RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-02478
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150424
SEPARATION DATE:  20050816

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Security Forces Journeyman) medically separated for subacromial bursitis of the left shoulder.  The left shoulder condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was issued a P4U4 profile and referred for a Medical Evaluation Board (MEB).  “Subacromial bursitis” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “subacromial bursitis of the left shoulder” as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI initially demanded a Formal PEB; however, he subsequently waived a formal hearing.  He made no further appeals and was medically separated.

CI CONTENTION:  “Had to have additional surgery on shoulder and still have trouble using left arm.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

IPEB – Dated 20050511	VA* - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Subacromial Bursitis of the Left Shoulder	5019	10%	Bursitis, Left Shoulder	5019	0%**	STR	
Other x 0 (Not In Scope)	Other x 3 	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20060307 (most proximate to date of separation [DOS]).
**VARD dated 20060725 increased rating to 20% effective 20050817 (DOS) based on exam 10 months after separation

ANALYSIS SUMMARY:

Left Shoulder Subacromial Bursitis Condition.  The right handed CI first developed brief episodes of intermittent left shoulder pain in approximately 1995.  In March 2004 he experienced sudden pain while working on his truck.  Evaluation showed a cartilage tear which required arthroscopic surgery in May 2004.  Recurrent pain was evaluated with a magnetic resonance imaging study in January 2005 which showed shoulder bursitis, but no other abnormalities.  An orthopedic examination on 12 November 2004 (9 months prior to separation) noted evidence of left shoulder tenderness, tendon impingement and abduction weakness.  Shoulder flexion was 140 degrees (normal 180 degrees) and abduction was 140 degrees (normal 180 degrees).  At orthopedic follow-up on 19 January 2005 (7 months prior to separation), the CI stated that symptoms were better after surgery, “but not perfect.”  Examination showed “full” range-of-motion (ROM) of the left shoulder and mild weakness of abduction.

At the VA Compensation and Pension (C&P) exam performed approximately 10 months after separation, the CI reported intermittent left shoulder pain with movement.  He complained of an inability to fully lift his left arm, and that it felt unstable; but dislocations were not reported.  The examiner cited electrodiagnostic studies of the left upper extremity that were normal.  Examination showed no left shoulder tenderness.  Although painful motion was present, guarding of movement was not reported.  One shoulder impingement sign was positive and one sign of mild instability was present.  Forward flexion was 180 degrees and abduction 155 degrees.  Mild left rotator cuff weakness was noted, but there was no additional limitation of motion after repetitive motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under code 5019 (bursitis), which defaults to rating for limitation of motion.  The VA initially assigned a 0% rating under the same code, but after the C&P exam cited above changed the rating to 20% effective the day after separation, coded 5201 (arm, limitation of motion of).  The Board agreed there was sufficient evidence of painful motion (VASRD §4.59) to support a 10% rating.  Under the 5201 code a 20% rating is justified for ROM “at shoulder level.”  All available evidence showed ROM above that level; therefore, a compensable rating was not supported on this basis.  The Board also debated if a rating was warranted under the 5202 code (humerus, other impairment of).  A 20% rating requires “infrequent episodes” of recurrent dislocation, and “guarding of movement only at shoulder level.”  Although left shoulder instability (albeit mild) was possibly present, there was no evidence of the recurrent dislocation stipulation to support a rating using this code.  Under code 5203, it was agreed that “non-union, with loose movement” of the clavicle was not described by the evidence; therefore a 20% rating was not justified via this pathway.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left shoulder condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the subacromial bursitis of the left shoulder condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131122, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXX

Dear XXXXXXX:
	
Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2013-02478.

	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.

Sincerely,

XXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR