RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02791
BRANCH OF SERVICE:  Army 	BOARD DATE:  20150717
SEPARATION DATE:  20080708

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-2 (Military Police Trainee) medically separated for a right clavicle fracture.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The “right shoulder and clavicle pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated her right clavicle fracture as unfitting, rated 20%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated. 

CI CONTENTION:  The applicant has asked for consideration of all conditions in her application.  Her complete submission is at Exhibit A.

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/Naval 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 20080617	VA* - (~4 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Clavicle Fracture	5201	20%	Residuals of Right Clavicle Fracture 	5301-5203	10%	20081112	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 5 (equals SC, NSC & deferred)	
RATING: 20%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20090121 (most proximate to date of separation [DOS]) 

ANALYSIS SUMMARY:  

Right Clavicle Fracture.  In November 2007, during basic training, this CI fell and fractured her right clavicle.  She underwent open reduction and internal fixation (ORIF).  After surgery, her fracture appeared to heal well radiographically.  However, she continued to have significant pain in the right shoulder region.  Due to the chronic, persistent nature of the shoulder pain, she was not able to resume military training and an MEB was initiated.  The MEB physical examination (PE) was in May 2008.  The CI reported that she was unable to do push-ups, or wear a rucksack.  It was difficult for her to get her right arm behind her head.  Whenever she tried to run, the jarring from the ground caused pain in her right shoulder.  On PE of the right clavicle, there was mild tenderness to palpation (TTP).  The contour of the surgical hardware could be seen through the skin.  There was pain with shoulder motion.  She was able to shrug her shoulder with very little difficulty, but it did cause some pain.  When her arm was moved, the clavicle appeared, from the outside, to move as a unit.  Range-of-motion (ROM) was measured by physical therapy (PT), and is summarized in the chart below.  The narrative summary (NARSUM) diagnosis was: “Right shoulder and clavicle pain.”
  
Four months after separation, on 7 November 2008, the hardware was removed from her right clavicle.  On 12 November 2008, she had a VA Compensation and Pension (C&P) exam.  This was 5 days after the surgery for hardware removal.  She reported problems sleeping at night flat on her back.  She usually slept with the head of her bed elevated.  She denied any incapacitating episodes.  She said that her discomfort was daily, but did not restrict her usual activities, or prevent her from engaging in repetitive use of the right trapezius, thoracic spine, or neck.  On PE, her posture and gait were normal.  On PE of her shoulders, there was no atrophy or asymmetry.  ROM was measured and is summarized in the chart below.  There was pain with motion of the right shoulder, but no additional limitation of motion with repetitive movement.  The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, are summarized in the chart below.

Right Shoulder ROM
(Degrees)	MEB ~7 weeks Pre-Sep
(20080522)	VA C&P ~4 mos. Post-Sep
(20081112)	
Flexion (180 Normal)	143	140	
Abduction (180)	125	170	
Comments	Pain with motion	Pain with motion	
§4.71a Rating	10%*	10%*	
                            *10% rating IAW VASRD §4.40 (Functional loss), §4.45 (The joints), and §4.59 (Painful motion)

The Board carefully reviewed the data from the examinations described above and directed attention to its rating recommendation based on the evidence.  At both the MEB exam and the C&P exam, her active shoulder ROM (for flexion and abduction) was greater than 90 degrees (shoulder level). The Board determined that the painful right clavicle condition was essentially non-compensable based solely on the VASRD §4.71a codes for loss of shoulder motion (5200 and 5201).  However; IAW VASRD §4.40, §4.45, and §4.59, when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  There was no path to a higher rating, because there was insufficient evidence of a seriously disabling bone or joint abnormality that would justify a higher rating.  After separation, the CI re-fractured her clavicle and was later diagnosed with clavicular nonunion.  But at DOS, her clavicle was joined together with surgical hardware in place.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the unfitting right clavicle 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 unfitting right clavicle condition and IAW VASRD §4.71, 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 20140527, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

06 Jul 2016

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for AR20160003432 (PD201402791)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (DoD PDBR) recommendation and record of proceedings pertaining to the
subject individual. Under the authority of Title 10, United States Code, section 1554a,
I accept the Board's recommendation and hereby deny the individual's application.
This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure
CF:
( ) DoD PDBR
( ) DVA