RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02703
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070330

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Basic Trainee, medically separated for “left clavicle pain following surgical repair of a fracture,” with a disability rating of 0%.

CI CONTENTION:  The CI’s condition continues to worsen and negatively impact his activities.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 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 Veterans Affairs Schedule for Rating Disabilities (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:  

SERVICE PEB - 20070312	VARD - 20070719	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Clavicle	5099-5003	0%	Fractured Left Clavicle	5203	0%	20070615	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Clavicle.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented a fracture of the left (non-dominant) clavicle in May 2006 (10 months before separation) which required surgical reduction and internal fixation.  Post-operative STR entries document an uncomplicated recovery and restoration of normal range of motion (ROM), but persistent painful motion and bone tenderness incompatible with general soldiering requirements.  Post-operative X-rays demonstrated a healed fracture with normal alignment, but a prominent callous (extra bone deposition with fracture healing).  The outpatient STR evidence probative to rating was consistent with that related by the NARSUM, and there was no STR evidence of incapacitating episodes after surgery recovery.

The NARSUM was conducted 18 January 2007 (2 months before separation) and documented “continues to have severe pain in the area ... any motion is also painful,” noting functional limitations of inability to do overhead work and a 15-pound carrying limit.  The NARSUM physical examination recorded “very prominent clavicle ... very tender ... full [ROM] of the shoulder but all of it is painful for him.”  Formal ROM measurements for the MEB by physical therapy were conducted after the NARSUM (3 weeks before separation); and, recorded forward flexion to 170 degrees (normal 180) and abduction to 180 degrees (normal 180), specifying painful motion.

At the VA Compensation and Pension (C&P) examination in June 2007 (3 months after separation) documented “denies daily pain, but has flare-ups of pain associated with lifting over 20 pounds and pushups.”  The VA physical examination recorded clavicular tenderness and ROM measurements of forward flexion and abduction to 175 degrees, specifically denying painful motion or ROM decrement with repetitions.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous code 5009-5003 (degenerative arthritis) citing application of the USAPDA pain policy.  The VA assigned a 0% rating using code 5203 (clavicle or scapula, impairment of) which is a fracture code specifying dislocation, nonunion, or malunion for compensable ratings.  The VA’s 0% rating under that code was compliant with VASRD §4.71a, given that the C&P negated application of §4.59.   It should be noted, however, that code 5203 also specifies “or rate on impairment of function of contiguous joint.”  There is compelling evidence that §4.59 was supported at the time of separation, and members agreed that, under any applicable code for the Service rating, the minimum compensable rating required by §4.59 was indicated.  After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the left shoulder condition; coded 5099-5010 (traumatic arthritis) for its clinical compatibility.  

BOARD FINDINGS:  In the matter of the left clavicle condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5010 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Surgical Residuals, Left Clavicular Fracture	5099-5010	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140604, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160007637, 

Dear 

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  l have reviewed the Board's recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical
Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.

This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,

Enclosure