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-2017-02951.

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.

						 

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02951
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20060110

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

CI CONTENTION:  Review of all conditions requested.  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 - 20051117	VARD - 20060118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain, Moderate	5399-5304	20%	Healed Acromioplasty for Torn Rotator Cuff Chondromalacia Right Shoulder …	5201	30%	20051017	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI had a history of three arthroscopic surgeries of the right shoulder for repair of rotator cuff and superior labral tears.  0n 16 December 2004, he underwent another right shoulder arthroscopy with revision of his previous posterior superior labral tear repair and debridement of a partial thickness rotator cuff tear.  He had also developed early chondromalacia of the glenohumeral joint.  After shoulder surgery, he initially did well but had a setback and then a steady increase in pain.  At an orthopedic follow-up visit on 1 July 2005, physical examination showed shoulder tenderness and flexion of 90 degrees.  
The 5 September 2005 MEB NARSUM examination, 4 months prior to separation and 9 months post-surgery, noted complaints of right shoulder pain.  The CI reported difficulty with activities of daily living such as reaching to the top of his head, getting dressed, or tucking in his shirt, and he had difficulty performing his job.  Physical examination of the right upper extremity showed shoulder range of motion (ROM) was flexion of 100 degrees (normal 180) and abduction of 70 degrees (normal 180).  He had tenderness over the biceps and the supraspinatus muscles anteriorly and some supraspinatus atrophy noted.  There was tenderness of the shoulder without swelling.  He had pain with testing for impingement, labral tears and biceps tendonitis (O'Brien, Speed, Neer's, and Hawkins' tests).  He had pain through the arc of motion.  He had 4/5 muscle strength about the shoulder due to pain, but full strength distally to the hand.  There were no signs of instability.  

At the 17 October 2005 VA Compensation and Pension (C&P) examination, 3 months before separation and 10 months post-surgery, the CI reported constant right shoulder pain with numbness and tingling in the right arm and hand.  He was treating the shoulder condition with narcotic pain medication as needed and he was unable to lift heavy objects or work above his chest.  He stated his condition did not cause incapacitation.  Physical examination showed multiple well healed arthroscopy scars, without tenderness.  Shoulder ROM was flexion of 70 degrees, but the examiner indicated pain began at 90 degrees of flexion and abduction was 75 degrees, also with painful motion.  The joint function was additionally limited by the following after repetitive use: pain, weakness, lack of endurance, with pain having the major functional impact.  The joint function was not additionally limited by fatigue and incoordination after repetitive use.  The examiner stated additional limitation of motion in degrees could not be estimated without resorting to speculation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 20%, analogously coded 5399-5304 (Group IV muscle injury, includes rotator cuff muscles), citing moderate pain.  The VA rated the right shoulder condition 30%, coded 5201 (arm, limitation of motion), based on the STR and C&P examination, citing limitation of arm motion midway between side and shoulder level.  

The VASRD §4.71a threshold for rating for ROM impairment (code 5201) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion limited to this level.  The next higher 30% rating for the dominant arm requires motion limited to “midway between side and shoulder level” (approximately 45 degrees from the side), however, examinations in evidence did not reflect this degree of limitation.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment), and no higher ratings are available under the 5203 code (clavicle or scapula, impairment).  The panel also considered an analogous rating under 5304 for rotator cuff injury, and agreed that the shoulder disability did not reach the level of severe injury for a higher rating under this code without evidence of significant shoulder muscle atrophy or weakness.  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 shoulder pain.  

BOARD FINDINGS:  In the matter of the chronic right 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 20170326, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record