RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04266
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090909

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Military Police, medically separated for “arthritis, traumatic…resulting in right clavicle fracture” and “scar, painful,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  Review all conditions.  The 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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20090604	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arthritis, Traumatic (Right Clavicle)	5010	10%	No VA Examination Proximate to Separation in Evidence	
Scar, Painful (Right Clavicle)	7804	10%		
Irritable Bowel Syndrome	Not Unfitting		
Generalized Anxiety Disorder			
Astigmatism			
Prior Right Ankle Strain			
Nicotine Dependence-Smoking	Not Compensable		
Overweight			
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Traumatic Arthritis (Right Clavicle).  According to the service treatment record and MEB narrative summary (NARSUM), the CI fractured her right (dominant) clavicle during an all-terrain vehicle accident in July 2008, and underwent surgery with debridement of fibrotic tissue and open reduction internal fixation (ORIF) of the non-union fracture with plating and screw fixation.  Despite physical therapy, she continued to report right shoulder pain and weakness.  Radiographic studies on 13 April 2009 revealed the distal right clavicle resection with anatomic reduction and alignment, plate and screws intact, and no fracture line seen.  

During the 21 April 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported right shoulder pain and acromioclavicular (AC) joint instability with numbness in the upper inner arm and around the incision.  Pain was exacerbated by running more than 2 miles, lifting/carrying more than 50 pounds, or standing at parade rest for more than 20 minutes.  She did not have pain during normal standing.  Physical examination revealed tenderness over the right clavicle and a 7.5 cm scar.  

The 7 May 2009 MEB NARSUM examination, 4 months before separation, noted CI complaints of chronic right shoulder and AC joint pain (rated at 0-3/10) and instability.  Physical examination showed range of motion (ROM) with flexion of 160 degrees (normal 180), with pain, and normal abduction.  The examiner documented right shoulder AC joint grinding, popping, crepitance, as well as positive tests for painful motion and instability (Hawkin’s, empty bottle test, scarf sign and resisted lifting of the right hand off the flat of the back).  There was some right shoulder drooping and AC joint tenderness, but normal strength in all directions and no muscle atrophy.  The examiner discussed possible surgical reconstruction, but the CI was not interested in further surgery.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, coded 5010 (arthritis, due to trauma), citing satisfactory evidence of painful motion.  Panel members agreed the ROM examination demonstrated motion above shoulder level which did not support a higher rating under diagnostic code 5201 (arm limitation of motion).  However, a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion with moderate or marked deformity or frequent episodes of recurrent dislocation of the humerus, or guarding of all arm movements at shoulder level to justify a higher rating under code 5202 (humerus, other impairment of).  An alternative 10% rating under code 5203 (clavicle or scapula, impairment) was supported, however, there was insufficient evidence of loose movement for a higher 20% rating under that code.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right shoulder condition.  

Painful Scar (Right Clavicle).  The scar was a result of the right clavicle ORIF and interfered with wear of body armor and a rucksack.  The MEB NARSUM examination noted complaints of right shoulder scar pain with any physical contact.  Physical examination showed a 7 cm x 1 cm horizontal scar following the contour of the right clavicle.  The scar was reddened, hypertrophic, raised and very tender to palpation, but there was no adherence, loss of underlying tissue or ROM restriction. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the scar 10%, coded 7804 (scar, unstable or painful), citing evidence of a painful scar.  The CI had only one painful scar and therefore did not meet the next higher rating criteria under 7804 which requires three or four unstable or painful scars.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the scar condition.  

Contended PEB Conditions:  Irritable Bowel Syndrome, Generalized Anxiety Disorder, Astigmatism, Prior Right Ankle Strain, Nicotine Dependence-Smoking, Overweight.  The panel’s main charge is to assess the fairness of the PEB determination that the contended irritable bowel syndrome, generalized anxiety disorder, astigmatism and prior right ankle strain were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  The contended nicotine dependence-smoking and overweight conditions do not constitute a physical disability and are therefore not ratable.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right shoulder condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the scar and IAW VASRD §4.118, the panel recommends no change in the PEB adjudication.  In the matter of the contended irritable bowel syndrome, generalized anxiety disorder, astigmatism and prior right ankle strain, the panel recommends no change from the PEB determinations as not unfitting.  In the matter of the contended nicotine dependence-smoking and overweight conditions, these do not constitute physical disabilities and are therefore not ratable.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

	PD-2017-04266

AR20190011774, XXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXXXXX	

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.