RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20070415 

 
NAME:  XXXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1101113 
BOARD DATE:  20130213 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  National  Guard  (Temporary  Tour  of  Active  Duty)  SGT/E-5 
(19D/Cavalry Scout), medically separated for chronic neck pain, chronic low back pain (LBP) and 
right  knee  pain.    The  CI  sustained  injuries  to  his  neck,  back  and  right  knee  while  deployed.  
Degenerative disc disease of the spine and a torn lateral meniscus of the knee were shown on 
imaging.  His chronic neck, low back and right knee pain conditions did not improve adequately 
with  treatment  to  meet  the  physical  requirements  of  his  Military  Occupational  Specialty  or 
satisfy physical fitness standards.  He was issued a permanent U3/L3 profile and referred for a 
Medical Evaluation Board (MEB).  Posttraumatic stress disorder, left shoulder pain, right wrist 
pain and alcohol abuse conditions, identified in the rating chart below, were also identified and 
forwarded by the MEB.  The Physical Evaluation Board (PEB) adjudicated the chronic neck pain, 
chronic  LBP  and  the  right  knee  pain  conditions  as  unfitting,  rated  10%,  10%  and  0% 
respectively, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  
The remaining conditions were determined to be not unfitting and not considered disabilities 
(alcohol abuse).  The CI made no appeals, and was medically separated with a 20% disability 
rating.   
 
 
CI CONTENTION:  “I have daily problems with my neck, back and knees. My combined rating 
from VA is 180percent combined.  I feel my daily pain and its extent was not foreseen at the 
time of my separation. Thank you very much”.  
 
 
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.    The  not  unfit  PEB  conditions  and 
remaining conditions rated by the VA at separation 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 20070322 
Condition 
Chronic Neck Pain 
Chronic Low Back Pain 
Right Knee Pain 
(PTS) 
Left Shoulder Pain 
Right Wrist Pain 
Alcohol Abuse 

Code 
5237 
5237 
5099-5003 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not 
a 
Disability 

Rating 
10% 
10% 
0% 

Ratable 

↓No Additional MEB/PEB Entries↓ 

Spine  with  Mild 

Rating 
10% 
20% 
10% 
100% 

Code 
5242 
5237 
5010-5260 
9411 

VA (3 Mos. Post-Separation) – All Effective Date 20070416 
Condition 
Cervical 
Degenerative Changes 
Low Back Pain 
DJD Right Knee; Menisectomy 
Posttraumatic Stress Disorder 
NO VA ENTRY 
NO VA ENTRY 
NO VA ENTRY 
Degen.  Joint Disease, Left Knee 
Tinnitus 
Tender Scar, Left Shin 
Migraine Headaches 
Not Service-Connected x 2 
Combined:  100% 

5010-5262 
6260 
7804 
8100 

10% 
10% 
10% 
10% 

Exam 
20070724 
20070724 
20070724 
20070724 

20070724 
20070626 
20070724 
20070724 
 

Combined:  20% 

 
 
 
ANALYSIS SUMMARY:  The Disability Evaluation System (DES) is responsible for maintaining a fit 
and  vital  fighting  force.    While  the  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 DES 
has neither the role nor the authority to compensate members for anticipated future severity 
or  potential  complications  of  conditions  resulting  in  medical  separation  nor  for  conditions 
determined  to  be  service-connected  by  the  Department  of  Veterans  Affairs  (DVA)  but  not 
determined to be unfitting by the PEB.  However the DVA, operating under a different set of 
laws  (Title  38,  United  States  Code),  is  empowered  to  compensate  all  service-connected 
conditions and to periodically re-evaluate conditions for the purpose of adjusting the Veteran’s 
disability rating should the degree of impairment vary over time.  The Board’s role is confined 
to the review of medical records and all evidence at hand to assess the fairness of PEB rating 
determinations, compared to VASRD standards, based on severity at the time of separation.   
 
Chronic Neck Pain Condition.  There were four goniometric range-of-motion (ROM) evaluations 
and  one  non-goniometric  evaluation  in  evidence,  with  documentation  of  additional  ratable 
criteria, which the Board weighed in arriving at its rating recommendation; as summarized in 
the chart below.   
 
Cervical ROM 
(Degrees) 
Flexion (45 Normal) 
Extension (45) 
R Lat Flex (45) 
L Lat Flex (45) 
R Rotation (80) 
L Rotation (80) 
Combined (340) 
Comment 
§4.71a Rating 
 
The CI initially injured his neck in 1990 while on active duty during a motorcycle crash.  Medical 
records  from  that  time  recorded  that  he  was  able  to  get  up  and  walk  away  from  the  crash, 
however he was hospitalized for evaluation and treatment.  No neurologic complications were 
documented.    He  reinjured  the  neck  in  2004  while  deployed  in  Iraq  during  combat  and 

VA C&P  
~3 Mo. Post-Sep 
(20070724) 
40 
30 
40 
35 
45 
45 
235 
Painful motion 
No spasm 
10% 

VA 
~10 Mo. Pre-Sep 
(20060707) 
20 (30 25 20) 
10 (20 10 10) 
25 (35 35 25) 
15 (25 25 15) 
30 (38 30 30) 
35 (35 35 35) 
135 
 

Orthopedics  
~5 Mo. Pre-Sep 
(20061115) 
Not recorded 
45 
45 
45 
45 
45 
 
Painful motion 

MEB (PT)  
~5 Mo. Pre-Sep 
(20061114) 
10 (10 10 10) 
20 (22 22 22) 
20 (18 18 18) 
15 (14 14 14) 
20 (20 20 20) 
20 (18 18 18) 
105 
 

10% 

20% 

30% 

2                                                           PD1101113 
 

combative  training.    X-rays  demonstrated  degenerative  disc  and  joint  disease,  particularly  at 
the C5-6 level.  Physical therapy (PT) examination 20 October 2004 documented 3 months of 
neck pain incurred when seeking cover during combat.  On examination there was full flexion 
(100%), full extension (100%), and mildly decreased motion in side bending and rotation (75% 
of normal).  A follow up PT examination 8 November 2004 documented full flexion, extension, 
and rotation (all 100%) with mildly decreased lateral bending to both sides (75% of normal).  He 
completed his deployment in March 2005 without further injury.   
 
Orthopedic  evaluation  on  17  March  2005  upon  return  from  deployment  recorded  full  neck 
ROM  with  normal  strength  and  reflexes.    Magnetic  resonance  imaging  (MRI)  of  the  cervical 
spine 9 May 2005 demonstrated normal alignment with disc desiccation (degenerative change) 
at  all  levels  and  mild  narrowing  at  C4-5.    There  was  fusion  of  C5-6  consistent  with  a 
developmental  variation.    There  was  no  disc  herniation  or  compression  of  neural  structures.  
These findings, including the fusion of C5-6, were similar to those reporting from an MRI dated 
26 July 2000.  A 10 August 2005 PT  examination recorded full cervical spine ROM in flexion, 
extension, side bending, and rotation.  A Physical Medicine and Rehabilitation examination on 
16 February 2006 documented the neck ROM as normal.  The electrodiagnostic study (nerve 
conduction velocity and electromyogram) of bilateral upper extremities in February 2006 was 
normal.  A VA clinic examination on 7 July 2006 recorded decreased cervical spine ROM after 
repetition (flexion 20 degrees, extension 10, left lateral bending 15, right lateral bending 25, left 
rotation 35, and right rotation 30).  A 24 July 2006 neurology examination recorded the neck as 
supple.  A 2 November neurologic examination recorded a normal neurologic examination.  A 
PT ROM examination, 14 November 2006 recorded further decrease in the cervical spine ROM 
(flexion 10 degrees, extension 22, left lateral bending 14, right lateral bending 18, left rotation 
18, and right rotation 20; unchanged after repetition).  At the time of orthopedic examination 
15 November 2006, cervical spine ROM was improved.  The CI was able to extend his neck to 
look  up  at  the  ceiling  but  with  pain.    Lateral  bending  and  rotation  were  45  degrees  to  both 
sides.  Flexion was not reported.  Upper and lower extremity strength and reflexes were normal 
and sensation was intact.  X-rays of the cervical spine 16 November 2006 noted normal spinal 
curvature  with  the  previously  noted  degenerative  changes  and  fusion  of  C5-6.    The  MEB 
narrative summary (NARSUM), dictated 20 November 2006, recorded CI’s report that his neck 
was severely limiting and that it was his major complaint.  The CI reported the pain as constant, 
at  the  base  of  his  neck,  and  worsened  with  “cracking”  sensations  that  cause  radiating  pain 
down  his  arms,  trunk  and  body.    He  stated  PT,  nonsteroidal  anti-inflammatory  drugs  and 
traction  had  not  improved  his  neck  pain.    The  CI  reported  two  neck  injuries,  the  first  in  a 
motorcycle accident in 1990 when he was paralyzed from the neck down, and a second while 
deployed in 2004.  On examination, cervical spine ROM was consistent with the 15 November 
2006 orthopedic examination (flexion 40 degrees, extension 30, left lateral bending 35, right 
lateral  bending  40,  left  rotation  45,  and  right  rotation  45)  and  was  associated  with  painful 
motion.  There was no muscle spasm, and strength and reflexes were normal. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
Board  noted  that  the  examinations  of  7  July  2006  and  14  November  2006  supported 
consideration of a rating higher than the 10% adjudicated by both the PEB and the VA.  The 
Board  noted  the  CI’s  report  of  a  stable  condition  since  return  from  deployment,  and  the 
examinations  following  return  from  deployment  that  were  more  consistent  with  the 
15 November 2006 and the post separation C&P examination.  The Board therefore concluded 
that  the  15  November  2006  orthopedic  examination  and  the  C&P  examination  which  were 
more  proximate  to  separation,  best  reflected  the  overall  disability  picture  at  the  time  of 
separation.    ROM  correlated  with  the  10%  rating.    There  was  no  muscle  spasm  to  warrant 
consideration for a higher rating.  After due deliberation, considering all of the evidence and 
mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board concluded that there was 
insufficient  cause  to  recommend  a  change  in  the  PEB  adjudication  for  the  chronic  neck 
condition.   

3                                                           PD1101113 
 

Thoracolumbar ROM 
(Degrees) 
Flexion (90 Normal) 
Extension (30) 
R Lat Flex (30) 
L Lat Flex (30) 
R Rotation (30) 
L Rotation (30) 
Combined (240) 

Comment 

VA 
~10 Mo. Pre-Sep 
(20060707) 
40 (45 40 40) 
15 (25 15 15) 
25 (25 25 25) 
25 (22 25 25) 
30 (35 38 35) 
30 (30 35 35) 
165 
 

MEB (PT)  
~5 Mo. Pre-Sep 
(20061114) 
40 (40 40 40) 
20 (20 20 20) 
20 (18 18 18) 
15 (16 16 16) 
15 (16 16 18) 
20 (18 18 18) 
130 
 

Orthopedics 
~5 Mo.s Pre-Sep 
(20061115) 
Touch toes 
 
Touch knees 
Touch knees 
45 
45 
 
Lateral 
knees ~45 degrees 

bend, 

touch 

VA C&P  
~3 Mo. Post-Sep 
(20070724) 
75 (75) 
30 (30) 
30 (30) 
30 (30) 
30 (45) 
30 (45) 
225 
Painful motion,  pain at 
70 degrees flexion 
No muscle spasm 
Gait normal 
10% 

 
Chronic Low Back Pain Condition.  The NARSUM notes the CI reported LBP that began when he 
was taking cover during combat operations.  The back pain was not associated with radiation 
into the buttocks or legs, loss of sensation, or weakness.  X-rays of the lumbo-sacral spine were 
normal.  PT did not improve his symptoms.  There were four 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.   
 

§4.71a Rating 

20% 

20% 

10% 

 
The orthopedic MEB examination 15 November 2006 observed that the CI could bend at the 
knees and waist to touch his toes, able to rotate at the waist to 45 degrees in both left and right 
directions, and to laterally bend and touch his knees on both sides.  Pain was reported with two 
examination  maneuvers  not  expected  to  cause  pain.    Strength,  sensation  and  reflexes  were 
normal  throughout  the  lower  extremities  and  straight  leg  raise  tests  were  negative.    The 
orthopedic surgeon noted X-rays that day showed mild narrowing of the L5-S1 disc space but 
were otherwise normal including alignment and contour.  At the C&P examination on 24 July 
2007, 3 months after separation, the CI reported that the back pain started when dropping low 
to  seek  cover  and  that  he  later  fell  through  a  roof  top  landing  on  his  shoulder  and  back.  
Examination of the low back revealed tenderness on the spinal muscles in the lumbar regions 
but no muscle spasm.  ROM was mildly limited in flexion with painful motion in all planes per 
the chart.  Gait, muscle strength, reflexes and sensation were normal. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
Board discussed whether the disability due to the back condition more nearly approximated the 
10%  or  the  20%  rating  based  on  limitation  of  motion.    Although  the  PT  examination  in 
November 2006 supported the 20% rating, the orthopedic examination the next day reflected 
better  motion  (rotation  45  degrees,  lateral  bending  touching  the  knee  approximating  30 
degrees)  than  the  PT  examination.    The  Board  also  noted  the  mild  X-ray  findings  and  the 
improved motion at the time of the C&P examination which was more proximate to separation.  
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of 
reasonable  doubt),  the  Board  concluded  that  there  was  insufficient  cause  to  recommend  a 
change in the PEB adjudication for the chronic low back condition.   
 
Right  Knee  Pain  Condition.    The  NARSUM  notes  the  right  knee  pain  began  while  the  CI  was 
deployed and seeking cover during combat operations in 2004.  The CI subsequently underwent 
arthroscopic surgery with partial meniscectomy of the medial meniscus on 14 October 2005.  
The orthopedic surgeon recorded (5 weeks post operatively) good outcome with pain on deep 
bending with a normal right knee ROM (flexion 130 degrees, extension 0 degrees).  There were 
three  goniometric  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.   

4                                                           PD1101113 
 

 

Right Knee ROM 
(Degrees) 
Flexion (140 Normal) 
Extension (0 Normal) 

Comment 

VA Clinic 
~10 Mo. Pre-Sep 
(20060628) 
95 
5 
5 degrees loss extension 

Orthopedic MEB 
~5 Mo. Pre-Sep 
(20061115) 
135 
0 
Tenderness 
No instability 
+McMurray 
Gait normal 
10% 

VA C&P  
~3 Mo. Post-Sep 
(20070724) 
70 
0 
Painful motion 
No laxity 
+McMurray 
Gait normal 
10% 

§4.71a Rating 

10% 

 
At the orthopedic MEB examination on 15 November 2006, there was tenderness only along 
the medial joint line consistent with previous meniscectomy and pain with McMurray tests of 
the meniscus but no palpable click or pop noted.  There was also pain with shrug and grind of 
the patellofemoral joint.  There was no instability, effusion or swelling.  Gait was normal.  ROM 
was near normal per the chart.  At the C&P examination on 24 July 2007, three months after 
separation,  there  was  no  effusion,  tenderness  or  laxity.    The  C&P  exam  ROM  of  the  knee  is 
delineated in the chart provided.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
ROM in the MEB and VA examinations was not compensable under the codes for limitation of 
motion.  There was no evidence of instability or condition that could cause instability.  There 
was  no  dislocated  and  locking  meniscus.    The  CI  remained  symptomatic  status  post  partial 
meniscectomy meeting the guideline for the 10% rating under VASRD code 5259 (symptomatic 
status  post  removal  of  semilunar  cartilage).    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 condition coded 5259.  
 
 
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.    In  the  matter  of  the 
chronic neck pain condition and IAW VASRD §4.71a, the Board unanimously recommends no 
change in the PEB adjudication.  In the matter of the chronic LBP condition and IAW VASRD 
§4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter 
of the right knee pain condition, the Board unanimously recommends a disability rating of 10%, 
coded 5259 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of 
review for consideration.   
 

 

5                                                           PD1101113 
 

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:   
 

UNFITTING CONDITION 
Chronic Neck Pain 
Chronic Low Back Pain 
Right Knee Pain 

VASRD CODE  RATING 
5237 
5237 
5259 
COMBINED 

10% 
10% 
10% 
30% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20110801, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXX, DAF 
           Acting Director 
           Physical Disability Board of Review 

6                                                           PD1101113 
 

 
 

 
 
 

 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXXXXX, AR20130003805 (PD201101113) 
 
 
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 

 

7                                                           PD1101113 
 

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 
 
 
 

     XXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

8                                                           PD1101113