RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX						            CASE:  PD-2014-04211
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20051014

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E-6 (Structural Maintenance Technician) medically separated for right shoulder pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).  He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The “chronic right shoulder pain” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic right shoulder pain, post rotator cuff repair” as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The IPEB determined “hypertension and low back pain” to be Category II (can be unfit, but are not currently compensable/ratable) and “hyperlipidemia” was determined to be Category III (not separately unfitting and not compensable/ratable).  The CI made no appeals and was medically separated.  

CI CONTENTION:  His conditions continue to worsen and negatively impact his daily activities.  His complete submission is at Exhibit A.

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 20050909	VA* - (~7 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic R Shoulder Pain …	5399-5304	10%	Chronic Muscular strain … R Shoulder	5201	20%	20050715	
Low Back Pain	Cat II	Low Back Strain	5237	20%	20060410	
Other MEB/PEB Conditions x 2 (Not In Scope)	Other x 7	
RATING:  10%	RATING:  50%	
*Derived from VA Rating Decision (VARD) dated 20060914 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  The record shows that the CI had an injury to the right (dominant) shoulder in 1991, but was able to return to full duty after treatment.  This was reinjured when he was in a car accident on 27 March 2004.  An MRI on 19 April 2004 was significant for a tear of the shoulder cartilage and an injury to one of the shoulder tendons (supraspinatus).  He was treated with physical therapy (PT), medications, and duty restrictions without resolution.  He subsequently had surgical repair of an impingement of the right shoulder as well as a partial tear of the supraspinatus tendon on 3 November 2004.  At a PT appointment on 20 December 2004, the range-of-motion (ROM) was slightly reduced as charted below.  Despite rehabilitation in PT, he was not able to meet full duty requirements and referred for MEB.  The shoulder addendum to the narrative summary (NARSUM) was dated 6 July 2005 and accomplished by an orthopedist.  The CI reported a reduction in pain since the surgery, but still had some ROM limitations.  The examiner noted that there was some indication for a SLAP lesion (an injury to the cartilage in the shoulder joint), but that this should have been noted and repaired at the surgery; the operative report was not available.  Some pain was present on testing for an impingement.  The examiner also noted that the shoulder could take up to a year for full recovery after the surgery.  The shoulder was stable.  Strength and sensation were normal to testing and an X-ray that day showed some degenerative changes to the orthopedist review (normal on the report though).  At the VA Compensation and Pension (C&P) examination a week later on 15 July 2005, also performed by an orthopedic surgeon, the CI reported right upper extremity pain, but denied hand weakness.  His pain flared with activity, especially overhead activities.  The ROM was reduced and painful.  The shoulder was tender to examination.  The scars were well healed.  No comment was made on signs of instability or impingement, implying that they 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 ~11 Mo. Pre-Sep	MEB ~4 Mo. Pre-Sep	VA C&P ~4 Mo. Pre-Sep	
Flexion (180 Normal)	153	115	110	
Abduction (180)	165	Not measured	80	
Comments		8 months post-op	Painful Motion	
§4.71a Rating	0%	10%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the shoulder at 10%, coded 5399-5304 (analogous to Group IV muscles).  The VA rated the shoulder at 20%, coded 5201 (limitation of motion).  The VA examination and PEB measurements were similar, but the former also included abduction which did not reach the shoulder level.  This limitation in motion supports a 20% rating using the code 5201.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the right shoulder condition coded 5201.  

Contended PEB Condition: Low Back Pain.  The Board’s main charge is to assess the fairness of the PEB’s implied determination that low back pain (LBP) was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The LBP was not specifically profiled, but the CI did carry a L3 profile at separation.  The commander noted multiple medical problems without further specification.  The LBP was not judged to fail retention standards by the MEB.  The last clinical record in evidence specifically for the LBP was an emergency room visit on 22 March 2004, after the car accident, and over a year prior to release from active service and 19 months prior to separation.  It was reviewed and considered by the Board.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended LBP condition and so no additional disability rating is recommended.  

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 condition, the Board unanimously recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  In the matter of the LBP 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 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	
Chronic Right Shoulder Pain, Post Rotator Cuff Repair	5201	20%	
Low Back Pain	Category II	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140928, 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-2014-04211.

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,

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR