RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03988
BRANCH OF SERVICE:  Air force	SEPARATION DATE:  20090827

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

CI CONTENTION:  No specific contention was made.  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 - 20090316	VARD - 20090929	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain…	5203	20%	Recurrent Dislocation, Left Shoulder...	5201	20%	20090202	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Left Shoulder Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left (non-dominant) shoulder pain began in February 2001 after a traumatic anterior shoulder dislocation that was reduced in the emergency department.  He had a second dislocation in May 2002, and a third in August 2003.  He was diagnosed with a rotator tear and radiologic studies performed in April 2004 and in 2008 revealed a normal shoulder.  Surgery was offered (diagnosis of capsular imbrications) and reasonably declined.  

The 14 November 2008 MEB NARSUM examination, 9 months prior to separation, noted complaints of continued left shoulder pain that prevented military duties and restricted daily living activities (no specific details).  Physical examination showed no effusion, normal neurologic findings, and full range of motion (ROM), with pain.   A prior NARSUM from 21 August 2008 (cited by the PEB) revealed left shoulder flexion of 140 degrees (normal 180) and abduction of 160 degrees (normal 180) with a positive sulcus sign, non-localizing shoulder pain, positive (pain and perch) anterior and posterior drawer tests, with negative provocative labral testing.  

At the 2 February 2009 VA Compensation and Pension (C&P) examination, 7 months before separation, the CI reported constant left shoulder pain, rated at 7/10 in severity, with weakness, stiffness, and dislocation that caused difficulty picking up items, driving, carrying, and working overhead.  Physical examination showed a normal appearing shoulder with no guarding of movement or subluxation, and a normal neurologic evaluation.  The examiner recorded flexion to 90 degrees and abduction to 80 degrees, each limited by pain.  Following repetition there was additional functional limitation due to pain, weakness, and lack of endurance, but not fatigue or incoordination, and there was no additional loss of ROM.  Shoulder X-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 20%, coded 5203 (impairment of clavicle or scapula).  The VA also rated the left shoulder at 20%, but coded 5201 (limitation of arm motion), based on the C&P examination.  Panel members noted that the VASRD §4.71a threshold for rating ROM impairment under code 5201 is “at shoulder level” (approximately 90 degrees from the side), and the VA examination in evidence demonstrated motion limited to this level.  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 is no rating higher than 20% available under code 5203, and there was no fibrous union or nonunion of the humerus to justify a higher rating under code 5202 (humerus, other impairment of).  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 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.  

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

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03988.

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.