RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXX CASE: PD1201067 

BRANCH OF SERVICE: ARMY BOARD DATE: 20130410 

SEPARATION DATE: 20020212 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (12B/Combat Engineer) medically separated 
for a chronic thoracic area pain and myofascial pain syndrome (MPS) of upper back and 
shoulders. The CI experienced bilateral scapula and shoulder pain in 1999 while performing 
push-ups. He has been seen by the pain management clinic, orthopedics, and physical therapy 
and modified his activities with no resolution of symptoms. The condition could not be 
adequately rehabilitated 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 condition, characterized as two separate 
conditions of “chronic thoracic spine pain and myofascial pain syndrome,” was forwarded to 
the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the 
MEB. The Informal PEB (IPEB) adjudicated “chronic thoracic area pain and myofascial pain 
syndrome of upper back and shoulders” as a single unfitting condition, rated 0%, citing the US 
Army Physical Disability Agency (USAPDA) pain policy. The CI requested a formal hearing, but 
waived the request prior to hearing date; he was then medically separated with a 0% disability 
rating. 

 

 

CI CONTENTION: “Veteran was separated February 12, 2002 by MEB/PEB. He was seen by VA 
medical staff nurse practitioner Lamphier at Fort Harrison VAMC beginning April 25, 2002 for 
the disabilities that led to his involuntary discharge. At that time he was awarded 50% rating for 
the same conditions that led to his disability separation with a 0% rating. Due to the disparity in 
rating evaluations Veteran requests a review of his file for the purpose of records correction.” 

 

 

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. Ratings for unfitting conditions will be reviewed 
in all cases. The unfitting chronic thoracic area pain and MPS of upper back and shoulders 
condition meets the criteria prescribed in DoDI 6040.44 for Board 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 Board for Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20011115 

VA - (2 Mos. Post-Separation) 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Thoracic Area 
Pain & Myofascial Pain… 

5099-5021-
5003 

0% 

Hypermobility Of Right Shoulder… 

5202 

30% 

20020525 

No Additional MEB/PEB Entries 

Hypermobility Of Left Shoulder… 

5202 

20% 

20020425 

Scapulothoracic Pain Syndrome… 

5291 

10% 

20020425 

Other x 1 

20020425 

Combined: 0% 

Combined: 50% 



Derived from VA Rating Decision (VARD) dated 20030130 (most proximate to date of separation [DOS]). 


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 Veteran 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 said 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 Thoracic Area Pain and Myofascial Pain Syndrome of Upper Back and Shoulders 
Condition. The CI was first seen for bilateral shoulder pain on 7 March 2000 when he 
complained of an 8 month history of shoulder pain especially with pushups. He noted that the 
shoulders came out of place. The range-of-motion (ROM) was normal. He was evaluated in 
orthopedics and found to have hypermobile shoulders and scapular winging. He was referred 
for an evaluation for possible Marfans Syndrome, a connective tissue disorder, which was 
negative. He was again seen in orthopedics on 14 December 2000 and noted to have chronic 
pain in the thoracic spine and suprascapular area. He was referred to physical therapy (PT) 
where normal ROM was noted as well as scapular winging. He failed to respond to 
conservative management and was referred to MEB. The narrative summary (NARSUM) was 
dictated by an orthopedic surgeon on 5 October 2001, 4 months prior to separation. It noted 
that despite extensive conservative management, he had continued chronic scapulothoracic 
pain. On examination, he had “scapular waning” (winging) bilaterally with pushups. 
Hypermobility at the elbows, wrists, and scapular joints was noted. Strength and sensation 
were intact. Bilateral shoulder X-rays on 7 March 2000 were noted as being normal as were X-
rays of the thoracic spine. His chronic pain was noted as being unacceptable. At the VA 
Compensation and Pension (C&P) exam performed by a family nurse practitioner on 25 April 
2002, a little over 2 months after separation, the CI reported pain precipitated by overhead 
reaching or heavy lifting. He also noted instability, popping, weakness, and pain/numbness. He 
stated that he could not lift greater than 10 to 20 pounds, but was working as a janitor and was 
able to bowl using a 15 pound bowling ball. On examination, his ROM was reduced to 80 
bilaterally in abduction and on left flexion. Right flexion was not attempted due to pain. The 
ROM of the spine was normal. Strength of the upper extremities was reduced at 3-4/5 
bilaterally. The examiner noted shoulder dislocation on the left and potential dislocation on the 
right. Spasm of the muscles about the thoracic spine was absent. The CI was seen in 
orthopedics at the VA on 23 July 2002, 3 months after the C&P and 5 months after separation, 
and noted to have some scapular winging with resistance. Subluxation was appreciated both 
anteriorly and posteriorly. The strength was normal. He was thought to have scapulothoracic 
pain syndrome and hypermobile shoulders. 

 

The Board directed attention to its rating recommendation based on the above evidence. The 
PEB rated the chronic thoracic area pain and MPS of the upper back and shoulders at 0% using 
analogous codes for degenerative arthritis (5003) and myositis (5021). The VA rated 
hypermobility of the right shoulder with recurrent dislocation at 30% and coded it 5202, other 
impairment of the humerus. It similarly coded the left shoulder, but rated it 20% as it was the 
non-dominant arm. The scapulothoracic pain syndrome was rated 10% and coded 5291, an old 
code for limitation of motion of the thoracic spine. The Board considered the significant 
disparity between the PEB and VA ratings as well as the disparity of the C&P examination 
compared to the remainder of the record. The Board noted that the VA based the ratings for 


the right and left shoulders for recurrent dislocations which were documented on the C&P 
examination. The Board observed that while the C&P examiner, a nurse practitioner diagnosed 
dislocations, different orthopedic surgeons, both prior to separation and afterwards, noted only 
hypermobility. The VA orthopedist who examined the CI 5 months after separation also noted 
subluxation, which is not the same as dislocation, but did not note that reduction was 
necessary. The Board determined that the record does not support the presence of recurrent 
dislocations for either shoulder. The hypermobility was not found to be an unfitting condition 
or medically unacceptable; only the chronic pain was. The PEB adjudicated the pain from the 
shoulders and thoracic spine as one condition. The Board noted that the X-rays of the 
shoulders and spine were normal, the ROM normal, and motor examination normal other than 
on the C&P examination. While hypermobility of the shoulders was noted, it was also present 
in other joints. The pain was primarily related to activity. 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 chronic 
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 the chronic pain of the thoracic spine, upper back 
and bilateral shoulders was operant in this case and the condition was adjudicated 
independently of that policy by the Board. In the matter of the chronic thoracic area pain and 
MPS of upper back and shoulders condition and IAW VASRD §4.71a, the Board unanimously 
recommends no change in the PEB adjudication. 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 Thoracic Area Pain And Myofascial Pain Syndrome Of 
Upper Back And Shoulders Condition. 

5099-5021-
5003 

0% 

COMBINED 

0% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120627, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Director of Operations 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
xxxxxxxxxxxxxxxxxxxxxxxxx, AR20130009516 (PD201201067) 

 

 

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 xxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)