RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03953
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20060414

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Supply Management Journeyman, medically separated for “chronic right shoulder pain and mild weakness,” with a disability rating of 10%.

CI CONTENTION:  The applicant makes no specific contention in his application.  The CI’s 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 Physical Evaluation Board (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:  

SERVICE PEB -  20060130	VARD - 20080409	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5399-5304	10%	Right Shoulder S/P Repaired SLAP Lesion w/DJD	5201-5010	10%	20080409	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Right Shoulder.  The narrative summary (NARSUM) noted the CI injured his dominant right shoulder while playing football in June 2003.  While blocking another player he felt his shoulder “pop out of joint” and he had to manually “pop it back” into position.  The CI experienced a recurrent dislocation in February 2004 and orthopedic evaluation noted positive signs of instability and impingement, with good range of motion (ROM).  Physical therapy was continued, but right shoulder pain and weakness persisted.  Magnetic resonance imaging (MRI) of the shoulder 6 May 2004 showed evidence of shoulder dislocation with ligament and SLAP [superior labral tear from anterior to posterior] injury.  The CI underwent arthroscopic surgery 15 September 2004 for repair.  According to the NARSUM, after the surgery, the shoulder pain increased and repeat arthroscopy was performed in October 2004, with removal of loose bodies in the joint.  The CI continued to have pain and a feeling of instability and a repeat MRI suggested the repair was unsuccessful. A third arthroscopy was performed 19 September 2005.  At the arthroscopy, no SLAP lesion was found, and the operative report noted there was minimal laxity, but the shoulder was not able to be dislocated during the procedure.  Mild debridement of the joint and humeral head was performed and degenerative joint disease (DJD) was noted.  Following the third surgery the CI continued to have shoulder pain and decreased ROM and a Medical Evaluation Board (MEB) was initiated.  At an orthopedic evaluation 5 December 2005, shoulder ROM was flexion 170 degrees (normal 180) and abduction 160 degrees (normal 180).  At the MEB exam, 3 months before separation, the CI reported decreased shoulder ROM, pain, and weakness.  The MEB physical exam noted ROM as “decreased … on flexion, abduction and extension over the head.”  There was “popping” noted with internal rotation.  Shoulder strength was graded 4/5, with normal grip strength bilaterally.  Upper extremity reflexes were normal.

At the VA Compensation and Pension (C&P) exam, 24 months after separation, the CI reported pain, stiffness, and weakness of the right shoulder, but no episodes of dislocation or subluxation.  He reported flare-ups weekly with mild functional impairment.  The exam noted right shoulder ROM of flexion 140 degrees and abduction 160 degrees, with painful motion, crepitus and tenderness, but no additional loss of ROM with repetition.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the shoulder condition 10%, coded 5399-5304 (analogous to Group IV muscle injury), an analogous code for rotator cuff injury.  The VA rated the shoulder condition 10%, coded 5201-5010 (traumatic arthritis with limited arm motion).  The Board agreed that the evidence supports a 10% rating based upon shoulder DJD with painful limited motion IAW VASRD §4.59 (painful motion), coded either as 5003 or 5201 IAW VASRD §4.71a (musculoskeletal injuries or coded analogously as 5399-5304 for “moderate” muscle injury IAW VASRD §4.73 (muscle injuries).  The Board reviewed to see if the evidence supports a higher rating with any applicable coding approach.  There was no evidence of limited arm motion sufficient to meet rating criteria based on ROM alone.  There was no evidence of nonunion or malunion of the humerus, or recurrent dislocations following the last surgery.  If coded as 5299-5203 (analogous to impairment of the clavicle/scapula), another analogous code for rotator cuff injury, there was likewise no evidence of loose movement to equate with a 20% rating.

The Board next reviewed the rating criteria of 5399-5340 which are subjective, with a 0% rating for “slight,” 10% rating for “moderate,” 20% for “moderately severe,” and 30% for “severe” muscle injury.  The Board considered that when coding the shoulder disability analogously as 5304, the discrimination between the “slight” and “moderate” characterizations depends on the presence of at least one “cardinal sign or symptom” of muscle injury specified as “loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement” for “moderate,” as opposed to none for “slight.”  At both the MEB and C&P exams pain and mild weakness of the shoulder were noted.  Therefore, the Board concluded that based on the presence of the cardinal symptoms of pain and mild weakness, the disability due to the shoulder was best described as “moderate” and not “slight” and met the 10% rating, but judged it could not be characterized as “moderately severe,” which by analogy members judged would require more findings such as additional loss of ROM with repetition or greater objective evidence of muscle weakness, such as atrophy.  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 shoulder condition. 

BOARD FINDINGS:  In the matter of the shoulder condition and IAW VASRD §4.73, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration. 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 20140902, 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 XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03953.

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,

Attachment:
Record of Proceedings