RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXX CASE: PD1200767 

BRANCH OF SERVICE: ARMY BOARD DATE: 20130423 

SEPARATION DATE: 20030123 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an Army National Guard SGT/E-5 (91B/Combat Medic) medically 
separated for neck and shoulder pain which started while doing sit-ups. Despite conservative 
treatment, the pain condition could not be adequately rehabilitated to meet the requirements 
of her Military Occupational Specialty or physical fitness standards. She was issued a 
permanent U3 profile and referred for a Medical Evaluation Board (MEB), which forwarded the 
following three diagnoses to the Physical Evaluation Board (PEB): (1) degenerative cervical 
spondylosis, (2) undifferentiated somatoform disorder, and (3) somatic manifestations of 
depression. The Physical Evaluation Board (PEB) adjudicated “neck and shoulder pain with 
degenerative cervical spondylosis” as unfitting and rated 0% IAW the US Army Physical 
Disability Agency (USAPDA) pain policy. The remaining conditions were determined to be not 
unfitting. The CI made no appeals and she was medically separated with a 0% disability rating. 

 

 

CI CONTENTION: “Persistent lower back pain/while sitting, walking, turning and laying. 
Increase[d] weakness in left leg. Early morning stiffness/aching in right arm. Severe pain in 
both knees.” 

 

 

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, 
paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for 
continued military service and those conditions identified but not determined to be unfitting by 
the PEB when specifically requested by the CI. The rating for the unfitting neck and shoulder 
pain is addressed below. All other conditions contended by the CI (low back pain [LBP], left leg 
weakness, right arm stiffness/aching, and bilateral knee pain) are not in the scope of the Board. 
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 Board for Correction of 
Military Records. 

 

 

RATING COMPARISON: 

 

Service PEB – Dated 20011220 

VA – (11 Mos. Pre-Separation) 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Neck and Shoulder Pain with 
Degenerative Cervical Spondylosis 

5099-5003 

0% 

Degenerative Disk Disease/ 
Cervical Spondylosis 

5010-
5290 

10% 

20020228 

Undifferentiated Somatoform 
Disorder 

Not Unfitting 

No VA entry 

20020228 

Somatic Manifestations of 
Depression 

Not Unfitting 

Headaches 

8100 

NSC 

20020228 

Memory Loss 

8999 

NSC 

20020228 

No Additional MEB/PEB Entries 

Other x 4 

Combined: 0% 

Combined: 10% 



Derived from VA Rating Decision (VARD) dated 20020415. 

 


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 service and VA evidence proximal to separation in arriving at its 
recommendations and DoDI 6040.44 defines a 12-month interval for special consideration of 
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 and Shoulder Pain with Degenerative Cervical Spondylosis. 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. 

 

Cervical ROM 

(Degrees) 

MEB ~16 Mo. Pre-Sep 

VA C&P ~11 Mo. Pre-Sep 

Flex (45 Normal) 

Not Measured 

 

 

 

 

 

45 (55) 

Extension (45) 

45 

R Lat Bending (45) 

25 

L Lat bending (45) 

20 

R Rotation (80) 

60 

L Rotation (80) 

55 

Combined (340) 

-- 

250 

Comment 

Pain in neck and arm with ROM and reflex testing; 
tenderness over cervical spine, throughout trapezius, 
and extending into the deltoid; spasm in trapezius 
muscle; positive Spurling’s sign with pain radiating to 
her right shoulder upon cervical extension and 
rotation; negative compression test; motor 5/5 
bilaterally; sensory normal bilaterally; reflexes 2+ and 
symmetric 

Increased cervical lordosis 
and thoracic kyphosis; 
midline and paraspinous 
muscle tenderness; no 
spasm neuro exam normal 
in bilateral upper 
extremities 

§4.71a Rating 

 

 

5290 

10% 

10% 

5293 

20% 

10% 



 

The CI first reported symptoms of neck pain after a motor vehicle accident (MVA) while on 
active duty in the Army in 1983, when she was found to have trapezius muscle spasm. When 
she was a civilian in 1988, she was again evaluated for neck pain and LBP. At that time, neck X-
rays noted “straightened cervical lordosis” and lumbar X-rays noted “mild DJD.” A Line of Duty 
(LOD) investigation documents that the CI was a Texas Army National Guard soldier, who 
experienced the onset of neck pain and back pain while doing sit-ups during an Army Physical 
Fitness Test (APFT) on 21 August 1999. Clinic notes document trapezius muscle trigger point 
tenderness. The shoulder examinations were always normal, and the shoulder pain was 
attributed to radiation of pain from the trapezius muscles. Prior to the MEB, no specific ROM 
measurements were documented, but decreased cervical flexion and extension were noted, 
due to tender trigger points in the upper lateral left neck and left upper trapezius. Outpatient 
orthopedic notes from March and April 2000 note continued neck pain and right upper 
extremity radicular symptoms. 

 

The MEB narrative summary (NARSUM) completed approximately 16 months prior to 
separation noted that, although she mentioned a MVA in 1982, the CI denied “specific injuries 
or trauma,” adding that her pain has been present for “2-3 years off and on.” At the MEB 
exam, the CI reported neck pain radiating into her head, into her right shoulder, and down her 


back. It was aggravated by movement, lifting heavy objects, or wearing Kevlar. She also 
reported right hand paresthesias and tingling, and the pain woke her up at night. The pain did 
not moderate with conservative therapy and was present approximately 50% of the time. The 
NARSUM recorded her pain as “slight and occasional.” The NARSUM also documented cervical 
spine X-ray findings of osteophyte formation and disc space narrowing at C5 through C7 levels 
with intact alignment consistent with degenerative changes and spondylosis. A cervical 
magnetic resonance imaging (MRI) demonstrated degenerative spondylosis, worse at C5-6 and 
C6-7, with significant neuroforaminal narrowing on the right at C5-6 and C6-7 and with left 
paracentral disc, osteophyte complex, and indention of the cord at C5-6. The physical 
examination findings are noted in the chart above. At the VA Compensation and Pension (C&P) 
exam approximately 11 months prior to separation, the CI reported neck pain upon arising in 
the morning, improving with motion but worsening with rest and head turning. The VA 
examination reported that she described occasional “right greater than left upper extremity 
radicular symptoms.” No objective evidence of upper extremity radiculopathy was noted. The 
VA examiner added that the “shoulder pain” was actually not in the shoulder joint itself, but 
was a combination of cervical radicular and myofascial symptoms. At the time of the VA 
examination, the CI had not yet separated from the Army National Guard pending a medical 
separation and was working as a substitute teacher and as a telemarketer. The physical 
examination findings are noted in the chart above. 

 

The 2002 Veterans Administration Schedule for Rating Disabilities (VASRD) coding and rating 
standards for the spine, which were in effect at the time of separation, were changed to the 
current §4.71a rating standards on 26 September 2003. The 2002 standards for rating based on 
ROM impairment were subject to the rater’s opinion regarding degree of severity, whereas the 
current standards specify rating thresholds in degrees of ROM impairment. When older cases 
have goniometric measurements in evidence, the Board reconciles (to the extent possible) its 
opinion regarding degree of severity for the older spine codes and ratings with the objective 
thresholds specified in the current VASRD §4.71a general rating formula for the spine. This 
promotes uniformity of its recommendations for different cases from the same period and 
more conformity across dates of separation, without sacrificing compliance with the DoDI 
6040.44 requirement for rating IAW the VASRD in effect at the time of separation. 

 

Board precedent is that a functional impairment tied to fitness is required to support a 
recommendation for addition of a peripheral nerve rating at separation. Although upper 
extremity radicular symptoms were noted in the service treatment records and both the MEB 
NARSUM and C&P examinations, no abnormal neurologic findings were ever noted and there 
was no evidence of any functional impairment. Since no evidence of functional impairment 
exists in this case, the Board cannot support a recommendation for additional rating based on 
peripheral nerve impairment. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB concluded that the degenerative cervical spondylosis, rated as “slight and occasional” was 
unfitting, and rated this condition, IAW the USAPDA pain policy, at 0% analogous to 5003. The 
VA rated the condition using code 5010 arthritis, due to trauma, substantiated by X-ray findings 
with 5290 spine, limitation of motion of at 10% based on the X-ray findings and slight decreased 
ROM of the cervical spine. Both the MEB NARSUM and the C&P examinations support a 10% 
disability rating with VASRD code 5290, the NARSUM exam for painful motion and the VA exam 
for slightly decreased ROM. The Board also considered VASRD code 5293 intervertebral disc 
syndrome. However, while both examinations noted radicular symptoms and the NARSUM 
exam noted frequency of the presence of pain, neither of the examinations noted the 
frequency or severity of intervertebral disc syndrome symptoms. The Board concluded there 
was not enough information available to determine an appropriate rating using 5293. After 
due deliberation, considering the totality of the evidence and mindful of VASRD §4.3 


Reasonable doubt, the Board recommends a disability rating of 10% for the neck and shoulder 
pain with degenerative cervical spondylosis 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 condition was adjudicated 
independently of that policy by this Board. In the matter of the neck and shoulder pain with 
degenerative cervical spondylosis condition, the Board unanimously recommends a disability 
rating of 10%, coded 5290 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, effective as of the date of her prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Neck and Shoulder Pain with Degenerative Cervical Spondylosis 

5290 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120618, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Director of Operations 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxxx, AR20130009073 (PD201200767) 

 

 

1. I have reviewed the enclosed Department of Defense Physical Disability Board of Review 
(DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. 
Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s 
recommendation to modify the individual’s disability rating to 10% without recharacterization 
of the individual’s separation. This decision is final. 

 

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. 

 

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 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 xxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)