SAF/MRBD (PDBR)
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

MEMORANDUM FOR THE DIRECTOR, AIR FORCE REVIEW BOARDS AGENCY

SUBJECT:  Physical Disability Board of Review Recommendation on 
	Case Number PD-2019-00153

	In accordance with Title 10 § 1554a and in compliance with DoDI 6040.44, the Physical Disability Board of Review (PDBR) adjudicated the disability rating accompanying the medical separation of the covered individual from the United States Air Force.  After carefully reviewing the application and medical separation case file, the PDBR recommended no re-characterization of the separation or modification of the disability rating previously assigned.  I recommend you accept this proposed decision.

The covered individual (CI) was an active duty  E4, Security Forces Journeyman, medically separated for “multidirectional instability of right shoulder” and “left hip pain,” rated 20% and 0%, respectively, with a combined disability rating of 20%.  The PEB coded the right shoulder 5201 (arm, limitation of motion), citing VASRD guidelines.  The VA also used code 5201, but rated the right shoulder at 30%, based on the Compensation and Pension examination, citing flexion more closely approximates the criteria for a 30 percent evaluation.  Panel members first deliberated with regards to examination probative value and concluded that near exclusive value be placed upon the pre-separation narrative summary and physical therapy encounters due to their close time reference to separation.  Range of motion measurements above 90 degrees did not support a rating under code 5201, however the presence of painful motion about the right shoulder girdle easily supported the maximum 10% rating under VASRD §4.59.  Panel members then focused their attention on the clear evidence of right shoulder weakness coupled with intermittent episodes of spontaneous dislocations and concluded that the most appropriate rating approach in this case was supported by VASRD criteria of ‘other impairment of the humerus’ noting specific recurrent dislocations.  The difference in rating levels is determined by either having “frequent” or “infrequent” episodes of dislocations of the shoulder.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel agreed that although there was weakness and laxity about the entire right shoulder girdle, the episodes of frank dislocation of the shoulder joint was not supported as being frequent.  Under VASRD code 5202 (humerus; other impairment), the maximum rating for infrequent shoulder dislocations for the dominant arm is 20%; equivalent to the PEB’s current rating.  Therefore, the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder instability condition.  

In the matter of the left hip pain, the PEB analogously coded 5299-5250 (hip, ankylosis), citing VASRD Guidelines.  There was no VA rating of the left hip.  Panel members agreed that the completely normal physical findings with regards to the CI’s hips would not support any level of a positive impairment rating.  Therefore, after due deliberation, considering all the evidence and mindful of VASRD §4.3, the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the left hip pain condition.   

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

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2019-00153.

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.