RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00741
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060801

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

CI CONTENTION:  The applicant contends that her shoulder condition continues to negatively impact her life.  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 - 20060615	VARD 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5399-5304	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Shoulder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI manifested right (dominant) shoulder instability from the time of her 1999 service entry.  In July 2004 (23 months before separation) she underwent surgical intervention (open capsular shift).  There was ample documentation in outpatient STR entries that she suffered no recurrent subluxation, dislocations, or subjective instability after the surgery; and, multiple physical examinations that demonstrated joint stability without impingement (none to the contrary).  There were multiple range of motion (ROM) measurements evidenced in STR entries from the period between surgery and separation.  The majority of these documented near normal or modestly limited ROM (some specifying painful motion), and there were no probative entries for ROM limitation meeting minimum compensable VASRD rating thresholds (see below).  Post-operative imaging (MRI) demonstrated some degenerative changes but an intact rotator cuff with no structural abnormalities.  The CI continued, however, to experience pain prohibiting push-ups and other military fitness requirements.  Additional surgery was not indicated; and, she was referred for an MEB which in turn forwarded “right shoulder pain” to the PEB.  

The NARSUM examination in April 2006 (3 months before separation) documented “persistent and progressive” pain rated 3-5/10 that “increases with activity ... [but] ... denies any recurrent instability ... or significant weakness.”  The physical examination recorded negative signs for impingement or instability and 5/5 strength of all involved muscle groups.  Measured ROM was forward flexion to 170 degrees (normal 180, 90 for minimum 20%) and abduction to 170 degrees (same parameters).  There was no VA claim, examination, or rating decision in this case, and no other post-separation evidence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated under the analogous muscle code 5399-5304 (Group IV, intrinsic muscles of shoulder girdle), and its 10% determination was for “moderate” muscle disability under that code.  Code 5304 also offers a 20% rating for “moderately severe” and 30% (major) for “severe” disability.  Members agreed that the functional evidence (and paucity of cardinal signs) would not support either of the higher ratings under 5304.  There was no ROM limitation supporting a rating higher than 10% (conceding painful motion); and, there was no ankylosis, fracture (nonunion/malunion) or subluxation/instability (at separation) that would support a higher rating via any other applicable code available under §4.71a.  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 of the right shoulder condition.  

BOARD FINDINGS:  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.  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 20150605, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR
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-2015-00741.

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