RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03029
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20081121

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aircraft Structural Maintenance Journeyman, medically separated for “chronic right shoulder pain” with a disability rating of 10%.   

CI CONTENTION:  “My right arm, leg and back.  The whole right side of my body.”  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 - 20080905	VARD - 20091006	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5009-5003	10%	Right Shoulder Dislocation and Rotator Cuff Tear, Status Post (S/P) Surgery	5202	20%	20090914	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right shoulder arthroscopic surgeries in August 2005 and February 2007 due to recurrent dislocations.  At a 10 June 2008 neuromusculoskeletal evaluation, 5 months prior to separation, the CI presented for a right shoulder range of motion (ROM) study.  Physical examination revealed an upright posture, non-antalgic gait, no obvious deformities, and four healed surgical incision sites.  Right shoulder ROM showed flexion to 149 degrees (normal 180) and abduction to 135 degrees (normal 180), with pain.  
During the 3 July 2008 MEB NARSUM examination, 4 months before separation, the CI reported chronic right shoulder pain and that he refrained from exacerbating movements.  Physical examination showed tenderness over the acromio-clavicular joint line and positive Neer’s, Hawkin’s and empty can tests.  There was no atrophy or swelling, and neurovascular testing was intact.  Right shoulder ROM was flexion of 118 degrees, with end range “pinching” and pain; abduction was 115 degrees (normal 180) with pain.  

At the 20 July 2007 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported right shoulder pain, which was aggravated by cold weather.  Physical examination showed a normal posture and gait without deformities.  There was no joint swelling, effusion, tenderness or laxity, and neurovascular findings were normal.  Right shoulder flexion was to 105 degrees and abduction to 83 degrees with pain, but no change after three repetitions.  

The 14 September 2007 C&P joint examination, 10 months after separation, noted CI complaints of right shoulder pain with continued dislocations despite two corrective surgeries.  Physical examination showed decreased ROM with pain but no neurovascular or skin disruption, deformities, discolorations, atrophy, or other apparent associated pathology.  Right shoulder flexion was to 125 degrees and abduction to 105 degrees, with pain.  The examiner documented recurrent shoulder dislocations and guarding of movement only at the shoulder level, and a diagnosis of “right shoulder dislocation and rotator cuff tear status post two surgeries.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing well-controlled pain without medications and by refraining from exacerbating movements.  The VA rated the right shoulder condition 20%, coded 5202 (humerus, other impairment of), based on the C&P examination, citing infrequent episodes of dislocation of the scapulohumeral joint with guarding of arm movements only at the shoulder level; and malunion with a moderate deformity of the humeral head.  Panel members agreed the right shoulder examinations met the intent of VASRD §4.59 (painful motion), but that the primary problem was recurrent dislocations, which is more appropriately characterized by code 5202.  Rating shoulder instability under code 5202 requires judging the frequency of any dislocations and the amount of guarding present with shoulder motion.  While the evidence did not document “frequent dislocation with guarding of all shoulder movements” required for a 30% rating, the panel concurred that all examinations met criteria for a 20% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the chronic right shoulder pain, coded 5202.  

BOARD FINDINGS:  In the matter of the chronic right shoulder pain, the panel recommends a disability rating of 20%, coded 5202 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Shoulder Pain	5202	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, undated, 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-2017-03029.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.

						Sincerely,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
1.  Directive 
2.  Record of Proceedings