RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE: ARMY 
SEPARATION DATE:  20061002 

 
NAME: DEVERE, XXXXXXXXXXXXXX 
CASE NUMBER:  PD1200276 
BOARD DATE:  201211O1 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an activated Army National Guard 1LT/0-2(15A, Aviation), medically 
separated  for  neurological  constellation  of  symptoms  of  unknown  etiology  and  a  low  back 
condition.  He did not respond adequately to treatment and was unable to perform within his 
Military Occupational Specialty (MOS), meet worldwide deployment standards or meet physical 
fitness  standards.    He  was  issued  a  permanent P3L3  profile underwent a  Medical  Evaluation 
Board (MEB).  Neurological constellation of symptoms to include shooting pain with sneezing 
from the neck down into the entire body, visual disturbance, and a decrease in his fine motor 
skills  of  his  right  hand  of  unknown  etiology  at  this  time;  and  chronic  lower  back  pain  with 
lumbar  radiculopathy  and  herniated  nucleus  pulposus  at  L5-S1  central  to  the  left  were 
forwarded to the  Physical  Evaluation  Board  (PEB)  as  medically  unacceptable  IAW  AR 40-501.  
Four  additional  conditions,  identified  in  the  rating  chart below,  were  forwarded  on  the  MEB 
submission  as  medically  acceptable  conditions.    The  PEB  adjudicated  the  neurological 
constellation of symptoms of unknown etiology; and low back condition as unfitting, rated 0% 
and 0% respectively, with application of the US Army Physical Disability Agency (USAPDA) pain 
policy.  The CI made no appeals, and was medically separated with a 0% disability rating.   
 
 
CI CONTENTION:  The CI states: “I have continued pain, soreness, and additional surgeries on 
the open heart surgery site.  Both knees have become completely disabled to the point where I 
cannot resume normal activities at all.”  
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in the 
Department of Defense Instruction (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 knee condition (Retropatellar Pain Syndrome) requested for consideration and 
the PEB unfitting conditions meet the criteria prescribed in DoDI 6040.44 for Board purview, 
and  are  accordingly  addressed  below.    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:   
 

Condition 
Severe Intermittent 
Fleeting Shooting Pains 
and Paresthesias 
Following Each Sneeze, 
Accompanied by 
Momentary Visual 
Disturbances and Brief 
Episodes of 
Incoordination of the R 
Dominant Hand 

Service PEB – Dated 20060913 

VA (2 Mos. Post-Separation) – All Effective Date 20061003 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

5099-5003 

0% 

Pre-Syncope and Dizziness 
(Claimed as Syncope and 
Neurological Disorder) 

7010-8108 

NSC 

20061205 

No MEB Entry 

 

 

Cervical Strain 
Heart Murmur, Residual ASD 
surgery 
Scars, Residual Atrial Septal 
Defect Surgery 
Mid-Chest Scar, Residual Atrial 
Septal Defect Surgery 

5237 

7099-7000 

7804 

7804 

5243 

 
 

10% 
0% 

10% 

10%* 

10% 

 
 

 

20061205 
20061205 

20061205 
20061205 

20081119 
20061205 

& 

 
 
 

5260 

10% 

20061205 

Chronic Radiating Low 
Back Pain 
Gastroesophageal Reflux 
Disease 
Irritable Bowel Syndrome 
Dyslipidemia 
Retropatellar Pain 
Syndrome 

5243 

0% 

Intervertebral Disc Syndrome 

Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 

No VA Entry 
No VA Entry 
No VA Entry 
Patellofemoral Pain Syndrome, L 
Knee 

 

 
 

 
 

↓No Additional MEB/PEB Entries↓ 

0% X 2 / Not Service-Connected x 2 

20061205 

Combined:  0% 

Combined:  40% 

*Added by a VARD increasing combined to 40%. 
 
 
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  wishes  to  clarify  that  it  is  subject  to  the  same  laws  for  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.  The Board acknowledges that an electroencephalography (EEG) was referenced in 
the service treatment record (STR) but the results were not available in the evidence before it, 
and could not be located after the appropriate inquiries.  However, the CI responded that he 
had had the study which had been scheduled prior to the MEB, in addition at the VA exam he 
reported he did not have a seizure disorder thus he likely was referencing the normal results.  
Further attempts at obtaining the relevant documentation would likely be futile and introduce 

additional  delay  in  processing  the  case.    The  missing  evidence  will  be  referenced  below  in 
relevant context, and it is not suspected that the missing evidence would significantly alter the 
Board’s recommendations.   
 
Neurological Constellation of Symptoms of Unknown Etiology Condition.  The CI began having 
episodes of sneezing which resulted in “extreme pain shooting from my neck down throughout 
my entire body, and will see starts and dots, and lose my peripheral vision” which would last 3-
4 minutes.  He had 3-4 in the summer of 2005 prior to seeing his flight surgeon in the fall of 
2005.    The  CI  underwent  an  extensive  evaluation  by  Cardiology,  Neurology,  Optometry  and 
Internal  medicine.    The  Cardiology  evaluation  revealed  a  defect  of  the  heart,  (Atrial  Septal 
defect [ASD]), which may have contributed to his symptoms and therefore this was repaired.  
The postoperative course was uneventful and even a month later the cardiologist documented 
his  prior  symptoms  of  lightheadedness  or  losing  his  vision  with  sneezing  had  gone  away.  
However,  the  episodes  reoccurred,  became  more  frequent  and  gradually  worsened.    A 
transesphogeal  echocardiogram  was  performed  which  revealed  the  "the  heart  was  fine,  and 
the  repair  was  holding."    The  Internal  Medicine  evaluation  included;  Cervical  Spine  (C-Spine) 
and brain Magnetic Resonance Imaging (MRI) studies which were within normal limits.  In late 
April  2006 the  CI  reported  new  symptoms  of  "losing  the  fine  motor  skills  in  my  right  hand".  
Multiple  neurologic  evaluations  were  conducted  which  included;  physical  exams,  laboratory 
evaluations, a repeat MRI of his C-spine, and new images of his Thoracic (T-spine) and Lumbar 
(L-spine)  spine,  nerve  conduction  studies  of  the  upper  and  lower  extremities,  and  a  lumbar 
puncture that were all were within normal limits.  The neurologist could not find any specific 
etiology  for  his  symptoms  and  opined  the  ASD  was  a  coincidental  finding.    The  Optometry 
evaluation  documented  no  abnormalities  except  for  farsightedness. 
  The  neurologist 
summarized for the MEB; the CI was evaluated extensively for Valsalva related paresthesias in 
extremities  (L’hermitte’s  sign)  with  negative  results  for  organic  causes  to  include;  multiple 
sclerosis,  cervical  stenosis  and  neuropathy  and  diagnosised  tingling  (paresthesias)  with 
subjective  complaints  related  to  neck  flexion  without  definitive  etiology  and  no  neurologic 
diagnosis.    An  electroencephalography  (EEG)  was  scheduled  after  the neurology  opinion  and 
prior  to  the  MEB  yet  the  result  was  not  in  evidence.    The  profile  allowed  for  wearing  of 
protective  mask  and  chemical  equipment  only  and  otherwise  was  limited  in  all  functional 
activities.    The  commander’s  statement  additionally  documented  the  CI  was  reassigned  to 
medical hold and that his paresthesias impacted his fine motor skills in his hands which made it 
difficult for him to be a pilot and with writing. 
 
At the MEB exam, the CI reported the episodes were occurring 2 to 3 times a week lasting 1 to 
4 minutes with all symptoms occurring 30% of the time and just visual symptoms 70% of the 
time.    These  had  been  occurring  only  with  sneezing;  however,  more  recently  he  would 
occasionally get the visual symptomatology with having a bowel movement.  The episodes did 
not occur with coughing or with a regular Valsalva maneuver to clear his ears.  He also reported 
gradually worsening in his fine motor skills in his right hand.  He did not report abnormalities 
with  his  gait  or  other  neurologic  symptoms.    He  was  concerned  with  his  sneezing  episodes 
which “could be catastrophic as a pilot” and that he had difficultly handling the instruments 
with his right hand.  The MEB physical exam documented a very fine intension tremor on the 
right, and possibly very slight on the left otherwise normal neurologic and cardiac findings.  The 
examiner  cited  the  unremarkable  laboratory;  X-rays  and  other  studies  completed  for  the 
evaluation and added no new diagnoses.  At the VA Compensation and Pension (C&P) exam, 
the  CI  additionally  reported  having;  recurring  headaches  which  were  not  migraines  which 
happened after sneezing, 3 times per week lasting 10 minutes and dizziness 3 times per week.  
He  reported  he  did  not  suffer  from  a  seizure  disorder  and  he  was  able  to  work  with 
medications.  The C&P exam additionally demonstrated a heart murmur without evidence of 

congestive heart failure, cardiomegaly, or cor pulmonale, noted normal neurologic findings and 
was silent to a tremor exam. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB assigned a rating of 0% coded analogous to 5003 (arthritis, degenerative) for infrequent 
episodes with sneezing and for moderate, intermittent pain.  The VA coded analogous to 8108 
(Narcolepsy)  with  7010 (Supraventricular  arrhythmias),  a  neurologic  and  cardiac  VASRD  code 
respectively,  for  pre-syncope  and  dizziness  symptoms  which  could  be  related  to  a  heart, 
neurologic or cervical spine condition.  Since these symptoms were not actually diagnosed the 
VA  denied  service-connection.    The  Board  considered  multiple  coding  options,  including; the 
PEB’s recommendation to code under a musculoskeletal code for pain due to possible C-spine 
pathology, the VA’s analogous coding to the neurologic code 8108, the analogous cardiac code 
7010 (Supraventricular arrhythmias), an analogous code to 8210, (tenth (vagus) nerve paralysis) 
for autonomic vasovagal symptoms, an analogous cardiac code 7000 (Valvular heart disease) 
for vasovagal symptoms related to heart disease and finally an analogous code to 8911 (petit 
mal  seizure)  for  vasovagal  symptoms  and  the other  residual  neurologic symptoms  and  signs, 
specifically  the  tremor.    Due  to  lack  of  evidence  for  C-spine  pathology  and  residual  heart 
pathology the Board agreed that a VASRD musculoskeletal or cardiac code is not applicable to 
the clinical unfitting pathology of neurologic constellations of symptoms.  This disability is not 
specifically  listed  in  the  rating  schedule;  therefore,  therefore  the  Board  considered  rating 
analogous to a disability in which not only the functions affected, but anatomical localization 
and symptoms, are closely related.  The Board considered the 8210 code and the 8911 code 
neurologic codes.  The VASRD specifies if syncope is seizure-associated to analogize to 8911 and 
if vasovagal related to analogize to 8210.  The Board agreed the evidence does not reflect a 
diagnosis of seizures, and the symptoms were more valsalva (vasovagal) related and therefore 
the Board agreed the 8210 code best captures the residual neurologic impairments without a 
diagnosis.  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  neurologic 
constellation of symptoms of unknown etiology condition.   
 
Low Back Condition.  During one of his neurologic exams the CI reported atraumatic low back 
pain with sitting which radiated into his left leg and left foot.  An MRI of the L-Spine revealed a 
moderately  large  central  and  to  the  left,  herniated  nucleus  pulposus  (HNP)  at  L5-S1,  which 
seemed  to  affect  the  S1  nerve  root  and  a  mild  bulge  at  L4-5.    He  was  referred  to  a  pain 
specialist  and  underwent  2  epidural  steroid  injections  with  a  week  of  improvement  with  the 
first and little improvement with the second.  He was further recommended to seek care with 
chiropractic treatment which resulted in no manipulations.  He reported he would seek possible 
surgical  treatment  at  a  later  date.    There  were  three  goniometric  range-of-motion  (ROM) 
evaluations  in  evidence,  with  documentation  of  additional  ratable  criteria,  which  the  Board 
weighed in arriving at its rating recommendation; as summarized in the chart below.   
 

DOS 20061002 

MED Exam ~4 Mo. Pre-

Thoracolumbar ROM 
Flexion (90⁰ Normal) 

Ext (0-30) 

R Lat Flex (0-30) 
L Lat Flex 0-30) 
R Rotation (0-30) 
L Rotation (0-30) 
Combined (240⁰) 

Comment 

Sep 

45/45/48⁰ 
10/10/10⁰ 
30/30/30⁰ 
30/28/30⁰ 
20/20/20⁰ 
20/20/20⁰ 

155⁰ 

 

MEB ~2 Mo. Pre-Sep 

VA C&P ~2 Mo. Post-Sep 

64/63/68⁰ 

30⁰ 

30/27/32⁰ 
28/28/27⁰ 
42/44/44⁰ 
43/45/46⁰ 

215⁰ 

painful motion, no 

90⁰ 
30⁰ 
30⁰ 
30⁰ 
30⁰ 
30⁰ 
240⁰ 

painful motion normal 

spasm, normal gait and 

posture 

10% 

posture, curvature, gait 

10%* 

§4.71a Rating 

20% 

*Conceding painful motion 4.59 

 
At the MEB exam, the CI reported  an average pain level is "6 to 7", aggravated by; running, 
lifting and carrying (max 20 pounds), prolonged sitting and standing (max 45 minutes each), sit-
ups and push-ups, biking, swimming and prolonged walking (max a half a mile).  The back and 
leg  pain  were  improved  with  the  use  of  narcotic  pain  medications.    The  MEB  physical  exam 
demonstrated  no  tenderness  over  the  lumbar  spine  or  SI  joint  and  normal  neuromuscular 
findings.    At  the  C&P  exam  the  CI  additionally  reported  his  condition  did  not  cause 
incapacitation  and  he  could  function  with  medication.    He  also  reported  difficulty  moving 
during  a  flare-up  but  there  was  no  evidence  of  the  frequency  of  flare-ups.    The  C&P  exam 
demonstrated  a  sensory  deficit  of  the  bilateral  posterior  thighs  otherwise  normal 
neuromuscular  findings  and  no  DeLuca  observations.    The  lumbar  spine  X-ray  findings  were 
within normal limits. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB and VA both applied the code 5243 (Intervertebral disc syndrome) which is appropriate to 
the diagnosis and rated IAW §4.71a—Schedule of Ratings–Musculoskeletal System under the 

general rating formula for diseases and injuries of the spine.  Although there are no relevant 

differences in the ratable parameters between the MEB and VA exams, it was agreed that the 
MEB evidence, 2 months prior to separation, was most probative for its proximity to the date of 
separation.  The Board notes the MEB evidence, 4 months prior to separation reflects a more 
limited  flexion  from  either  of  the  other  exams  likely  reflective  of  the  waxing  and  waning 
functional  pain  impairment  of  his  back  condition.    The  PEB’s  0%  rating,  derived  from  the 
USAPDA pain policy, is not compliant with VASRD §4.71a criteria.  The ROM measurements by 
both  the  MEB  and  VA  are  consistent  with  a  10%  rating  IAW  §4.71a.    The  Board  considered 
whether  additional  rating  could  be  recommended  under  a  peripheral  nerve  code  for  the 
residual  sciatic  radiculopathy  at  separation.    Firm  Board  precedent  requires  a  functional 
impairment tied to fitness is required to support a recommendation for addition of a peripheral 
nerve rating to disability in spine cases.  The pain component of a radiculopathy is subsumed 
under the general spine rating as specified in §4.71a.  The sensory component in this case has 
no  functional  implications;  and  no  motor  weakness  was  in  evidence.    Since  no  evidence  of 
functional  impairment  exists  in  this  case,  the  Board  cannot  support  a  recommendation  for 
additional  rating  based  on  peripheral  nerve  impairment.    There  was  no  documentation  of 
incapacitating  episodes  which  would  provide  for  higher  rating.    After  due  deliberation, 
considering  all  of  the  evidence  and  mindful  of  VASRD  §4.3  (reasonable  doubt),  the  Board 
recommends a separation rating of 10% for the low back condition. 
 
Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB 
was retropatellar pain syndrome.  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.    This  condition  was  not  profiled,  not  implicated  in  the  commander’s 
statement, and, not judged to fail retention standards.  This was 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 retropatellar 
pain syndrome 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  the 
unfitting and fitting conditions was operant in this case and the conditions were adjudicated 
independently  of  that  policy  by  the  Board.    In  the  matter  of  the  neurologic  constellation  of 
symptoms  of  unknown  etiology  condition,  the  Board  unanimously  recommends  a  disability 
rating of 10%, with the analogous code 8299-8210 IAW VASRD §4.124a.  In the matter of the 
low back condition, the Board unanimously recommends a disability rating of 10%, coded 5243 
IAW  VASRD  §4.71a.    In  the  matter  of  the  contended  retropatellar  pain  condition,  the  Board 
unanimously recommends no change from the PEB determination as not unfitting.  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 

8299-8210 

5243 

COMBINED 

10% 

10% 
20% 

Severe Intermittent Fleeting Shooting Pains and Paresthesias 
Following Each Sneeze, Accompanied by Momentary Visual 
Disturbances and Brief Episodes of Incoordination of the R 
Dominant Hand 
Chronic Radiating Low Back Pain 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120314, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXXXX, AR20120020916 (PD201200276) 
 
 
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 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 

     XXXXXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)