IMPAIRMENT OF CLAVICLE OR SCAPULA

J. KIRBY · 2026 · Case ID: A26039914

GRANTED

Summary

The Veteran, who served from June 1983 to June 1985, appeals the denial of a compensable rating for residuals of a left clavicle fracture. The Board reviewed the evidence, including a September 2020 VA examination and the Veteran's testimony from a November 2024 Board hearing. The VA examination noted pain, weakness, and clicking in the left shoulder, with limited motion during flare-ups, but no ankylosis, instability, or malunion. The Veteran testified to pain and weakness, avoiding use of his left arm, and taking pain medication. The Board found the Veteran's statements and the VA examination credible and probative, noting painful motion in the AC joint, a residual of the clavicle fracture. Applying 38 C.F.R. § 4.59, the Board found a 20 percent rating warranted for painful motion of the AC joint, as the Veteran's impairment did not meet the criteria for a higher rating. The Board considered the doctrine of reasonable doubt but found it inapplicable as the evidence persuasively weighed against higher ratings. Therefore, the Board granted a 20 percent rating for residuals of the left clavicle fracture.

Rationale

Competent and probative evidence supports a 20 percent rating for painful motion of the AC joint.; Painful motion of the AC joint is a residual of the left clavicle fracture.; A higher rating is not warranted as motion was not limited to 25 degrees from side.

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7203

Docket No.

210419-153747

Full Decision Text

Citation Nr: A26039914
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 210419-153747
DATE: April 29, 2026

ORDER

Entitlement to a 20 percent rating, but no higher, for residuals of a left clavicle fracture is granted, subject to the laws and regulations governing the award of monetary benefits.

FINDING OF FACT

The credible, competent and probative evidence shows that the Veteran's left clavicle fracture manifested in painful motion in the acromioclavicular (AC) joint, with resulting functional impairment without medication to flexion and/or abduction limited to 45 degrees from side (halfway between shoulder and side).

CONCLUSION OF LAW

The criteria for entitlement to a 20 percent rating, but no higher, for residuals of a left clavicle fracture have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.3, 4.7, 4.20, 4.59, 4.71a, Diagnostic Codes 5201, 5203.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from June 1983 to June 1985.

In the March 12, 2021, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on November 15, 2024.

Therefore, the Board may only consider the evidence of record at the time of the November 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Entitlement to a compensable rating for residuals of a left clavicle fracture.

Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1.

Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of a "staged" rating is required. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). VA adjudicators must consider whether to assign different ratings at different times during the rating period to compensate the Veteran for times when the disability may have been more severe than at others. This applies to established ratings as well as initial ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007).

Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. It is essential that the examination upon which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervations, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a
system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. It is essential that the examination upon which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervations, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like. 38 C.F.R. § 4.40.

In evaluating musculoskeletal disabilities, consideration must be given to additional functional limitation due to factors such as pain, weakness, fatigability, and incoordination. See 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). The Court of Appeals for Veterans Claims (Court) has held that diagnostic codes predicated on limitation of motion do not prohibit consideration of a higher rating based on functional loss due to pain on use or due to flare-ups under 38 C.F.R. §§ 4.40, 4.45, and 4.59. See Johnson v. Brown, 9 Vet. App. 7 (1996); DeLuca, 8 Vet. App. at 206. However, in Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the Court clarified that there is a difference between pain that may exist in joint motion as opposed to pain that actually places additional limitation of the particular range of motion.

Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. §§ 4.40 and 4.45 must be considered. DeLuca, 8 Vet. App. at 207-08. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. In addition, the assignment of a disability rating should consider limitation of functional ability during flare-ups or when a joint is used repeatedly over a period of time. See Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017). Additionally, the Board must consider pain on both active and passive motion of the affected joint, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint. See Correia v. McDonald, 28 Vet. App. 158 (2016).

The Veteran's left clavicle fracture is currently rated under 38 C.F.R. § 4.71a. Diagnostic Code 7203, impairment of clavicle or scapula. Under Diagnostic Code 7203, a 10 percent rating is warranted for malunion of the clavicle or nonunion without loose movement. A 20 percent rating is warranted for nonunion with loose movement or dislocation. The ratings are the same for both the major and minor joints. Diagnostic Code 7203 also allows to rate the clavicle on impairment of function of contiguous joint. Id.

The nearest affected joint is the AC joint. The AC joint is rated under 38 C.F.R. § 4.71a. Diagnostic Code 7201, Arm, limitation of motion. The Veteran's left arm is his minor arm.

Effective February 7, 2021, VA amended Diagnostic Code 5201 to reflect that limitation of motion may be shown by flexion and/or abduction and clarified the degrees of limitation of motion that correspond to each rating. Limitation of motion at the shoulder level (flexion and/or abduction limited to 90 degrees) warrants a 20 percent rating for the minor extremity. Limitation of motion of the arm midway between side and shoulder level (flexion and/or abduction limited to 45 degrees) also warrants a 20 percent rating for the minor extremity. Flexion and/or abduction limited to 25 degrees from the side warrants a maximum 30 percent rating for the minor joint. 38 C.F.R. § 4.71a, Diagnostic Code 5201.

Prior to February 7, 2021, the criteria of Diagnostic Code 5201 were substantially the same, only without parentheticals explaining what "shoulder level" and "midway between side and shoulder level" meant in terms of degrees of motion. The criteria for the maximum, 30 percent (for the minor joint) and 40 percent (for the major joint) ratings are unchanged.

Diagnostic Code 5201 "does not provide separate ratings for limitation of motion in the flexion and abduction planes but rather is addressed generically to limitation of motion of the arm." Yonek v. Shinseki, 722 F.3d 1355, 1358 (Fed. Cir. 2013).

In August 2020, a left shoulder X-ray showed degenerative joint disease of the AC joint and glenohumeral joint, as well as signs of an old, healed fracture of left clavicle, with still some bony abnormality noted.

At a VA examination in September 2020, the Veteran reported that he has pain, weakness, clicking, difficulty (pain) moving in certain ways, decreased mobility. The Veteran avoids lifting, pushing, pulling, reaching, and other upper arm activities due to left shoulder injury condition. The examiner noted that the Veteran is right hand (major) dominant. The Veteran further reported experiencing flare-ups that occur three to four times per year that last for several days. The Veteran described the flare-ups as pain that ranges from mild to severe that is precipitated by reaching overhead and alleviated by ice, rest and nonsteroidal anti-inflammatory drugs (NSAIDs). The Veteran also reported that his left shoulder interferes with reaching overhead.

During the examination, the initial range of motion (ROM) for the left shoulder showed 0 to 150 degrees flexion and 0 to 145 abduction. The examiner estimated that ROM during repeated use and flare-ups was also 0 to 150 degrees flexion and 0 to 145 abduction. There was no rotator cuff involvement of the left shoulder. There was not ankylosis, instability, nonunion or malunion of the left shoulder noted. The examiner did identify that the Veteran has a history of a clavicle fracture that causes pain and tenderness to the left AC joint.

At his November 2024 Board hearing, the Veteran stated that he has pain in his left shoulder to the point that he doesn't use his left arm anymore because his shoulder is weak and hurts to extend it or lift anything. He sleeps on his side to reduce the pain. The Veteran also states he takes "pain killers" to alleviate the pain. The Veteran further testified that he has to move around and stretch his joints.

After review of the record, the Board finds that competent and probative evidence of record supports a 20 percent rating for the left shoulder (minor arm) under 38 C.F.R. § 4.59. The evidence of record shows that, although the Veteran's left shoulder did not have any malunion or nonunion, his nearest affected joint, the AC joint, has painful motion. Thus, the AC joint impairment is the residual of his left clavicle fracture during service. Although the Veteran's painful motion of the left arm does not manifest a ROM of 90 degrees or less for flexion or abduction, there is painful motion. The Board finds the September 2020 VA examination and the Veteran's statements credible and probative in that he has pain in his shoulder during lifting and reaching overhead. Under 38 C.F.R. § 4.59, a 20 percent is the minimum compensable rating for the AC joint. See Diagnostic Code 7201.

A higher 30 percent rating is not warranted as
have any malunion or nonunion, his nearest affected joint, the AC joint, has painful motion. Thus, the AC joint impairment is the residual of his left clavicle fracture during service. Although the Veteran's painful motion of the left arm does not manifest a ROM of 90 degrees or less for flexion or abduction, there is painful motion. The Board finds the September 2020 VA examination and the Veteran's statements credible and probative in that he has pain in his shoulder during lifting and reaching overhead. Under 38 C.F.R. § 4.59, a 20 percent is the minimum compensable rating for the AC joint. See Diagnostic Code 7201.

A higher 30 percent rating is not warranted as the Veteran's left arm (minor) did not manifest as flexion or abduction limited to 25 degrees from side. The Veteran's reports of functional impairment due to pain have been considered and are the basis of awarding the 20 percent rating based on painful motion of the AC joint. While consideration has been given to the effect of the Veteran's pain medication on his left shoulder/AC joint function, the Board finds that it does not rise to the level of being limited to 25 degrees from side. Ingram v. Collins, 38 Vet. App. 130 (2025); 38 C.F.R. § 4.10. The VA examination report indicated that his pain occurs from raising his left arm, and the flareups are precipitated by reaching over his head. At no point did the Veteran indicate that the pain limited his ability to raise his arm past 45 degrees (halfway between shoulder and side), and the Veteran's testimony at his Board hearing similarly did not indicate that degree of limited motion.

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In summary, the competent and probative evidence shows that a 20 percent rating, but no higher, is warranted for the residuals of left clavicle fracture. To that extent only, the appeal is granted. The Board has considered the doctrine of reasonable doubt but has determined that it is inapplicable, because the evidence is persuasively against the assignment of higher ratings beyond that awarded by this decision. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7.

J. Kirby

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. G. Perkins, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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