RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201389 SEPARATION DATE: 20081016 

BOARD DATE: 20130221 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty Soldier, SGT/E-5(11B20/Infantryman) medically 
separated for malunion of the left clavicle. The CI fractured his left clavicle, for the fourth time, 
in a biking accident in May 2007. He did not improve adequately with treatment to meet the 
physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness 
standards. He was issued a permanent U3 profile and referred for a Medical Evaluation Board 
(MEB). The MEB forwarded malunion of the left clavicle fracture as medically unacceptable and 
adjustment disorder with anxiety as meeting retention standards. The Physical Evaluation 
Board (PEB) adjudicated malunion of the left clavicle as unfitting, rated 10%, with application of 
the Veteran’s Affairs Schedule for Rating Disabilities (VASRD), and the adjustment disorder with 
anxiety as meeting retention standards. The CI made no appeals and he was medically 
separated with a 10% disability rating. 

 

 

CI CONTENTION: “MEB rated left shoulder @ 10%, VA rated 20%, plus VA rated as service 
connected PTSD – 30%, Tinnitus – 10%.” 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44 Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by 
the PEB to be specifically unfitting for continued military service; or, when requested by the CI, 
those condition(s) “identified but not determined to be unfitting by the PEB.” The rating for the 
unfitting malunion of the left clavicle condition will be reviewed. The requested conditions of 
posttraumatic stress disorder (PTSD) and tinnitus are not within the Board’s purview. Any 
conditions or contention not requested in this application, or otherwise outside the Board’s 
defined scope of review, remain eligible for future consideration by the Army Board for 
Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service PEB – Dated 20080715 

VA (3 Mos. Post-Separation) – All Effective Date 20081017 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Malunion of Left Clavicle 

5203 

10% 

Malunion of Left Clavicle 

5202 

20% 

20090128 

Adjustment Disorder w/Anxiety 

Meets Retention Standards 

Anxiety Disorder, NOS 

9400 

30% 

20090212 

.No Additional MEB/PEB Entries. 

Bilateral Tinnitus 

6260 

10% 

20090128 

Not Service-Connected x4 

20090128 

Combined: 10% 

Combined: 50% 



 

 

ANALYSIS SUMMARY: The Board acknowledges the CI's contention suggesting that ratings 
should have been conferred for other conditions documented at the time of separation and for 
conditions not diagnosed while in the service (but later determined to be service-connected by 
the Department of Veterans Affairs [DVA]). While the Disability Evaluation System (DES) 
considers all of the member's medical conditions, compensation can only be offered for those 
medical conditions that cut short a member’s career, and then only to the degree of severity 


present at the time of final disposition. The DVA, however, is empowered to compensate 
service-connected conditions and to periodically re-evaluate said conditions for the purpose of 
adjusting the Veteran’s disability rating should the degree of impairment vary over time. The 
Board notes the current DVA ratings listed by the CI for all of his service-connected conditions, 
but must emphasize that its recommendations are premised on severity at the time of 
separation. The DVA ratings that it considers in that regard are those rendered most proximate 
to separation. The DES has neither the role nor the authority to compensate members for 
anticipated future severity or potential complications of conditions resulting in medical 
separation. That role and authority is granted by Congress to the DVA. 

 

Malunion of Left Clavicle. There were two goniometric range-of-motion (ROM) evaluations in 
evidence, with documentation of additional ratable criteria, which the Board weighed in 
arriving at its rating recommendation as summarized in the chart below. 

 

Left Shoulder ROM 

NARSUM Addendum 4 Mos. Pre-Sep 

VA C&P 3.5 Mos. Post-Sep 

Flexion (0-180°) 

150 

140 

Abduction (0-180°) 

135 

85° 

Comments 

Mild prominent deformity mid-shaft of 
clavicle; Mild tenderness to palpation; No 
crepitance with motion; Full range of motion; 
Pain at the malunion site with overhead 
motion; Neurovascularly intact distally 

Noticeable callus formation middle third of 
clavicle; Tenderness with palpation; Normal 
rotation of arms inward &outward motion; 
Normal strength in the upper extremities; 
Negative Deluca; No redness or inflammation of 
shoulder or clavicle; Normal sensory exam 

§4.71a Rating 

10%* 

20% 



*IAW VASRD policy §4.59, painful motion 

 

The narrative summary (NARSUM) prepared 4 months prior to separation noted the CI had 
chronic left shoulder pain over a previous clavicular fracture. He sustained a left closed clavicle 
fracture in a bike accident in May 2007. The CI had a history of fracturing the same clavicle 
three other times, all before the age of 17; he healed uneventfully from each of the previous 
fractures and entered the military without pain over his left clavicle. He underwent non-
operative treatment and the fracture completely healed; however, he had a significant 
malunion and a prominent callus that bothered him during his military duties. He did have 
some pain with overhead motion, and he had a notable amount of pain with direct pressure 
over the mid portion of his mal-united and deformed clavicle. He could not do push-ups and 
sit-ups hurt him because of his shoulder striking on the ground beneath him. He could not lift 
over 30 pounds for longer than approx. 15 minutes and he could not wear a flack vest or load 
bearing equipment for extended periods of time. His pain persisted despite activity 
modifications. Significant physical exam findings are summarized in the chart above. 
Radiographs of the left clavicle demonstrate a healed left clavicle fracture with resulting 
malunion deformity and prominent callus formation. Previous CT scan also verified the fracture 
union and malunion. At the MEB exam accomplished 4 months prior to separation, the CI 
reported he suffered a broken clavicle four times. The MEB physical exam noted mildly 
exaggerated “S-shape” with depression over lateral 1/3 junction. He was quite tender over the 
prominent mid-shaft. There was pain with movement of proximal clavicle but not the distal 
portion. His left shoulder had a full ROM at the glenohumeral joint with pain only noted on 
movements requiring movement of the clavicle. The acromioclavicular joint was non-tender. 

 

At the VA Compensation and Pension (C&P) exam accomplished 3 months after separation, the 
CI reported a history similar to the one above with the following significant additions. Since 
being out of the military, the CI had less pain in his left shoulder. He was able to lift more, up to 
50 pounds of weight, and he was able to work above his head for a lengthy period of time. He 


did continue to have pain over the mid one-third area of the left clavicle with any sort of 
pressure being put on that area. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
left clavicle malunion condition was adjudicated by the PEB with application of VASRD code 
5203, impairment of the clavicle or scapula, and rated 10% disabling consistent with a malunion 
of the clavicle. The VA coded it 5202, other impairment of the humerus, and rated it 20% based 
on “marked deformity.” This VASRD code refers directly to impairment of the humerus that 
was not present in this case. The PEB utilized VASRD code 5203 which refers directly to 
disability from impairment of the clavicle and is the appropriate VASRD code for this case. The 
rating levels for VASRD 5203 are based on dislocation, nonunion or malunion with or without 
loose movement. There is no difference in rating based on impairment of the dominant vs. 
non-dominant upper extremity. The CI in this case had a malunion of the clavicle that directly 
corresponds to a 10% rating. The next higher 20% rating requires either a nonunion with loose 
movement or dislocation of the clavicle, neither of which were present in this case. Code 5203 
does allow for rating based on impairment of function of the contiguous joint. If that rating 
option was utilized, a 10% rating would be recommended based on VASRD code 5003 with 
painful motion of the shoulder without compensable ROM measurements. That would be of no 
benefit to the CI. After due deliberation, considering all of the evidence and mindful of VASRD 
§4.3 (reasonable doubt), the Board recommends no change in the PEB adjudication for the 
malunion of the left 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 malunion of the left clavicle condition, 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 recharacterization of 
the CI’s disability and separation determination, as follows: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Malunion of the Left Clavicle Condition 

5203 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120727, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 


 

SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 
for xxxxxxxxxxxxxxxxxx, AR20130005376 (PD201201389) 

 

 

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: 

 

 

 

 

Encl xxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)