RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00483
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20070615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E4, Heavy Machine Gunner, medically separated for “malunion of the left clavicle,” with a disability rating of 10%.

CI CONTENTION:  “Permanent bone deformity from fractured left clavicle.”  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 based on 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 - 20070404	VARD - 20080916	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Malunion of the Left Clavicle	5299-5003	10%	Residuals of Fracture, Left Clavicle	5201	0%	20080407	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Malunion of the Left (non-dominant) Clavicle.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s closed left clavicle fracture occurred on 15 July 2006 while playing football.  X-rays on 24 July revealed a comminuted fracture with acceptable bayonet position.  Follow up X-rays on 3 November 2006 and 9 February 2007 revealed complete healing.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “malunion of fracture” for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated February 2007, 4 months prior to separation, the CI reported continued pain in the left shoulder.  Physical examination noted a boney callous on the left clavicle.  At the time of the physical therapy clinic appointment on 30 October 2006, 8 months prior to separation, the CI reported a pain rating of 0 for several days and felt he was ready for discharge.  The left shoulder range of motion (ROM) was normal.  The MEB NARSUM examination on 21 December 2006, 6 months prior to separation, showed a prominent malunion with the proximal fragment easily palpated subcutaneously.  There was no tenderness on palpation.  There was no appreciable movement at the fracture site with compression of the clavicle.  Range of motion was normal and equal with the right shoulder.  

At the 7 April 2008 VA Compensation and Pension (C&P) evaluation, performed 9 months after separation, the CI reported constant pain in the left shoulder radiating into the clavicle and stiffness.  The CI denied any weakness, swelling or instability.  Pain was aggravated by heavy lifting in front of the body and with pushing or pulling movements.  Physical examination showed a deformity of the mid-shaft of the clavicle with tenderness over the anterior deltoid of the left shoulder and the lateral aspect. There was no muscle atrophy and no instability.   The left shoulder ROM following repetitive movement showed flexion of 140 degrees with pain (normal 180 degrees) and abduction of 140 degrees with pain (normal 180 degrees).  There was no change to the ROM after repetitive movements, but increased pain was noted.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left clavicle condition 10%, coded 5299-5003 (arthritis, degenerative), citing the CI had regained full ROM but that the malunion would prevent him from carrying out his duties in his military specialty.  The VA rated the left clavicle condition 0% coded 5201 (arm, limitation of motion of), based on the VA C&P examination 9 months after separation, citing non-compensable limitation of motion.  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 motion above this level.  Although there was insufficient limitation of motion to support a rating under the 5201 code, Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was malunion of the clavicle to warrant a 10% rating under code 5203; however, there was not nonunion or dislocation of the clavicle to justify the next higher 20% rating under the 5203 code (clavicle or scapula, impairment of).  Rating malunion of the clavicle 10% coded 5203 is of no advantage to the CI.  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 clavicle condition.  

BOARD FINDINGS: In the matter of the left clavicle 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 20150601, 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 16 Nov 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:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXX
	     				  	  Assistant General Counsel
						  (Manpower & Reserve Affairs)