RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01622
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080407

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Civil Engineer, medically separated for “chronic left shoulder status post clavicle excision and osteoarthritis” with a disability rating of 10%.   

CI CONTENTION:  Review of all conditions requested.  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 - 20071207	VARD – 20081105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder S/P Clavicle Excision and Osteoarthritis	5003	10%	Left Shoulder, Post-Operative	5203-5019	10%	20080509	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Left Shoulder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left shoulder surgery in March 2003 for resection of the clavicle.  Shoulder pain improved after surgery but would recur with repetitive exercise.  The 10 October 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of chronic left shoulder pain.  Physical examination showed a normal inspection of the shoulder with no tenderness and normal range of motion (ROM) which is 180 degrees for both flexion and abduction.  Muscle strength and sensation were normal and painful motion was not addressed.

At the 9 May 2008 VA Compensation and Pension (C&P) examination, one month after separation, the CI reported shoulder pain relieved by rest and medication (non-steroidal anti-inflammatory and narcotic medications).  Physical examination was reported as abnormal for the right shoulder and normal for the left shoulder; however a VA addendum noted “the scar and pain is in the left shoulder not right.”  There was no guarding of movement or subluxation.  ROM was flexion and abduction of 180 degrees.  Joint function after repetitive use was noted to be limited by pain of 0 degrees.  Shoulder X-rays showed widening of acromioclavicular joint post resection of distal clavicle and otherwise within normal limits.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder 10%, coded 5003 (degenerative arthritis).  The VA also rated the left shoulder at 10%, coded 5203-5019 (impairment of clavicle or scapula-bursitis), based on the C&P examination, citing “for painful motion of a major joint.”  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 MEB NARSUM examination 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) based on the C&P examination.  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).  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 and IAW VASRD §4.71a, 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 20170224, 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-2017-01622.

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 Proceeding