The clavicle, a curved bone, articulates with the sternum and the scapula. A fracture is a break in a bone.

A fracture of the clavicle is caused by a fall or a direct blow. In sports, a fractured clavicle is a result of "piling on" as in football.

A protuberance is visible over the broken bone and there is pain and swelling. The shoulder is painful, and the arm is immobile and in need of support.

X-rays will confirm the fracture and any displacement.

A simple fracture is treated by drawing the arms and shoulders backwards and maintaining the position with a figure-of-eight wrap for 6 to 8 weeks. Frequent adjustments are necessary to maintain the position and to avoid skin breakdown. A possible open reduction of the fracture will be needed if the upper extremity is cyanotic and there is vascular compromise.

Failure of a fracture to unite is established if there are no signs of healing nine months after the injury.

• Where service connection (SC) of a fracture or fracture residuals is claimed, SC will be established when sufficient evidence, such as x-rays, a surgical report, casting, or a physical evaluation board report, documents the fracture. If SC of a fracture has not been claimed and objective evidence such as x-ray report documents an in-service fracture, invite a claim for SC for the fracture.

• To properly rate disability, accurate measurement of rotator cuff ranges of motion (ROM) is required and must be reported in degrees.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• Description of any instability and frequency of any dislocations is required.

• Multiple precedential decisions have impacted the application of 38 CFR 4.59 for musculoskeletal disabilities.  Refer to the M21-1 musculoskeletal disabilities section for a listing of impactful precedential court holdings, a brief description of the impact, and the applicability date (date of decision) for each.

• Separate evaluations may be given for disabilities of the shoulder and arm under 38 CFR 4.71a, diagnostic codes (DCs) 5201, 5202, or 5203 if the manifestations represent separate and distinct symptomatology that are neither duplicative nor overlapping. Refer to the M21-1 for examples of separate evaluations for disabilities of the shoulder and arm.  

• It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. See 38 CFR 4.2 – Interpretation of examination reports. If the report or examination is inadequate, the rating agency may return for a supplementary report. See 38 CFR 4.70 – Inadequate examinations. 

• None.