RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-01826
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090528

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Network Integration Craftsman, medically separated for “left arm pain” with a disability rating of 10%.  

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 - 20090219	VARD - 20090215	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Arm Pain	5203	10%	Left Shoulder Degenerative Arthritis	5299-5201	0%	20090810	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Arm Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the right-hand dominant CI underwent a left shoulder acromioplasty and distal clavicle resection on 12 October 2007.  The physical therapy progress report dated 9 January 2008 noted the ROM was great and strength was rapidly improving.  

At the time of the 4 September 2008 orthopedic clinic appointment, the CI reported persistent pain in the anterior and lateral aspects of the left shoulder (not at the distal clavicle).  He reported the pain occurred occasionally with certain motions, specifically when doing push-ups.  Physical examination revealed 5/5 strength in all directions with a trace positive impingement in internal rotation, adduction and forward flexion.  There was no tenderness about the distal clavicle.  The examiner noted a recent MRI of the left shoulder (3 June 2008) showed a minor irregularity of the superior labrum, but the examiner did not feel it demonstrated any form of instability.  The CI was then released as fit for duty with for his job in the National Guard without any requirements for routine follow up.  

At the time of the 17 September 2008 physical therapy assessment, the CI reported he could only do 12 push-ups and then had a severe increase in pain.  Physical examination showed full ROM and good strength with the exception of forward flexion which was “weaker and quite painful.”  No goniometric measurement were documented in the record.  The examiner did note that the evaluation was “significant for reproduction of shoulder symptoms with cervical motions indicative of possible cervical derangement.”    

The 9 October 2008 neuro-musculoskeletal clinic MEB goniometric ROM test showed left shoulder flexion and abduction of 180 degrees each (normal), without mention of pain.  According to the 31 October 2008 MEB NARSUM evaluation, 7 months prior to separation, the CI complained of shoulder pain in several locations including the left lateral shoulder, mid upper arm, mid trapezius and to a lesser extent the left lateral neck.  His pain was aggravated by lifting of any type with the left arm and especially by overhead work.  He was unable to do push-ups, carry objects over the shoulder or use a compound bow.  Physical examination revealed no swelling, erythema or mass in appearance.  The ROM was “full abduction, internal rotation and external rotation.”  The CI had no pain with ROM measurements.  There was no palpable swelling or mass along his neck or shoulder.  There was mild tenderness over the left lateral upper arm, left lateral shoulder and mid trapezius muscle.  Muscle strength was 5/5 with abduction and internal and external rotation.  There was no pain against resistance and he had negative Neer and Hawkins signs (indicative of shoulder impingement).  

At the 10 August 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the examiner noted left shoulder instability but no giving way.  There was pain at rest but no stiffness, weakness or incoordination.  There was no evidence of dislocation, subluxation, locking, effusion or inflammation.  He reported pain resulted in decreased endurance by 40% and he occasionally used a sling.  Physical examination showed significant atrophy of the delta muscle.  The left biceps/triceps muscle measured 29 cm on the left and 31 cm and on the right, suggesting a loss of nerve function.  Left shoulder ROM was 180 degrees of flexion and abduction.  There was no objective evidence of pain with active motion of the left shoulder.  There was no objective evidence of pain with repetition and there was no ankylosis of the left shoulder joint.  X-rays showed irregularity of the distal clavicle and acromion possibly related to old trauma or surgery.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating, coded 5203 (clavicle or scapula, impairment of), citing DoD and VASRD guidelines IAW NDAA 2008.  The VA assigned a 0% rating, coded 5299-5201 (arm, limitation of motion of) citing full ROM.  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.  The C&P examination, most proximal to separation, noted X-rays showed irregularity of the distal clavicle and acromion, consistent with mal union of the clavicle and therefore consistent with a 10% rating.  There was no mal-union 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 of).  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.

BOARD FINDINGS:  In the matter of the left shoulder condition 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 20170308, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment 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-2017-01826.

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