RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
NAME:  XXXXXXXXXXXXXX 
                               BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1201305                                                              SEPARATION DATE:  20030710 
BOARD DATE:  20130205 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty PFC/E-3 (88H/Cargo Specialist) medically separated 
for  chronic  neck  pain  with  right  arm  radiculopathy  that  initially  manifested  in  January  2002.  
Despite physical therapy (PT), medications and surgery, the soldier could not be rehabilitated to 
meet  the  requirements  of  her  Military  Occupational  Specialty  (MOS)  or  physical  fitness 
standards.  She was consequently issued a permanent U3L3 profile and referred for a Medical 
Evaluation  Board  (MEB).    The  MEB  forwarded  four  diagnoses  cervical  spondylosis,  radicular 
pain, weakness in the right biceps and hand, and continued postoperative pain to the Physical 
Evaluation Board (PEB) as medically unacceptable IAW AR 40-501.  No other conditions were 
forwarded by the MEB.  The PEB incorporated all four diagnoses into the single unfitting chronic 
neck pain with right arm radiculopathy condition and rated it 20% disabling.  The CI made no 
appeals and she was medically separated with a 20% disability rating. 
 
 
CI CONTENTION: The application states “I do not feel that I was given the proper rating, when 
reviewed by VA Doctors I was given a higher disability rating.” She did not elaborate further or 
specify a request for Board consideration of any additional conditions. 
 
 
SCOPE  OF  REVIEW:    The  Board  wishes  to  clarify  that  the  scope  of  its  review  as  defined  in 
Department of Defense Instruction (DoDI) 6040.44 (Enclosure 3, paragraph 5.e.2) is limited to 
those  conditions  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  rating  for  the  unfitting  chronic  neck  pain  with  right  arm 
radiculopathy condition is 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 service Board for Correction of Military Records. 
 
 
RATING COMPARISON: 
 

Service PEB – Dated 20030426 
Condition 

Code 

Rating 

Chronic Neck Pain 
w/ Right Arm 
Radiculopathy 

8510 

20% 

↓No Additional PEB Entries↓ 

Combined:  20% 

*Both  VASRD  codes  5010  added  &  Combined  rating  to  40%  effective  20030711;  8599-8510  changed  to  8599-8513  and 
increased to 40% based on VA C&P exam of 20051031, both 5010s changed to 5010-5242 and increased to 20% & Combined 
rating to 60%, Not Service Connected to 3; effective 20050415 
 
 

Condition 

VA (5 Mos. Post Separation) –All Effective 20030711 
Rating 
20% 
10% 
10% 

Residuals, Cervical Foraminotomy w/ Right 
Sided Radiculopathy 
Degenerative Arthritis Cervical Spine 
Degenerative Arthritis Lumbosacral Spine 

5010* 
5010* 

8599-8510* 

Code 

Exam 

20031210 
20031210 
20031210 

Not Service Connected x2* 

Combined:  20%* 

for  all  of  her  service-connected  conditions,  but  must  emphasize  that 

ANALYSIS  SUMMARY:    The  Board  notes  the  current  Department  of  Veterans  Affairs  (DVA) 
ratings 
its 
recommendations are premised on severity at the time of separation.  The DVA ratings, which it 
considers  in  that  regard,  are  those  rendered  most  proximate  to  separation.    The  Disability 
Evaluation  System  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 DVA. 
 
The PEB rated chronic neck pain with right arm radiculopathy under the single 8510 (paralysis 
of  the  upper  radicular  group)  code.    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, 
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 is achieved IAW VASRD §4.71a and §4.124a.  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  reasonably  justified  as  unfitting  in  and  of 
itself.  Since §4.71a and §4.124a criteria are met for each condition in this case, the Board is 
pursuing separate fitness and rating evaluations as follows. 
 
Chronic  Neck  Pain  Condition.    The  Board  first  considered  if  the  chronic  neck  pain  condition, 
having  been  de-coupled  from  the  combined  PEB  adjudication,  remained  independently 
unfitting  as  established above.    Although the PEB  did  not  individually adjudicate the  cervical 
spondylosis and continued post-operative pain condition, collectively addressed by the PEB as 
chronic  neck  pain,  each  was  presented  in  the  MEB  evidence  as  individually  medically 
unacceptable.    Additionally,  “neck  pain”  was  noted  on  the  permanent  profile  prepared  for 
consideration  by  the  MEB/PEB  with  a  specific  limitation  of  no  helmet  wearing.    The  CI’s 
commander’s statement contained the following passage: “Because of her medical profile from 
degenerative joint disease, she is not able to work in the motor pool.”  The Board’s threshold 
for separate fitness determinations is “reasonably justified” which is consistent with the VASRD 
§4.3 (reasonable doubt) standard used for its rating recommendations, and remains adherent 
to the DoDI 6040.44 “fair and equitable” standard.  All members agreed that the chronic neck 
pain,  as  an  isolated  condition,  would  have  rendered  the  CI  incapable  of  continued  service 
within her MOS, and accordingly it merits a separate service rating. 
 
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. 
 

PEB requested addendum  

4 Mos. Pre-Sep 

Cervical ROM  
Flex (45° Normal) 

Ext (0-45°) 

R Lat Flex (0-45°) 
L Lat Flex (0-45°) 
R Rotation (0-80°) 
L Rotation (0-80°) 
COMBINED (340°) 

Comment 

NARSUM 7.5 Mos. Pre-Sep 

- 
- 
- 
- 
40° 
30° 
- 

Pos. limitation of flexion & 

extension; Pos. Spurling's test 
on right; Right biceps, triceps, 

wrist extensor, & digital 

extensor muscle weakness of 
4/5; Right deltoid weakness 
due to pain inhibition; intact 
pinprick & light touch in upper 
extremities; DTRs were 2+ and 

15° 
45° 
30° 
30° 
40° 
40° 
210° 

Motor Power: Flexion right 
elbow 3+/5; Extension right 
elbow 4+/5; Flexion right 
wrist 4+/5; Extension right 
wrist 3+/5; Right hand grip 

test-4kg, 6kg, 6kg; No 

weakness right shoulder; 
Left hand grip test-32kg, 

34kg, 27kg; Pos. 

VA C&P 5 Mos. Post-Sep 

30° 
30° 
30° 
30° 
60° 
60° 
240° 

Right shoulder stiffness due to 

neck pain; Pos. posterior 
laminectomy scar; Pos. 

tenderness, soreness & pain to 
palpation in & around the neck; 
Pos. pain throughout the range of 
motion; Pos. decreased sensation 
over the C6-7 distribution right 
hand; diminished grip & grasp 

2                                                           PD1201305 
 

§4.71a Rating* 

Current §4.71a Rating 

symmetric with no pathologic 
reflexes; No atrophy upper 

ext. 
- 
- 

radiculopathy 

Severe (30%) 

30% 

right hand; Reflexes symmetric in 

both upper extremities. 

Moderate (20%) 

20% 

*IAW the VASRD in effect at the time of separation 
 
The narrative summary (NARSUM) prepared 7 months prior to separation noted that the CI had 
onset  of  right  shoulder  pain  in  January  of2002.    In  particular,  she  recalled  the  onset  of  pain 
while doing a military press with "iron picks.”  Initially, the pain was achy in character, and it 
gradually progressed to where her right arm would "lock up.”  She developed shooting right 
arm pain that radiated down the posterior aspect of her right arm and into her right hand.  She 
also  noted  associated  numbness  and  paresthesias  in  a  similar  pattern.    She  developed 
subjective  weakness  and  noted  difficulty  with  simple  tasks  such  as  throwing  peanuts  to 
squirrels.    She  tried  non-steroidal  anti-inflammatory  drugs  and  was  referred  to  PT.    She  was 
initially  seen  in  the  neurosurgery  clinic  in  June  2002.    Magnetic  resonance  imaging  (MRI) 
showed significant spondylotic disease of the cervical spine with normal spinal cord images.  A 
computed tomography myelogram was done to further elucidate the degree of stenosis.  The 
pertinent physical exam findings are summarized in the chart above.  Hospital course revealed 
that  the  patient  underwent  a  right  C5-6  and  C6-7  cervical  foraminotomy  in  October  2002.  
Postoperatively, she experienced quite a bit of pain and spasm.  The CI felt that she had some 
new numbness into her hands.  The CI did not improve over the next several weeks, but by 6 
weeks,  she  had  some  improvement  in  her  postoperative  pain,  but  the  patient  still  had  no 
improvement as compared to her condition before surgery.  Essentially, all of her preoperative 
pain  continued.    The  CI’s  right  hand  and  arm  were  still  difficult  to  use.    She  tended  to  drop 
things.  She found it hard to open jars and she found it difficult to salute because she could not 
raise  her  right  hand.    She  continued  to  have  biceps  weakness,  as  well  as  intrinsic  hand 
weakness.  The final diagnosis was cervical spondylosis, radicular pain, weakness, right biceps 
and right intrinsic hand muscles, secondary to radicular pain and continued postoperative pain.  
The additional information requested by the PEB is summarized in the chart above.  At the MEB 
exam  accomplished  6  months  prior  to  separation,  the  CI  simply  reported  neck  surgery.    The 
MEB  physical  exam  noted  right  brachial  and  radial  reflexes  1+,  unequal  hand  grips  and 
dysesthesias in the right 1stt & 2nd metacarpals. 
 
At the VA Compensation and Pension (C&P) exam performed 5 months after separation, the CI 
reported a similar history to the one above with the following additional items.  She had no 
specific joint injury to the shoulder, elbow, or wrist, and consequently, no surgeries have been 
done there.  This had all been a neurologic radicular complaint.  She had persistent problems 
with neck and right radicular pain since surgery.  With normal daily activity, she had difficulties 
with repetitive use of the neck, right arm and hand.  Medication used at the time was Elavil.  
The  pertinent  physical  exam  findings  are  summarized  in  the  chart  above.    Plain  film  X-ray 
revealed  minimal  degenerative  arthritic  changes  of  the  bodies  of  C4  to  C7,  inclusive,  with 
minimal marginal spur formation and narrowing of the disc spaces between C5 and C6, and C6 
and C7.  The intervertebral foramina were within normal limits.  There were no cervical ribs.  
Impression: Degenerative arthritic changes of the bodies of C4 to C7, inclusive.  Another C&P 
examination performed 27 months after separation contained additional goniometric cervical 
spine ROM measurements.  That exam yielded the following results: flexion: 50 degrees with 
flexion  pain  beginning  at  40  degrees  ends  at  50  degrees;  extension:  45  degrees;  left  lateral 
flexion: 45 degrees; right lateral flexion: 45 degrees; left lateral rotation: 75 degrees and right 
lateral rotation: 75 degrees. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB applied the VASRD code of 8510, paralysis of the upper radicular group, and rated it 20% 
for a mild incomplete paralysis.  That VASRD code applies solely to the neurologic impairment 

3                                                           PD1201305 
 

of that peripheral nerve group and does not take into account the disability caused be the CI’s 
chronic neck pain.  As noted above, the chronic neck pain was adjudged to be unfitting by the 
Board and warrants a separate disability rating IAW VASRD §4.71a.  The VASRD in effect at the 
time  of  separation  utilized  the  subjective  criteria  of  slight,  moderate  and  severe  to  rate  the 
limitation of motion in the cervical spine and would have been coded 5290.  When older cases 
have goniometric measurements in evidence, the Board reconciles (to the extent possible) its 
opinion regarding degree of severity for the older spine codes and ratings with the objective 
thresholds  specified  in  the  current  VASRD  §4.71a  general  rating  formula  for  the  spine.    This 
promotes  uniformity  of  its  recommendations  for  different  cases  from  the  same  period  and 
more conformity across dates of separation (DOS), without sacrificing compliance with the DoDI 
6040.44  requirement  for  rating  IAW  the  VASRD  in  effect  at  the  time  of  separation.  
Furthermore,  the  Board  policy  (discussed  above)  of  reconciling  recommendations  under  the 
older 5290 rating schedule with current §4.71a based recommendations (when reasonable to 
do  so)  was  considered.    As  reflected  in  the  cervical  spine  ROM  chart  above,  at  the  time  of 
separation, the CI had a moderate to severe limitation of motion in her cervical spine.  Using 
the  corresponding  objective  rating  criteria  of  the  current  VASRD,  those  ROM  values  would 
result in a 20% or 30% evaluation.  At some point around the DOS, the CI’s limitation in cervical 
motion  improved  from  the  severe,  30%,  level  to  the  moderate,  20%  level.    The  ROM 
measurements of each exam were accomplished approximately equidistant on either side of 
the  date  of  separation  with  the  ROM  measurements  consistent  with  the  20%  rating  level 
present  after  separation.    Both  exams  were  equally  detailed  and  well  documented.    In 
reconciling  this  difference  in  ROM  measurements,  the  Board  discussed  two  additional 
considerations.    First,  is  the  concept  that  as  more  time  passed  after  CI’s  surgical  procedure, 
healing  and  rehabilitation  would  result  in  improved  motion  of  her  neck.    Second,  was  the 
presence of another set of cervical spine ROM measurements accomplished 27 months after 
separation.  These measurements were consistent with a “slight” limitation in motion and they 
support  the  conclusion  that  as  time  passed  after  surgery,  the  CI’s  neck  ROM  continued  to 
improve.    After  due  deliberation,  considering  all  of  the  evidence  and  mindful  of  VASRD  §4.3 
(reasonable doubt), the Board recommends a disability rating of 20% for the chronic neck pain 
condition. 
 
Right Arm Radiculopathy Condition.  The Board first considered if the right arm radiculopathy 
condition,  having  been  de-coupled  from  the  combined  PEB  adjudication,  remained 
independently unfitting as established above.  Although the PEB did not individually adjudicate 
the  radicular  pain  and  weakness,  right  biceps  and  right  intrinsic  hand  muscles  secondary 
cervical  spondylosis,  collectively  addressed  by  the  PEB  as  right  arm  radiculopathy,  each  was 
presented  in  the  MEB  evidence  as  individually  medically  unacceptable  IAW  AR  40-501.    The 
evidence  present 
in  the  service  treatment  records  documented  significant  functional 
impairment  resulting  from  the  weakness  in  the  CI’s  right  upper  extremity.    The  NARSUM 
documented that the CI tended to drop things and found it difficult to salute due to right arm 
weakness.    Objective  testing  on  several  exams  documented  significant  weakness  of  the  CI’s 
right  upper  extremity,  which  is  the  CI’s  dominant  hand.    The  Board’s  threshold  for  separate 
fitness  determinations  is  “reasonably  justified”  which  is  consistent  with  the  VASRD  §4.3 
(reasonable doubt) standard used for its rating recommendations, and remains adherent to the 
DoDI 6040.44 “fair and equitable” standard.  All members agreed that right arm radiculopathy, 
as an isolated condition, would have rendered the CI incapable of continued service within her 
MOS, and accordingly it merits a separate rating. 
 
The data contained in the NARSUM, the PEB requested addendum, the MEB history and exam 
and the C&P exam documented in the chronic neck pain section above equally applies to the 
right  arm  radiculopathy  condition  discussed  below.    Additionally,  some  of  the  comments 
contained in the cervical ROM chart above specifically pertain to rating considerations for the 
right arm radiculopathy condition. 
 

4                                                           PD1201305 
 

The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB applied the VASRD code of 8510, paralysis of the upper radicular group, and rated it 20% 
for a mild incomplete paralysis.  The VA initially applied the analogous code of 8599-8510 and 
rated it 20% also for a mild incomplete paralysis of the upper radicular peripheral nerve group.  
They later changed the code to 8513 and rated it 40% for a moderate paralysis of all radicular 
groups  in  the  CI’s  dominant  hand  with  an  effective  date  21  months  after  separation.    This 
change in coding was significant in that it now accounted for all the documented physical exam 
findings  related  to  the  CI’s  radiculopathy.    The  VASRD  in  effect  at  the  time  of  separation 
differentiated the disability related to peripheral nerve impairment based on three functional 
and anatomical locations of the muscles affected.  The upper radicular group corresponded to 
shoulder  and  elbow  movement;  the  middle  radicular  group  corresponded  to  rotation  of  the 
arm,  elbow  flexion  and  wrist  extension;  and  the  lower  radicular  group  corresponded  to  the 
intrinsic hand muscles and some or all flexors of the wrist and fingers.  A fourth VASRD code, 
8513, encompassed paralysis involving all radicular groups.  At the time of separation, the CI 
had documented objective weakness of the following movements of her right upper extremity: 
hand  grip  strength  along  with  flexion  and  extension  of  her  wrist  and  elbow.    There  was  no 
objective evidence of right shoulder weakness.  Her deep tendon reflexes were normal.  The VA 
C&P exam documented decreased sensation of the right hand while the NARSUM documented 
normal sensory function in the upper extremities.  It is noteworthy that there was a discrepancy 
between  the  MEB  addendum  prepared  for  the  PEB’s  adjudication  and  the  likely  source 
document that was prepared by a physical therapist concerning the strength testing of the CI’s 
right  arm.    The  probable  source  document  has  a  3+,  slightly  weaker,  designation  for  elbow 
flexion  and  wrist  extension  as  compared  to  the  4+  designation  for  the  same  movements 
contained  in  the  MEB  addendum.    This  discrepancy  could  be  due  to  transcription  error  or 
because  the  MEB  addendum  author  actually  did  the  testing  themself.    Under  either 
circumstance, the fact remains that the CI had objective weakness of those muscle groups.  The 
pattern of muscle weakness documented at the time of separation correlates with incomplete 
paralysis  involving  all  radicular  groups  warranting  application  of  VASRD  code  8513.    Rating 
incomplete  paralysis  of  all  radicular  groups  requires  applying  the  subjective  criteria  of  mild, 
moderate and severe along with consideration of the dominant hand.  The CI was right hand 
dominant.  While her wrist and elbow weakness was 3+ to 4+ on a five-point scale and in the 
mild, 20%, rating category, the weakness in her right hand grip strength, approximately 20% of 
the  grip  strength 
impairment.  
Additionally,  the  evidence  in  the  C&P  examination  presented  an  improving,  less  impaired, 
disability  picture  after  separation  at  a  point  equidistant  as  the  MEB  addendum  was  before 
separation.  This improving disability picture tempered the Board’s deliberation and resulted in 
settling  on  a  moderate  impairment  of  all  radicular  groups  of  the  CI’s  dominant  right  upper 
extremity.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 
(reasonable  doubt),  the  Board  recommends  a  disability  rating  of  40%  for  the  right  arm 
radiculopathy 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  condition,  the  Board  unanimously 
recommends a disability rating of 20%, coded 5290, IAW VASRD §4.71a.  In the matter of the 
right  arm  radiculopathy  condition,  the  Board  unanimously  recommends  a  disability  rating  of 
40%,  coded  8513,  IAW  VASRD  §4.124a.    There  were  no  other  conditions  within  the  Board’s 
scope of review for consideration. 
 
 

left  non-dominant  hand,  represented  a  severe 

in  her 

5                                                           PD1201305 
 

Chronic Neck Pain Condition 
Right Arm Radiculopathy Condition 

 

5290 
8513 

COMBINED 

20% 
40% 
50% 

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as 
follows;  and,  that the discharge  with  severance pay  be  recharacterized to  reflect  permanent 
disability retirement, effective as of the date of her prior medical separation. 
 

UNFITTING CONDITION 

VASRD CODE  RATING 

 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120629, w/atchs. 
Exhibit B.  Service Treatment Record. 
Exhibit C.  Department of Veterans’ Affairs Treatment Record. 
 
 
 
 
 
 
 
 

 

           xxxxxxxxxxxxxxxxxxxxxxxx, DAF 
           Acting Director 
           Physical Disability Board of Review 

6                                                           PD1201305 
 

 
 

 
 
 

 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / xxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for xxxxxxxxxxxxxxxxxx, AR20130002966 (PD201201305) 
 
 
1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the 
enclosed recommendation of the Department of Defense Physical Disability Board of 
Review (DoD PDBR) pertaining to the individual named in the subject line above to 
recharacterize the individual’s separation as a permanent disability retirement with the 
combined disability rating of 50% effective the date of the individual’s original medical 
separation for disability with severance pay.   
 
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: 
 
 
a.  Providing a correction to the individual’s separation document showing that 
the individual was separated by reason of permanent disability retirement effective the 
date of the original medical separation for disability with severance pay. 
 
 
disability effective the date of the original medical separation for disability with 
severance pay. 
 
 
account for recoupment of severance pay, and payment of permanent retired pay at 
50% effective the date of the original medical separation for disability with severance 
pay. 
 
 
and medical TRICARE retiree options. 
 
 
 
 
 
 
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 

c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will 

d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) 

b.  Providing orders showing that the individual was retired with permanent 

7                                                           PD1201305 
 

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 
 
 
 
 

     xxxxxxxxxxxxxxxxxxxxxxxx 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

8                                                           PD1201305