RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02874
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20080121

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aircraft Armament Systems Craftsman, medically separated for “right shoulder instability and subluxation, status-post bankart repair and open capsulorrhaphy” 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 - 20071204	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Instability and Subluxation…	5399-5304	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Shoulder Instability and Subluxation.  According to the service treatment record and MEB narrative summary (NARSUM), the left hand-dominant CI had right shoulder surgeries on 25 January and 21 June 2007 (Bankart repair and open capsulorrhaphy) for pain and instability following an injury.  Diagnostic imaging showed post-surgical changes but no other abnormalities.  

The 23 October 2007 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of right shoulder instability and subluxation, and that he could not lift more than 10 pounds or perform work over his head.  Physical examination showed right shoulder range of motion (ROM) of flexion and abduction each to 160 degrees (normal 180).  External rotation and horizontal abduction lacked approximately 15 degrees and he had weakness with internal rotation and supraspinatus testing (weakness and/or pain occurs with arm approximating shoulder level and indicates tendinopathy).  

At the 5 November 2007 physical therapy (PT) evaluation, the CI complained of continuing right shoulder pain with looseness, popping, and additional sharp pain with certain arm movements.  The examination documented right shoulder tenderness with flexion to 154 degrees and abduction to 142 degrees.  There were positive sulcus, Neer, and supraspinatus tests (instability, rotator cuff impingement, and painful motion) but no weakness.  The 28 November PT formal strength testing evaluation showed 4 to 4+/5 motor strength (slight weakness) in right shoulder abduction, adduction and rotations.  

During the VA orthopedic clinic evaluation on 3 July 2008, CI complained of right shoulder pain, mostly at night, and popping, but no feeling of dislocations or subluxations.  Examination revealed flexion to 170 degrees with normal strength, and a positive Yergason’s test (suggestive of bicipital tendon issue and painful motion).  There was no excessive laxity, significant crepitus, or scapular instability noted.  There was no VA Compensation and Pension examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, analogously coded 5399-5304 (muscle Group IV; the shoulder girdle and arm), citing moderate decrease in function.  Members noted that VASRD §4.56 (evaluation of muscle disabilities) provides classification guidance for muscle injuries.  The CI did not have debridement, prolonged infection, sloughing, intermuscular scaring, prolonged hospitalization, or other sufficient evidence to more closely approach a moderately severe muscle disability for the next higher rating under code 5304.  There was no malunion or recurrent dislocation of the humerus to justify a higher 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).  The VASRD §4.71a threshold for rating 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.  A 10% rating was also alternatively supported under §4.71a coding IAW VASRD §4.59 (painful motion) and documented on most examinations proximate to separation, however, any change in disability code would offer no higher than the 10% rating adjudicated by the PEB.  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 condition and IAW VASRD §4.73, 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-2017-02874.

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