RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02695
BRANCH OF SERVICE:  Air force	SEPARATION DATE:  20090827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Communication and Computer System Operator Journeyman, medically separated for “chronic right ankle pain” and “chronic left shoulder pain,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI contended the left shoulder.  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 - 20090220	VARD - 20090930	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5271	10%	Right Ankle Reconstruction	5299-5271	10%	20081203	
Chronic Left Shoulder Pain	5203	10%	Left Shoulder Impingement…	5299-5203	10%	20081203	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Right Ankle Pain.  According to the MEB narrative summary (NARSUM) and service treatment record (STR), the CI had right lateral ankle instability and underwent surgery to repair the calcaneofibular and anterior talofibular ligaments on 12 April 2004.  Post-surgical X-rays showed mild tissue swelling, but were otherwise normal.  The 3 November 2008 MEB physical therapy (PT) examination, 10 months before separation, recorded right ankle dorsiflexion of 15 degrees (normal 20) and plantar flexion of 60 degrees (normal 45).  The examiner did not address painful motion, instability or motor strength.  At the 17 November 2008 MEB NARSUM examination, 9 months before separation, the CI reported severe right ankle pain with full range of motion (ROM).  Physical examination revealed “full” ROM of the extremities with right ankle pain.  The examiner did not address instability or motor strength.

At the 3 December 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported right ankle pain elicited by physical activity.  He also reported weakness and lack of endurance, but denied stiffness, swelling, giving way, locking, dislocation or functional impairments.  Physical examination revealed normal gait, ankle reflexes and lower extremity motor strength.  There was right ankle weakness and tenderness with inversion, but no deformity, swelling, guarding of movement or subluxation.  The ROM study showed dorsiflexion of 20 degrees and plantar flexion of 45 degrees, with painful motion.  The examiner noted an unquantified loss of ROM due to pain, fatigue, weakness or lack of endurance, after repetition.  Right ankle X-rays showed suture anchors and no indication of malunion of the os calcis or astragalus.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5271 (ankle, limited motion).  The VA also rated the right ankle condition 10%, analogously coded 5299-5271, based on the C&P examination, citing “moderate” limitation of ankle motion.  The panel considered if the ankle limitation of motion was “moderate” for a 10% rating or “marked” for a 20% rating when considered under 5271.  Based on the MEB PT and VA ROM examinations the panel agreed that the CI’s ROM most approximated a “moderate” limitation to support a 10% rating at the time of separation.  The panel considered a rating under code 5262 (fibula and ankle, impairment), but there was no STR or VA evidence of nonunion or malunion to support a higher rating under that code.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable to rating.  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 right ankle condition.

Chronic Left Shoulder Pain.  According to the STR and MEB NARSUM, the right-hand dominant CI underwent left shoulder labrum surgery on 2 October 2006 and left shoulder surgery to repair a partial tear of the mid-supraspinatus tendon on 31 October 2007.  The CI had no significant improvement.  An MRI arthrogram of the left shoulder on 25 September 2008 showed a type II acromion, but the left labrum and supraspinatus tendon were grossly intact.

The MEB PT ROM examination showed flexion and abduction of 180 degrees each (normal); painful motion was not addressed.  An orthopedic examination on 12 November 2008, 10 months before separation, recorded intact left shoulder sensation, but rotator cuff strength was 4+/5.  The ROM study showed left shoulder flexion and abduction of 180 degrees each, with painful motion.  Provocative testing to detect left shoulder impingement, instability, a labral tear or acromioclavicular joint pathology was negative.  The 17 November 2008 MEB NARSUM examination revealed no effusion, normal reflexes and “full” but painful left shoulder ROM.

At the VA C&P examination the CI reported chronic left shoulder burning and aching pain with stiffness, lack of endurance and locking.  Pain occurred 5 times per week, lasted 2 hours and was elicited by physical activity.  Physical examination showed left shoulder weakness and tenderness without edema, effusion, redness, heat, subluxation or guarding of movement.  The ROM study showed left shoulder flexion of 170 degrees and abduction of 160 degrees, with painful motion.  The examiner noted an unquantified loss of ROM due to pain, fatigue, weakness or incoordination, after repetition.  Left shoulder X-rays showed a type II acromion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, coded 5203 (clavicle or scapula, impairment).  The VA also rated the left shoulder condition 10%, analogously coded 5299-5203, based on the C&P examination, citing pain after repetitive motion.

The VASRD §4.71a threshold for rating shoulder limitation (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), but examinations in evidence showed ROM above this level.  However, there was sufficient evidence of painful motion to support a 10% rating IAW VASRD §4.59.  The panel agreed there was no fibrous union or nonunion of the humerus (5202), or clavicle or scapula impairment (5203) to support a higher rating.  Although the CI had a repair of a partial tear of the supraspinatus tendon, a post-operative MRI arthrogram showed evidence of an intact tendon and orthopedic testing showed no instability.  Therefore, use of the muscle code 5304 (Group IV stabilization of shoulder against injury in strong movements) or other muscle codes IAW §4.73 (schedule of rating-muscle injuries) did not offer a rating option.  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 right ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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 20170323, 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

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02695.

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.