RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00742
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040813

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Tactical Aircraft Maintenance F-16/F-117 Journeyman, medically separated for “right shoulder pain associated with instability” with a disability rating of 10%.  

CI CONTENTION:  “I was medically separated due to a shoulder tear, but as evidenced by the VA Decision Letter, I was unfit due to more than just the shoulder.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20040609	VARD - 20050512	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain Associated with Instability 	5304	10%	Dislocation and Anterior Labral Tear, Right Shoulder 	5299-5203	10%	20041117	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:

Right (Dominant) Shoulder Pain Associated with Instability.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s (dominant) right shoulder pain condition began in July 2003 after lifting a heavy tool box.  An MRI in August 2003 revealed a probable tear of the anterior labrum and an MRI arthrogram in November 2003 confirmed the tear.  The 20 November 2003 orthopedic surgeon office visit noted multidirectional instability in both of his shoulders with occasional painful catching sensation reported.  The sports medicine orthopedist recommended a posterior shoulder capsule tightening which the CI did not feel comfortable with so he returned to the general orthopedic surgeon.  The general orthopedic surgeon did not feel there was a surgical indication.  

The 12 May 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of pain with overhead and rotational activities of his shoulder.  Physical examination noted some instability of his shoulder which was also present on the contralateral side.  Forward flexion was to 150 degrees (180 normal).  He had a mild sulcus sign (instability) and other signs of subluxation.  When examined in the supine position, the arm forward extended 90 degrees and “driven out of the back of his shoulder” (subluxation without frank dislocation) there was spontaneous relocation with extension and abduction, this was equal with the left, unaffected, side.  The examiner also noted 5/5 (normal) strength in all components of the rotator cuff.  

At the 17 November 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported daily pain in his shoulder.  The CI stated he felt that his right shoulder popped out and back in.  Any movement which involved elevating the arm above 90 degrees easily aggravated his symptoms.  Lifting even fairly light objects hurt.  Physical examination showed right shoulder forward flexion to 170 degrees (normal 180) and adduction to 180 degrees (normal) with painful motion present.  The rotator cuff muscles showed normal strength with the exception of the subscapularis which caused pain so he did not attempt.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder with instability condition 10%, coded 5304 (Group IV, muscle code (stabilization of the shoulder), moderate). The VA rated the right shoulder condition 10%, coded 5299-5203 (analogous to clavicle or scapula, impairment of) based on the C&P examination 3 months after separation, citing a slight decrease in ROM along with pain.  

The VASRD §4.71a (code 5201, arm limitation of motion) threshold for a rating for ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion well above this level.  Although there was insufficient / no limitation of motion to support a rating under 5201, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion of the humerus; although there was a sense of subluxation there was no recurrent frank dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment of).  There was no demonstrable weakness of any of the rotator cuff muscles (Group IV muscles) to validate a rating using code 5304.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder condition.  

BOARD FINDINGS:  In the matter of the right shoulder condition and IAW VASRD §4.71a and §4.73, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.   

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160915, 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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00742.

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.  The Board recommended no re-characterization or modification of your separation.

I 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.  I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings