RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03763
BRANCH OF SERVICE:  Air force	SEPARATION DATE:  20090427

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Tactical Air Control Party Craftsman, medically separated for “left shoulder acromial clavicular (AC) joint separation (Grade III), status post repair with chronic 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 - 20090205	VARD - 20100202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder AC Joint Separation	5201	20%	Left Shoulder Injury Residuals, Grade III AC Separation …	5203	10%	20091216	
Left Anterior Cruciate Ligament (ACL) Tear, S/P Repair	5003	Not Unfitting	Left Knee, ACL Tear, and Postoperative Scar	5260	10%	20091216	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left Shoulder AC Joint.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI underwent left shoulder surgery in August 2007 for AC ligament reconstruction with a modified Weaver-Dunn procedure.  An additional arthroscopic subacromial decompression with acromioplasty was performed 5 months prior to separation on 17 November 2008.  

The 5 August 2008 MEB NARSUM examination, 9 months prior to separation, noted the CI continued to have dull, achy pain localized to the AC joint of his left shoulder.  Baseline was 2-4/10 that increased to 6-7/10 with pulling or pushing maneuvers, or lifting objects greater than 40 pounds.  On examination the left shoulder range of motion (ROM) following repetitive movement showed flexion of 170 degrees (normal 180), abduction of 40 degrees (normal 180), and adduction of 170 degrees (normal 50), all limited by pain [NOTE:  The panel considered that the examiner likely transposed the abduction and adduction figures, and should have read 170 degrees abduction, which would have been more consistent with the other examinations in evidence at the time, as well as anatomic ROM of the shoulder].  

At the time of the physical therapy (PT) clinic appointment on 17 September 2008, 8 months prior to separation, the CI reported pain that reached 10/10 with weight bearing.  On examination there was tenderness, and the left shoulder ROM following repetitive movement showed flexion of 135 degrees and abduction of 148 degrees, all limited by pain.  Orthopedic examination on the same day diagnosed failed distal clavicle resection.  The 3 February 2009 orthopedic examination was following the CI’s 17 November 2008 left shoulder acromioplasty, and indicated there had been only temporary relief following surgery.  Pain had returned and “was basically unchanged since before surgery.”  

At the 16 December 2009 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported pain in the left shoulder that was worse with activity.  The left shoulder ROM following repetitive movement showed flexion and abduction of 150 degrees each, all limited by pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 20%, coded 5201 (arm, limitation of motion).  The VA rated the left shoulder condition 10%, coded 5203 (clavicle or scapula, impairment), based on the C&P examination, citing painful motion and functional impairment limiting flexion to 150 degrees of a healed joint.  

The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the MEB examination cited abduction at this level [40 degrees abduction; although likely an error of recording adduction values versus abduction ROMs].  However, the highest 30% rating for a non-dominant arm requires motion limited to “25 degrees from side,” but examinations did not reflect this degree of limitation.  There was no fibrous union or nonunion of the humerus to justify a higher rating under the 5202 code (humerus, other impairment), and no higher ratings available under the 5203 code.  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.  

Contended PEB Condition:  Left ACL Tear, S/P Repair.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  Following left ACL surgical repair on 19 May 2008 the CI had constant knee pain.  September 2008 evaluations found left knee ROM of flexion 123 degrees (normal 145) and extension -8 degrees (normal 0) with mechanical limitations and a bilaterally symmetric +1 Lachman’s.  The 18 November 2008 IPEB found the left knee unfitting and rated at 10% coded 5003 (degenerative arthritis), recommending a combined 30% disability and temporary retirement.  The CI appealed to the formal PEB (FPEB; via counsel) requesting separation with severance pay at 20% and stated that his left knee was healed and he had “no restrictions in connection with his left knee …” The CI submitted a 3 February 2009 orthopedic evaluation indicating he had worked on quadriceps strengthening and returned to running 1.5 miles with minimal symptoms.   Per the FPEB, at the 3 February 2009 examination, the left lower extremity was neurovascularly intact without lesions or erythema/effusion.  He had good musculature and symmetry between the two legs and approximately 90% of strength back in his left leg.  The ROM of the bilateral knees was symmetric in flexion, negative Lachman's, varus/valgus stress, anterior/posterior drawer, or McMurray's.  The CI's prognosis was good and he had no restrictions related to his left knee.  The FPEB found the left knee not unfitting.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the FPEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left shoulder condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended left anterior cruciate ligament tear, the panel agrees it cannot recommend it for additional disability rating.  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
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03763.

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.