RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX	CASE:  PD-2017-00258
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050302

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Security Forces Journeyman, medically separated for “chronic left shoulder pain status post rotator cuff injury” with a disability rating of 10%.  

CI CONTENTION:  “I continually am unable to retain employment that requires me to stand for long periods of time and repetitively carry, push or pull 30 lbs. or more.”  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 - 20041129	VARD - 20051123	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain…	5304	10%	Chronic Left Shoulder Strain	5299-5201	0%	20051020	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Left Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI injured his left shoulder in December 2001 while participating in a training event that required him to use an axe.  In May 2002, he presented for care with a 4-month history of constant, sharp, left shoulder pain.  On 18 March 2003, he underwent left shoulder arthroscopy with debridement of a posterior slap lesion.  At an orthopedic evaluation on 15 April 2004, the CI reported continued pain since resuming physical training in January 2004.  The provider noted pain with resisted flexion and supination without supraspinatus or infraspinatus wasting.  Left shoulder range of motion (ROM) showed full forward “elevation [flexion],” abduction, and external rotation and internal rotation to 40 degrees.  Abduction and external rotation strength were intact.  An MRI on 23 July 2004 revealed post-operative changes at the labrum without evidence of rotator cuff pathology.  

At the 29 September 2004 MEB NARSUM orthopedic examination, the CI reported pain by the end of long work days.  Physical examination showed a trigger point over the left rhomboid, pain at the posterior acromial and anterior shoulder, and pectoral discomfort.  Measured ROM revealed forward elevation to 170 degrees (normal 180), abduction to 170 degrees (normal 180), and full internal and external rotation.  During the 25 October 2004 MEB NARSUM examination, 4 months prior to separation, the CI reported continued left shoulder discomfort and pain which made it difficult to accomplish his security forces duties.   

At the 20 October 2005 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported an inability to perform throwing motions or push-ups, and that reaching over head was painful.  Measured ROM, in degrees, showed: flexion to 160, abduction to 90, external rotation to 90, and internal rotation to 75.   Repetitive ROM was not additionally limited by pain, fatigue, weakness or lack of endurance.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, coded 5304 (muscle group IV: shoulder girdle).  The VA rated the left shoulder condition 0%, analogously coded 5299-5201 (arm limitation of motion), based on the C&P examination, citing a non-compensable evaluation since the CI filed his claim within one year.  Members noted that the VASRD §4.71a threshold for rating ROM impairment under code 5201 is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence recorded motion above this level.  However, 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 to justify a rating under code 5202 (humerus, other impairment of); and, no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under code 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 left shoulder condition.  

BOARD FINDINGS:  In the matter of the chronic left shoulder pain 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.  

XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00258.

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.