  The CI reported ongoing pain with overhead activities.  The examiner cited an orthopedic evaluation from 19 May 2009.  The scars were well healed and some weakness was present, as would be expected 4 months after surgery.  The range-of-motion (ROM) was reduced.  An orthopedic note dated 14 July 2009, a month prior to separation, documented that he could elevate his arm fully overhead and could do so against resistance.  Signs of impingement and instability were absent.  No atrophy was present and his strength was normal.  He did have some clicking at the joint between the sternum and clavicle (collar bone) with movement.  The examiner noted that the CI might need another year to return to full active function and that the MEB could proceed.  At the VA Compensation and Pension exam performed 2 months after separation, the CI reported weakness, stiffness, swelling, heat, redness, giving way, lack of endurance, locking, fatigability, tenderness, pain, dislocation, and popping sensation.  He could not lift heavy objects or do pushups.  He also noted tenderness and itching of his surgical scars.  On examination, the scars were non-tender and otherwise unremarkable.  The shoulder was tender and the ROM was limited by pain.  Otherwise, the examination was normal.  DeLuca criteria were absent.  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.

Right Shoulder ROM
(Degrees)	PT ~3 Mo. Pre-Sep	PT ~2 Mo. Pre-Sep	PT ~2 Mo. Pre-Sep	MEB ~2 Mo. Pre-Sep	VA C&P ~2 Mo. Post-Sep	
Flexion (180 Normal)	140	130	100/105/105	150	130/130	
Abduction (180)	125	110	115/115/115	150	120/120	
External Rotation (90)	--	--	70/74/75	50	90/90	
Internal Rotation (90)	--	--	20/21/22	50	70/70	
Comments	Four months post op.  Limited by pain	Five months post op Limited by pain	Five months post op Limited by pain	Used 19 May 2009 examination Limited by pain	Nine months post op Limited by pain	
§4.71a Rating	10%	10%	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the right shoulder at 10% using the codes 5304 (Group IV muscles: Stabilization of the shoulder…) and 5203 (impairment of the clavicle or scapula), respectively.  The Board considered these and other codes available for the shoulder, but found no route to a rating higher than the 10% adjudicated by both the PEB and VA at separation.  The Board also considered the scars, but found no evidence to support a finding that these were unfitting.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder condition.

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the right shoulder pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140723, 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

XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03386.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR