RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20040124  

 
NAME:  XXXXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200541 
BOARD DATE:  20130213 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered 
individual  (CI)  was  an  Active  National  Guard  SPC/E-4  (88M10/Transportation 
Specialist),  medically  separated  for  chronic  neck  pain  with  associated  headaches  (without 
neurologic or electrodiagnostic abnormality); and for low back pain (LBP) (without neurologic or 
electrodiagnostic  abnormality).    The  CI’s  neck  pain  began  in  June  2002  when  he fell  off  of  a 
truck.  His LBP began in about March or April 2003 when he ran through a hole during physical 
training.    The  CI  failed  conservative  treatment  measures  and  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 U2/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  neck  and  low  back  conditions  as 
unfitting,  rated  10%  and  10%,  with  application  of  the  Veterans  Affairs  Schedule  for  Rating 
Disabilities (VASRD).  The CI made no appeals, and was medically separated.   
 
 
CI CONTENTION:  “Had to have a surgery on my shoulder after medically released – Headaches 
so severe I have been totally unable to work due to these injuries from this time frame.”  The CI 
also  states,  “I  don’t  understand  why  they  allowed  me  to  deteriorate  to  a  point  that  I’m  in 
constant pain due to the things I was involved in during my deployment.”   
 
 
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  neck  pain  with  associated  headaches,  and  LBP,  meet  the  criteria 
prescribed  in  DoDI  6040.44  for  Board  purview  and  are  addressed  below.    The  shoulder 
condition  and  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 20031114 
Condition 
Chronic  Neck  Pain  w/ 
HAs (w/o neurologic …) 
LBP (w/o neurologic …) 

Code 
5299-5237 

5299-5237 

Rating 
10% 

10% 

↓No Additional MEB/PEB Entries↓ 

Code 
5237-5010 
8199-8100 
5237 

VA (6 Mos. Post-Separation) – All Effective Date 20040124 
Rating 
Condition 
10% 
Mild C-Spine DDD after Injury 
0% 
Chronic Occipital HAs 
Lumbar Spine Injury w/ Limitation 
20% 
of Motion 
Adjustment  D/O  w/  Depressed 
Mood 
Mild 
Syndrome (CTS) 
Mild LUE CTS 
Lt Shoulder S/P Anterior Capsular 
Labial Reconstruction 
0% X 2 (Includes Above)/ Not Service-Connected x 3 
Combined:  80%* 

10% 
10% 
20%* 

Tunnel 

9400 

8615 
8615 
5203 

RUE 

Carpal 

50%* 

Exam 
20040607 
20040607 
20040730 

20040730 

20040607 
20040607 
20050115 
20040730 

Combined:  20% 
*Original VARD dated 20040826 did not include the MH or left shoulder conditions; combined rating was 40%.  Left shoulder 
and combined ratings were temporarily increased to 100% effective 20041004 due to shoulder surgery and then  decreased 
back down to 10% / 80% respectively effective 20050101, per VARD dated 20050405.   
 
 
ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application 
regarding the significant impairment with which his service-connected condition continues to 
burden  him  and  his  contention  that  suggests  ratings  should  have  been  conferred  for  other 
conditions documented at the time of separation.  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.    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.  
However  the  Department  of  Veterans  Affairs  (DVA),  operating  under  a  different  set  of  laws 
(Title 38, United States Code), is empowered to compensate all service-connected conditions 
and  to  periodically  reevaluate  said  conditions  for  the  purpose  of  adjusting  the  Veteran’s 
disability  rating  should  the  degree  of  impairment  vary  over  time.    The  Board  utilizes  DVA 
evidence proximal to separation in arriving at its recommendations; and, DoDI 6040.44 defines 
a  12-month  interval  for  special  consideration  to  post-separation  evidence.    The  Board’s 
authority as defined in DoDI 6040.44, however, resides in evaluating the fairness of DES fitness 
determinations  and  rating  decisions  for  disability  at  the  time  of  separation  and  is  limited  to 
conditions adjudicated by the PEB as either unfitting or not unfitting.  Post-separation evidence 
therefore  is  probative  only  to  the  extent  that  it  reasonably  reflects  the  disability  and  fitness 
implications at the time of separation. 
 
Chronic  Neck  Pain  with  Associated  Headaches,  without  Neurologic  or  Electrodiagnostic 
Abnormality Condition.  The goniometric range-of-motion (ROM) evaluations in evidence which 
the Board weighed in arriving at its rating recommendation, with documentation of additional 
ratable criteria, are summarized in the chart below:   
 

Cervical ROM 
(Degrees) 
Flexion (45 Normal) 
Extension (45) 
R Lat Flexion (45) 
L Lat Flexion (45) 
R Rotation (80) 
L Rotation (80) 
Combined (340) 

MEB /PT ~4 Mo. Pre-Sep 
40 
45 
30 
30 
70 
65 
280 

VA C&P ~5.5 Mo. Post-Sep 
(45) 50 
(45) 65 
30 
30 
70 
70 
290 

Comment:  Spine note 2 
applied 
(limit 
to  VA 
normal ROM) 
§4.71a Rating 

Mildly  decreased 
flexion 
and  combined  ROM;  right 
trapezius muscle spasm 
10% 

Numbness/tingling in hands, pin 
prick 
decreased, 
mildly positive Tinel’s sign 
10% 

sensation 

Magnetic  resonance  imaging  (MRI)  in  July  2002,  18  months  before  separation,  showed  mild 
degenerative changes at C6/7.  The CI was evaluated by a neurosurgeon in July-August 2002 
who  did  not  recommend  surgical  intervention.    An  electromyelogram  (EMG)  and  a  nerve 
conduction study (NCS) of the upper extremities in August 2002 were normal.  At the neurology 
evaluation  in  April  2003,  9  months  prior  to  separation,  the  neurologist  noted  prior  epidural 
injections to treat neck pain and reported that “ever since he had epidural, he has been having 
bad headaches.”  The neurologist described his headaches as a “pressure-type sensation at the 
back of the head (occipital area) more on right than on left side,” with occasional “pounding” 
headaches.    The  headaches  were  not  associated  with  nausea,  focal  weakness,  or  visual 
alterations.    The  physical  exam  found  “well-localized  tenderness  in  the  right  occipital  nerve 
origin.”    The  neurological  exam  was  otherwise normal.    The  neurologist  opined that  the  CI’s 
headaches (and neck pain) were likely due to occipital neuralgia.  X-rays of the cervical spine in 
June 2003, 7 months prior to separation, showed no abnormalities.  A brain MRI in September 
2003, 4 months prior to separation, was normal.  The MEB physical exam in September 2003, 4 
months  prior  to  separation,  noted  tenderness  (spasm)  in  the  right  trapezius  muscle,  normal 
deep  tendon  reflexes  (DTRs),  and  no  muscle  atrophy  or  sensory  abnormality.    The  examiner 
noted  “no  limitation  of neck  movement.”   The ROM  is  summarized  in  the  chart  above.   The 
PEB’s 10% rating for neck pain with associated headaches for code 5299-5237 noted “combined 
ROM 280 degrees.”  At the VA Compensation and Pension (C&P) exam performed in June 2004, 
5 months after separation, the CI reported daily posterior cervical neck pain without radicular 
pain in his upper extremities.  He described numbness and tingling primarily involving the palms 
of both hands, which awoke him at night, was worsened by driving, and caused some difficulty 
in firing a weapon (he was a police officer).  The examiner noted almost daily, non-prostrating 
occipital headaches, with occasional nausea.  On physical exam, he had “full ROM.”  Strength 
and tone of upper extremity muscle groups were normal.  Pin prick sensation was decreased 
and  there  was  a  mildly  positive  Tinel  sign  over  the  wrist.    There  was  no  other  sensory 
abnormality.    DTRs  were  normal  and  symmetrical.    X-rays  of  the  cervical  spine  in  June  2004 
showed normal disc spaces, no bony abnormalities, no subluxations with flexion and extension, 
and no spinal stenosis.  The VA Rating Decision (VARD) assigned a 10% rating under code 5237-
5010, for “painful or limited motion and degenerative changes confirmed by MRI (July 2002).”  
The  ROM  is  summarized  in  the  chart,  above.    The  VARD  assigned  a  separate  0%  rating  for 
chronic occipital headaches under the analogous code 8199-8100.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  rated  the  chronic  neck  pain  with  associated  headaches  condition  under  the  single 
analogous 5237-5010, cervical strain and degenerative arthritis codes.  This coding approach is 
countenanced by AR 635-40 (B.24 f.), but IAW DoDI 6040.44 the Board must apply only VASRD 
guidance to its recommendation.  The Board must therefore apply separate codes and ratings 
in  its  recommendations  if  compensable  ratings  for  each  condition  are  achieved  IAW  VASRD 
§4.71a.    The  Board  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.    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.  Since §4.71a and 4.124a criteria are met for separate 
ratings for chronic neck pain and headaches, respectively, the Board considered separate rating 
and fitness evaluations as follows.  The Board first considered whether the headaches, having 
been  de-coupled  from  the  combined  PEB  adjudication,  remained  independently  unfitting  as 

established  above.    In  analyzing  the  intrinsic  impairment  for  fitness,  coding  and  rating  the 
headache condition, the Board is left with a questionable basis for arguing that this condition 
was independently unfitting.  The headaches and chronic neck pain were determined to have a 
common etiologic basis in occipital neuralgia; the headaches were non-prostrating and never 
profiled; and there was no evidence of unfitting or ratable peripheral nerve deficit due to the 
spine  condition.    Any  apportionment  of  limitations  to  residuals  of  the  CI’s  headaches  as 
opposed to the chronic neck pain condition would be mere speculation.  After due deliberation, 
the Board agreed that the evidence does not support a conclusion that the headaches, as an 
isolated condition separate from the chronic neck pain condition, would have rendered the CI 
incapable of continued service within his MOS, and accordingly cannot recommend a separate 
disability rating for it.  The Board therefore recommends rating the headache and chronic neck 
pain conditions together as one unfitting condition as discussed below.  The Board members 
agreed  that  the  MEB  evaluation  was  more  complete  and  held  greater  probative  value  in  its 
deliberation  of  the  chronic  neck  pain  and  associated  headaches  at  separation.    The  forward 
flexion  of  40  degrees  and  combined  ROM  of  280  degrees  separately  met  criteria  for  a  10% 
rating under code 5299-5237; stated as forward flexion greater than 30 degrees but not greater 
than  40  degrees,  and  combined  ROM  greater  than  170  degrees  but  not  greater  than  335 
degrees,  respectively;  with  or  without  symptoms  such  as  pain  (whether  or  not  it  radiates), 
stiffness,  or  aching  in  the  area  of  the  spine  affected  by  residuals  of  injury  or  disease;  and 
without  evidence  of  abnormal  spinal  contour.    There  was  insufficient  evidence  of  additional 
functional  loss  IAW  §4.40,  to  warrant  consideration  of  a  higher  evaluation.    After  due 
deliberation,  considering  all  of  the  evidence  and  mindful  of  VASRD  §4.3  (Resolution  of 
reasonable  doubt),  the  Board  concluded  that  there  was  insufficient  cause  to  recommend  a 
change in the PEB adjudication for the chronic neck pain with associated headaches, without 
neurologic or electrodiagnostic abnormality condition.   
 
  The 
Low  Back  Pain,  without  Neurologic  or  Electrodiagnostic  Abnormality  Condition. 
goniometric  ROM  evaluations  in  evidence  which  the  Board  weighed  in  arriving  at  its  rating 
recommendation,  with  documentation  of  additional  ratable  criteria,  are  summarized  in  the 
chart below. 
 

Thoracolumbar ROM 
(Degrees) 
Flexion (90 Normal) 
Extension (30) 
R Lat Flexion (30) 
L Lat Flexion (30) 
R Rotation (30) 
L Rotation (30) 
Combined (240) 
Comment:    Spine  note 
2  applied  (limit  to  VA 
normal ROM) 
§4.71a Rating 

MEB /PT ~4 Mo. Pre-Sep 

VA C&P ~6 Mo. Post-Sep 

70 
30 
15 
25 
(30) 40 
(30) 50 
200 
Mild 
paravertebral 
tenderness 
10% 

lumbar  DJD,  mild 
lumbar 

60 
10 
20 
20 
20 
20 
150 
Tenderness  at  L3-5  and 
midline,  intermittent  LE 
numbness  w/o  radiation 
of pain 
20% 

 
An  MRI  of  the  lumbar  spine  in  May  2003,  8  months  prior  to  separation,  was  reported  as  a 
“normal study.”  An EMG of the lower extremities in May 2003 was normal.   The examining 
neurologist reported no evidence of peripheral nerve entrapment and no radiculopathy based 
on a limited needle test.  The neurologist also reviewed the MRI and noted mild degenerative 
joint disease (DJD) with no herniated disc, spinal stenosis, or nerve impingement.  At the MEB 

exam in September 2003 the CI reported chronic upper and lower back pain.  The physical exam 
noted mild tenderness in the right paravertebral lumbar region.  Reflexes were normal.  There 
was no muscle atrophy or sensory abnormality.  Straight leg raising (SLR) and Waddell sign were 
negative.  He could walk on his heels and toes.  The forward flexion and combined ROM were 
mildly reduced per chart, above.  The PEB’s 10% rating for neck pain with associated headaches 
under code 5299-5237 noted “thoracolumbar combined ROM 230 degrees.”  At the C&P exam 
in July 2004, 5 month after separation, the CI reported intermittent, LBP without radiation.  His 
pain  increased  with  all  activities.    He  experienced  intermittent  numbness  in  his  legs.    He 
reported no functional losses.  He had no bladder or bowel dysfunction.  He reported erectile 
difficulty  which  was  evaluated  and  no  specific  cause  was  determined. 
  He  had  no 
hospitalizations  for  the  back  condition  or  incapacitating  episodes.    The  physical  exam  found 
tenderness  to  palpation  at  the  L3-5  level  and  midline.    On  the  neurological  exam,  strength, 
sensation,  and  DTRs  were  normal.    SLR  and  Babinski  tests  were  negative.    His  gait  was 
unimpaired.  X-rays of the lumbar spine in July 2004 showed normal height and alignment of 
the vertebral bodies; normal disc spaces; symmetry of the pars, pedicles, and sacroiliac joints; 
and a probable bone island in the L2 vertebral body, of undetermined clinical significance.  The 
ROM  is  summarized  in  the  chart,  above.    The  VARD  assigned  a  20%  rating  under  code  5237 
based on forward flexion of 60 degrees.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
Board  members  agreed  that  the  MEB  evaluation  was  more  complete  and  held  greater 
probative value in its deliberation of the LBP at separation.  The forward flexion of 70 degrees 
and combined ROM of 230 degrees separately met criteria for a 10% rating under code 5299-
5237, stated as forward flexion greater than 60 degrees but not greater than 85 degrees and 
combined ROM greater than 120 degrees but not greater than 235 degrees, respectively; with 
or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of 
the spine affected by residuals of injury or disease; without muscle spasm or guarding severe 
enough to result in an abnormal gait or abnormal spinal contour which would support a higher 
rating.    There  was  no  evidence  of  incapacitating  episodes,  or  associated  objective  non-pain 
neurologic  abnormalities,  such  as  peripheral  nerve  deficit,  which  would  warrant  other  rating 
considerations.    There  was  insufficient  evidence  of  additional  functional  loss  IAW  §4.40,  to 
warrant  consideration  of  a  higher  evaluation.    After  due  deliberation,  considering  all  of  the 
evidence  and  mindful  of  VASRD  §4.3  (Resolution  of  reasonable  doubt),  the  Board  concluded 
that there was insufficient cause to recommend a change in the PEB adjudication for the LBP 
(without neurologic or electrodiagnostic abnormality) 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.    The  Board  did  not 
surmise  from  the  record  or  PEB  ruling  in  this  case  that  any  prerogatives  outside  the  VASRD 
were  exercised.    In  the  matter  of  the  chronic  neck  pain  with  associated  headaches,  without 
neurologic  or  electrodiagnostic  abnormality,  and  the  low  back  pain,  without  neurologic  or 
electrodiagnostic  abnormality,  conditions  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.   
 

UNFITTING CONDITION 

VASRD CODE  RATING 

Chronic Neck Pain with Associated Headaches, …  
Low Back Pain, … 

 
 
 

 

5299-5237 
5299-5237 
COMBINED 

10% 
10% 
20% 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120605, 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 / XXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXX, AR20130003826 (PD201200541) 
 
 
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)