RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03502
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20061210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aircrew Life Support Journeyman, medically separated for “chronic left shoulder pain, status-post repair of posterior labral tear, with reduced range of motion” with a disability rating of 20%. 

CI CONTENTION:  Review requested of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 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 - 20061103	VARD – 20061031 & 20070927	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain ...	5201	20%	Left Shoulder [Surgical Residuals]	5299-5201	0%	20060912	
					  20%	20070727	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Left Shoulder Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent arthroscopic repair of a labral tear of his non-dominant left shoulder in December 2005.  Post-operative provider entries in the STR documented the absence of any complications and recovery to normal or near-normal range of motion (ROM).  There was a suggestion of some residual mechanical joint impingement, but no further surgery was recommended.  There was ample documentation of the absence of instability or other VASRD-ratable findings.

The 20 September 2006 MEB NARSUM examination, 3 months prior to separation, noted nonspecific left shoulder pain that interfered with lifting and other military fitness requirements.  The physical examination recorded some joint tenderness and pain with overhead motion, but no impingement or instability was noted.  Goniometric ROM measurements conducted for the MEB a week later revealed forward flexion to 112 degrees and abduction to 102 degrees (normal 180 for both), specifying painful motion.

At the 22 September 2006 VA Compensation and Pension (C&P) orthopedic examination, 3 months before separation, the CI reported constant pain, rated at 8/10, that was worsened by lifting and “any use of the left arm.”  The physical examination recorded tenderness and normal (5/5) joint strength, with no mention of impingement or instability.  Measured ROM showed forward flexion to 145 degrees and abduction to 110 degrees, specifying painful motion. 

At a 27 July 2007 VA repeat orthopedic C&P examination, 7 months after separation, the CI reported constant pain, rated at 7/10, that was aggravated by overhead work, but had no effect on usual activities; he also denied instability or locking.  The examiner recorded tenderness and normal strength, with no mention of impingement or instability.  Both forward flexion and abduction were to 160 degrees, with the onset of pain at 90 degrees in each plane, and increased pain, weakness, and fatigability with repetition (no specified ROM loss).   
  
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 20%, coded 5201 (limitation of motion), referencing the VASRD without specifying the rated criteria.  The VA initially rated the left shoulder condition 0%, coded 5299-5201, based on the pre-separation C&P examination, but this was increased to 20%, based on the post-separation C&P examination.  The rating decisions cited failure to satisfy minimum ROM criteria for the 0% rating, and cited DeLuca considerations for the 20% rating.   Panel members agreed that there was no evidence to support a higher rating under code 5201, and after considering other VASRD shoulder and analogous codes, all were less applicable and/or not advantageous for 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 left shoulder condition.

BOARD FINDINGS:  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:

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03502.

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 rating modification or re-characterization 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 modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.