Citation Nr: 0006432 Decision Date: 03/09/00 Archive Date: 03/17/00 DOCKET NO. 95-37 866 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Boise, Idaho THE ISSUES 1. Entitlement to an evaluation in excess of 20 percent for the residuals of a L-2 fracture. 2. Entitlement to an evaluation in excess of 10 percent for the residuals of a left clavicle fracture. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD E. Pomeranz, Associate Counsel INTRODUCTION The appellant served on active duty from December 1990 to February 1993. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a July 1994 rating action by the Department of Veterans Affairs (VA) Regional Office (RO) located in Boise, Idaho. The Board notes that in October 1995, the appellant requested a hearing at the RO before a local hearing officer. However, the Board observes that in January 1996, the appellant's representative contacted the RO and indicated that the appellant wanted to cancel his hearing. FINDINGS OF FACT 1. The appellant's residuals of a L-2 fracture result in characteristic pain on motion, with demonstrable fracture deformity of the L-2 vertebral body. 2. The appellant's residuals of a left clavicle fracture are manifested by symptomatology that nearly approximates that of malunion of the left shoulder. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 20 percent for the residuals of a L-2 fracture have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 4.1, 4.40, 4.45. 4.59, 4.71a, Diagnostic Codes 5285, 5292, 5293, 5295 (1999). 2. The criteria for an evaluation in excess of 10 percent for the residuals of a left clavicle fracture have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 4.1, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5202, 5203 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual Background The appellant's service medical records include an Injury Report which shows that in April 1992, the appellant was involved in an automobile accident. At that time, his car collided with a rock wall and he was ejected from the car. Following the accident, the appellant suffered numerous injuries including the following: (1) L-2 compression fracture with back pain, and (2) distal clavicle fracture of the left shoulder. In August 1993, the appellant underwent a VA examination. At that time, he gave a history of his back and shoulder injuries. The appellant stated that at present, he had occasional subluxation of his left shoulder, especially if he worked over his head or pulled a rope down from overhead. He noted that he did not have chronic pain in his shoulder. According to the appellant, he had no neck complaints, and he had low back pain in the region of the L-2 fracture. The physical examination showed that the appellant's left clavicle was in normal position and was not causing any symptoms. His back was slightly tender over the L-2 vertebral. Flexion was to 90 degrees in the lumbar area, backward extension was to 30 degrees, and lateral bending was to 40 degrees. In regards to a neurological examination, the cranial nerves were intact, and proprioception and light touch were all present. There was no loss to pin prick, and there was no ataxia. Plantar response was down bilaterally. The reflexes were 1+ in the biceps, triceps, and radialis, and 1+ in the ankles in the Achilles on each side and the patella on each side. The diagnoses included the following: (1) history of compression fracture of L-2, with recurrent back ache, and (2) history of fracture of left clavicle, without recurrent symptoms. An x-ray of the appellant's lumbosacral spine was interpreted as showing a mild anterior compression fracture involving L-2. There was some deterioration in the articular space between L-1 and L-2, with some thinning of the interspace. The frontal film suggested a mild scoliosis, with the convexity directed toward the left. Sacroiliac joints appeared normal. The impression was of an old compression fracture in the vertebral body of L-2. The examiner noted that there was indication of deterioration in the articulation between L-1 and L-2. In a July 1994 rating action, the RO granted the appellant's claims for entitlement to service connection for the residuals of an L-2 fracture and entitlement to service connection for the residuals of a left clavicle fracture. At that time, the RO assigned a 10 percent disabling rating under Diagnostic Code 5299-5293 for the appellant's back disability and a zero percent disabling rating under Diagnostic Code 5299-5010 for his left shoulder disability. A report from the Physical Evaluation Board (PEB) of the Department of the Navy, dated in December 1994, shows that at that time, the PEB determined that the appellant was unfit for duty. The PEB primarily based its decision on the following diagnoses: (1) status post L-1 lumbar compression fracture, with chronic back pain, and (2) status post left clavicle fracture open, with chronic pain, improving. Temporary Disability Retirement Evaluation (TDRE) reports from the Madigan Army Medical Center, from July 25, 1995 to July 27, 1995, show that on July 26, 1995, the appellant underwent a physical examination. At that time, the appellant gave a history of his motor vehicle accident and resulting injuries. The appellant stated that at present, he had occasional left shoulder instability. Following the examination, he was diagnosed with the following: (1) healed femur fracture, asymptomatic, and (2) healed clavicle fracture, with normal shoulder examination. In September 1995, the appellant underwent a VA examination. At that time, in regards to his low back disability, he stated that his low back pain was somewhat more pronounced. The appellant indicated that his pain was more frequent, and that it was easier to aggravate his back distress. He noted that sitting for long periods of time bothered him, as well as lifting in the wrong position. According to the appellant, approximately once a month, he was awakened due to pain in his back. In regards to his left shoulder disability, the appellant reported that at times, he could feel the fracture area "give," especially when reaching upward over his head. The appellant stated that on at least two occasions when reaching a considerable distance, he had had a pronounced popping in the acromioclavicular (AC) joint, with pain. He noted that he had pain and popping of the left clavicle area, with some intermittent tingling into the shoulder and arm. According to the appellant, he used to be very athletic in basketball, football, track, and tennis, and that his injuries had effectively reduced his capacity to participate in sports. The physical examinations showed that the appellant's posture was good and his gait was normal. Back examination revealed normal contours. There was no tenderness and no spasm was evident. In regards to range of motion, forward flexion was to 108 degrees, extension was to 33 degrees, lateral flexion, right, was to 32 degrees, lateral flexion, left, was to 30 degrees, rotation to the right was to 38 degrees, and to the left was to 40 degrees. In the left clavicle region, there was a noticeable prominence of the left AC joint, which was not tender. The diagnoses included the following: (1) L-2 vertebral fracture, old, with 15 to 20 percent residual compression deformity, and (2) left clavicular fracture, compound, old, with symptoms compatible with traumatic arthritis at the AC joint. An x-ray of the appellant's lumbar spine was interpreted as showing a 15 to 20 percent loss of vertebral body height of L-2. The examining physician stated that by history, the loss of vertebral body height represented an old compression injury which did not appear to be acute. There was some mild disk space narrowing at L1-L2. The diagnoses included the following: (1) old, mild compression (15 to 20 percent), body L-2, and (2) narrowed disk space, L1-L2. In a December 1995 rating action, the RO increased the appellant's disabling rating for his residuals of an L-2 fracture from 10 percent to 20 percent disabling under Diagnostic Code 5285. In addition, the RO also increased the appellant's disabling rating for his residuals of a left clavicle fracture from zero percent to 10 percent disabling under Diagnostic Code 5203. In a January 1998 decision, the Board remanded this case. At that time, the Board stated that under 38 C.F.R. §§ 4.40 and 4.45, functional limitation due to pain on use or during flare-ups could be a basis for an increased evaluation. The Board indicated that those criteria under the VA Schedule for Rating Disabilities had not been considered by the RO. Thus, the Board remanded the case and requested that the appellant undergo a VA orthopedic examination. The Board noted that the examination was necessary in order to consider the criteria under 38 C.F.R. §§ 4.40 and 4.45, and to adequately portray the nature and extent of any functional loss due to pain and weakness on use. See DeLuca v. Brown, 8 Vet. App. 202 (1995). In December 1999, the appellant underwent a VA orthopedic examination. At that time, the appellant stated that he had pain in his low back and left shoulder. According to the appellant, his left shoulder ached as a constant ache and was aggravated by lifting weights and overhead activities, in general. The appellant reported that if he slept with his left arm in the abducted position, it would become numb. He indicated that his range of motion was "good," but that heavy activity in general caused increased aching in his left shoulder. The appellant revealed that on one occasion, he reached over his head to grab a rope and pull down on it, and his left shoulder popped in and out. The appellant also complained of pain in his mid-low back area, with occasional radiation to the anterior portion of the right leg down to his right knee. Mechanical activity, such as pushing, pulling, lifting, and carrying, would cause increased pain in his back, not at the time he was doing it, but at a somewhat later date. According to the appellant, he recently started running or jogging. The appellant stated that he could sit comfortably for 20 minutes and that he could walk indefinitely. He noted that he could lift quite a few pounds if he took lifting precautions or used his back and legs. According to the appellant, if he slept on his stomach or back, he had increased low back complaints. Prior to the physical examination, the examining physician noted that he had informed the appellant that if anything he did caused increased pain during any part of the examination, the appellant was to inform him since one of the goals of the examination was not to produce any increased pain. The physical examination showed that the appellants gait was intact. Toe and heel walking were intact, and hopping caused some increased low back discomfort. Squatting was 100 percent. Posture was normal and spinal curves appeared normal. Axial compression of the head and shoulders did not produce increased low back pain, and Waddell's tuncal rotation was negative for increased low back pain. Palpation of the lumbar spine revealed no obvious tenderness, and there was no paralumbar spinal tenderness or spasm. There was no tenderness of either sacroiliac (SI) joint. There was no tenderness of either gluteal region or over either sciatic notch. In regards to range of motion of the lumbar spine, forward flexion was to 85 degrees, extension was to 30 degrees, with some increased low back pain, lateral flexion to the right was to 35 degrees, and to the left was to 30 degrees, and rotation to the left and right was to 35 degrees. Range of motion of the shoulders revealed that both shoulders flexed and abducted to 180 degrees. Internal and external rotation of both shoulders were 75 to 80 degrees. The shoulders extended and adducted at 50 to 55 degrees. Deep tendon reflexes of both biceps, both triceps, and both brachioradialis were symmetrical at 2 bilaterally. Examination of the left clavicle revealed that there was a deformity of the junction of the mid and distal one-third of the left clavicle, with obvious callus formation. There was some minor tenderness over that area. Palpation on the right showed no deformity or tenderness. The clavicle appeared to be stable to palpation, with no obvious movement. Sensory examination to light touch and pinprick was symmetrical and normal in all areas of the upper extremities. Muscle strength examination was 5/5 of all muscle groups of both upper extremities. Sitting straight leg raising was full and negative for pain. Sensory examination to pinprick and light touch was symmetrical in all areas of both lower extremities. Muscle strength testing of all muscle groups of both lower extremities was symmetrical at 5/5. Straight leg raising, left and right, was 80 to 85 degrees, bilaterally, and negative for sciatic nerve augmentation, bilaterally. Log rolling left and right was full and negative for pain. Both hips flexed to 125 degrees and were negative for increased low back pain. Following the physical examination, the appellant was diagnosed with the following: (1) fracture of the middle and distal one-third left clavicle, and (2) compression fracture, L-2 vertebra. The examining physician stated that the neurological and orthopedic examinations were essentially unremarkable, and there were no significant abnormal objective findings. According to the examiner, the appellant's complaints were rather vague, and there was no good correlation between the appellant's subjective symptomatology and any abnormal objective findings in the current examination. It was the examiner's opinion that there was no evidence that the L-2 fracture disability or the left clavicle fracture disability should be increased. The examiner noted that his opinion was based on a paucity of abnormal objective findings at the time of the current examination. II. Analysis Initially, the Board finds that the appellant's claims for an evaluation in excess of 20 percent for the residuals of an L- 2 fracture, and an evaluation in excess of 10 percent for the residuals of a left clavicle fracture, are well grounded pursuant to 38 U.S.C.A. § 5107(a) (West 1991). See Arms v. West, 12 Vet. App. 188, 200 (1999), citing Proscelle v. Derwinski, 2 Vet. App. 629 (1992). In this regard, as previously stated, the Board remanded this case in January 1998. At that time, the Board requested that the appellant be afforded a VA examination in order to consider the provisions of 38 C.F.R. §§ 4.40 and 4.45 and to adequately portray the extent of any functional loss due to pain and weakness on use. The Board notes that in December 1999, the appellant underwent a VA examination. Therefore, the Board is satisfied that all available relevant evidence is of record and that the statutory duty to assist the appellant in the development of evidence pertinent to his claim has been met. Disability ratings are determined by the application of a schedule of ratings which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155. Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The United States Court of Appeals for Veterans Claims (Court) has considered the question of functional loss due to pain and weakness as it relates to the adequacy of assigned disability ratings. See DeLuca v. Brown, supra. In DeLuca, the Court stated that 38 C.F.R. § 4.40 requires consideration of factors such as lack of normal endurance, functional loss due to pain, and pain on use. Id. at 205-206. The Court also stated that 38 C.F.R. § 4.45 requires consideration of weakened movement, excess fatigability, incoordination, and pain on movement, in addition to limitation of motion. Id. at 206. As the appellant takes issue with the initial ratings assigned following the grant of service connection for residuals of an L-2 fracture and for residuals of a left clavicle fracture, the Board must consider the applicability of a higher rating for each disability for the entire period in which the appeal has been pending. See Fenderson v. West, 12 Vet. App. 119, 125-127 (1999). To summarize, the appellant contends that his current ratings for his service-connected residuals of an L-2 fracture and service-connected residuals of a left clavicle fracture, are not high enough for the amount of disability that his low back and left shoulder disabilities cause him. The appellant states that he suffers from chronic low back pain. He indicates that his low back pain curtails the physical activities that he can participate in. The appellant further maintains that he suffers from chronic left shoulder pain. According to the appellant, when he makes a quick upward motion, his shoulder displaces causing severe pain. In this regard, lay statements are considered to be competent evidence when describing symptoms of a disease or disability or an event. However, symptoms must be viewed in conjunction with the objective medical evidence of record. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The Residuals of an L-2 Fracture The appellant's service-connected residuals of a L-2 fracture are currently rated as 20 percent disabling under 38 C.F.R. § 4.71, Diagnostic Code 5285. Under this diagnostic code, a 60 percent evaluation is warranted for residuals of a fracture of a vertebra, without cord involvement but with abnormal mobility requiring a neck brace. In other cases, the residuals of a fracture of a vertebra will be rated in accordance with definite limited motion or muscle spasm, adding 10 percent for demonstrable deformity of a vertebral body. 38 C.F.R. § 4.71a, Diagnostic Code 5285. The Board notes that when the RO granted a 20 percent rating for the appellant's residuals of a L-2 fracture, pursuant to Diagnostic Code 5285, the RO explained that a 10 percent rating was assigned for pain on motion, with little if any actual limitation of lumbar spine motion, citing 38 C.F.R. §§ 4.40 and 4.71a, Diagnostic Code 5295; and that 10 percent was being added for demonstrable fracture deformity of the L- 2 vertebral body pursuant to Diagnostic Code 5285. A 10 percent evaluation is warranted under Diagnostic Code 5295 for disability manifested by characteristic pain on motion. A 20 percent evaluation requires muscle spasm on extreme forward bending and unilateral loss of lateral spine motion in a standing position. A 40 percent evaluation requires severe disability manifested by listing of the whole spine to the opposite side, a positive Goldthwait's sign, marked limitation of forward bending in a standing position, loss of lateral motion with osteoarthritic changes, or narrowing or irregularity of the joint spaces. A 40 percent evaluation is also warranted if only some of these manifestations are present with abnormal mobility on forced motion. 38 C.F.R. § 4.71a. A 10 percent evaluation is warranted under Diagnostic Code 5292 for slight limitation of motion of the lumbar segment of the spine. A 20 percent evaluation is warranted for moderate limitation. A 40 percent evaluation requires severe limitation of motion. 38 C.F.R. § 4.71a. A 10 percent evaluation is warranted under Diagnostic Code 5293 for mild impairment. A 20 percent evaluation is warranted for moderate impairment with recurring attacks. A 40 percent rating is warranted for severe impairment with recurring attacks with intermittent relief. 38 C.F.R. § 4.71a. To summarize, in the appellant's August 1993 VA examination, flexion was to 90 degrees in the lumbar area, backward extension was to 30 degrees, and lateral bending was to 40 degrees. The appellant was diagnosed with a history of compression fracture of L-2, with recurrent back ache. An x- ray of the appellant's lumbosacral spine was interpreted as showing an old compression fracture in the vertebral body of L-2. In addition, the December 1994 PEB report shows that at that time, the appellant was diagnosed with status post L-1 lumbar compression fracture, with chronic back pain. The Board further notes that in the appellant's September 1995 VA examination, back examination revealed normal contours. There was no tenderness and no spasm was evident. In regards to range of motion, forward flexion was to 108 degrees, extension was to 33 degrees, lateral flexion, right, was to 32 degrees, lateral flexion, left, was to 30 degrees, rotation to the right was to 38 degrees, and to the left was to 40 degrees. The appellant was diagnosed with L-2 vertebral fracture, old, with 15 to 20 percent residual compression deformity. An x-ray of the appellant's lumbar spine was interpreted as showing the following: (1) old, mild compression (15 to 20 percent), body L-2, and (2) narrowed disk space, L1-L2. In addition, in the appellant's December 1999 VA examination, hopping caused some increased low back discomfort. Axial compression of the head and shoulders did not produce increased low back pain, and Waddell's tuncal rotation was negative for increased low back pain. Palpation of the lumbar spine revealed no obvious tenderness, and there was no paralumbar spinal tenderness or spasm. There was no tenderness of either SI joint, and there was no tenderness of either gluteal region or over either sciatic notch. In regards to range of motion of the lumbar spine, forward flexion was to 85 degrees, extension was to 30 degrees, with some increased low back pain, lateral flexion to the right was to 35 degrees, and to the left was to 30 degrees, and rotation to the left and right was to 35 degrees. Sitting straight leg raising was full and negative for pain. Sensory examination to pinprick and light touch was symmetrical in all areas of both lower extremities. The appellant was diagnosed with compression fracture, L-2 fracture. Moreover, the examiner noted that the appellant's complaints were rather vague and there was no good correlation between his subjective symptomatology and any abnormal objective findings in the current examination. According to the examiner, on the basis of a paucity of abnormal objective findings, it was his opinion that there was no evidence that the L-2 fracture disability should be increased. The Board has considered the evidence of record, but finds that there is no basis for a higher evaluation under Diagnostic Codes 5285 and 5295. See, e.g., Butts v. Brown, 5 Vet. App. 532, 539 (1993) (holding that a selection of a diagnostic code in a particular case may not be set aside unless "such selection is 'arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law'"). In this regard, as aptly noted above, the medical data of record show that the appellant's lumbar spine disability is manifested by characteristic pain on motion, and hence, a 10 percent evaluation is warranted under Diagnostic Code 5295. Thus, the 10 percent rating adequately takes into account the appellant's complaints of pain which are supported by adequate pathology. See generally DeLuca, supra; 38 C.F.R. §§ 4.40, 4.45, 4.59. In addition, the September 1995 VA examination report indicates a diagnosis of L-2 vertebral fracture, old, with 15 to 20 percent residual compression deformity, thereby warranting an additional 10 percent rating under Diagnostic Code 5285 for demonstrable deformity of the L-2 vertebral body. Notably, however, the medical data of record provide no evidence that the appellant currently suffers from muscle spasm or loss of unilateral spine motion. Indeed, the findings contained in reports of examination dated in September 1995 and December 1999, reveal that there was no spinal spasm or tenderness, and that the appellant demonstrated a range of lumbar spine maneuvers without any apparent difficulty being noted. Thus, a higher evaluation is not warranted under Diagnostic Code 5295. In addition, there is no evidence of more than slight limitation of motion, and the August 1993, September 1995, and December 1999 VA examination reports do not reveal clinical findings to suggest that the appellant's pain on extended use is sufficient to translate into moderate limitation of lumbar spine motion, as required for a 20 percent evaluation under Diagnostic Code 5292. See 38 C.F.R. § 4.71a, Diagnostic Code 5292. In a similar manner, a rating in excess of 10 percent is not also warranted under Diagnostic Code 5293, since the medical data of record do not reflect evidence of intervertebral disc syndrome with moderate recurring attacks and intermittent relief. As illustrated by the record, the VA examiner in December 1999 concluded that the results of the neurological and orthopedic examinations were essentially unremarkable, and that there were no significant abnormal objective findings. Therefore, the symptomatology associated with the appellant's service-connected residuals of a L2 fracture is appropriately evaluated as 10 percent disabling under Diagnostic Code 5295, with 10 percent added for demonstrable deformity of the vertebral body pursuant to Diagnostic Code 5285. Accordingly, an evaluation in excess of 20 percent is not warranted. Residuals of a Left Clavicle Fracture The appellant's service-connected residuals of a left clavicle fracture are currently rated as 10 percent disabling under Diagnostic Code 5203. Under Diagnostic Code 5203, ratings are based on impairment of the clavicle or scapula. Malunion of the clavicle or scapula is rated 10 percent. Dislocation of the clavicle or scapula is rated 20 percent. Non-union of the clavicle or scapula with loose movement is rated 20 percent. Or, as noted under this code, rate on impairment of function of the contiguous joint. 38 C.F.R. § 4.71a, Diagnostic Code 5203 (1999). Arthritis is rated on the basis of limitation of the joint involved. 38 C.F.R. § 4.71a, Diagnostic Code 5003, 5010 (1999). Normal range of motion for the shoulder joint is as follows: forward elevation (flexion) to 180 degrees; abduction to 180 degrees; internal rotation to 90 degrees; and external rotation to 90 degrees. 38 C.F.R. § 4.71, Plate I (1999). Under Diagnostic Code 5201, limitation of motion of the (major and minor) arm, at shoulder level, will be assigned a 20 percent evaluation. Limitation of motion of the arm, midway between the side and shoulder level, will be assigned a 20 percent evaluation for the minor arm, and a 30 percent evaluation for the major arm. Limitation of motion of the arm, to 25 degrees from the side, will be assigned a 30 percent evaluation for the minor arm, and a 40 percent evaluation for the major arm. 38 C.F.R. § 4.71a, Diagnostic Code 5201 (1999). Upon a review of the record, the Board determines that the appellant is not entitled to an evaluation in excess of 10 percent for his service-connected residuals of a left clavicle fracture. In this regard, the record reflects that in the August 1993 VA examination report, the appellant was diagnosed with a history of a fracture of the left clavicle, without recurrent symptoms. In addition, the December 1994 PEB report shows that at that time, the appellant was diagnosed as status post left clavicle fracture open, with chronic pain, improving. The record further reflects that the TDRE report indicates that on July 26, 1995, the appellant was diagnosed with a healed clavicle fracture, with a normal shoulder examination. Moreover, on VA examination conducted in September 1995, there was a noticeable prominence of the left AC joint, which was not tender. The diagnosis was of a left clavicular fracture, compound, old, with symptoms compatible with traumatic arthritis at the AC joint. In the appellant's December 1999 VA examination, deep tendon reflexes of both biceps, both triceps, and both brachioradialis were symmetrical at 2 bilaterally. Examination of the left clavicle revealed that there was a deformity of the junction of the mid and distal one-third of the left clavicle, with obvious callus formation. There was some minor tenderness over that area. Palpation on the right showed no deformity or tenderness. The clavicle appeared to be stable to palpation, with no obvious movement. In addition, muscle strength examination was 5/5 of all muscle groups of both upper extremities. Following the physical examination, the appellant was diagnosed with fracture of the middle and distal one-third left clavicle. According to the examiner, the appellant's complaints were rather vague, and there was no good correlation between the appellant's subjective symptomatology and any abnormal objective findings in the current examination. It was the examiner's opinion that based on the paucity of abnormal objective findings, there was no evidence that the left clavicle fracture disability should be increased. As aptly noted above, in the appellant's September 1995 VA examination, there was a noticeable prominence of the left AC joint. In addition, in the December 1999 VA report, the examination of the left clavicle revealed that there was a deformity of the junction of the mid and distal one-third of the left clavicle, with obvious callus formation. Thus, these medical data are consistent with a finding that is suggestive of a malunion of his left clavicle fracture, and hence a 10 percent rating is warranted under Diagnostic Code 5203. However, although the evidence of record suggest a finding of a malunion of his left clavicle fracture, an evaluation in excess of 10 percent is not warranted, because there is no evidence showing non-union of the left clavicle with loose movement or dislocation of the clavicle or scapula. Indeed, in the appellant's December 1999 VA examination, the examiner noted that the orthopedic examination was essentially unremarkable, and there were no significant abnormal objective findings. Accordingly, an evaluation in excess of 10 percent is not warranted under Diagnostic Code 5203. Additionally, an evaluation in excess of 10 percent is also not warranted under Diagnostic Code 5201. In this regard, in the December 1999 VA examination report, the appellant was able to flex and abduct both shoulders to 180 degrees. In addition, he rotated both shoulders, internally and externally, at 75 to 80 degrees; and he extended and adducted the shoulders at 50 to 55 degrees. Although there was some minor tenderness detected in the left clavicle area on examination, the resulting functional limitation demonstrated by that same examination report is not at the level contemplated by 20 percent rating under Diagnostic Code 5201. See generally DeLuca, 8 Vet. App. at 207-208 (explaining §§ 4.40 and 4.45 require that the findings as to pain and weakness must cause additional disability beyond that reflected in measured limitation of motion); 38 C.F.R. §§ 4.40, 4.45, 4.59. Accordingly, the Board finds that an evaluation in excess of 10 percent for the appellant's service-connected residuals of a left clavicle fracture is not warranted. The Board has considered all pertinent sections of 38 C.F.R. § Parts 3 and 4 as required by the Court in Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Board finds that the preponderance of the evidence is against the claims for entitlement to an evaluation in excess of 20 percent for the residuals of an L-2 fracture and entitlement to an evaluation in excess of 10 percent for the residuals of a left clavicle fracture. ORDER An evaluation in excess of 20 percent for the residuals of a L-2 fracture is denied. An evaluation in excess of 10 percent for the residuals of a left clavicle fracture is denied. DEBORAH W. SINGLETON Member, Board of Veterans' Appeals