RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200825 SEPARATION DATE: 20031223 

BOARD DATE: 20130222 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (63B10/Light Wheel Vehicle Mechanic), 
medically separated for chronic neck and upper back pain, myofascial pain syndrome (MPS), 
with low back pain (LBP). The CI did not improve adequately with treatment to meet the 
physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness 
standards. He was issued a permanent U3/L3 profile and referred for a Medical Evaluation 
Board (MEB). The MEB forwarded no other conditions for Physical Evaluation Board (PEB) 
adjudication. The PEB adjudicated the chronic neck and upper back pain, MPS, with LBP 
condition as unfitting, rated 10%, with application of the US Army Physical Disability Agency 
(USAPDA) pain policy. The CI made no appeals, and was medically separated with a 10% 
disability rating. 

 

 

CI CONTENTION: “Herniated Disc in L-4 & 5 in spine, migraine headaches, left and right knee, 
hypertension.” 

 

 

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 remaining conditions rated by the VA 
at separation and listed on the DD Form 294, (migraine headaches, left and right knee, and 
hypertension) 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 IPEB – Dated 20030911 

VA (2 Mos. Pre-Separation) – All Effective Date 20031224 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Neck and Upper 
Back Pain, Myofascial Pain 
Syndrome w/ LBP 

5099-5003 

10% 

Myofascial Pain Syndrome, Neck 
and Upper Back and Lower Back 

5099-5021 

10%* 

20031029 

.No Additional MEB/PEB Entries. 

0% X 2 / Not Service-Connected x 2 

20031029 

Combined: 10% 

Combined: 10%** 



*VARD 20050420 changed the rating to lumbar disc disease (5243) rated 10% and myofascial pain syndrome neck, upper back 
with cervical strain (5099-5021) rated 0%, both effective the day after separation. 

 


ANALYSIS SUMMARY: 

 

Chronic Neck and Upper Back Pain, Myofascial Pain Syndrome, with LBP with a History of a 
Military Vehicle Accident. The PEB combined the chronic neck pain, upper back pain and with 
lower back pain conditions as a single unfitting condition coded analogously to 5003 and rated 
10%. The approach by the PEB not uncommonly reflected its judgment that the constellation of 
conditions was unfitting, and there was no need for separate fitness adjudications or implied 
adjudication that each condition was separately unfitting. The Board also noted that 
“bundling,” the combining of two or more major joints is permissible under the VASRD 5003 
rating requirements, and that this approach does not compromise the VASRD §4.7 directive to 
choose the higher of two valid ratings. The Board’s initial charge in this case was therefore 
directed at determining if the PEB’s approach of combining conditions under a single rating was 
justified in lieu of separate ratings. When considering a separate rating for each condition, the 
Board considers each bundled condition to be reasonably justified as separately unfitting unless 
a preponderance of evidence indicates the condition, standing alone, would not cause the 
member to be referred into the Disability Evaluation System or be found unfit because of 
physical disability. When the Board recommends separate fitness recommendations in this 
circumstance, its recommendations may not produce a lower combined rating than that of the 
PEB. 

 

The MEB narrative summary (NARSUM) records a history of “chronic neck/upper back and low 
back pain since September 2000” following a motor vehicle accident (MVA). At the time of the 
MEB NARSUM, the CI reported he was initially injured during a rollover accident in September 
2000 while riding in a Humvee (the line of duty [LOD] records the vehicle hit an embankment 
without mention of rollover). Review of the service treatment record (STR) indicates that the CI 
did not seek medical attention until approximately 6 weeks later when he sought care for 
headache and was subsequently diagnosed with migraine headache due to concussion. A 
physical therapy evaluation in November 2000 noted an upper trapezius trigger point 
associated with the headache (STRs from April and May 2000 show a history of upper trapezius 
pain prior to the vehicular accident). The record then falls silent after November 2000 with 
regard to neck pain until November 2001 when he strained the neck exercising in the gym. 
Care for LBP first appears in the STR in July 2001 when the CI reported back pain after physical 
training. The CI received intermittent care for these conditions leading to the time of the MEB. 
The Board next considered each condition separately with regard to fitness and rating 
recommendation for those conditions that are concluded to be separately unfitting as 
described above. 

 

Chronic Neck and Upper Back Pain, Myofascial Pain Syndrome. The Board noted that the 
chronic neck and upper back pain was considered to be myofascial in origin by the physical 
medicine physician and that the neck and upper back myofascial pain were intertwined. The 
upper trapezius connecting to the cervical spine was tender on examinations, and the adjacent 
lower cervical spine, C7, and upper thoracic spine region, T1-2 were stated to be tender and 
symptomatic by physical therapy. The Board therefore considered chronic myofascial neck and 
upper back pain as a single condition. The Board first considered whether the chronic 
myofascial neck/upper back pain condition was separately unfitting as described above. The 
first mention of neck pain in the STR is a physical therapy appointment in November 2000 
noting trapezius tenderness. The record falls silent until neck muscle strain at the end of 
October 2001 performing exercises in the gym and the CI was evaluated by physical therapy in 
November 2001. At the time of a physical therapy appointment 8 January 2002 the CI reported 
there was no neck pain although some stiffness remained and there was neck pain with activity 
rated 3/10. Symptoms were increased by sit ups with arms behind the head, extending the 


neck, and there was slight discomfort with running. There were no radiating symptoms. On 
examination active range-of-motion (ROM) was normal except for mild decreased left rotation 
and symptoms were increased by extension and flexion. Upper extremity ROM, strength was 
normal. Physical therapy examinations in February 2002 were similar. The CI was evaluated by 
Physical Medicine and Rehabilitation (PM&R) on 8 March 2002. The history of neck and upper 
back pain since the strain exercising in the gym a few months before was noted. On 
examination, cervical spine ROM and strength was normal and examination of the extremities 
demonstrated normal strength, reflexes and sensation. Chronic neck and upper pain due to 
MPS was diagnosed. Follow up examination by physical medicine 14 June 2002 recorded full 
cervical spine ROM in all ranges, normal strength, and negative provocative maneuvers for 
nerve root irritation. There was tenderness at the left greater occipital nerve reproducing his 
headache. The examination was otherwise unremarkable. On 13 August 2002, the CI passed 
his Army physical fitness test (APFT) with 72 pushups, 58 sit-ups and the two mile run in 15 
minutes 28 seconds. At a 21 January 2003 PM&R appointment the CI reported continued neck 
and upper back pain interfering with wear of back pack and body armor. The CI reported he 
had not taken the APFT since November 2001. The physician issued a U3L3 profile and initiated 
the MEB. The MEB NARSUM dictated on 2 April 2003 noted the history of “neck/upper back 
and low back pain” that was worse with activities and had not improved with treatment. The CI 
continued to report persistent neck/upper back pain and lower back pain aggravated by 
running, high impact activities, sit-ups, lifting, repetitive bending, wearing/carrying military 
equipment, and limited performance of his MOS and the APFT. The summary did not 
distinguish between the neck/upper back pain and the low back pain with regard to impact on 
duty. On examination there was tenderness of the neck but active ROM was normal with 
report of pain at end range. Muscle strength and reflexes were normal. The VA Compensation 
and Pension (C&P) examination was 29 October 2003, 2 months prior to separation. On 
examination posture and gait were normal and the neck was supple. The neck appeared 
normal with normal contour and no evidence of muscle atrophy. Cervical ROM was normal 
(flexion 45 degrees, extension 45, lateral bending 45 right and left, rotation 80 right and left) 
without pain on motion or evidence of discomfort. There was no evidence of any additional 
limitation by pain, fatigue, weakness or lack of endurance of instability following repetitive 
movement. The shoulders also demonstrated full ROM without discomfort with normal 
strength. Neurologic examination was normal. The examiner concluded the trapezius strain 
was resolved at that time. The C&P examiner reported a magnetic resonance imaging (MRI) of 
the cervical spine performed on 6 September 2002 was normal. 

 

The Board considered whether the myofascial neck/upper back pain condition, when 
considered alone separate from the LBP condition, was unfitting for continue military service. 
The Board noted treatment for neck/upper back pain beginning in November 2001 to the time 
of MEB, as well as the military activity limitations described in the January 2003 PM&R record, 
the April 2003 NARSUM and the commander’s statement. The Board noted that that neither 
distinguished between the neck/upper back conditions and the low back condition with regard 
to limitations. The Board reviewed the evidence of the STR and concluded there was not a 
preponderance of evidence to overcome a conclusion that the myofascial neck/upper back pain 
condition, when considered separately was unfitting for military service. The Board then 
considered its rating recommendation for the condition at the time of separation. In 
accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in 
effect at the time of separation. The Board notes that the 2002 Veteran Administration 
Schedule for Rating Disabilities (VASRD) standards for the spine, were in effect at the time of 
the PEB, were changed to the current §4.71a rating standards effective in September 2003, 
prior to the CI’s separation in December 2003. The Board therefore considered the rating 
based on the current VASRD guidelines. The Board noted that examinations from March 2002 


to the C&P examination in October 2003 always documented full ROM, full strength, and mild 
tenderness with some pain with extension. At the January 2002 physical therapy appointment 
there was no neck pain but mild neck pain (3/10) reported to occur with activity such as sit ups. 
Pain with running was characterized as slight. Records show the CI passed the APFT in August 
2002 performing 72 push-ups, 58 sit-ups and completing the run with a good time. The April 
2003 MEB NARSUM neck examination was essentially normal. The C&P examination, 2 months 
prior to separation, was completely normal. There was no limitation of motion attaining a 
compensable level, and no muscle spasm altering spinal contour. No painful motion or 
functional limitations were indicated by the C&P examination. The September 2003 MRI was 
also normal. The Board noted the condition involved neck and upper back but that separate 
ratings for neck and upper back would be based on the same disability and is prohibited by 
§4.14 (avoidance of pyramiding). After due deliberation, considering all of the evidence and 
mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 0% 
(zero) for the myofascial neck/upper back condition (5099-5021). 

 

Chronic Low Back Pain Condition. The Board first considered whether the chronic LBP condition 
was separately unfitting as described above. The CI sought care for LBP in July 2001 after 
physical training and again in April 2002. At the time of evaluation in April 2002, a non-
traumatic onset was noted and, examination recorded normal ROM and normal gait and 
posture. There are recurring visits for low back after this time. The CI presented for care of 
increased back pain the day after the August 2002 APFT. A pain clinic evaluation 10 September 
2002 recorded painful limitation of motion. The CI declined therapeutic injections. An MRI was 
reported to show a herniated L4-5 lumbar disc, however examinations consistently 
documented absence of radicular symptoms or examination findings. At a 21 January 2003 
physical medicine appointment the CI reported continued have LBP interfering with wear of 
back pack and body armor. The CI reported he had not taken the APFT since November 2001. 
The physician issued a U3L3 profile and initiated the MEB. The MEB NARSUM 2 April 2003 
noted the history of “neck/upper back and low back pain” that was worse with activities and 
had not improved with treatment. The CI continued to report persistent neck/upper back pain 
and lower back pain aggravated by running, high impact activities, sit-ups, lifting, repetitive 
bending, wearing/carrying military equipment, and limited performance of his MOS and the 
APFT. The summary did not distinguish between the neck/upper back pain and the LBP with 
regard to impact on duty. On examination muscle strength and reflexes were normal and 
provocative maneuver for lumbar nerve root irritation was negative. Thoracolumbar ROM was 
not reported. At the C&P examination, 29 October 2003, 2 months prior to separation, posture, 
gait and neurologic examination were normal. The back had a normal curvature. There was 
mild discomfort of lower back. Thoracolumbar ROM was flexion 70 degrees with “slight 
discomfort”, extension 30 degrees, lateral flexion 30 degrees left and right, rotation 45 degrees 
left and right. The examiner noted that there was no evidence of any additional limitation by 
pain, fatigue, weakness or lack of endurance of instability following repetitive movement. The 
C&P examiner reported an MRI of the lumbar spine performed 6 September 2002 
demonstrated a herniated disc at L4-5. 

 

The Board considered whether the LBP condition, when considered alone separate from the 
myofascial neck/upper back pain condition, was unfitting for continued military service. The 
Board noted treatment for LBP, results of imaging demonstrating intervertebral disc disease 
and the activity limitations described in the January 2003 PM&R record, the April 2003 
NARSUM, and the commander’s statement. The Board concluded that the evidence of the 
record reasonably supported a conclusion that the chronic LBP condition was unfitting. The 
Board then considered its rating recommendation for the condition at the time of separation. 
In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD 


in effect at the time of separation. The Board notes that the 2002 VASRD standards for the 
spine, were in effect at the time of the PEB, were changed to the current §4.71a rating 
standards effective in September 2003, prior to the CI’s separation in December 2003. The 
Board therefore considered the rating based on the current VASRD guidelines. Although the 
MEB NARSUM did not document a thoracolumbar ROM, the C&P examination which was more 
proximal to separation, documented a complete examination that reflected the overall 
disability picture at the time of separation. The limitation of motion supported a 10% under the 
current VASRD rating guidance which became effective after the PEB but prior to the date of 
separation. There was no muscle spasm causing altered gait or spinal contour to support a 
higher rating. There were no incapacitating episodes to support a rating using the rating 
formula for incapacitating episodes due to intervertebral disc syndrome. There was no 
evidence of an associated unfitting radiculopathy for consideration of a separate peripheral 
nerve rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 
(reasonable doubt), the Board recommends a disability rating of 10% for the chronic LBP 
condition coded 5237. 

 

 

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 for rating the chronic neck/upper back myofascial pain and 
LBP was operant in this case and the condition was adjudicated independently of that policy by 
the Board. As discussed above, the PEB bundled the chronic neck/upper back myofascial pain 
and LBP conditions together for a single rating. The Board considered each condition 
separately with regard to fitness and rating. In the matter of the neck/upper back myofascial 
pain condition, the Board unanimously recommends a determination of separately unfit with a 
disability rating of 0% (zero) coded 5099-5021 IAW VASRD §4.71a. In the matter of the chronic 
LBP condition, the Board unanimously recommends a determination of separately unfit with a 
disability rating of 10% coded 5237 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 his prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Chronic Low Back Pain 

5237 

10% 

Chronic Neck/Upper Back Myofascial Pain Syndrome 

5099-5021 

0 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120607, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 


 XXXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for XXXXXXXXXXXXXXX, AR20130004066 (PD201200825) 

 

 

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 description 
without modification of the combined rating or 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 XXXXXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)