RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-00235
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20061020

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was active duty E4, Security Forces Journeyman, medically separated for “chronic rotator cuff tendonitis” with a disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060906	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Rotator Cuff Tendonitis	5304	10%	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Rotator Cuff Tendonitis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left (dominant) shoulder condition began on 1 July 2005 after a motor vehicle accident.  Treatment consisted of pain medications and a muscle relaxer along with physical therapy (PT) for several weeks; a steroid injection on 29 August 2005 provided some relief.  At a PT visit on 12 September 2005, he reported decreased shoulder pain and soreness, and at a neurology appointment the next day, he stated his shoulder was pain-free. On examination, active range of motion (ROM) throughout left shoulder was normal.  At a primary care visit on 24 October 2005, the CI reported pain with certain shoulder movements, and the physician noted an audible popping as well snapping and clicking, but no grating sensation.  The shoulder was tender over the anterior lateral aspect. 
On 18 January 2006, a family practice provider documented “normal” active forward flexion and “active internal rotation at 90 degrees abduction,” and “elevation through active abduction,” with pain.  During an orthopedic visit on 30 January 2006, after several positive shoulder tests (Neer’s, O’Brien’s and Speed’s), and the examiner ruled out a superior labral from anterior to posterior tear.  An MRI with contrast showed mild symptomatic tendinopathy marked by mild thickening and increased fluid signal only in the supraspinatus tendon.  At an orthopedic follow-up on 26 April 2006, the CI reported he had a second opinion that was in agreement with the diagnosis of mild symptomatic tendinopathy/impingement syndrome secondary to underlying subtle multidirectional instability.  However, he was not ready to undergo surgery.  

At the 19 July 2006 MEB NARSUM examination, 3 months prior to separation, the CI complained of left shoulder pain.  Physical examination showed forward flexion of 170 degrees (normal 180), “extension” of 90 degrees, and internal rotation “within normal limits.”  Biceps and triceps strength was normal with no hand or arm sensory deficits, and pain was reproduced with a positive Speed’s test (for labral tears).  He was able to hold the left arm out with abduction, however, due to pain with resistance, it slowly dropped to his side.  The examiner thought that this was more related to pain and not to weakness in general.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, coded 5304 (Group IV function).  Panel members noted that the PEB’s rating was based on the orthopedic impression of a tendinopathy.  Nevertheless, there was no evidence of a moderately severe disability to warrant a higher rating of 30% using code 5304.  The VASRD §4.71a threshold for rating for ROM impairment under code 5201 (arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion at or above this level.  Although there was insufficient limitation of motion to support a rating under code 5201 code, the panel 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 and no dislocation or nonunion of the clavicle or scapula to justify a higher rating under code 5202 (humerus, other impairment of) or 5203 (clavicle or scapula, impairment of).   After due deliberation, considering all 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 chronic left shoulder condition.  

BOARD FINDINGS:  In the matter of the left shoulder rotator cuff tendonitis and IAW VASRD §4.73, the panel recommends no change in the PEB adjudication.  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 20151201, 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

XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00235.

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.