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 XXXXXXXXXXXXX
	Case Number PD-2019-00214

	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, Missile and Space Systems Maintenance, medically separated for “chronic left shoulder pain,” with a disability rating of 10%.  The PEB rating was for moderate pain, non-dominant shoulder and it was coded 5304 (muscle Group IV function: stabilization of shoulder).  The VA rated the left shoulder condition 20% coded 5201 (limitation of motion of arm), based on the Compensation & Pension examination, citing “pain starts at 90 degrees” and “an evaluation of 20 percent is assigned whenever arm motion is limited at shoulder level.”  The CI had cardinal symptoms analogous to a muscle injury and the PEB’s 10% rating equates to “moderate” muscle injury under code 5304 IAW VASRD §4.73 (schedule of ratings–muscle injuries).  VASRD §4.56 (evaluation of muscle disabilities) provides guidance of muscle injury classification as slight, moderate, moderately severe or severe with indicators including the type of injury, history and complaint, and objective findings.  There was insufficient evidence of a “moderately severe” or “severe” (20%) muscle injury since there was no history of a through and through or deep penetrating wound, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring; no hospitalization for a prolonged period for treatment; nor, indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side; nor weakness when compared with sound side demonstrating positive evidence of impairment.

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 examinations in evidence demonstrated active motion above this level (despite onset of pain at that level).  Although there was insufficient limitation of motion to support a rating under the 5201 code, panel members agreed that a 10% rating was alternatively justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment).  The panel considered alternative VASRD shoulder and analogous codes, but all were less applicable and/or not advantageous to 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.  

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-2019-00214

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.