RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02365
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20070930

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Machine Gunner, medically separated for “clavicle fracture, healed,” with a disability rating of 10%.

CI CONTENTION:  The CI contends TBI and a leg injury that were not identified by the MEB or PEB.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20070719	VARD - 20071219	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Clavicle Fracture, Healed	5203	10%	Residual Fracture, Left Collarbone	5203	0%	STR	
Prominent Hardware	Cat II					
Shoulder Pain						
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Clavicle Fracture, Healed.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right dominant CI fractured his left clavicle on 19 May 2006.  He was treated with an immobilizer and light duty with improvement in his symptoms.  Several months later, the CI re-fractured the clavicle and underwent open reduction and internal fixation on 24 October 2006.  Post-operatively, he did well other than aggravation from being on work parties.  In family practice on 16 March 2007, he was noted to have tenderness, but full range of motion (ROM).  He was on his second 6 month period of LIMDU.  It was determined that he was unlikely to return to full duty in less than 12-18 months, less that the remainder of his service obligation, and he was referred for an MEB.  

The report of the MEB, dated 21 June 2007, recorded that the CI had ongoing pain.  On examination, the clavicle (collar bone) was non-tender, although palpation of the surgical plate was tender.  The ROM lacked 10 degrees flexion and 20 degrees abduction.  Strength was normal but some local sensory loss was present (from the surgery and cutting of the local nerves).  The MEB forwarded closed fracture of clavicle, unspecified part and pain in joint involving shoulder region for PEB adjudication.  X-rays showed a healed fracture and good hardware placement.  During the MEB examination (recorded on DD Forms 2807 and 2808) dated 10 July 2007, 3 months prior to separation, the examiner noted good shoulder strength and decreased range of motion (ROM) when the CI lifted his arm above his shoulder.  Motion was limited to 70 degrees; the examiner did not specify if this was flexion or abduction.  

The CI failed to attend the scheduled VA Compensation and Pension (C&P) examination, on 26 November 2007.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating, coded 5203 (impairment of the clavicle or scapula).  The VA assigned a 0% rating using the same code, citing insufficient evidence to determine if a compensable evaluation was warranted.  There was no nonunion with loose movement and no dislocation of the clavicle or scapula to warrant the next higher 20% rating under the 5203 code.  The limitation in motion recorded on the DD 2808 was to 70 degrees which supports a 20% rating.  However, the MEB report and a family practice encounter recorded near normal and normal ROM, respectively.  The panel could not account for the significant decrease in the ROM on the Form 2808 in the space of a few weeks and noted that it was an outlier from the two earlier examinations.  In addition, this degree of limitation would not be expected from the pathology in evidence.  Accordingly, the DD 2808 ROM was not used for rating purposes.  There was likewise no route to a higher rating for limitation of motion (5201) or for malunion or recurrent dislocation of the humerus (5202).  The Navy PEB also listed prominent hardware and shoulder pain as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  These conditions were properly subsumed under the overall rating for the left clavicle condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left shoulder condition.

BOARD FINDINGS:  In the matter of the clavicle fracture condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended prominent hardware and shoulder pain conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150804, w/atchs
Exhibit B.  Service 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

      In accordance with reference (a), I have reviewed the cases listed below and 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, USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
	 	- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

		
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