RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20070627 

  Despite  conservative  treatment  as  well  as  a  right  anterior  cruciate 

 
NAME:  XXXXXXXXXXXXXX                 
CASE NUMBER:  PD1100228 
BOARD DATE:  20130131    
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  a  National  Guard  member  on  a  temporary  tour  of  Active  Duty 
SSG/E-6 (11B30/Infantryman), medically separated for chronic neck pain and chronic right knee 
pain.  The CI injured his neck in April or May 2005 and he injured his right knee in December 
2005. 
ligament 
reconstruction in September 2006, neither condition improved adequately; the CI was unable 
to meet the physical requirements of his Military Occupational Specialty or to satisfy physical 
fitness  standards.    He  was  issued  a  permanent  U3/L3  profile  and  referred  for  a  Medical 
Evaluation  Board  (MEB).    Recurrent  headaches,  obstructive  sleep  apnea,  and  depression 
conditions,  identified  in  the  rating  chart  below,  were  identified  by  the  MEB  as  meeting 
retention standards and forwarded to the Physical Evaluation Board (PEB).  The PEB adjudicated 
the neck pain and knee pain conditions as unfitting, rated 10% and 0% respectively, with cited 
application of the US Army Physical Disability Agency (USAPDA) pain policy and the Veterans 
Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to 
be not unfitting.  The CI made no appeals, and was medically separated with a 10% disability 
rating.   
 
 
CI CONTENTION:  The CI elaborated no specific contention in his application.   
 
 
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 ratings 
for  unfitting  conditions  will  be  reviewed  in  all  cases.    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 IPEB – Dated 20070618 
Condition 
Chronic Neck Pain 

Code 
5242 

Rating 
10% 

Chronic Knee Pain 

5099-5003 

0% 

Recurrent Headaches 

Not Unfitting 

Obstructive Sleep Apnea 
Depression, NOS 

Not Unfitting 
Not Unfitting 

↓No Additional MEB/PEB Entries↓ 

5024 

Headache 
Post-

Rating 
30% 

Code 
5243-5242 

VA (5 Months After Separation) – All Effective Date 20070628 
Condition 
Exam 
Degenerative  Disc  Disease 
20071120 
of the C-Spine C4-7 
Right  Knee  Residuals  ACL 
Repair 
Migraine 
with 
combined 
Traumatic headache 
Sleep Apnea 
PTSD  
Bilateral Hearing Loss 
Tinnitus 
0% x 2/Not Service Connected x 2 

20071120 
20071120 
20071120 
20071120 
20071120 

6847 
9499-9411 
6100 
6260 

50% 
30% 
10%* 
10% 

10% 

20071120 

9304-8100 

30% 

20071120 

Combined:  90% 

Combined:  10% 
*Increased to 40% effective 20100628 but the combined rating remained unchanged. 
 
 
ANALYSIS SUMMARY:  The Board’s authority as defined in DoDI 6040.44, resides in evaluating 
the fairness of Disability Evaluation System (DES) fitness determinations and rating decisions for 
disability at the time of separation.  The Board utilizes VA evidence proximal to separation in 
arriving  at  its  recommendations;  and,  DoDI  6040.44  defines  a  12-month  interval  for  special 
consideration to post-separation evidence.  Post-separation evidence is probative only to the 
extent  that  it  reasonably  reflects  the  disability  and  fitness  implications  at  the  time  of 
separation.  
 
Neck Pain Condition.  The goniometric range-of-motion (ROM) evaluations in evidence which 
the Board weighed in arriving at its rating recommendation, with documentation of additional 
ratable criteria, are summarized in the chart below. 
 

Goniometric  ROM 
– Cervical 

MEB ~ 5 Mo. Pre-Sep 

VA C&P ~ 5 Mo. After-Sep 

VA C&P ~ 17 Mo. After-Sep 

Flex (0-45) 

30° (29, Pain at 19) 

Ext (0-45) 

R Lat Flex (0-45) 
L Lat Flex (0-45) 
R Rotation (0-80) 
L Rotation (0-80) 
COMBINED (340) 

45⁰ (Pain at 40) 

35⁰ (Pain at 25) 
45⁰ (With Pain) 
25⁰ (Pain at 20) 
40⁰ (Pain at 30) 
220⁰ 

15⁰ (Pain at 20);  
15° after repetition 
20⁰ (21);  
30° (29) after repetition 
20⁰ (18) 
10⁰ 
30⁰ (28) 
15⁰ 
110⁰ 

Comment 

Pain  limits  ROM  all  directions; 
tenderness of bilateral paraspinal 
areas;  normal 
and 
sensory exam 

reflexes 

Limited by pain & fatigue; spasm 
from C3 to C6 on right and C4 to 
C6  on  left,  spasm  in  trapezius 
bilaterally; 
lordotic 
curvature 

loss  of 

 

20° (Pain at 15) 

40° 

30° 
30° 
45° 
45° 
210° 
No  change  with  repetition; 
mildly  tender  to  palpation  of 
cervical  spine;  no  crepitus, 
instability, 
or 
weakness;  normal  neurologic 
exam 
20% 

spasm, 

30% 

20% 

§4.71a Rating 
 
The  CI  injured  his  neck  in  April  or  May  2005  when  he  fell  approximately  5  feet  out  of  an 
elevated trailer landing on his neck and upper back on sandbags.  He continued to have neck 
and upper back pain as well as headaches despite conservative care.  He did get some relief of 
his  pain  and  decreased  frequency  of  headaches  with  trigger  point  and  facet  injections; 
however, he continued to have significant neck pain.  Magnetic resonance imaging (MRI) of the 
cervical  spine  from  November  2006  noted  diffuse  multilevel  degenerative  disk  disease  and 
uncovertebral  osteophyte  formation.    The  MEB  narrative  summary  (NARSUM),  completed 
approximately 5 months prior to separation reported MRI findings that were more detailed.  No 
study date  was  specified  and  most  likely,  the NARSUM  was  referring to  the November  2006 
study.  The NARSUM reported the MRI showed moderate to severe narrowing of the C4-5 left 
neural foramen, moderate narrowing of the C5-6 bilateral neural foramina, and a broad based 
disk bulge with patent neural foramina at C6-7.  Cervical spine degenerative changes were also 
shown  on  X-ray.    The  NARSUM  stated  the  CI’s  pain  was  mild  and  constant.    Physical 
examination findings are recorded in the ROM chart above.  The VA Compensation and Pension 
(C&P)  exam  completed  about  5  months  after  separation  noted  the  CI  had  been  medically 
retired from his civilian job as a police officer due to his neck, knee, and posttraumatic stress 
disorder (PTSD) conditions.  This exam includes the CI’s report of standing up and then passing 

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out and falling backwards while in Iraq, after which he had been evacuated to Germany to see 
neurology  for  chronic  headaches  without  any  known  trauma.    The  CI  also  reported  several 
sprain-type injuries to his neck while deployed due to wearing gear, jolting rides, and being in 
the  vicinity  of  explosions.    After  separation,  the  CI  reported  chronic  pain  and  stiffness  in  his 
upper neck and posterior suboccipital region with occasional radiation to his scalp but without 
weakness  or  flare-ups.    Physical  exam  findings  are  noted  in  the  ROM  chart  above.    An  MRI 
completed  in  January  2008  (7  months  after  separation  from  service)  documented  mid  and 
lower cervical degenerative disk disease with significant neural encroachment bilaterally at C4-
5  and  C5-6  and  mild  spinal  stenosis  at  C6-7.    A  second  C&P  examination  was  completed  17 
months after the CI separated and the physical examination findings are reported in the ROM 
chart above.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  and  the  VA  rated  the  CI’s  neck  pain  using  the  same  coding  option  of  5242.    The  PEB 
assigned a 10% rating for cervical spine ROM limited by pain even though cervical flexion was 
limited to 30 degrees.  It appears this was based on language in the NARSUM which indicated 
the neck pain was “mild and constant,” which apparently derives from the USAPDA pain policy.  
The VA assigned a 30% rating based on cervical flexion limited to 15 degrees after repeated 
motion.  Both examinations appear to be complete and valid at the time they were done and 
both  were  approximately  5  months  from  the  date  of  separation.    However,  the  C&P 
examination was completed after separation and it appears the CI’s condition worsened over 
time; the CI was also having particularly severe spasms the day of that examination.  The Board 
noted that a VA examination 17 months after separation was similar to that of the MEB exam 
prior  to  separation  and  it  surmised  that  the  VA  exam  5  months  after  separation  likely 
represented an acute worsening or exacerbation of his condition, which subsequently improved 
to  his  baseline  exam.    There  is  no  evidence  in  the  record  that  supports  a  finding  of  cervical 
flexion of 15 degrees or less prior to separation.  After due deliberation, considering all of the 
evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board recommends 
a disability rating of 20% for the neck pain condition.   
 
Knee Pain Condition.  The goniometric range of motion (ROM) evaluations in evidence which 
the Board weighed in arriving at its rating recommendation, with documentation of additional 
ratable criteria, are summarized in the chart below.  
 
 
 

Goniometric ROM – 
Right Knee 
Flexion (140⁰ normal) 
Extension (0⁰ normal) 

MEB ~ 4 Mo. Pre-Sep 
 
100⁰ (Pain at 95) 
Not Measured 

Comment 

Pain  limits  ROM;  normal 
neurologic examination  

VA C&P ~ 5 Mo. After-Sep 
 
120⁰; 115° (113) after repetition 
0⁰ (2); 5° after repetition 
ROM limited due to pain and decreased with repetition; Instability 
signs negative; no antalgic gait;  no effusion; negative McMurray; 
right thigh 2.5cm smaller than left; normal neurologic examination 
10% 

§4.71a Rating* 

10% 

 
The NARSUM, completed approximately 5 months prior to separation, noted that in December 
2005, the CI twisted his right knee as he evacuated a vehicle while on convoy escort in Iraq and 
noticed immediate pain and swelling.  An MRI in June 2006 noted a complete ACL tear, multiple 
bone contusions, and degenerative changes but no tears in the medial and lateral meniscus.  
Despite an ACL repair and physical therapy, he continued to have chronic right knee pain.  The 
physical examination findings are in the ROM chart above.  The CI had previously undergone 
removal of the right patella bursa in 1985, prior to entering service.  At the C&P examination, 
completed approximately 5 months after separation, the CI reported no chronic pain but did 

   3                                                           PD1100228 
 

have flare ups 2 to 3 times per week with pain rated as 5-6/10 lasting 4 to 6 hours each.  These 
were  precipitated  by  crouching  down  or  bending  and  included  symptoms  of  weakness, 
stiffness, and occasional swelling.  He reported no instability or locking but did report “giving 
way”  symptoms.    The  CI  used  medications  which  were  helpful  in  alleviating  pain,  but  which 
were sedating.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB rated the CI’s knee pain condition at 0% for slight/intermittent pain IAW the USAPDA pain 
policy.  The PEB noted that while the CI did have a right knee condition prior to service, the 
current impairment was due to the reported injury in December 2005, and the condition was 
therefore  aggravated  by  service.    The  VA  rated  this  condition  at  10%  under  code  5024 
(tenosynovitis)  based  upon  VASRD  §4.59  (Painful  motion).    Both  the  service  and  the  VA 
examinations document pain-limited motion of the right knee at a noncompensable level and 
neither  examination  documents  instability  or  meniscal  injury.    The  Board  deliberated  on  the 
most applicable code for the application of VASRD §4.59 Painful motion and agreed that code 
5099-5003 is appropriate.  After due deliberation, considering all of the evidence and mindful 
of VASRD §4.3 (Resolution of reasonable doubt), the Board recommends a disability rating of 
10% for the right knee pain 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.  As discussed above, PEB 
reliance  on  the  USAPDA  pain  policy  was  operant  in  this  case  and  the  CI’s  conditions  were 
adjudicated  independently  of  that  policy  by  the  Board.    In  the  matter  of  the  neck  pain 
condition,  the  Board  unanimously  recommends  a  disability  rating  of  20%,  coded  5242  IAW 
VASRD  §4.71a.    In  the  matter  of  the  right  knee  pain  condition,  the  Board  unanimously 
recommends  a  rating  of  10%  coded  5099-5003  IAW  VASRD  §4.71a.    There  were  no  other 
conditions within the Board’s scope of review for consideration.   
 
 
 
 
RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as 
follows  and  that  the  discharge  with  severance  pay  be  recharacterized  to  reflect  permanent 
disability retirement, effective as of the date of his prior medical separation:   
 

VASRD CODE 
5242 
5099-5003 
COMBINED 

RATING 
20% 
10% 
30% 

UNFITTING CONDITION 
Chronic Neck Pain 
Chronic Right Knee Pain 

 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, undated, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 

 

   4                                                           PD1100228 
 

 
 
 
 

 

XXXXXXXXXXXXXXXXX, DAF 
Director 
Physical Disability Board of Review 

   5                                                           PD1100228 
 

 
 

 
 
 

 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXXXX, AR20130003074 (PD201100228) 
 
 
1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the 
enclosed recommendation of the Department of Defense Physical Disability Board of 
Review (DoD PDBR) pertaining to the individual named in the subject line above to 
recharacterize the individual’s separation as a permanent disability retirement with the 
combined disability rating of 30% effective the date of the individual’s original medical 
separation for disability with severance pay.   
 
2.  I direct that all the Department of the Army records of the individual concerned be 
corrected accordingly no later than 120 days from the date of this memorandum: 
 
 
a.  Providing a correction to the individual’s separation document showing that 
the individual was separated by reason of permanent disability retirement effective the 
date of the original medical separation for disability with severance pay. 
 
 
disability effective the date of the original medical separation for disability with 
severance pay. 
 
 
account for recoupment of severance pay, and payment of permanent retired pay at 
30% effective the date of the original medical separation for disability with severance 
pay. 
 
 
and medical TRICARE retiree options. 
 
 
 
 
 
 
3.  I request that a copy of the corrections and any related correspondence be provided 
to the individual concerned, counsel (if any), any Members of Congress who have 

c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will 

d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) 

b.  Providing orders showing that the individual was retired with permanent 

   6                                                           PD1100228 
 

shown interest, and to the Army Review Boards Agency with a copy of this 
memorandum without enclosures. 
 
BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 
 
 
Encl 
 
 
 
 
 
 

     XXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

   7                                                           PD1100228