Author: JOHN J. D'ORAZIO
Last saved by: Weathers, Janice R SrA MIL USAF AFDW SAF/MRBD
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD 13-00571
BRANCH OF SERVICE:  Army 	BOARD DATE:  20131114
SEPARATION DATE:  20060816

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SGT/E-5 (19D20, Calvary Scout and 11B20 Infantryman) medically separated for knee and mental health conditions.  The CI developed bilateral knee pain and was treated with surgical and conservative treatments over a three year period, but continued to have significant pain.  The CI also reports having insomnia, irritability, anxiety and depressive symptoms after returning from Iraq.  He was followed by mental health and civilian providers and prescribed medications for his mental health symptoms.  He could not be medically rehabilitated and had difficulty functioning to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent L3/S2 profile and referred for a Medical Evaluation Board (MEB).  The knee and mental health conditions, characterized as “bilateral knee osteoarthritis and post-traumatic stress disorder (PTSD)”, were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated bilateral knee pain secondary to osteoarthritis; and depressed mood and chronic anxiety conditions as unfitting, rated 10% respectively, with likely application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated.

CI CONTENTION:“I do not have a job at present because I can’t be around people.  My PTSD is worse as well as my physical being. (continued) I would like to have my percentage raised because I can’t work around people.  My knees prevent me from doing much physical labor and the rest of my problems contribute.”

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 Service ratings for the unfitting bilateral knee pain and depressed mood and chronic anxiety conditions are addressed below.  The contended PTSD condition was identified by the MEB; thus, it is within the DoDI 6040.44 defined purview of the Board.  The other contended VA service connected conditions (irritable bowel syndrome and headaches associated with mental health disorders) were not identified by the MEB or PEB and, therefore, are not within the Board’s purview.  These, and any other condition or contention not requested in this application, remain eligible for future consideration by the Army Board for Correction of Military Records (BCMR).  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected conditions continue to burden him; but, must emphasize that the Military Disability Evaluation System has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veteran Affairs (DVA), operating under a different set of laws.

RATING COMPARISON:

Service IPEB – Dated 20060712 | VA* - (1.5 to 2 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
B/L Knee Pain... | 5003 | 10% | Post-Traumatic Arthritis, L Knee... | 5010 | 10% | 20060930
| | | Post-Traumatic Arthritis, R Knee... | 5010 | 10% |
Depressed Mood & Chronic Anxiety | 9400 | 10% | PTSD & Adjustment D/O... | 9440-9411 | 50%** | 20061019
| | | HAs Associated with PTSD... | 8199-8100 | 0% |
No Additional MEB/PEB Entries | Other x 1 | 20060930
Combined:  20% | Combined:  60%
* Derived from VA Rating Decision (VARD) dated 20070626 (most proximate to date of separation (DOS)).
** Increased to 70% based on C&P exam 20071025

ANALYSIS SUMMARY:  

Bilateral Knee Pain Secondary to Osteoarthritis.  The CI was first seen for left knee pain on 2 October 1986 after a fall off of a motorcycle.  He was diagnosed with a contusion.  On 1 September 1987 he was seen for a one week history of right knee pain with running.  There are no other entries in the records available for review until in 2004, after he was activated.  The CI was activated on 12 October 2003 and subsequently deployed from March through December 2004.  He was evacuated out of theater for what proved to be irritable bowel syndrome (IBS).  While being evaluated for this in Germany, he also reported that he had bilateral knee pain.  The Board found no record of treatment prior to this evaluation, but observed that at the 11 February 2005 orthopedic appointment, the CI reported that he had undergone left knee arthroscopy with meniscal repair in 2002.  The 26 June 2006 VA Rating Decision (VARD) recorded that the CI had undergone surgery on the right knee on 23 September 2003 in addition to the two surgeries on the right knee while activated.  Neither of these records was in evidence.  The Board found one clinical entry in the records in evidence after the CI was activated in 2003 and prior to his evacuation to Germany.  On 30 November 2004, the CI was evaluated for a two month history of diarrhea which was refractory to treatment.  He was evacuated to Germany for further evaluation by gastro-enterology (GI) on 6 December 2004.  Neither the flight surgeons clearance nor the air evacuation movement request form documents a knee condition.  The CI was evaluated for knee pain on 8 December 2004 after arrival in Germany.  He reported a 3-4 month history of bilateral pain which was refractory to conservative treatment and aggravated by walking.  He denied a history of injury, but reported that he had been told that he had arthritis.  The examination was unremarkable other than movement of the patella.  He was referred to internal medicine (IM) and treated with a non-steroidal anti-inflammatory drug (NSAID) for degenerative joint disease (DJD) of the knee on 17 December 2004.  He was returned to his home station four days later and next evaluated for his knee pain on 29 December 2004.  He was placed on medical hold for his knee pain and IBS, but noted loss of sleep as well.  On 4 January 2005 the CI had MRIs of both knees.  Both knees had oblique meniscal tears with osteoarthritis.  A line of duty (LOD) determination on 12 January 2005 noted that the CI had sustained an injury from walking/running on rough terrain throughout his active duty service with an effective date of 7 November 2004.  No specific traumatic event was cited.  The CI was evaluated in orthopedics on 11 February 2005 and noted to have right greater than left knee pain which had been worse since November 2004.  He reported a history of a left knee arthroscopy with meniscal debridement in 2002 with good relief of his symptoms.  He had signs of meniscal irritation on the right consistent with the MRI and an arthroscopy was scheduled.  On 8 March 2005 he had a partial debridement of the right medial meniscus.  At the 14 April 2005 physical therapy (PT) appointment, the CI noted that he had no particular injury, but just had “wear and tear” from doing his job.  He continued PT with improvement and was scheduled for repair of the left meniscus as well.  This was accomplished on 8 July 2005 with debridement of the patella and medial femoral condyle and a partial medial meniscectomy.  The CI continued to have pain and a repeat MRI of the right knee on 17 August 2005 showed that there was persistent torn cartilage of the meniscus and repeat surgery was indicated.  However, the left knee was improving as anticipated.  On 23 September 2005, the CI underwent debridement of the medial femoral condyle and a partial medial meniscectomy of the right knee.  The CI’s orders were extended on 4 January 2006 for post-operative care after his recent surgery.  He was seen in orthopedics follow up that day and placed in a locked brace.  At the MEB narrative summary (NARSUM) examination on 23 January 2006, approximately seven months before separation, the CI reported that he was thrown against the dash in an accident while deployed and that his knee pain had persisted since that incident.  The Board noted that this is inconsistent with the previously reported history of no trauma given to multiple examiners.  He reported that he used knee braces bilaterally and could not walk without them and noted instability without them.  He also used a cane on occasion.  On examination, he had normal extension with slightly reduced flexion (130 degrees) and significant pain at the extremes of flexion.  He had medial and lateral joint line tenderness bilaterally as well as crepitus, left greater than right.  He was diagnosed with bilateral osteoarthritis and determined to not meet retention standards.  At the 15 February 2006 orthopedic appointment, he was seven weeks out from surgery and was doing well.  The brace was unlocked and an aggressive range of motion and strengthening program was begun.  His left knee pain recurred and he was scheduled for another surgery on the left knee.  On 13 April 2006, he had a left knee tibial tubercle osteotomy and lateral release.  Severe chondromalacia of the left patella was noted at surgery.  The CBHCO (community based health care organization) note dated 5 May 2006 stated that the orthopedist had determined that the CI required a sedentary position and that a MEB was required.  It noted that the mental health issues were managed with medications and that therapy should be continued.  The CI was seen in orthopedics on 30 May 2006.  He had slipped in the mud while washing his car a few days previously, but was doing well and ambulating without a brace.  On examination, the repair was well-aligned and the CI issued a hinged knee brace.  The CI was seen in PT for range of motion (ROM) measurements on 21 June 2006.  These are recorded below.  The CI continued to have his care managed by the CBHCO until separation.  He also continued PT.  At the VA Compensation and Pension (C&P) orthopedic examination on 30 September 2006, six weeks after separation, the CI reported that his knee pain dated back to the accident while deployed when his knees hit the dashboard.  He also reported that he received multiple lidocaine and cortisone shots.  The Board again noted that this history of an accident was not found in the contemporaneous records.  There were no records in evidence that indicate that the CI received the above care while in theater.  He stated that he used a motion control brace bilaterally and had also been using a cane for the prior six months.  He endorsed a total of four surgical procedures, two on each knee, all of which were after his return from deployment.  He denied dislocation or subluxation as well as limitations in the activities of daily living.  On examination, the right knee showed a total flexion of 170 degrees which exceeds the VA normal value by 30 degrees and is thought to be a typographical error.  A slight effusion was present.  The ROM was not painful, there was no instability, and provocative testing for meniscal irritation was negative.  He had a positive patella grind, but no apprehension with patellar mobilization; both are tests for chondromalacia patella.  The CI was tender along the lateral and medial joint line.  The surgical screws were palpable, but non tender.  DeLuca criteria were negative.  The examination of the left knee was essentially identical other than more limited motion of the knee which had 120 degrees of flexion.  Crepitus was documented on the left, but not the right.  On x-ray, each knee showed medial joint space narrowing and degenerative changes (osteophytes.)  The examiner remarked that there was pain with motion in both knees in his assessment and contradicted his comments in the history.  The VA rating decision (VARD) dated 26 June 2007 noted from the service treatment records that the CI had surgery of the right knee on 23 September 2003 (pre-activation; this record is not in evidence) in addition to the two procedures after return from deployment.  The 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.

DOS 20060816

Knee ROM
(Degrees)

MEB ~7 Mo. Pre-Sep

PT ~2 Mo. Pre-Sep

VA C&P ~1.5 Mo. Post-Sep

| Left | Right | Left | Right | Left | Right
Flexion (140 Normal) | 130 | 130 | 110 | 120 | 120 | 170**
Extension (0 Normal) | 0 | 0 | 0 | 0 | 0 | 0
Comment | Significant pain at extremes of flexion bilaterally | Limited by pain | No pain with motion.  Knees stable; **This does make sense physically
§4.71a Rating | 10%* | 10%* | 10%* | 10%* | 10% | 10%

The Board considered the appropriate rating for the bilateral knee condition.  It noted that the CI had evidence for surgery in each knee while in an inactive status in the year prior to activation.  However, the total active service exceeded eight years and both knee conditions were determined to be line of duty, rendering an EPTS (existed prior to service) determination moot.  The PEB combined the two conditions for rating using the diagnostic code 5003 at 10% for two or more major joints with x-ray evidence of arthritis.  The VA rated each knee separately at 10% using the 5010 code for traumatic arthritis.  The Board noted that although different codes were used, the coding criteria are identical.  At the time of separation, the PT and C&P examination were equally proximate to the date of separation.  The Board noted that the limitation in motion on either examination was non-compensable.  While the CI had multiple surgical procedures, there was neither instability nor signs of meniscal irritation noted on the VA C&P examination.  However, the CI used a brace on each knee and had been profiled for both knees.  The Board determined that each knee was separately unfitting and therefore should be separately rated.  The 5010 rating for traumatic arthritis is applicable given the numerous surgical procedures on each knee; no other coding option for the knee provided a rating advantage to the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% each for the left and right knee pain secondary to osteoarthritis conditions for TDRL (temporary disability retired list) entry.  

At the VA Compensation and Pension (C&P) (PTSD) exam, approximately fourteen and half months after separation from active duty, the CI reported (189) swelling and popping (with relief of pain), but no locking.  He used a brace and could walk up to ½ mile.  He denied problems with the activities of daily living or the use of an assistive device (cane or crutches).  Flexion was reduced to 125 degrees bilaterally with normal extension; there was no pain with motion of either knee.  There was tenderness to palpation and a positive patellar grind bilaterally, but no instability, signs of meniscal irritation, or effusion.  The Board directed attention to its rating recommendation based on the above evidence.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends continuation of the disability rating of 10% each for the left and right knee pain secondary to osteoarthritis conditions at TDRL exit and permanent retirement.  

Depressed Mood and Chronic Anxiety (PTSD).  At the 29 December 2004 primary care clinic (PCC) follow up appointment for IBS, the CI endorsed feeling down and anhedonia.  The CI again endorsed feeling down at several evaluations for his knees over the next few weeks as well as sleep disturbance.  The CI was placed on medical hold on 19 January 2004 for his knee problems.  The CI was evaluated by social work and noted to have combat stress reactions including sleep disturbances and referred to psychology for biofeedback.  A master problem list dated 17 March 2005 included a diagnosis of PTSD and endorsed anger outbursts.  A formal psychological interview on 17 April 2005 the CI noted problems with anger and poor sleep for which he had been in counseling for two months.  He was diagnosed with an anxiety disorder not otherwise specified (NOS) and rule/out PTSD.  A 14 September 2005 treatment plan noted that the CI had PTSD symptoms, but did not make the formal diagnosis.  However, numerous CBHCO entries document that the CI was being treated in mental health for PSTD and depression and that he was making progress with treatment.  The CI was extended on active duty orders on 4 January for his right knee condition and PTSD.  On 15 January 2006, a CBHCO physician noted that the CI was being treated with Lexapro, an anti-depressant, for PTSD and issued a S3 profile until the “status is clarified.”  The case was reviewed by a social worker on 16 February 2006 and an S2 profile was recommended, noting that the CI had at least one anger outburst, but was improving with treatment.  Ten days later, the same CBHCO physician noted the above, but determined that the CI should retain a temporary S3 profile as treatment was ongoing for PTSD symptoms and that he was stable enough for the MEB to proceed; in a subsequent note on 7 April 2006, the same physician noted that the determination of the MEB hinged on the functional status of the knees.  Psychiatric notes dated 15 March 2006 and 5 April 2006 listed PTSD as the diagnosis.  A summary of treatment dated 18 May 2006 listed anxiety, flashbacks (Criterion B), sleep disturbances, relationship problems (Criterion F), avoidance (Criterion C), and hypervigilance.  There were no further mental health clinical entries prior to separation.  The initial NARSUM was for the orthopedic issues and dictated on 23 January 2006.  It did not address any mental health concerns.  A pre-NARSUM summary dated 1 June 2006 noted that the CI had additional diagnoses combat stress, anger management, and insomnia; all of which were initially diagnosed in March 2005.  He was described as having mild stress symptoms.  The commander’s statement was dictated on 15 June 2006.  It noted that the CI’s duty restrictions stemmed from the knee issues.  The commander observed that the CI continued to see a psychiatrist, but did not report any duty impairment from a mental health condition.  At the MEB examination on 20 June 2006, approximately two months before separation, the CI reported anxiety, sleeping problems, and depression.  The psychiatric examination was noted as normal.  The NARSUM mental health summary was dictated 23 June 2006 exam, approximately two months before separation.  The CI reported that he developed insomnia and irritability shortly after return from deployment (Criterion E).  He endorsed anxiety, avoidance behavior, depressive symptoms, a lack of interest “in doing anything”, no joy in his life and emotional numbness.  He reported that his symptoms had improved with treatment and thought that he could re-deploy, but that his symptoms would worsen if he did.  He endorsed participation in combat and stated that he had killed and seen many people killed (Criteron A).  On the mental status examination (MSE), he was open and honest.  Eye contact was good.  Thought processes were intact and he denied suicidal or homicidal ideation (SI/HI).  Insight, judgment, and cognition were intact.  He denied hallucinations or delusions.  He was diagnosed with chronic, moderate PTSD and assigned a global assessment of function (GAF) of 68, indicative of mild symptoms or difficulty.  He was determined to not meet retention standards.  The final profile was dated 5 July 2006 and was for an L3S2 for bilateral knee injury.  However, the CI was restricted from weapons handling and access.  The Board noted that the two previous profiles included PTSD in the diagnoses and were L3S2 on 7 April 2006 and L3S3 on 26 June 2006.  All profiles previous to these were S1.  The VA Compensation and Pension (C&P) PTSD examination was performed on 19 August 2006, two months after separation.  The CI reported good and bad days and that he was frequently agitated and had a short temper.  He stated that the symptoms had become significantly worse since his return from deployment.  He needed medications to sleep and endorsed significant anhedonia and loss of libido.  His daily routine involved taking care of his daughter and preparing meals, although he spent much of the day “sitting outside and thinking.”  He watched television with his wife and daughter, but denied much interest; rather, he sat there to spend time with them.  He continued to see the same psychologist and remained on medications.  He also endorsed a period of suicidal ideation six months earlier when he had put a loaded gun to his head.  The Board noted that the CI specifically denied suicidal ideation to the MEB examiner during the evaluation which would have been two months after this event.  He also noted that he injured both knees when a HUMVEE he was commanding hit a bomb crater and wrecked, shoving both knees into the front panel and needed cortisone injections to keep him mobile during combat duty.  The CI had two marriages.  The first ended after two years due to his ex-wife being “mentally ill.”  His second marriage was described as solid and the couple had a 12 year old daughter.  He endorsed stress and worry about financial issues once his severance pay ran out.  The CI described a period of heavy alcohol abuse between the ages of 18 and 23.  He discontinued the abuse without recorded intervention.  He reported traumatic events including rocket attacks, witnessing the death of fellow soldiers and hearing attacks over the radio, and IED (improvised explosive device) attacks.  He was noted to have received the Combat Infantry Badge which is documented on his DD 214 dated 16 August 2006.  He denied nightmares and flashbacks.  He did have distress around people of Middle Eastern descent.  He also endorsed avoidance behavior, numbing, and reduced activities while feeling detached and estranged from others.  He had a foreshortened sense of the future and arousal symptoms including sleep difficulties, irritability and anger, hypervigilance, and exaggerated startle (Criterion D).  He stated that he would like to return to work, but that his physical symptoms “overwhelmed” him.  The MSE showed him to be well groomed with a briefcase containing various papers documenting his treatment.  He was calm and cooperative, but did display some agitation when discussing his combat-related traumas, grasping his cane tightly.  Speech and thought were normal.  He denied delusions or hallucinations as well as SI or HI.  He did endorse some symptoms of hypomania. The examiner diagnosed PTSD and Adjustment Disorder with Depressed Mood, Chronic.  A GAF of 50 was assigned indicative of serious symptoms and/or impairment.  On a general C&P dated 16 October 2007, 14 months after separation, the CI denied any history of depression, panic attacks, relationship problems, suicidal ideation, sleep impairment, anxiety, or memory problems.  His psychiatric examination was normal.  The CI underwent a second VA C&P mental examination on 25 October 2007, 14 months after separation.  He reported that there were problems in the marriage, but that it was solid.  He reported numerous exposures to IED explosions, two of which were close enough to his vehicle to damage it.  He also reported that he may be suffering from TBI (traumatic brain injury) symptoms since he was dazed “for some time” after these two explosions.  He denied substance abuse, but endorsed a limited social life.  On examination, he was well groomed, alert and oriented, and cooperative and pleasant.  His mood was anxious, but speech was normal.  His affect was mildly agitated.  He was goal directed with mildly concrete thinking.  He denied delusions, hallucinations, or disorganized thinking and none was observed.  He had a subjective short term memory deficit, but this was not observed.  He reported poor sleep, nightmares, and flashbacks.  Judgment, insight, and impulse control were all fair.  He endorsed a past history of suicidal ideation, but denied any attempt or current SI or HI.  On MSE, testing was acceptable at the low normal limits with some difficulty with abstract thinking.  He was diagnosed with chronic PTSD and assigned a GAF of 55, indicative of moderate symptoms or difficulty.  This is improved from the prior VA C&P.  The MEB forwarded PTSD to the PEB as a medically unacceptable condition.  The PEB adjudicated the CI as unfit for a Generalized Anxiety Disorder, coded 9400, and rated at 10%.  The VA rated the mental health condition at 50% and coded the CI 9440-9411 for PTSD and Adjustment Disorder with Depressed Mood, Chronic.  The VA rated the CI at 70% effective 19 July 2007 based on the 25 October 2007 examination.  The Board noted that although the GAF improved, the VA awarded a higher rating.  The Board also observed that the VA rated headaches associated with PTSD at 0% coded 8199-8100 for analogous to migraine headaches.  A review of the records indicates that the CI reported headaches on the separation history and was determined to have tension type headaches which responded well to over the counter medications.  There were no other entries found in the record regarding headaches prior to separation and no indication that the headaches impaired duty.  The Board determined that the mental health diagnosis was changed to the applicant's possible disadvantage in the disability evaluation process.  Therefore, this applicant did meet the inclusion criteria in the Terms of Reference of the Mental Health Diagnosis Review Project.  The Board considered the criteria for diagnosis according to the Diagnostic and Statistical Manual for Mental Disorders IV TR including: the evidence for the stressor (criterion A), re-experiencing of the event (criterion B), persistent avoidance of stimuli associated with the trauma (criterion C), hyperarousal (criterion D), duration and onset (criterion E), presence of clinically significant distress or impairment in social, occupational or other important area of functioning (criterion F).  The Office of the Under Secretary of Defense memorandum dated 17 July 2009 states:  "Therefore, as a matter of policy, the PDBR and all three BCMRs will apply VASRD Section 4.129 to PTSD unfitting conditions for applicants discharged after September 11, 2001, and in such cases, where a grant of relief is appropriate, assign a disability rating of not less than 50% for PTSD unfitting conditions for an initial period of 6 months following separation, with subsequent fitness and PTSD ratings based on the applicable evidence.”  The Board considered the evidence.  It noted that the PEB did not determine that either the knee condition or the mental health condition was related to combat.  However, the Board noted that the CI carried the diagnosis of PTSD in ~~the~~ treatment notes, the NARSUM, and the MEB.  The VA examiner, a psychiatrist, also diagnosed PTSD.  The Board finds that the preponderance of evidence supports a diagnosis of PTSD and, therefore, recommends that VASRD §4.129 be applied and the CI be placed on a six month constructive period of TDRL at a rating.  The Board did not find that the level of disability exceeded the minimum 50% rating for the TDRL period.  The Board then considered the permanent disability rating IAW §4.130.  The closest examination to the six month point from separation is the VA C&P which was done a little over two months after separation.  It noted that the history provided to the VA examiner was not completely consistent with the historical record in that he endorsed a suicide attempt previously denied and also endorsed a motor vehicle accident which is not part of the military health records.  The Board determined that this reduced the probative value of the VA examination, but it was still considered in the adjudication.  On examination, he was noted to be open and honest, mood was a little nervous, affect was appropriate, thought processes intact, no suicidal or homicidal ideation, and without delusions or hallucinations.  Insight and judgment were good and cognition grossly intact.  The psychiatrist diagnosed his condition as moderate and stated, “based on his need for multiple medications and follow up therapy, it is likely that he would destabilize quickly if reintroduced into the combat setting”.  As noted, he was thought to have difficulty functioning in a military environment and moderate impairment of industrial adaptability.  The Board considered the description for a 30% rating “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal)” and for a 10% rating “occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication.”  The Board determined that the description for the 30% best fit the disability evidenced on the MEB NARSUM.  

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 left knee pain secondary to osteoarthritis condition, the Board unanimously recommends a disability rating of 10%, coded 5010 IAW VASRD §4.71a for both TDRL entry and exit.  In the matter of the right knee pain secondary to osteoarthritis condition, the Board unanimously recommends a disability rating of 10%, coded 5010 IAW VASRD §4.71a for both TDRL entry and exit.  In the matter of the mental health condition and IAW VASRD §4.130, the Board unanimously recommends change that the be placed on TDRL for a six month constructive period rated at 50% for PTSD coded 9411 and that the permanent rating at TDRL exit be 30% for the PTSD condition.  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
| | TDRL | PERMANENT
Left Knee Pain Secondary to Osteoarthritis | 5010 | 10% | 10%
Right Knee Pain Secondary to Osteoarthritis | 5010 | 10% | 10%
Post-traumatic Stress Disorder | 9411 | 50% | 30%
COMBINED | 60% | 40%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130521, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			XXXXXXXXXXXXXXXX, DAF
			President
			Physical Disability Board of Review

SFMR-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 XXXXXXXXXXXXXXXXXXX, AR20140003612 (PD201300571)

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  constructively place the individual on the Temporary Disability Retired List (TDRL) at 
60% disability for six months effective the date of the individual’s original medical separation for disability with severance pay and then following this six month period recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 40%.

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 temporary disability 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 day following the six month TDRL period.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, provide 60% retired pay for the constructive temporary disability retired six month period effective the date of the individual’s original medical separation and then payment of permanent disability retired pay at 40% effective the day following the constructive six month TDRL period.  

	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						     XXXXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary
						         (Army Review Boards)

PD 1300571