RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01214
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060517

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Air Transportation Craftsman, medically separated for “left shoulder anterior instability,” with a disability rating of 20%.

CI CONTENTION:  “Review all conditions.”  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 based on 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 - 20060405	VARD - 20070822	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Anterior Instability	5202	20%	Left Shoulder Instability	5202	0%	STR	
Bilateral Patellofemoral Syndrome 	Cat II	Left Knee Condition	5257	NSC		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Shoulder Anterior Instability.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI dislocated his left shoulder in July 2004 while boxing.  Magnetic resonance imaging (MRI) confirmed the dislocation.  He dislocated it again in February 2005 while playing basketball.  MRI showed a labrum tear.  Evaluation by orthopedics concluded with a diagnosis of left shoulder subluxation/instability and recommended non-surgical treatment.  Despite treatment, the left shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  Dominant hand could not be discovered in the case file.  The MEB forwarded “left shoulder instability” for PEB adjudication.

At the orthopedic clinic examination on 26 January 2006, 4 months prior to separation, the examiner recorded the CI still had instability and couldn’t fully do his duties.  On examination the CI had full range of motion (ROM).  Examination tests for instability were positive and the Hawkins test for shoulder impingement, which is equivalent to painful motion, was also positive.  According to the MEB NARSUM evaluation on 3 March 2006, 3 months prior to separation, the CI complained his “shoulder [went] out of socket at any given ROM. 

The CI not did report for his VA C&P exam.
 
The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under 5202 code (humerus impairment).  The VA assigned a 0% rating using the 5202 code, citing “no current medical evidence to show the current status of this condition.”  Although the MEB, PEB, and STRs did not indicate if his left arm was dominant or not, the Board noted that there was no pathway to the next higher rating for either the dominant or non-dominant arm.  For the dominant arm, there was no malunion with marked deformity of the humerus or frequent episodes of recurrent dislocation with guarding of all arm movements to warrant the next higher 30% rating.  There was likewise no route to a higher rating for limitation of motion (5201), and no higher ratings available under the 5203 code (clavicle or scapula, impairment of).  For the non-dominant arm, there was no fibrous union or nonunion of the humerus to justify the next higher 40% or 50% rating.  There was likewise no route to a higher rating for limitation of motion (5201), and no higher ratings available under the 5203 code (clavicle or scapula, impairment of); therefore, regardless of whether his left arm was dominant or not, there was no route to a higher rating than the 20% adjudicated by the PEB.  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 left shoulder condition.

Contended PEB Condition:  Bilateral Patellofemoral Syndrome.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The PEB recorded the condition as Category II, a condition that could be unfitting but was not currently compensable or ratable.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left shoulder condition and IAW VASRD §4.71a, the Board recommends no change in the PEB adjudication.  In the matter of the contended bilateral patellofemoral syndrome, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 20150611, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01214.

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