RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02819
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20081217

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Integrated Avionics Systems Apprentice, medically separated for “painful anterior right shoulder instability associated with glenoid chondromalacia” with a disability rating of 20%.  

CI CONTENTION:  Requested review of shoulder, sinus and memory issues.  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 - 20080930	VARD - 20090430	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Painful Anterior Right Shoulder Instability…	5202	20%	Right Shoulder Revision Anterior Stabilization	5202	20%	20090413	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the right-hand dominant CI had a traumatic right shoulder dislocation in September 2005 followed by multiple dislocations.  He underwent a subacromial decompression on 2 December 2006 and arthroscopic anterior stabilization in October 2007.  Surgical treatment stabilized the shoulder with no further dislocations, but the pain persisted with little relief from medication, physical therapy (PT), and pain management injections.
The 5 May 2008 MEB NARSUM examination, 7 months prior to separation, noted CI complaints of right shoulder pain mostly when reaching forward and across his body, but not overhead.  Since the second surgery, he had persistent anterior shoulder pain but denied subluxation.  Range of motion (ROM) showed flexion to 170 degrees (normal 180).  At the 13 May 2008 MEB PT ROM evaluation, the CI reported continued right shoulder pain, particularly with overhead movements.  He declined further surgical intervention or injections as he believed these were not likely to improve his condition.  Physical examination showed forward flexion to 150 degrees and abduction to 130 degrees (normal 180) with pain at motion endpoints.  
	
At the 13 April 2009 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported constant, sharp right shoulder pain that woke him from sleep.  He had flare-ups of moderate severity about 3-4 days per week lasting 15 minutes or more, and generally brought on with reaching, lying on the shoulder in an unusual position, and occasionally with writing or keyboarding.  He could only lift or carry about 10 pounds with his right arm due to pain but denied locking, instability or incapacitating episodes in the 12 months prior to the examination.  Physical examination showed painful right shoulder ROM with forward flexion to 150 degrees and abduction to 160 degrees.  

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), citing no further shoulder dislocations and normal right arm muscle mass, sensation and strength.  The VA also rated the right shoulder condition 20%, coded 5202, based on the C&P evaluation, citing infrequent episodes of dislocation of the scapulohumeral joint with guarding of arm movements only at shoulder level.  Members noted there was no malunion with marked deformity of the humerus or frequent episodes of recurrent dislocation with guarding of all arm movements to warrant the next higher 30% rating.  There was likewise no higher rating for limitation of motion (5201), and no higher ratings available 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 right shoulder condition.  

BOARD FINDINGS:  In the matter of the right shoulder pain 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 20170421, 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-2017-02819.

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