RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01706
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050329

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E6, Medical Service Craftsman, medically separated for “right shoulder arthropathy associated with bursitis” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 - 20050207	VARD - 20060428	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Arthropathy Associated with Bursitis 	5304-5399	10%	Residuals, Right Shoulder Injury	5203	10%	20051227	
Degenerative Cervical Neck Disease Associated with Herniated Nucleus Pulposus C5-6	Not Unfitting
Cat II	Degenerative Disc Disease, Cervical Spine	5237	20%	20051227	
Right Radiculopathy	Not Unfitting	Right Cervical Radiculopathy Associated with Degenerative Disc, Cervical Spine	8615	10%	20051227	
History of Hyper-supination Injury Right Elbow	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY

Right Shoulder Arthropathy.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI’s condition began in March 2003 when he was carrying a tent with another Soldier who dropped the tent, causing the CI to injury his right shoulder, elbow, and neck.  An MRI completed on 10 August 2004 showed a partial tear of the right supraspinatus tendon, mild degenerative joint disease (DJD) of the right acromioclavicular (A/C) joint, and a small bursal effusion.  At the evaluation by orthopedics on 25 August 2004 the examiner noted a recent MRI represented tendinopathy of the supraspinatus tendon and some mild DJD of the A/C joint with no significant rotator cuff tear.  The examiner recorded his range of motion (ROM) as abduction “past 165” degrees (180 normal).  The CI was treated with an injection of Marcaine and Kenalog to help with his right shoulder tendonitis pain.  

At the time of the physical therapy clinic appointment on 11 October 2004, 6 months prior to separation, the examiner recorded right shoulder ROM measurements as 165 degrees flexion (180 normal) and 145 degrees abduction.  At the flight medicine appointment on 27 October 2004 the examiner noted the CI had some anterior right shoulder tenderness and a positive supraspinatus test.  The CI’s right shoulder ROM was measured at 180 degrees flexion and 170 degrees abduction with pain noted between 85 and 105 degrees.  

According to the 2 December 2004 MEB NARSUM evaluation, 4 months prior to separation, the CI stated that his shoulder symptoms had significantly improved after the injection and being placed on Naprosyn.  The examiner noted that the 27 October 2004 examination showed the CI had pain at a level of 4/10 and full ROM. The examiner recorded the right shoulder ROM as 170 degrees flexion and 150 degrees abduction.  

At the 27 December 2005 VA Compensation and Pension (C&P) examination (Joints), 9 months after separation, the CI reported constant right shoulder pain that radiated to the right arm.  He reported his pain as stabbing and shooting at an average intensity of 4/10.  It was aggravated by prolonged sitting and decreased by stretching exercises.  There was no weakness noted in his upper extremities.  Physical examination of his right shoulder showed no gross deformity.  He had mild tenderness to palpation of the A/C joint.  Right shoulder ROM was 170 degrees flexion and 160 degree abduction.  Discomfort was noted at the end of the ROM measurements.  There was no additional pain, fatigue, weakness, or lack of endurance noted with repetition.  There was “good” rotator cuff strength without pain.  He had a negative apprehension and relocation test.  His muscle strength was 5/5 in all extremities.  Sensation was impaired to light tough in his entire right upper extremity except for the medial aspect of his arm.  Deep tendon reflexes were 1+ throughout with a negative Hoffman sign.  His gait was normal and he was not using any assistive devices.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5399-5304 code (Group IV muscle code for shoulder).  The VA also assigned a 10% rating using the 5203 code (clavicle or scapula impairment) with no reason for the rating stated.  

The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level.  Although there was insufficient limitation of motion to support a rating under the 5201 code, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent 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).  The panel also considered a rating analogous to 5304; however, there was no evidence of shoulder weakness to support a 20%rating for moderately severe muscle dysfunction.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder condition.  

Contended PEB Condition:  Degenerative Cervical Neck Disease Associated with Nucleus Pulposus C5-6.  According to the STR and MEB NARSUM, the CI injured his neck in March 2003.  At the neurology clinic appointment on 11 February 2004, 5 months prior to separation, the CI reported neck stiffness and intermittent numbness involving the right ring and small finger.  Physical examination showed decreased sensation in the right forearm, palm, small finger, and right finger.  There was mild limitation of rotation of the neck bilaterally.  Strength was normal.  The examiner opined that the CI’s prior injury may have resulted in a traumatic right C-8 radiculopathy.  A 26 February 2004 cervical spine MRI showed C5-C6 small, midline, herniated, degenerative disc without evidence of cord compression.  A follow-on MRI of the cervical spine done on 21 June 2004 with gadolinium showed a small hydromyelia (the accumulation of fluid within the central canal of the spinal cord) at C4 with an otherwise normal contrast study.  At the 2 December 2004 MEB NARSUM examination the examiner noted the CI’s cervical ROM as flexion to 2 inches of chest (45 degrees normal) and reflexes were normal.  

At the 27 December 2005 VA C&P evaluation the CI reported constant, dull, aching, localized posterior neck pain with intermittent, stabbing, 4/10 pain radiating to the right arm.  The pain was aggravated by prolonged sitting and decreased by stretching exercises.  He denied bowel and bladder incontinence.  Physical examination showed no gross deformity.  The cervical ROM was 35 degrees flexion and combined ROM was 140 degrees (normal 340).  There was pain with motion and mild tenderness over lower portions of the cervical paraspinal muscles.  There was no additional limitation of motion; pain; fatigue; lack of endurance; or increased weakness with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the cervical condition as a Category II condition (a condition that can be unfitting but was not currently compensable or ratable) coded 5243 (intervertebral disc syndrome).  The VA rated the cervical condition as “degenerative disc disease, cervical spine,” 20%, coded 5237 (cervical spine strain), based on the C&P examination, citing limitation of motion.  

Panel members deliberated whether the preponderance of the evidence supported an unfitting determination for the cervical condition.  The panel noted a limited duty (LIMDU) assignment for back pain and multiple LIMDUs for right shoulder pain.  The commander’s statement implicated physical restrictions which were primarily related to the right shoulder condition.  Panel members agreed that the preponderance of the performance-based evidence did not demonstrate that the cervical condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB Category II adjudication for the cervical spine condition.  

Contended PEB Conditions:  Right Radiculopathy/Right Elbow.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The right radiculopathy and elbow conditions were identified as contributing to the restriction of worldwide deployment.  There was no performance-based evidence from the record that residual right elbow impairment significantly interfered with satisfactory duty performance at separation.  The primary presentation of the right cervical radiculopathy was right upper extremity pain and IAW §4.14 (avoidance of pyramiding) would not be separately ratable.  There was no evidence of right upper extremity motor dysfunction.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right shoulder condition and IAW VASRD §4.73, the panel recommends no change in the PEB adjudication.  In the matter of the contended cervical spine and right upper extremity radiculopathy conditions, the panel unanimously recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20161104, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-01706.

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,

		

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings