RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:   ARMY 
SEPARATION DATE:  20070104 

 
NAME:  XXXXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200666 
BOARD DATE:  20130131 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  Active  Guard  Reserve  (AGR)  of  the  National  Guard  SGT/E-5 
(88M/Truck  Driver),  medically  separated  for  a  cervical  spine  and  right  shoulder  conditions 
(chronic  neck  pain  status  post  C5-7  fusion  and  chronic  right  shoulder  pain  status  post  AC 
separation).  The CI did not improve adequately with conservative treatment for right shoulder 
condition  or  surgical  treatment  and  post-rehabilitative  treatment  for  the  cervical  spine 
condition 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  U3,  H2,  S3  profile  and  referred  for  a  Medical  Evaluation  Board  (MEB).  
Posttraumatic stress disorder (PTSD) and hearing loss with tinnitus conditions, identified in the 
rating chart below, were also identified and forwarded by the MEB.  The Physical Evaluation 
Board (PEB) adjudicated the cervical spine and right shoulder conditions as unfitting, rated 10% 
and 10%, respectively with application of the US Army Physical Disability Agency (USAPDA) pain 
policy.  The remaining MEB conditions were determined to be not separately unfitting and not 
rated.  The CI made no appeals, and was medically separated with a 20% combined disability 
rating.   
 
 
CI CONTENTION:  The CI elaborated no specific contention in his application.   
 
 
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.  The remaining conditions; PTSD, tinnitus 
and  bilateral  hearing  loss  and  any  combat  relation  to  his  injuries  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  PEB – Dated 20061101 

VA (2 Mos. Post-Separation) – All Effective Date 20070105 

Condition 
Chronic Neck Pain 
Chronic R/Shoulder Pain 
S/P AC Separation 
PTSD 
Hearing Loss/Tinnitus 

Code 
5241 

Rating 
10% 

5099-5003 

10% 

Not Unfitting 
Not Unfitting 

Condition 
Cervical Fusion C5-6-7 
w/Hardware 
DJD R/Acromioclavicular Joint 
w/Fractured Clavicle 
PTSD 
Tinnitus 
Bilateral Hearing Loss 

Code 
5241 

5201 
9411 
6260 
6100 

Rating 
10%* 

20% 
50% 
10% 
0% 

Exam 

20070306 

20070306 
20070306 
20070306 
20070306 

 

↓No Additional MEB/PEB Entries↓ 

Combined:  20% 

0% X # / Not Service-Connected x # 

Combined:  70% 

*increased to 20% based on 20071019 exam effective 20070815 
 

ANALYSIS  SUMMARY:    The  Board  utilizes  Department  of  Veterans  Affairs  (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  Disability  Evaluation 
System (DES) fitness determinations and rating decisions for disability at the time of separation.  
Post-separation evidence therefore is probative only to the extent that it reasonably reflects 
the disability and fitness implications at the time of separation.  The Department of Veteran 
Affairs  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. 
 
Cervical Spine Condition.  The CI sustained a fall from a 5 ton truck in Iraq in June 2004 and 
injured his neck and right shoulder.  He was medevac’d 6 months later due to worsening neck 
pain  with  radicular  symptoms  in  his  right  arm  to  include  his  index  and  middle  fingers  which 
prevented him from performing his duties in theater.  He was initially was treated with epidural 
steroid  injections  for  a  magnetic  resonance  imaging  (MRI)  confirmed  multilevel  cervical 
herniated disc disease (HNP) with a normal electromyogram (EMG).  His symptoms persisted 
and he opted for surgery with a cervical diskectomy and fusion in January 2006.  He reported 
improvement of his radicular symptoms but still had persistent pain which prevented him from 
running or wearing Kevlar.  The permanent profile limitations included; no lifting greater than 
30 pounds, unable to move with a fighting load, construct an individual fighting position, or do 
3-5  second  rushes,  allowed  to  walk  for  an  alternate  fitness  test  and  walk  at  own  pace  and 
distance.  The commander statement corroborated his limitations and documented he was not 
able to perform his duties as an 88M or his secondary MOS 63B (Light Wheel Mechanic).  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.   
 

VA C&P ~7 Mo. Post-Sep 

MEB ~4 Mo. Pre-Sep 

VA C&P ~2 Mo. Post-Sep 

45⁰ 
35⁰ 
25⁰ 
25⁰ 
65⁰ 
70⁰ 
265⁰ 

10% 

+ Tenderness; painful motion 

Cervical ROM 

Flex (45⁰ Normal) 

Ext (0-45⁰) 

R Lat Flex (0-45⁰) 
L Lat Flex (0-45⁰) 
R Rotation (0-80⁰) 
L Rotation (0-80⁰) 
COMBINED (340⁰) 

Comment 

§4.71a Rating 

40⁰ 
45⁰ 
25⁰ 
25⁰ 
50⁰ 
50⁰ 
235⁰ 

 

10% 

25⁰ 
35⁰ 
30⁰ 
35⁰ 
50⁰ 
60⁰ 
225⁰ 

 

20% 

 
The MEB physical exam demonstrated cervical tenderness with normal upper extremity deep 
tendon reflexes (DTR), motor and sensory exams.  A cervical MRI revealed anterior fusion of C5-
C7  and  moderate  left  foraminal  stenosis  at  C5-C6  and  C6-C7.    At  the  VA  Compensation  and 
Pension (C&P) exam after separation, the CI reported decreased mobility, problems with lifting 
and carrying, and lack of stamina, weakness or fatigue.  The C&P exam demonstrated normal 
posture, cervical spine fusion limited extension, normal neuromuscular findings and no Deluca 
observations.  X-rays revealed fusion with spacers C5-6-7. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
Board notes that both the MEB exam and VA exam, 2 months after separation, were complete, 
well  documented,  and  compliant  with  VASRD  §4.46  (accurate  measurement)  and  similar  in 
terms of ratable data and therefore the Board assigns both exams equal probative value.  The 
PEB and VA applied the same VASRD code and assigned a 10% rating for limitation of motion as 
both combined ROM exams meet this rating criteria which is consistent with §4.71a.  While the 
VA exam performed 7 months after separation is within the DoDI 6040.44 12-month interval 
the Board acknowledges it is less probative due to its remoteness from separation however, 

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further notes the combine ROM also meets the 10% rating criteria which is very similar to the 

MEB combined ROM.  The Board considered whether additional rating could be recommended 

under a peripheral nerve code for the residual radicular pain.  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.  Any sensory component has 
no functional implications; and there is no motor weakness 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.  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  cervical spine 
condition.   
 
Right Shoulder Condition.  The CI suffered a right acromioclavicular separation during the same 
fall which was treated conservatively.  At the time of the MEB he was evaluated by orthopedics 
and reported pain with overhead, pushing or pulling activity and no pain at rest and that he had 
a Grade II shoulder separation.  He also reported not taking medication but did need narcotic 
medication when his pain flared up and further reported most of his limitations were due to his 
neck  pain.    He  had  no  limitations  with  activities  of  daily  living  due  to  his  shoulder  but  was 
unable  to  lift  over  30  pounds  or  perform  his  MOS  duties.    Orthopedics  opined  that  possible 
distal clavicle resection may help his pain but deferred the procedure as the CI was already in 
the MEB process. 
 

MEB ~6 Mo. Pre-Sep 

VA C&P ~2 Mo. Post-Sep 

130⁰ 
120⁰ 

Painful motion, 

Loss of 5-10 degrees 

With Deluca observations 

20%** 

Right Shoulder ROM 

Flexion (0-180⁰) 

Abduction (0-180⁰) 

160⁰ 
160⁰ 

Comments 

Pain on extremes of motion 

§4.71a Rating 

10%* 

*Conceding §4.59 (painful motion) 

**with Deluca  

 
The MEB physical exam demonstrated a tender acromioclavicular joint with palpable lump.  X-
rays revealed degenerative acromioclavicular joint with no residual separation noted.  At the 
C&P exam after separation, the CI reported decreased manual dexterity, problems with lifting 
and carrying, difficulty reaching, decreased strength of the upper extremity and no flare-ups.  
The C&P exam demonstrated additional 5-10 degrees loss of all ROM planes after 5 repetitions 
of movement for Deluca observations.  The evidence reflected active extension to 130 degrees 
and the action officer opined this likely was mislabeled and should be flexion, as a normal ROM 
for extension of the shoulder is 40-60 degrees.  X-rays revealed degenerative joint disease (DJD) 
of AC joint with bone callus suggestive of old fracture distal clavicle. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
Board notes that both the MEB and VA exams were complete, well documented, and compliant 
with  VASRD  §4.46  (accurate  measurement)  however  there  is  clear  disparity  with  the  active 
ROM 
implications  regarding  the  Board's  rating 
recommendation.  The Board thus carefully deliberated its probative value assignment to these 
conflicting  evaluations.    The  ROM  values  reported  by  the  VA  examiner,  2  months  after 
separation,  are  significantly  worse  than  those  reported  by  the  MEB  dated  6  months  before 
separation.  There is not a reasonable accounting for progressively impaired AROM in the fairly 
short interval between the MEB and VA examinations.  There were no other AROM exams 12 
months prior to separation however there were passive ROM (PROM) values in the VA exam 

(AROM)  data  with  very  significant 

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mindful  of  VASRD  §4.3  (reasonable  doubt),  the  Board  concluded  that  there  was  insufficient 

which  were  similar  to  the  MEB  exam,  flexion  of  145  degrees  and  abduction  of  160  degrees.  
These PROM are more consistent with the additional evidence in the case.  Therefore, based on 
all evidence and associated conclusions just elaborated, the Board is assigning more probative 
value to the MEB evaluation.  The PEB and VA chose different coding options for the condition 
which had also significant implications on the rating for the Board to consider.  The PEB’s DA 
Form 199 reflected application of the USAPDA pain policy for rating, and its 10% determination 
coded analogous to the 5003 code (arthritis, degenerative ) is consistent with §4.71a standards.  
The Board agreed there is no evidence of incapacitating episodes to support additional or a 20% 
rating under the 5003 code.  The VA assigned a rating of 20% coded 5201 (Arm, limitation of 
motion  of)  for  arm  being  limited  at  the  shoulder  level  with  Deluca  criteria.    The  Board 
considered  VASRD  code  5203  (Clavicle  or  scapula,  impairment  of)  for  its  clinical  specificity 
however agreed the evidence does not support the 20% higher ratings for either dislocation or 

nonunion  with  loose  movement.   After due  deliberation,  considering  all  of  the  evidence  and 
cause to recommend a change in the PEB adjudication for the right shoulder 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating cervical 
spine  and  right  shoulder  condition  was  operant  in  this  case  and  the  conditions  were 
adjudicated independently of that policy by the Board.  In the matter of the cervical spine and 
right  shoulder  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, as follows:   
 

VASRD CODE  RATING 

5241 

5099-5003 
COMBINED 

10% 
10% 
20% 

UNFITTING CONDITION 

Chronic Neck Pain 
Chronic R/Shoulder Pain S/P AC Separation 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120607, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

XXXXXXXXXXXXXXXXXXXXXX, DAF 
Acting Director 
Physical Disability Board of Review 

   4                                                           PD1200666 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXX, AR20130003122 (PD201200666) 
 
 
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 
 
 
 

     XXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

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