RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01766
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050617

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Nondestructive Inspection Craftsman, medically separated  for “bilateral shoulder pain” with a disability rating of 20%.  

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 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 – 20050429	VARD – 20050912	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Shoulder Pain	5003-5099	20%	Residuals: Right Shoulder Status Post Labral Surgery with Scars	5202-5010	10%	20050817	
			Left Shoulder Status Post Labral Surgery with Scars	5024	10%	20050817	
Tobacco Habituation	Cat III	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  The PEB separated the CI for bilateral shoulder pain with a single rating; however, it appropriately adjudicated each shoulder individually and the 20% rating was a combined rating after application of the bilateral factor.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right (dominant) shoulder condition began in November 2000 after heavy lifting at work.  He had normal strength and range of motion (ROM), but tenderness over the bursa for which he was given medications.  He again reported with right shoulder pain in June 2002 and was referred for an MRI, which was normal.  However, clinical examination was consistent with a labral tear (cartilage lining of the shoulder joint) which was surgically treated on 16 September 2002.  Multi-directional instability was also noted and rehabilitation in physical therapy (PT) was prescribed.  Despite this, the CI had continued pain and instability which required a second procedure on 30 January 2003.  He again was referred for rehabilitation and had some improvement, however on 10 April 2004, he dislocated his left shoulder while playing softball (below).  He continued PT for the right shoulder while in rehabilitation for the left, but reported right shoulder instability, with subluxation (incomplete dislocation) documented during an orthopedics visit.  Due to ongoing duty limitations from the right and left shoulders, the CI was referred for MEB.  

The 2 February 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of ongoing pain and instability.  Physical examination showed slightly reduced strength bilaterally (4+/5) with some decreased ROM (not quantified).  

At the 17 August 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported that he used Motrin about 3 times a week, but did not use a sling or have flares or incapacitation.  Physical examination revealed well-healed scars and a non-tender shoulder.  Forward flexion and abduction were both 120 degrees (normal 180 for both) with painful motion.  No comment was made regarding strength or stability.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, analogously coded 5003-5099 (degenerative arthritis), citing Department of Defense (DoD) and VASRD guidelines.  The VA also rated the right shoulder condition 10%, analogously coded 5202-5010 (post-traumatic arthritis), based on the C&P examination, citing painful and limited motion with X-ray evidence.  This was based on a C&P dated 20 April 2007, 22 months after separation, and not probative for rating purposes by the panel.  The VA administratively applied it retroactively as the CI had appealed the initial VA rating.  Members noted 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.  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 and no dislocation or nonunion of the clavicle or scapula to justify a higher rating under the 5202 (humerus, other impairment of) or 5203 (clavicle or scapula, impairment of) codes.  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.  

Left Shoulder Pain.  According to the STR and MEB NARSUM, the CI dislocated his left shoulder April 2004 while playing softball.  He subsequently underwent surgical repair of a labral tear and instability on 9 June 2004.  Despite rehabilitation, he remained symptomatic and was unable to perform full duty.  

The MEB NARSUM examination noted CI complaints of ongoing pain although his clinical examination had improved.  Physical examination showed slightly reduced strength bilaterally (4+/5) with some decreased ROM (not quantified).  

At the C&P examination, the CI reported that he used Motrin occasionally, but did not use a sling or have flares or incapacitation.  Physical examination revealed a well-healed but slightly deforming scar.  Forward flexion and abduction were both 120 degrees, with painful motion, and the provider did not comment on strength or stability.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, analogously coded 5003-5099 (degenerative arthritis), citing DoD and VASRD guidelines.  The VA also rated the left shoulder condition 10%, coded 5024 (tenosynovitis), based on the C&P examination, citing painful and limited motion of a major joint.  Members noted, as mentioned above, that the rating was subsequently increased to 20%, retroactive to separation.  Analogous to the discussion for the right shoulder, the left shoulder ROM studies proximate to separation demonstrated motion above shoulder level, which did not support a higher rating under diagnostic code 5201 (arm limitation of motion).  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 left shoulder condition.  The panel observed that as neither the right nor left shoulder conditions warranted modification, no change to the PEB adjudication for the bilateral shoulder pain is recommended.  

Contended PEB Condition:  Tobacco Habituation.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition is not considered a physical disability for rating purposes IAW DoDI 1332.38 E5.1.2.9.1., and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bilateral shoulder condition and IAW VASRD §4.59, the panel recommends no change in the PEB adjudication.  In the matter of the contended tobacco habituation condition, the panel 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 20170313, 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-2017-01766.

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