RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200973 SEPARATION DATE: 20020125 

BOARD DATE: 20130213 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty Soldier, SGT/E-5(63S, Heavy Wheeled Vehicle 
Mechanic); medically separated for chronic pain, neck, right shoulder, and right upper back. 
The CI injured his neck, upper back and right shoulder in a 1998 boating accident and then 
reinjured his back, neck, and shoulder when he fell off a trailer in 2001. Despite significant 
trials of physical therapy, spinal manipulations, and myofascial release to the trigger points in 
the right upper back and neck, the CI did not improve adequately to meet the physical 
requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. 
He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The 
MEB forwarded chronic right neck pain, chronic right upper back pain, and chronic right 
shoulder rotator cuff impingement syndrome IAW AR 40-501. The MEB forwarded no other 
conditions for PEB adjudication. The PEB combined all three MEB conditions and adjudicated 
chronic pain, neck, right shoulder, and right upper back as unfitting, rated 10%, with and 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: The CI states: “Neck pain, back pain, rotator cuff impingement”. Army rated 
total of 10%. VA rated total of 40.” 

 

 

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 the Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service PEB – Dated 20010904 

VA (4 Mos. Pre-Separation) – All Effective Date 20020126 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

 

Chronic Pain, Neck, Right 
Shoulder and Right Upper 
Back, Slight/Constant 

 

5099-5003 

10% 

DDD, C 4-5 w/Chronic Cervical 
Strain 

5293 

20% 

20010918 

R Shoulder Impingement 

5203 

10% 

20010918 

Chronic Thoracic Back Sprain 

5299-5291 

10% 

20010918 

.No Additional MEB/PEB Entries. 

GERD 

7346 

10% 

20010918 

0% X 2 / Not Service-Connected x 0 

20010918 

Combined: 10% 

Combined: 40% 



 

 

ANALYSIS SUMMARY: The PEB combined the chronic neck pain, chronic right shoulder pain and 
chronic right upper back pain conditions under a single code analogous to 5003 (degenerative 


arthritis) and rated 10%, relying on the USAPDA pain policy for not applying separately rated 
VASRD codes. IAW VASRD §4.71a, the Board must apply separate codes and ratings in its 
recommendations if compensable ratings for each condition are achieved. As elaborated 
below; separate compensable ratings for each condition are well supported by the evidence in 
this case. Having determined that separate ratings are warranted, however, the Board must 
also satisfy the requirement that each ‘unbundled’ condition was unfitting in and of itself. Not 
uncommonly, this approach by the PEB reflects its judgment that the constellation of conditions 
was unfitting and that there was no need for separate fitness adjudications, not a judgment 
that each condition was independently unfitting. The Board therefore exercises the prerogative 
of separate fitness recommendations in this circumstance, with the caveat that its 
recommendations may not produce a lower combined rating than that of the PEB. 

 

In this case, the neck, upper back and right shoulder impairments were well supported as 
unfitting by evidence from the narrative summary (NARSUM), service treatment record (STR) 
and the permanent profile. The commander’s statement specifically identified and implicated 
only the right shoulder, however the profile identified all the conditions as a permanent U3. 
The permanent U3 profile limited the CI to not carry or fire a rifle, limit Kevlar wear to 15 
minutes, able to wear helmet but allowed 15 minute rest periods in a soft cap, no KP, mopping 
or mowing grass, no marching, no lifting up to thirty pounds or working overhead with the right 
arm, limit running to onset of symptoms and an alternate physical fitness testing; sit-ups, bike 
but no push-ups. Separating the impairment related to the neck, upper back and the right 
shoulder requires undue speculation; and, there is clinical evidence of functional impairment 
referable to each joint. After deliberation, all members agreed that each of the conditions, in 
isolation, would have rendered the CI incapable of continued service within his MOS; and, 
accordingly each merits a separate disability rating. 

 

Chronic Neck Pain. The narrative summary (NARSUM), dictated 7 months prior to separation, 
documented pain of the lower neck, (similar to significant muscle tightness) which was a 
constant, dull ache that was exacerbated by movements of the neck or arm. The CI reported 
that his right arm felt weak compared to the left, and some loss of sensation in the ulnar nerve 
distribution. He reported no radiating pain to the arm. The CI reported activities at work 
aggravated the pain and prevented him from doing his job. A prior physical therapy 
consultation, 9 months prior to separation, demonstrated flexion chin to chest (normal), with 
pain limited right rotation of 50 degrees (normal 80) and left rotation of 65 degrees (normal 
80), and normal strength. The MEB NARSUM physical examination demonstrated tenderness 
from the C2 to T3 spinous processes and of the right cervical paraspinal muscles, negative 
Spurling’s test (cervical nerve root disorder), decreased pin-prick sensation on the right arm 
from the C5 to T1 distribution, decreased light touch on the right arm in a C7 and C8 
distribution, and normal deep tendon reflexes (DTR’s) of the upper extremities. There was right 
supraspinatus and shoulder external rotation weakness, 4/5, with pain. Cervical spine ranges of 
motion were; flexion 30 degrees (normal 45), extension 60 (normal 45), right and left lateral 
flexion 30 (normal 45), and right rotation 70 (normal 80), and left rotation 60 (normal 80), with 
painful motion. X-rays revealed mild degenerative disk disease (DDD) at C4-5. At the VA 
Compensation and Pension (C&P) exam, 4 months prior to separation, the CI reported constant, 
daily neck pain that waxed and waned with activity. Physical examination revealed no overt 
deformity, tenderness over the cervical vertebrae and spinal accessory muscles bilaterally, 
neurological findings were normal. Ranges of motion in degrees were flexion 40 (normal 45), 
extension 50 (normal 45), right rotation 55 (normal 80), left rotation 60 (normal 80). Pain, 
fatigability and weakness on motion were increased with repetitive use. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
Board carefully examined all evidentiary information available. The PEB used VASRD diagnostic 
code 5099-5003, for a combined rating of the neck, shoulder, and thoracic spine. The Board 
considered the evidence and found documented pain on motion, and the CI meets the 


minimum 10% rating using the 5003 code. The Board notes the 2002 VASRD standards for 
coding and rating were in effect at the time of the CI’s separation from service. These 
standards were subject to the rater’s opinion regarding degree of severity, whereas current 
standards specify rating thresholds in degrees of ROM impairment. The VASRD is not specific 
with delineating the criteria which satisfies the descriptors of ‘slight,` ‘moderate’ or ‘severe’ 
thus allowing the evaluator some latitude in applying these ratings. The Board considered 
VASRD code 5290 (cervical spine limitation of motion) and agreed the documented ROMs 
satisfies the slight limited descriptor and does not meet the moderate ROM impairment for the 
20% higher rating. The Board also considered VASRD code 5293 (intervertebral disc syndrome) 
used by the VA. The Board agreed the evidence does not support cervical radicular pain 
characterized as moderate, any demonstrable muscle spasm, or any incapacitating episodes 
which required physician prescribed bed rest for a higher rating under this code. The Board 
considered if the ulnar neuropathy, documented in the NARSUM as subjective weakness and 
objective sensory loss, could achieve a rating. Firm Board precedent requires a functional 
impairment tied to fitness to support a recommendation for addition of a peripheral nerve 
rating for service disability. The sensory symptoms have no documented functional 
consequences, and there are no motor deficits (well established by physical examinations). The 
CI was not dropping tools; and, grasp was unaffected. Thus, there is compelling evidence that 
the peripheral neuropathy is inconsequential to his military occupational specialty (MOS) 
requirements. After due deliberation in consideration of the preponderance of the evidence, 
there is not reasonable doubt in the CI’s favor supporting addition of any upper extremity 
radiculopathy as a separately unfitting condition for separation rating and therefore the Board 
recommends a disability rating of 10% for the chronic neck pain condition. 

 

Chronic right shoulder pain condition: The MEB NARSUM noted the CI stated he had the 
shoulder pain since a boating accident in 1998, re-aggravated by a fall off a trailer in 2001. He 
was treated conservatively, and evaluated by orthopedics, physical medicine, and physical 
therapy. His shoulder pain could not be adequately rehabilitated. His shoulder pain was 
described as sharp shooting pain that is intermittent. Physical examination found positive 
findings for impingement of the right shoulder, and decreased ranges of motion limited by pain 
summarized below. Radiological studies showed a normal magnetic resonance imaging of the 
right shoulder and an abnormal computerized tomogram (CT) which revealed subchondral 
sclerosis of the right acromioclavicular joint. At the VA C&P examination, 4 months before 
separation, the CI reported daily right shoulder pain. The VA C&P exam demonstrated 
tenderness over the coracoid process, no muscular asymmetry, negative drop on (rotator cuff 
test) and negative apprehension (anterior glenohumeral instability). 

 

ROM – R Shoulder 

In degrees (Normal) 

MEB ~7 Mo. Pre-Sep 

VA C&P ~4 Mo. Post-Sep 

Flexion (180) 

165 

150 

Abduction (180) 

160 

160 

Comment 

+Tenderness 

+Painful Motion 

+Tenderness 

+Painful Motion 

§4.71a Rating* 

10% 

10% 



*Conceding §4.59 (painful motion) 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
Board considered the VASRD diagnostic codes 5099-5003 code used by PEB. The Board finds 
non-compensable ranges of motion under codes 5201 and 5202. The Board finds evidence of 
painful motion, for application of §4.59 (painful motion), and concluded that the CI meets the 
10% adjudication and there is no evidence of incapacitating episodes to support additional or a 
20% rating under 5003. The Board then considered the VA’s chosen code 5203 (clavicle or 
scapula, impairment of). The Board does not find any evidence for a higher adjudication using 


this code. 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 shoulder 
pain condition. 

 

Chronic right upper back pain condition: The MEB NARSUM noted the CI stated he had right 
upper back pain since a boating accident in 1998, aggravated by a fall off a trailer on 2001. He 
received a series of spinal manipulations, myofascial release to trigger points with temporary 
relief but continued to have difficulty performing his duties in the Army. The right upper back 
pain was reported as sharp pain and exacerbated by movement of the head or arm. He was 
taking a nonsteroidal anti-inflammatory medication, celecoxib 200 mg per day, for this pain. 
Physical examination revealed tenderness of the spinous processes from C2 to T3. There were 
no thoracic-lumbosacral spine ranges of motion on the examination. Thoracic spine x-rays 
were normal. At the VA C&P examination the CI reported constant and daily, thoracic spine 
pain with no radiculopathy and the pain waxed and waned throughout the day dependent on 
his level of activity. No supports or braces were used for these joints. Physical examination 
demonstrated tenderness along the thoracic vertebrae and paravertebral muscles bilaterally, 
no overt deformity and normal neurological examination. Ranges-of-motion (ROMs) of the 
thoracic back were unobtainable. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
Board considered the 5099-5003 codes used by PEB. The Board found two ROMS of the 
thoracolumbar spine in the treatment record 11 months before separation after falling off 
trailer with low back pain and 10 years after separation and they were normal. VASRD § 4.45 
(the joints) directs that for the purpose of rating disability from arthritis, the cervical vertebrae, 
the dorsal vertebrae, and the lumbar vertebrae, are considered groups of minor joints, ratable 
on a parity with major joints. The Board considered §4.59 (painful motion) directing the 
intention to recognize actual painful, unstable, or malaligned joints, due to healed injury, which 
allows at least the minimum 10% rating for the joint. The Board also considered §4.14 
(avoidance of pyramiding), after subsuming painful motion in the cervical spine rating, and 
agreed the evidence is absence of isolated thoracic spine painful motion or any abnormal T-
spine radiologic findings to meet the 10% rating IAW §4.59. The Board then considered the 
VA’s chosen code 5299-5291 (dorsal spine limitation of motion). The Board notes the same 
2002 VASRD rating standards were in effect at the time of separation and the 5291 code (dorsal 
spine limitation of motion) is the only potential applicable code with the descriptors slight, 
moderate and severe. The Board agreed the evidence reflects a non-compensable ROM and 
therefore meets the slight criteria and does not achieve the moderate or severe criteria for a 
higher rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 
(reasonable doubt), the Board recommends a disability rating of 0% for the chronic thoracic 
back 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 for rating chronic neck pain, chronic right shoulder pain, 
and chronic right upper back pain was operant in this case and the condition was adjudicated 
independently of that policy by the Board. In the matter of the contended chronic neck pain 
condition, the Board unanimously agrees that it is unfitting; and, unanimously recommends a 
disability rating of 10%, coded 5009-5003 IAW VASRD §4.71a. In the matter of the contended 
chronic right shoulder pain condition, the Board unanimously agrees that it is unfitting; and, 
unanimously recommends a disability rating of 10%, coded 5009-5003 IAW VASRD §4.71a. In 
the matter of the contended chronic right upper back pain condition, the Board unanimously 
agrees that it is unfitting; and, unanimously recommends a disability rating of 0% coded 5291 


IAW VASRD §4.71a. There are 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 Neck Pain 

5099-5003 

10% 

Chronic Right Shoulder Pain 

5099-5003 

10% 

Chronic Right Upper Back Pain 

5291 

0% 

COMBINED 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120609, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

 XXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for XXXXXXXXXXXXXXXXXXXXX, AR20130003995 (PD201200973) 

 

 

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 20% 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 XXXXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards) 

 

CF: 

( ) DoD PDBR 

( ) DVA