RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200977 SEPARATION DATE: 20011025 

BOARD DATE: 20120306 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty PFC / E-3 (88M/Truck driver), medically separated for 
chronic neck, shoulder and back pain, posttraumatic. The chronic neck, shoulder, and back pain 
condition began when he suffered neck, shoulder, and back pain after an accident in which a 
trailer hit his HUMVEE in Germany in July of 2000 (and preceded by a 1998 shoulder injury). 
Despite prescriptions, physical therapy, trigger point injections at the back of his neck and his 
shoulders and profiling, his symptoms continued. In addition, the CI continued to experience 
pain from a fractured ankle/fibula in 1996 (falling on a trampoline) and in both knees. These 
conditions could not be adequately rehabilitated with treatment to meet the physical 
requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. 
He was issued a permanent P3 profile, and referred for a Medical Evaluation Board (MEB). 
Degenerative joint disease (DJD), both knees and old fracture left ankle conditions, identified in 
the rating chart below, were also forwarded by the MEB. The Physical Evaluation Board (PEB) 
adjudicated the chronic neck, shoulder, and back pain, posttraumatic condition as unfitting, 
rated 20%, with the cited application of the US Army Physical Disability Agency (USAPDA) pain 
policy. The remaining conditions were determined to be not unfitting. The CI made no appeals, 
and was medically separated with a 20% disability rating. 

 

 

CI CONTENTION: “having more pain & anxiety along with Depression.” 

 

 

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, specifically the chronic neck, shoulder, and back pain condition, will be 
reviewed in all cases. The conditions, DJD, both knees and old fracture, left ankle, as requested 
for consideration meet the criteria prescribed in DoDI 6040.44 for Board purview and, are 
addressed below. The depression and anxiety disorder conditions 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 20010718 

VA (4 ½ Mos. Post-Separation) – All Effective Date 20011026 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic neck, shoulder 
and back pain, 
posttraumatic 

5099-5003 

20% 

Residuals, lumbar spine injury 

5295 

0% 

20020307 

Residuals, injury to right 
shoulder status post 
arthroscopic rotator cuff repair 

5201 

0% 

20020307 

Residuals, left shoulder injury 
with single episode of 
dislocation 

5201 

0% 

20020307 

Residuals, cervical spine injury 

5290 

0% 

20020307 

Degenerative joint 
disease, both knees 

Not Unfitting 

Residuals, left knee injury 

5257 

0% 

20020307 

Status post-operative 
arthroscopic medial 
meniscectomy, right knee 

5257 

0% 

20020307 

Old fracture left ankle 
conditions 

Not Unfitting 

Residuals, fracture, left ankle 
status post-operative open 
reduction 

5271 

10% 

20020307 

.No Additional MEB/PEB Entries. 

0% X 1 / Not Service-Connected x 1 / 1 Deferred 

20020307 

Combined: 20% 

Combined: 10% 



 

 

ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application 
regarding the significant impairment with which his service-incurred condition continues to 
burden him. The Board also acknowledges the CI's contention suggesting that ratings should 
have been conferred for other conditions documented at the time of separation and for 
conditions not diagnosed while in the service (but later determined to be service-connected by 
the VA). The Board wishes to clarify that it is subject to the same laws for service disability 
entitlements as those under which the Disability Evaluation System (DES) operates. 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. That role and 
authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under 
a different set of laws (Title 38, United States Code). The Board evaluates DVA evidence 
proximal to separation in arriving at its recommendations, but its authority resides in evaluating 
the fairness of DES fitness decisions and rating determinations for disability at the time of 
separation. 

 

Combined Chronic Neck, Shoulder, And Back Pain Condition. In July 2000, a trailer rear ended 
the CI’s HUMVEE. The narrative summary (NARSUM) examiner completed the MEB exam and 
documented the CI had suffered a concussion as well as simultaneous neck, right shoulder and 
back pain for which he was hospitalized for 2 days. The service treatment record (STR) and the 
line of duty lack corroborating evidence of hospitalization or the suffering of a concussion. The 
CI was subsequently treated for chronic pain of the neck, right shoulder, and back, inclusive of 
myofascial pain, of these areas with multiple modalities. The pain persisted after a year of 
conservative treatment and he was issued a permanent profile and referred to a MEB. The 
permanent profile identified chronic neck and shoulder pain as a P3, rather than a U3, and 
documented the following limitations; no overhead arm movements, no flutter kicks, no 
running, no jumping, no marching, no sit-ups, no push-ups, or crunches allowed. He was 
authorized to lift up to 10 pounds, walk, bicycle, and swim at own pace and distance. The 
commander’s statement documented the profile restrictions would prevent him from wearing 
his helmet, load bearing equipment (LBE), and firing his assigned weapon. The commander 
further documented that he was not driving any motor vehicle, that he sat around in the tool 
room just doing miscellaneous work and that he was quite limited in his physical activities 
because of the pain. 

 


At the MEB exam, 5 months prior to separation, the CI reported pain and stiffness in the 
shoulders, neck and back which was constant and moderate, affected his sleep at night, and 
both hands and legs would go numb often. For relief he took narcotic based pain medication 
two to three times a day and a non-steroidal anti-inflammatory medication once a day. The 
MEB physical exam demonstrated pain with ankle dorsiflexion otherwise no mention of painful 
motion of the neck, right shoulder or low back. The Cervical spine (C-spine) range-of-motion 
(ROM) was within normal limits. The right shoulder demonstrated non compensable limited 
ROM of flexion and abduction and the low back flexion ROM lacked 20cm from the ground 
while all other back ROMs were within normal limits. The C-spine magnetic resonance imaging 
(MRI) exam revealed no evidence of stenosis or nerve impingement and the right shoulder MRI 
was normal. There were no X-rays of the low back. 

 

At the VA Compensation and Pension (C&P) exam 4 months after separation, the CI reported 
that he had had arthroscopic rotator cuff repair of his right shoulder (no date in evidence) and 
that he had arthroscopic medial meniscectomy of the right knee in January 2002. He took a 
narcotic based pain medication for relief of pain. He reported no new additional history. The 
C&P physical exam specifically for the neck, right shoulder and back demonstrated a normal 
curvature of C-spine, functional limitation in ROM due to pain of the C-spine with forward 
flexion of 50 degrees (45, normal), backward extension 50 degrees (45, normal), lateral flexion 
35 degrees bilaterally (45, normal), and rotation 45 degrees bilaterally (80, normal), for a 
combined limited ROM of 250 degrees (340 degrees normal). X-ray revealed the vertebral 
heights, disc spaces and intervertebral foramina were unremarkable; some straightening of the 
cervical lordosis and alignment of the cervical spine was normal. The right shoulder exam 
demonstrated tenderness on palpation, arthroscopic marks were healed, and functional 
limitation in ROM due to pain with flexion of 150 degrees (180 Normal) and abduction of 160 
degrees (180 Normal). X-rays revealed a normal exam. The low back exam demonstrated a 
normal curvature, gait, and neurologic findings of the lower extremities. There was functional 
limitation in ROM due to pain with 85 degrees of flexion (90 Normal). X-rays of the lumbar 
spine revealed vertebral heights, disc spaces, pedicles, and sacroiliac joints were unremarkable. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB combined the chronic neck, right shoulder, and back pain as a single unfitting condition 
coded analogously to 5003 and rated 20%. The PEB relied on the USAPDA pain policy for not 
applying separately compensable VASRD codes. The Board must apply separate codes and 
ratings in its recommendations if compensable ratings for each condition are achieved IAW 
VASRD §4.71a. If the Board judges that two or more separate ratings are warranted in such 
cases, however, it must 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 
notes the VA applied separate non compensable codes for each condition, a post separation 
exam which supports a worsening right shoulder condition that required surgery and that each 
condition demonstrated painful motion. The MEB exam prior to separation did not support 
painful motion nor any specific objective findings for separate pathologies of any of the 
conditions to include X-ray evidence for degenerative arthritis. The Board further notes the 
post separation X-ray evidence is also absent for degenerative arthritis for any of the 
conditions. Furthermore, the evidence supports the pain pathology originates from the MVA 
which likely resulted in a myofascial pain constellation of symptoms which is reflected as such 
as a P3 profile. Therefore, based on all evidence and associated conclusions just elaborated, 
the Board agreed with the PEB’s judgment that the constellation of conditions were unfitting 
and there is not a preponderance of evidence that each condition itself is separately unfitting. 
The PEB assigned the maximum 20% rating authorized by the USAPDA pain policy. The Board 
considered rating the pain disorder analogous to 5025 (fibromyalgia) and notes the 5025 code 


specifies “widespread pain means pain in both the left and right sides of the body that is above 
and below the waist…” While the subjective evidence supports this definition, the objective 
evidence does not. Furthermore even with consideration of the subjective evidence, the 
evidence meets the 10% criterion “that require continuous medication” and does not meet the 
20% criterion; “that are episodic, with exacerbations often precipitated by environmental or 
emotional stress or by overexertion, but that are present more than one-third of the time.” 
While this analogous coding approach best captures the specific clinical pathology of pain as 
the predominant symptom it does not confer a rating benefit, therefore no code change is 
recommended. After due deliberation, considering all of the evidence and mindful of VASRD 
§4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend 
a change in the PEB adjudication for the combined chronic neck, shoulder, and back pain 
condition. 

 

Contended PEB Conditions. The contended conditions adjudicated as not unfitting by the PEB 
were degenerative joint disease, knees and old fracture, left ankle. The Board’s first charge 
with respect to these conditions is an assessment of the appropriateness of the PEB’s fitness 
adjudications. The Board’s threshold for countering fitness determinations is higher than the 
VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains 
adherent to the DoDI 6040.44 “fair and equitable” standard. In March 1996 the CI fractured his 
left ankle which required bone grafting surgery for a nonunion in September 1996. He was 
casted for 3 months and thereafter received physical therapy. In November 1996 he was seen 
by orthopedic and had good ankle ROM and the X-rays revealed no displacement of the 
hardware or fracture. Since that date the STR was absent for future exams for the left ankle 
fracture condition. The CI complained of chronic knee pain at the time of the MEB. The 
evidence supported blunt right knee trauma from a fall off a horse. The knee was treated 
conservatively with temporary profiling and physical therapy. After 5 months, August 2000, the 
evidence was silent for right knee treatment. These conditions were forwarded by the MEB 
however, none of these conditions were profiled; nor implicated in the commander’s 
statement. All were reviewed by the action officer and considered by the Board. There was no 
indication from the record that any of these conditions significantly interfered with satisfactory 
duty performance. After due deliberation in consideration of the preponderance of the 
evidence, the Board concluded that there was insufficient cause to recommend a change in the 
PEB fitness determination for the any of the contended conditions and, therefore, no additional 
disability ratings can be recommended. 

 

 

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. The Board did not 
surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD 
were exercised. As discussed above, PEB reliance on the USAPDA pain policy for rating 
combined chronic neck, shoulder, and back pain condition was operant in this case and the 
condition was adjudicated independently of that policy by the Board. In the matter of the 
combined chronic neck, shoulder, and back pain condition and IAW VASRD §4.71a, the Board 
unanimously recommends no change in the PEB adjudication. In the matter of the contended 
degenerative joint disease, knees, and old fracture, left ankle conditions, the Board 
unanimously recommends no change from the PEB determinations as not unfitting. There were 
no other conditions within the Board’s scope of review for consideration. 

 

 


 

RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Chronic neck, shoulder and back pain, posttraumatic 

5099-5003 

20% 

COMBINED 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120625, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

XXXXXXXXXXXXXXXXXXXXX, DAF 

Acting Director 

Physical Disability Board of Review 

 


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 
XXXXXXXXXXXXXXXXXXXXXXXX, AR20130006081 (PD201200977) 

 

 

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 and hereby deny the individual’s application. 

This decision is final. The individual concerned, counsel (if any), and any Members of Congress 
who have shown interest in this application have been notified of this decision by mail. 

 

 BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl XXXXXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)