RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01691
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090927

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an Air National Guard E6, Combat Weather Airman, medically separated for “right shoulder pain” with a disability rating of 20%.  

CI CONTENTION:  “The rating is inaccurate.  I have two herniated discs in my neck which require pain management injections three times per year.”  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 - 20090325	VARD - 20100426	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain 	5202	20%	Right Shoulder Tendonitis	5024	10%	20091214	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI underwent a right shoulder arthroscopy in July 2006 for labral repair and subacromial decompression.  He underwent a second arthroscopic surgery in 2007.  

The 4 August 2008 MEB NARSUM examination, 14 months prior to separation, noted complaints of chronic right shoulder pain rated at 3/10.  Physical examination findings from June 2007 were cited, however, this information was prior to a third arthroscopy performed on 19 May 2008 for persistent shoulder pain.  At that time, an anterior labral tear and biceps tendon were repaired.
During an orthopedic follow-up on 17 March 2009, the CI reported increasing shoulder pain.  A magnetic resonance (MR) arthrogram showed a small tear that was new since the May 2008 surgery, and another procedure was considered.  At a family practice appointment on 4 June 2009, 4 months before separation, the CI reported chronic right shoulder pain due to a recurrent labral tear.  On examination, motion was normal, but there was pain with active abduction.  

The 14 December 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, noted complaints of chronic right shoulder pain rated at 7/10, and up to 9/10 with flare-ups.  Pain radiated into the arm, and during severe flare-ups, it radiated up the neck to the ear.  The CI also had tingling in the third, fourth and fifth fingers “for a few minutes when the weather [got] cold.”  Physical examination showed mild acromioclavicular joint tenderness.  After repetition, flexion and abduction were to 125 degrees each (normal 180), with pain.  

At a VA orthopedic surgical evaluation on 8 March 2010, 6 months after separation, the provider noted a biceps muscle deformity consistent with a rupture of the long head tendon.  There was mild pectoral muscle atrophy but no instability, and grip strength was normal.  Shoulder ROM was flexion to 160 degrees, with pain, and abduction to 120 degrees with pain and clicking.  An MR arthrogram, performed on 8 April 2010, showed a complete tear of the anterior labrum, but an electrodiagnostic study of the right upper extremity was negative.  During a VA orthopedic follow-up visit on 23 April 2010, the surgeon indicated he would perform a fourth arthroscopy, but counseled that the surgery would likely be less successful than previous operations.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 20%, coded 5202 (humerus, other impairment of).  The VA rated the right shoulder condition 10%, coded 5024 (tenosynovitis), based on the C&P examination, citing painful or limited motion of a major joint.  Members noted that the VASRD §4.71a threshold for rating ROM impairment under code 5201 (arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence showed motion above this level.  Although the panel agreed that a 10% rating was justified for painful motion (VASRD §4.59), IAW DoDI 6040.44, a combined rating lower than the 20% assigned by the PEB may not be recommended.  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.  

BOARD FINDINGS:  In the matter of the right shoulder pain 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 20170217, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01691.

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