RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-01533
BRANCH OF SERVICE:  Army	BOARD DATE:  20141209
Separation Date:  20050104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92Y/Unit Supply Specialist) medically separated for traumatic brain injury (TBI) with residual neck pain, a back condition and a left knee problem.  These conditions 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 P3/L3/S2 profile and referred for a Medical Evaluation Board (MEB).  The TBI with residual neck pain, back and left knee conditions, characterized as “head injury, closed, with associate residual headaches, neck pain and back pain,” “adjustment disorder, chronic, with anxiety and depressed mood due to TBI;” and “left knee degenerative joint disease (DJD),” were the only conditions forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “TBI with residual neck pain and headaches;” “low back pain (LBP);” and “left knee pain with degenerative joint disease (DJD),” as unfitting, rated at 10%, 10%, and 0% respectively, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The “adjustment disorder, chronic, with anxiety and depressed mood due to TBI,” was adjudicated as not unfitting.  The PEB further adjudicated “neurocognitive complaints secondary to depression as not unfitting.”  The CI non-concurred with the IPEB findings, thus requested and was granted a Formal PEB (FPEB).  The FPEB reviewed the IPEB proceedings, and affirmed the PEB’s findings and ratings.  The CI initially concurred with the FPEB adjudication, but later withdrew his concurrence and submitted a rebuttal.  The US Army Physical Disability Agency reviewed the CI’s IPEB/FPEB proceedings and ultimately issuing an administrative correction DA Form 199-2, changing the TBI condition VARSD code from 8045 to analogous code 8045-9304.  The CI made not further appeals and was medically separated.  

CI CONTENTION:  The CI writes: “The Army PEB gave very light consideration on TBI, residual headaches, depression, anxiety attach and PTSD; give no consideration on neck pain, C-Spine problems, up back pain and shoulder pain; give no consideration on visible large scar one sqft [sic] on the neck; disregard the third degree burn caused tissue lost which limited the movement in addition to painfulness; gave no consideration on left knee injury in addition to the instability of the left knee; give no consideration of the sleep disorder; and give no consideration on the hemorrhoids diseases.  All of these residual medical conditions are still affecting this Veteran’s daily life.  I thank (sic) the PDBR would like to give a carefully review of the Veteran’s historical and current medical conditions and correct the former Army’s PEB’s downgraded disability ratings.”

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.  The ratings for the unfitting TBI with residual neck pain and headaches, LBP and left knee pain conditions are addressed below; and, no additional conditions, to include the contended conditions of PTSD, shoulder pain, scar, burns, sleep disorder, and hemorrhoids are within the DoDI 6040.44 defined purview of the Board.  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 Admin PEB – Dated 20040924	VA - (4 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
TBI with Residual Neck Pain, Headaches, and Symptoms of Anxiety and Depression	8045-9304	10%	Major Depression, with History of Memory Loss, Secondary to TBI	9434	50%	20040920	
			Migraine Headaches, Secondary to TBI	8100	10%	20040920	
			Residuals, Cervical Spine Injury	5237	0%	20040920	
LBP	5237	10%	Residuals, Low Back Injury	5237	0%	20040920	
Left Knee Pain	5099-5003	0%	Left Knee, DJD	5099-5010	10%	20040920	
Adjustment Disorder	Not Unfitting	No VA Entry				
Other x0 (Not in Scope)	Other x3	20040920	
Combined:  20%	Combined:  60%	
Derived from VA Rating Decision (VARD) dated 20050323 (most proximate to date of separation)

ANALYSIS SUMMARY:  The PEB rated the TBI with residual neck pain, headaches and symptoms of anxiety and depression condition under the single code of 8045 TBI with 9304 major depressive disorder.  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.  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.

TBI with Residual Neck Pain, Headaches, and Symptoms of Anxiety and Depression Condition:  The Board first considered if the TBI with residual neck pain, headaches and symptoms of anxiety and depression conditions having been de-coupled from the combined PEB adjudication, remained independently unfitting as established above.  The CI was issued a permanent P3/L3/S2 profile for jump injuries with concussion/headaches, lower back pain/neck pain, left knee DJD and depression with specific restrictions related to his physical conditions.  The commander’s statement focused on the TBI residuals of memory impairment, neck strain along with specific references to the knee injury and headaches.  The MEB identified the closed head injury, with associated residual headaches, neck pain and back pain, along with the depressive symptoms as adjustment disorder, chronic, with anxiety and depressed mood due to TBI.

The Board first considered if the residual neck pain condition was “reasonably justified” as separately unfitting.  The well-established principle for fitness determinations is that they are performance-based.  The Board could not find evidence in the commander’s statement or elsewhere in the treatment record that documented any significant interference of the neck pain condition with the performance of duties at the time of separation, nor were any physical findings documented by the MEB or VA examiners which would logically be associated with significant disability.  All members agreed that residual neck pain was not separately unfitting as an isolated condition and would not have rendered the CI incapable of continued service within his MOS.

All of members agreed that the residual symptoms of anxiety and depression condition were considered purely subjective complaints and should be viewed as part of the TBI residuals.  The MEB examiner diagnosed adjustment disorder, chronic, with anxiety and depressed mood due to TBI which is neither compensable nor ratable.  All members agreed that the symptoms of anxiety and depression condition were not separately unfitting as an isolated condition would not have rendered the CI incapable of continued service within his MOS.

The Board then turned their attention to the residual migraine headache condition.  The Board considered if the migraine headache condition, having been de-coupled from the combined PEB adjudication, was “reasonable justified” as separately unfitting.  The TBI-associated migraine headaches condition was subsumed by the PEB under the code 8045 rating.  Members agreed that this was a distinct neurological condition that could be separately rated under its own VASRD code as allowed under code 8045.  Members further agreed that migraine headaches condition was reasonably justified as separately unfitting, and thus eligible for a rating.

TBI with Residual Neck Pain, and Symptoms of Anxiety and Depression.  The CI suffered a mild head injury while attending airborne school in July 2001 and then suffered a second head injury in February 2003.  He complained of a one-year history of neck pain as a result of his first head injury.  A cervical spine X-ray showed a loss of the normal cervical lordosis which was possibly due to spasm.  A second cervical spine X-ray performed after the second head injury in February 2003 showed a straightening of the normal lordotic curvature secondary to positioning or spasm.  The CI was evaluated by a general medicine provider for a 5-day history of dizziness, drooling, loss of memory, nausea, blurred vision and headaches after his head injury.  The physical findings were normal.  Based on the CI’s subjective complaints, the examiner diagnosed post-concussive syndrome.  The CI was referred to a chiropractor for neck manipulation and followed for treatment throughout 2003.  Neuropsychological testing was completed 27 March 2003 for an early post injury baseline and demonstrated common symptoms that appear early in the recovery process from a head injury.  The examiner diagnosed adjustment disorder with mixed anxiety and depressed mood, cognitive disorder, not otherwise specified; history of minor head injury and assigned a Global Assessment of Functioning of 70, some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships.  A brain magnetic resonance imaging (MRI) done for headaches and insomnia was essentially normal.  The neurologist noted that the CI felt depressed and diagnosed chronic neck pain without evidence of a radiculopathy and cognitive changes of decreased attention, memory secondary to TBI and depression.  The chiropractor noted that the neck was slightly better.  The CI underwent repeat neuropsychological testing on 19 September 2003 and the examiner concluded that the personality testing was consistent with depression and it was unclear if the mild cognitive deficits observed were due to depression or TBI.  The examiner diagnosed moderate, major depression, single episode.  The specialty care MEB addendum 12 months prior to separation documented mildly limited flexion range-of-motion (ROM) of 70%; however there was no tenderness to palpation over the posterior aspect of the cervical spine.  A neurologist provider MEB addendum (12 months prior to separation), documented ongoing memory problems, some motor slowing, decreased reaction, some anxiety, some difficulty with lack of concentration and loss of focus.  The neurologist further noted that the CI reported having a sleep disorder, short term memory, concentration, learning and reading retention problems which had been ongoing since his concussions.  The examiner diagnosed memory loss probably secondary to depression; increased fatigue secondary to lack of sleep and/or depression.  An electroencephalogram (EEG) performed for dementia and concussive syndrome was normal.  A cervical spine MRI done for multiple head injuries showed mild multilevel degenerative disc disease without evidence of distinct nerve root involvement.  

A third battery of neuropsychological testing performed on 12 August 2004 noted impairment of concentration and attention, feelings of anger, anxiety, depression and mood fluctuations, insomnia, reduced energy and activity levels, hopelessness and helplessness, phobic fear of heights, panic attacks hyper startle and nightmares, flashbacks of the static line injury.  The examiner concluded that there was evidence of cognitive impairment that ranged from mild to severe.  The examiner further concluded that the results of the personality evaluation were invalid because there were no there informants to corroborate the information and there was evidence to suggest a deliberate attempt to exaggerate the symptoms of psychopathology.  The examiner diagnosed moderate, recurrent major depressive disorder, panic disorder with agoraphobia, and rule out PTSD.  A MEB examination’s psychiatric addendum (performed approximately 8 months prior to separation), documented the CI’s reported occasional dizziness, sexual dysfunction insomnia and depression.  The examiner opined that the CI reported multiple somatic symptoms including decreased concentration, sexual dysfunction however there was evidence that his condition was improving.  The examiner diagnosed chronic adjustment disorder with anxiety and depressed mood due to TBI.  The MEB narrative summary (NARSUM) exam (performed approximately 8 months prior to separation), documented chronic neck pain, dizziness and difficulty with memory however there was a normal cervical spine exam.  The VA Compensation and Pension (C&P) exam (performed approximately 3 months prior to separation) documented memory loss, dizziness and chronic neck pain with limited ROM turning his head from side to side during flare-ups; however there was no incapacitation from work and the physical exam was normal.

The Board directed attention to its rating recommendation based on the above evidence, which must accommodate the DoDI 6040.44 requirement that its recommendations be premised on the VASRD in effect at the time of separation.  The only available code for rating TBI in 2005 was 8045 (Brain disease due to trauma).  Since its interpretation is a fundamental consideration in this case, it is excerpted below.

Purely neurological disabilities, such as hemiplegia, epileptiform seizures, facial nerve paralysis, etc., following trauma to the brain, will be rated under the diagnostic codes specifically dealing with such disabilities, with citation of a hyphenated diagnostic code (e.g., 8045–8207).

Purely subjective complaints such as dizziness, insomnia, etc., recognized as symptomatic of brain trauma, will be rated 10 percent and no more under diagnostic code 9304.  This 10 percent rating will not be combined with any other rating for a disability due to brain trauma. Ratings in excess of 10 percent for brain disease due to trauma under diagnostic code 9304 are not assignable in the absence of a diagnosis of multi-infarct dementia associated with brain trauma.

There was ample evidence in the service treatment record (STR) that the CI’s symptoms of dizziness, headache, depression, anxiety, insomnia and memory loss were all attributed to the TBI.  As noted above the Board agreed that the residual neck pain, anxiety and depression were residuals of TBI and not separately unfitting.  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 TBI with residual neck pain, and symptoms of anxiety and depression condition coded 8045-9304.

Migraine Headache Condition:  The CI suffered a mild head injury during airborne school in July 2001 and then suffered a second head injury in February 2003.  Approximately 2 weeks after the second concussion, the CI noted continuous photophobia, phonophobia and migraine headaches.  The medical examiner documented constant headaches with sharp pains in the back of the head and blurred vision for 5 days.  The neurologist noted headaches for 5 months with nausea and photophobia.  The neuropsychologist on 27 March 2003 noted that the CI experienced headaches approximately five-to-seven times per week with pain that felt like a band being tightened on his head.  A brain MRI performed for headaches and insomnia was essentially normal.  The medical examiner documented “headaches for three days” that the CI had trouble concentrating.  The CI had two emergency room visits for headaches in January and February 2004.  The neurologist documented an increase in headaches with diplopia and nausea.  The examiner diagnosed migraines and started medication specific for migraine treatment.  The civilian neurologist noted that the CI reported daily headaches which started on one side if his head and then radiated all over associated with nausea, vomiting and dizziness.  The lights and noise bothered him and these headaches could awaken him from his sleep.  At times “these headaches which are sometimes throbbing in nature and sometimes sharp in nature, he is shut out of it and he had to lie down and take a rest.”  The examiner diagnosed mixed type of headache, migraine type and tensions type headache.  An EEG performed for dementia and concussive syndrome was normal.  The civilian neurologist documented headaches that lasted 1-to-3 days.  A specialty care MEB addendum 12 months prior to separation documented a bi-frontal headache approximately 4-to-5 times per week that once every 2 weeks would become so severe the CI would have nausea, photophobia and phonophobia.  He was taking Motrin with no significant improvement.  The examiner diagnosed “rare migraine headaches, which are severe approximately twice per month and results in loss of work.”  The MEB NARSUM exam documented headaches that were severe at times and caused nausea, vomiting, and dizziness which were aggravated during physical exertion.  The headaches would cause a loss of attention and an inability to focus on his job which required computer based data entry.  The VA C&P exam documented that the CI had chronic migraine headaches which were severe, throbbing pain with blurry vision, nausea, weakness and noise sensitivity.  “When the attacks occur, he has to stay in bed and is unable to do anything.”  The headaches occurred once every three weeks and each attack lasted for 2 days.  He was taking migraine specific medication treatment.

The Board directed attention to its rating recommendation based on the above evidence.  As described above the PEB bundled the TBI with residual neck pain, headaches and symptoms of anxiety and depression conditions coded as 8045-9304 and rated at 10%.  The VA coded the migraine headaches, secondary to TBI condition as 8100 and rated at 10%.  The VASRD does not define prostrating, complete, prolonged, or characteristic; therefore, the PDBR Boards uses the evidentiary standard of reasonable doubt (IAW VASRD §4.3) when weighing evidence.  To determine whether the CI met the criteria for a prostrating event, the Board considered evidence of the stoppage of work or current activity, measures taken to alleviate the headache (time off from work, accommodations like having to go to a darkened/quiet room), evidence of self-management (medications, sleep), treatment notes and the commander’s statement.  There was ample documentation throughout the STR that the CI had severe debilitating migraine headaches that lasted 2 days rendering him unable to work and requiring bed rest.  The Board considered the 10% criteria - With characteristic prostrating attacks averaging one in 2 months over last several months versus 30% criteria - With characteristic prostrating attacks occurring on an average once a month over last several months.  After considering all of the evidence of the severe debilitating headaches that necessitated bed rest once every 3 weeks, the Board agreed that the 30% criteria was met.  The Board reviewed the VA’s 10% rating and agreed that based on the verbiage contained within the VARD the VA should have also granted a 30% evaluation for the migraine headache condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the migraine headaches condition coded 8045-8100.

Low Back Pain Condition.  The CI developed LBP as a result of his parachuting accident in July 2001.  The CI was given a temporary L3 Profile for acute mechanical low back pain for 30 days with additional related restrictions noted on the profile.  The neurologist documented LBP and a non-steroidal anti-inflammatory drug (NSAID) for pain.  The CI was followed by a chiropractor for chronic back pain throughout 2003 without pain resolution.  A thoracic spine X-ray was normal.  The CI was sent to physical therapy (PT) for MEB ROM measurements which were normal.  The PT noted that the CI’s pain was 7/10 and he continued with pain despite therapy.  The medical examiner noted sharp back pain, increased with activity and physical findings of tenderness to palpation and limited ROM.  A lumbar spine MRI was essentially normal.  A specialty care MEB addendum 12 months prior to separation documented mild pain in the thoracic spine for a year.  The examiner diagnosed mechanical back pain.  The physical exam findings are summarized in the chart below.  The MEB NARSUM exam documented that the CI had repeated LBP and the physical exam findings are summarized below.  The VA C&P documented a 2-year history of crushing, squeezing, burning, aching, sharp LBP that occurred three times per month and lasted for 3 days.  This pain was worsened by physical activity and stress and was relieved by NSAIDS.  The VA C&P physical exam findings are summarized in the chart below.  The lumbosacral spine X-ray performed on 27 September 2003 was normal.

There were three 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.

Thoracolumbar ROM (Degrees)	MEB Addendum 12 Mos. Pre-Sep	MEB 7.5 Mos. Pre-Sep	VA C&P 3.5Mos. Pre-Sep	
Flexion (90 Normal)	90	90	90	
Combined (240)		230	240	
Comment	Pos. Tenderness to palpation (TTP); Neg. straight leg raise (SLR)	Pos. TTP	No painful motion or spasm; Neg. SLR; No Deluca criteria	
§4.71a Rating	10%	10% (PEB 10%)	0% (VA 0%)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the LBP condition as code 5237 (lumbosacral or cervical strain) and rated at 10%.  The VA coded the residuals, low back injury condition as code 5237 and rated at 0%.  The General Rating Formula for Diseases and Injuries of the Spine considers the CI’s pain symptoms “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.”  There was evidence in the STR proximate to separation which stated that the CI had tenderness in the lower back.  At the time of the MEB exam, the CI met the 10% rating criteria “localized tenderness not resulting in abnormal gait or abnormal spinal contour.”  At the VA C&P exam which was closer to separation, the examiner documented a lack of painful motion or spasm.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 0% for the LBP condition.

Left Knee Pain Condition.  The CI developed left knee pain as a result of his parachuting accident in July 2001.  The CI was evaluated for left knee pain with physical findings of patellar grind and edema.  The examiner diagnosed left knee contusion and retro patellar syndrome, and recommended a two week duty restriction and NSAIDS.  The orthopedist noted chronic left knee pain, use of a knee sleeve intermittent swelling and localized anterior swelling.  The physical exam findings were positive grind, ROM limited to 130 degrees, atrophy and a left knee X-ray showed mild decreased medial joint space.  The examiner diagnosed left anterior knee pain.  The CI was seen in Medical clinic follow-up appointments and consistently reported left knee pain with activity and occasional weakness.  The examiner noted physical findings of tenderness to palpation over the patellar tendon.  The diagnosis was left knee patellar tendonitis.  A specialty care MEB addendum 12 months prior to separation documented that the left knee pain was aggravated by running and with continued airborne operations and reported localized left knee pain and numbness to the anterior aspect of his knee.  The MEB specialty physical exam findings are summarized in the chart below.  The MEB NARSUM exam documented left knee DJD pain which caused difficulty loading and unloading supplies and equipment due to sharp pain in his knee along with the knee pain aggravated by carrying heavy objects and running or marching long distances.  The MEB NARSUM physical exam findings are summarized in the chart below.  The commander’s statement specifically referred to the left knee condition and noted that PT had not eliminated his painful left knee condition which interfered with his MOS duties.  The VA C&P exam (approximately 3 months prior to separation) documented constant left knee pain, tenderness, stiffness and cracking noises.  The VA C&P physical exam findings are summarized in the following chart.  The left knee X-ray was normal.

There were three 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.

Left Knee ROM (Degrees)	MEB Addendum 12 Mos. Pre-Sep	MEB 7.5 Mos. Pre-Sep	VA C&P 3.5 Mos. Pre-Sep	
Flexion (140 Normal)	100	130	140	
Extension (0 Normal)	0	0	0	
Comment	No effusion or instability; Pos. patellar grind (crepitus)	-	No Deluca criteria; No instability	
§4.71a Rating	10%	0%	10% (VA 10%)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the left knee pain condition as 5099 analogous to 5003 arthritis, degenerative (hypertrophic or osteoarthritis) and rated at 0%.  The VA coded the left knee, DJD condition as 5099 analogous to 5010 arthritis, due to trauma, substantiated by X-ray findings and rated at 10%.  No exam documented limited ROM to a compensable level without application of §4.59 (painful motion).  VASRD §4.71a specifies for code 5003 that “satisfactory evidence of painful motion” constitutes limitations of motion and specifies  application of a 10% rating “for each such major joint or group of minor joints affected by limitation of motion.”  The Board considered the coding of 5257 Knee, other impairment of recurrent subluxation or lateral instability; however, there was no mention of instability.  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 Left Knee 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.  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 TBI with residual neck pain and symptoms of anxiety and depression condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the TBI with residual headaches condition, the Board unanimously recommends that the migraine headaches condition be separately adjudicated as follows: the unfitting migraine headache condition coded 8045-8100 and rated 30%, IAW VASRD §4.124a.  In the matter of the low back pain condition and IAW VASRD §4.71a, the Board unanimously recommends a disability rating of 0%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the left knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
TBI with Residual Neck Pain, and Symptoms of Anxiety and Depression	8045-9304	10%	
Migraine Headache	8045-8100	30%	
Low Back Pain	5237	0%	
Left Knee Pain	5099-5003	10%	
COMBINED	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 2013018, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXX, AR20150007013 (PD201301533)

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 40% 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.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 40% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) 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 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						     XXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						
CF: 
(  ) DoD PDBR
(  ) DVA