RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-03064
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20011215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Combat Engineer) medically separated for right posterior sternoclavicular joint subluxation, rated at 20%. 

CI CONTENTION:  The applicant has asked for consideration of all conditions in his application.  His 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 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 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 20011017	VA* - (~1 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Posterior Sternoclavicular Joint Subluxation	5203-5201	20%	Right Acromioclavicular Separation	5299-5203	20%	20011126	
Right Clavicular Fracture	Cat II	No VA Placement	
Other Conditions x 0 (Not In Scope)	Other x 5 	
RATING:  20%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20020129 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Right Sternoclavicular Joint Condition.  The CI is right hand/arm dominant.  In March 2000 the CI injured his right collar bone while playing football.  Initially diagnosed with a right shoulder muscle strain his symptoms improved with conservative treatment, but remained with residual pain.  Orthopedic consultation and radiographic work-up performed in May 2001 revealed the persistence of a right clavicular (collarbone) fracture and joint dislocation between the right collarbone and the sternum (breastbone).  He was deemed not a surgical candidate for the original injury was over a year remote.  Despite medication and activity restrictions, his painful symptoms remained.  He was placed on LIMDU and eventually referred to a Medical Evaluation Board (MEB).  The narrative summary (NARSUM) examination performed on 16 August 2001 (4 months prior to separation) did not reveal new or additional physical complaints.  The physical exam (PE) documented tenderness about the right collarbone.  There was decreased range-of-motion (ROM) and weakness in the right shoulder.  Neurological and vascular parameters of the right upper extremity were normal.  There was no swelling or atrophy present.    

At the VA Compensation and Pension (C&P) examination performed on 26 November 2001 (a month prior to separation), the CI reported pain aggravation with “lifting of any weights.”  His PE revealed right shoulder crepitus, decreased ROM, and mild decreased strength about the entire shoulder joint (provider estimate of 85%-90% of maximum comparison to opposite shoulder).  There was no comment IRT painful motion.  The diagnosis was listed as status post acromioclavicular separation with ROM diminution.  

The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Shoulder ROM
(Degrees)	MEB ~4 Mo. Pre-Sep
(20010816) 	VA C&P ~1 Mo. Pre-Sep
(20011126) 	
Flexion (180 Normal)	120	180	
Abduction (180)	150	150	
Comments	tenderness	crepitus	
§4.71a Rating	0%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB adjudged only the sternoclavicular joint subluxation as unfitting; dual coded 5203-5201 (impairment of clavicle-arm, limitation of motion) and rated 20%.  The right clavicular fracture was adjudged as Category II.  The VA also rated 20%, with the analogous coding scheme of 5203.  Board members then deliberated and agreed that this case reflected a chronic collarbone (part of the entire shoulder complex) condition of obvious and continued impairment which clearly was supported under code 5203 at the sole rating of 20%.  Absent evidence of marked mal-union deformity, ankylosis, or upper arm involvement, there were no other joint codes under VASRD §4.71a that would yield a rating greater than the current 20%.  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’s adjudication for the right shoulder (sternoclavicular) condition.  Board members then focused their attention to the single Category II condition.  Members agreed that the right clavicular fracture diagnosis was correctly considered related to the primary unfitting condition and disability was included under the 5203 rating code.

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 right sternoclavicular joint 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.  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 20140617, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 4 Feb 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXX, former USMC
-XXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC   
- XXXXXXXXXXXXXXX, former USMC 
-XXXXXXXXXXXXXXX, former USMC

						 				XXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)