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AF | PDBR | CY2012 | PD2012 00399
Original file (PD2012 00399.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1200399
BRANCH OF SERVICE: Army  BOARD DATE: 20130717
SEPARATION DATE: 20040521


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard CPL/E-4 (19K/Armor Crewman), medically separated for compression fracture of C5 (cervical spine), compression fracture T3/T4 & T10 (thoracolumbar spine) and posttraumatic stress disorder (PTSD). He was involved in a M1 tank rollover accident and sustained neck, back, chest (rib contusions), and knee injuries on annual training duty on 16 June 2000. X-rays showed compression fractures at C5, T3/T4, T10 and T11. He was hospitalized for several days for evaluation and then released, continuing with conservative treatment of his neck (to include mobilization) for approximately 3 months. A permanent profile was first written on 21 December 2001 as a U3. He returned to work in his civilian job as a corrections officer in March 2001. Prior to the accident, the CI had lower back pain in 1994, presumably from a fall in 1993, and was diagnosed with a mild thoracic scoliosis concave to the left in 1998. In response to the roll-over accident, which also killed his tank commander, he developed PTSD. Memories of the event overwhelm him and he avoids drill and is fearful of returning to a tank. His profile was incrementally increased and on 9 March 2004, he was issued a permanent 133113 (U3/L3/S3) profile which prohibited the wearing of Kevlar, carrying of a rucksack and limited his duties and physical training. He was then referred for a Medical Evaluation Board (MEB). The MEB forwarded cervical spine injury with compression fracture of C5 and left rib contusions, compression fracture T3/T4 & T10, retropatellar pain syndrome (RPPS), PTSD, right knee and idiopathic hypertension conditions, identified in the rating chart below. The Informal Physical Evaluation Board (IPEB) adjudicated the compression fracture of C5 and PTSD conditions as unfitting, rated 10% and 10% respectively, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The IPEB determined the remaining conditions to be not unfitting. The CI appealed to the Formal PEB (FPEB) which affirmed the IPEB findings regarding his C5 fracture and PTSD, but in addition, found his compression fracture T3/T4 & T10 also unfitting, rating it at 0%; and he was then medically separated.


CI CONTENTION: “I have never believed that the ratings given by the Physical Evaluation Board (PEB) was an accurate assessment of the injuries that I had incurred. After receiving my first award letter from the VA and comparing the two I was more certain than ever that the PEB's findings were not a fair reflection of the evidence provided for my injuries.” The CI does not elaborate further or specify a request for Board consideration of any additional conditions. Remarks in block 15 regarding duty status were noted.
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 cervical spine compression fractures, thoracic spine compression fractures and PTSD conditions are addressed below. No additional conditions 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 FPEB – Dated 20040412
 VA (STR, 9 & 12 Mos. Post-Separation) – Effective Date 200309268*
Condition
 Code Rating Condition Code Rating Exam
Eff 20030926:
Compression Fx of C5 5235 10% Residuals, burst Fx, C Spine, DDD 5242 10% 20050519
C radiculopathy, R arm/hand 8616 10% 20050519
C radiculopathy, L shoulder 8610 20% 20050519
Compression Fx T3/T4/T10 5235 0% Residuals, TL Spine compress. Fx & DDD w/ HA 5242 10% 20050519
Lumbar radiculopathy, L leg 8520 20% 20050519
PTSD 9411 10% PTSD 9411 30% STR/
20050203
Retropatellar pain syndrome, R knee Not Unfitting Retropatellar pain syn., R knee
(eff 20040730)		 5260 10% 20050519
Idiopathic hypertension Not Unfitting Hypertension NSC STR
↓No Additional MEB/PEB Entries↓
 Residuals, sternum w/ Fx ribs 7399-7346 10% STR
Residuals, R hip strain
(eff 20040730)		 5252 10% 20050519
0% X 0 / Not Service-Connected x 4 20050519
Combined: 20%
 Combined: 70% (2003) / 80% (2004)
*VARD 20050723: Right knee and right hip were effective 20040730. All other rati ngs were in effect at the DOS.


ANALYSIS SUMMARY: The Board acknowledges the CI’s implied contention for ratings of his RPPS, right knee and idiopathic hypertension conditions which were determined to be not unfitting by the FPEB; and, emphasizes that disability compensation may only be offered for those conditions that cut short the member’s service career. Should the Board judge that any contested condition was most likely incompatible with the specific duty requirements; a disability rating IAW the VASRD, and based on the degree of disability evidenced at separation, will be recommended.

The VA ratings of the CI’s conditions were adjudicated by the VA rating decision (VARD) of 2005 which applied retroactive ratings IAW the VASRD effective prior to September 2003 and used the service treatment record (STR). The VA simultaneously rated the CI’s condition under the VASRD in effect at separation, the CI’s claim and the post-separation VA exams in 2005. The Board applies the VASRD in effect at the time of separation (May 2004) for its rating determination.

Compression Fracture of C5 Condition. The narrative summary (NARSUM) noted the traumatic history of the CI’s C5 compression fracture as well as non-surgical treatments and profile restrictions. At the MEB exam, the CI reported pain and aching in the neck as well as frequent or severe headaches and pain and clicking in the left anterior chest with extremes of arm motion or with coughing since the time of the injury (see thoracolumbar spine below). Reflexes were normal with no evidence of focal motor or sensory deficit. A physical therapy note in August 2003 reported “stable 50% compression fracture of C-5.” Range-of-motion (ROM) evaluations from the physical therapy (PT) entry, as charted below, were noted in the NARSUM. Magnetic resonance imaging (MRI) performed in August 2002 showed a stable compression fracture without subluxation at C5. An MRI performed in September 2002 documented compression fracture of C5 at approximately 50% compression when compared to prior exam in 2001. An MRI performed in April 2003 documented 25% of anterior wedging of C5. There was a PT (or chiropractic) treatment note 5 months prior to separation that noted cervical spasm with forward flexion to 24 degrees (normal 45 degrees).

At the VA Compensation and Pension (C&P) exam performed 12 months after separation, the CI reported chronic neck pain that traveled down the back of his arms with numbness in the 3rd and 4th fingers of the right hand. Pain was regular and frequent and caused headaches, neck pain, shoulder pain, numbness/tingling feeling in the right shoulder and sometimes the left. Medication included anti-inflammatory, muscle relaxant and narcotic medications. The CI related incapacitating episodes as often as 10 times per year, which last for a day. Over the past year he had 8 incidents of incapacitation for a total of 8 days and the treatment and rest were prescribed by two physicians. The CI related missing 5 days of work per year due to his neck condition. Exam demonstrated pain-limited motion as charted below and “C4: Sensory deficit of bilateral shoulders; C5: Sensory deficit of right lateral shoulder and right upper arm; C6: Sensory deficit of right lateral forearm; and C8: Sensory deficit of right ulnar side of the ring finger and right little finger.” The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.
Cervical ROM
In degrees
 MEB ~14 Mo. Pre-Sep
(20030320)
 PT ~5 Mo. Pre-Sep
(20031215)		 VA C&P ~12 mo. Post-Sep
(20050519)
Flex (45 Normal)
 (45) 60 (25) 24 40
Ext (0-45)
 (45) 50 (25) 27 30
R Lat Flex (0-45)
 20 40
L Lat Flex (0-45)
 20 (30) 31 30
R Rotation (0-80)
 70 75
L Rotation (0-80)
 55 50
COMBINED (340⁰)
 255 265
Comment: Note s 2 and 4 of spine formula applied- (truncate to VASRD normal maximum & round )
“Mild LOM in passive Lt rotation. Feels like a mechanical restriction.” Stable 50% compression fracture of C-5. Normal reflexes and neurologic exam
Strength normal; muscle spasm
 Tender; painful motion. X - rays compression at C-5 not 50% or more of normal disc height. C4, 5, 6, & 8 sensory deficits (see text)
§4.71a Rating
10 %
 20% 10% (VA*)
invalid font number 31502 * VARD 20050723 : 20% prior to Sep 2003 (5235) , then 10% C -spine (5242) plus 10% right (8616) and 2 0% left (8610) peripheral nerve ratings

The Board directs attention to its rating recommendation based on the above evidence. At the time of separation, both the FPEB and VA rated the cervical spine condition at 10%. Both the service’s and VA’s rating exams warranted a 10% rating for ROM limitations. The Service exam would alternatively support a 10% for “vertebral body fracture with loss of 50% percent or more of the height,” while the VA exam could support an alternate 10% coded 5243 (intervertebral disc syndrome) for incapacitating episodes having a total duration of at least a week but less than 2 weeks during the past 12 months. The earlier VA 20% rating used the older spine rules no longer in effect at the time of separation with consideration of headaches and radiating pain. The single PT treatment note documenting spasm and decreased ROM to the 20% rating criteria was adjudged as an outlier and consideration of VASRD §4.7 (higher of two evaluations) was considered; however, the disability picture did not more nearly approximates the criteria required for that 20% rating. The Board considered whether an additional Service rating could be recommended under peripheral nerve codes, as conferred by the VA (for right and left upper extremities). However, there were no objective findings of functional radiculopathy at separation. Even were the VA sensory findings present at the time of separation, firm Board precedence requires a functional impairment linked to fitness to support a recommendation for addition of a peripheral nerve rating to Service disability in spine cases. The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a. The sensory component in this case (even if conceded versus post-separation worsening) has no functional implications, and no motor weakness was in evidence. There is thus no evidence of a separately ratable functional impairment (with fitness implications) from the residual radiculopathy; and, the Board cannot support a recommendation for an additional Service disability rating on this basis.

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 compression fracture of C5 condition adjudication at separation or at the end of the constructive Temporary Disability Retired List (TDRL) period (for PTSD-see below). The Board concluded therefore that this condition could not be recommended for additional disability rating.

Compression fractures of T3/T4 & T10 Condition. The NARSUM noted the CI’s complaints of pain and clicking in the left anterior chest with extremes of arm motion or with coughing since the time of the injury. The MEB physical exam noted that deep tendon reflexes were 2+ and symmetric throughout the upper and lower extremities (normal) with no evidence of focal motor or sensory deficit throughout. Gait and Romberg were normal. There was no thoracolumbar exam or ROMs documented. MRI of the T-spine of April 2003 showed compound fracture of T3 and T10 without spinal canal compromise. Diagnosis was “compression fracture T3/T4 with degenerative changes, and T10 without spinal canal compromise.” There were numerous PT treatment notes from December 2003 through February 2004 for lumbar or TL, or hip mobilization and a PT treatment note 5 months prior to separation documented thoracic and lumbosacral muscle spasms with forward flexion to 41 degrees (normal 90 degrees).

At the VA C&P exam performed 12 months after separation, the CI reported thoracic pain radiating to the right shoulder with tingling and numbness of the right hand and flares of pain requiring narcotic pain medication and physician prescribed treatment and bed rest of 8 days. Lumbar pain was noted to radiate to the right hip and be elicited by physical activity. Incapacitating episodes for 20 days was noted with physicians’ names provided. Exam documented muscle spasm with pain-limited ROM as charted below. There were sensory deficits noted from L1 through L5 distributions on the left lower extremity. Radiographs indicated compression deformities of the thoracic spine (T3, T4, T10, and T12) and lumbar spine degenerative arthritis and joint narrowing (degenerative joint disease).

The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.
Thoracolumbar ROM
In degrees
MEB ~14 Mo. Pre-Sep
(20030320)
 PT ~5 Mo. Pre-Sep
(20031215)		 VA C&P ~12 mo. Post-Sep
(20050519)
Flexion (90 Normal)
(40) 41 75⁰
Ext (0-30)
(20) 22 15⁰
R Lat Flex (0-30)
(20) 18 30⁰
L Lat Flex 0-30)
(20) 18 30⁰
R Rotation (0-30)
30⁰
L Rotation (0-30)
30⁰
Combined (240⁰)
210⁰
Comment: Note 4 of spine formula applied- (round to nearest 5)
 No ROM measurements taken for MEB. MRI shows compound fracture of T3 and T10 w/o spinal canal compromise. Normal gait. No rmal neurologic exam
Muscle spasms C4-6, T4-7 and L4-5 an d S1.
 M uscle spasm ; no tenderness or abnormal contours ; (-) SLR test
§4.71a Rating
 unk 20% 10 % (VA * )
invalid font number 31502 * VARD 20050723: 20% prior to Sep 2003 (5235) , then 10% for TL spine (5242) plus 20% for left leg lumbar radiculopathy (8520)

The Board directs attention to its rating recommendation based on the above evidence. The FPEB noted “Range of motion not impaired per medical records.” However, the Army guidance at the time (AR 635-40 and the USAPDA pain policy) indicated only mechanical ROM limitation was ratable (used passive versus active ROM) and did not include application of VASRD §4.59 (painful motion) for rating. The Board considered there was more likely than not overlap from the L3 profile restrictions of the knee attributable to the TL spine, as well as possible overlap from the rib conditions (costovertebral joints – thoracic spine articulations with the rib cage). The Board adjudged the evidence of the PT treatment notes and ROMs in evidence supported a 10% rating for painful motion. The single PT treatment note documenting spasm and decreased ROM to the 20% rating criteria was adjudged as an outlier and consideration of VASRD §4.7 (higher of two evaluations) was considered; however, the disability picture did not more nearly approximate the criteria required for that 20% rating. While the C&P history (20 days) could possibly support an alternate 20% coded 5243 (intervertebral disc syndrome) for incapacitating episodes having a total duration of at least at least 2 weeks but less than 4 weeks during the past 12 months, this was adjudged as post-separation worsening. No in-service incapacitating episodes were documented.

The Board considered whether additional Service rating could be recommended under peripheral nerve codes, as conferred by the VA (for the left lower extremity). However, there were no objective findings of functional radiculopathy at separation. Even were the VA sensory findings present at the time of separation, firm Board precedence requires a functional impairment linked to fitness to support a recommendation for addition of a peripheral nerve rating to Service disability in spine cases. The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a. The sensory component in this case (even if conceded versus post-separation worsening) has no functional implications, and no motor weakness was in evidence. There is thus no evidence of a separately ratable functional impairment (with fitness implications) from the residual radiculopathy; and, the Board cannot support a recommendation for an additional Service disability rating on this basis. 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 compression fractures of T3/T4 & T10 condition at separation and at the end of the constructive TDRL period (for PTSD-see below).

PTSD Condition. The CI developed symptoms of PTSD after he was involved in a tank roll-over accident during which he was injured (neck, back, chest and knee) and the tank commander was killed. The CI subsequently had intrusive recollections of this event, experienced marked anxiety in response to stimuli associated with or similar to the event, avoided situations in which such stimuli may be present, and noted recurring dreams of the event. His triggers included closed spaces such as a public bus, amusement park rides, and military vehicles. He limited contact with his unit and participating in weekend drill and annual training exercises since “the memories of the event are overwhelming to him.” He denied any significant neurovegetative signs or symptoms of depression or mania. He did not have any significant spontaneous (un-triggered) panic attacks. In October 2003, the MEB examiner stated in the NARSUM mental health consultation, “He has not had adequate or appropriate treatment for these symptoms to date,” and the CI was not on psychoactive medications. Mental status examination (MSE) was normal aside from difficulty-completing sentences when recalling significant events related to the accident. The Global Assessment of Functioning (GAF) score was 65 (in the range of “some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships).” The examiner diagnosed PTSD with definite impairment of social adjustment/adaptability (marked impairment for military). Prognosis was stated as “although (the CI) would likely benefit from individual psychotherapy as well as pharmacologic therapy, it is unlikely that his symptoms will likely change dramatically or sufficiently enough to enable him to return to full military duty.”

At the VA C&P exam performed 9 months after separation, the CI reported a similar event history. He was employed at the State Department of Corrections as a corrections office, and stated “the job is very tiring for him, but it is quite structured and predictable, which makes it more tolerable.” He further indicated that he “has few, if any, friends at work.” The CI endorsed symptoms of fearful dreams of loss of control, “has difficulty riding buses and riding in anything that is on winding roads” and indicated that he “cannot go to amusement parks and he has trouble watching movies or TV that has ‘certain things on them.’" The CI indicated that “since he has started taking Wellbutrin 150mg SR the triggers, as he calls them, seem to be less severe.” He endorsed increased irritability, startle reaction, intrusive thoughts, and “difficulty focusing on tasks as clearly and consistently now as compared to the time prior to the accident.” On the MSE, affect was somewhat constricted but speech and ability to communicate were appropriate. Infrequent panic attacks where reported when out in crowds. The exam was otherwise normal. GAF was assessed at 65 (MEB GAF=65) and the examiner stated PTSD symptoms “causes clinically significant distress or impairment in social, occupational and other areas of functioning.” More remote VA evidence, 39 months after separation, documented increased PTSD symptoms at an exam in August 2007. The CI had a flattened affect, impaired impulse control, unprovoked irritability, and periods of violence affecting motivation, increased panic attacks, mild memory impairment and difficulty concentrating. The CI stated that symptoms of anxiety and depression were significant contributors in his decision to resign from his job (approximately April 2006). The VA increased the CI’s rating based on this evidence to 50% effective July 2006 (date of request for increase).

The PEB rating, derived from DoDI 1332.39, preceded the promulgation of the National Defense Authorization Act 2008 mandate for DoD adherence to the VASRD §4.129. The Board, IAW DoDI 6040.44 and DoD guidance (which applies current VASRD §4.129 to all Board cases as appropriate), agrees that the stipulations of §4.129 are met in this case. The Board adjudged that there was insufficient evidence for a rating greater than 50% at the time of entry into the retroactive TDRL rating period, and recommends 50% for a retroactive 6-month period on the TDRL. The Board must then determine the most appropriate fit with VASRD §4.130 criteria at 6 months for its permanent rating recommendation, based on the facts in evidence which are most probative for that interval.

The most proximate source of comprehensive evidence on which to base the permanent rating recommendation in this case is the C&P examination performed 9 months after separation. There was no relevant VA outpatient or civilian provider evidence providing psychiatric details during the 6-month interval. For purposes of the permanent rating recommendation it was judged that the 9-month examination carried the highest probative value. It was the more proximate to the 6-month rating benchmark and it most fully reflects the stress of transition to civilian life, which is a core intent of §4.129 and thus intrinsic to the recommendation. The VA assigned a 30% rating for the PTSD condition based on §4.130 criteria without relying on the provisions of §4.129. As regards the permanent rating recommendation, all members agreed that the §4.130 threshold for a 50% rating was not approached and that the criteria for a 0% rating were exceeded. The deliberation settled on arguments for a 30% versus a 10% permanent rating recommendation. The VA rater’s rationale for a 30% rating was well-elucidated in the rating decision. The 30% description (occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks) is a reasonable fit with the occupational functioning in evidence since decreased efficiency can be assumed even though reliability and productivity were not affected. After due deliberation, considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a TDRL rating of 50% IAW §4.129 and a permanent PTSD disability rating of 30% IAW §4.130 in this case.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that RPPS, right knee; and idiopathic hypertension conditions were not unfitting. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. The RPPS, right knee and idiopathic hypertension conditions were not profiled or implicated in the commander’s statement. The idiopathic hypertension condition was not judged to fail retention standards. The right knee had pain with motion, was stable, and had normal imaging studies and ROM of 0 degrees-135 degrees (normal 0-145 degrees). All were reviewed by the action officer and considered by the Board. There was no performance based evidence from the record that either of these conditions significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the RPPS, right knee or the idiopathic hypertension contended conditions and so no additional disability ratings are recommended.


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. As discussed above, likely PEB reliance on AR 635-40 and the USAPDA pain policy for rating the spine conditions and application of DoDI 1332.39 for rating PTSD were operant in this case and the condition was adjudicated independently of those policy and instructions by the Board. In the matter of the compression fracture of C5 condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication at separation or at the end of the constructive TDRL period (for PTSD). In the matter of the compression fractures of T3/T4 & T10 condition, the Board unanimously recommends a disability rating of 10%, coded 5235 IAW VASRD §4.71a at separation and at the end of the constructive TDRL period (for PTSD). In the matter of the PTSD condition, the Board unanimously recommends a disability rating of 50% for a prescribed 6-month period of temporary retirement IAW VASRD §4.129; followed by a 30% permanent rating, coded 9411, IAW VASRD §4.130. In the matter of the contended RPPS, right knee and idiopathic hypertension conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting. 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 to reflect a 6 month period on TDRL with a disability rating of 60% (PTSD at 50% IAW §4.129 and DoD direction), and then permanently retired with a combined disability rating of 40%:

UNFITTING CONDITION
 VASRD CODE RATING
TDRL PERMANENT
Compression fracture of C5 5235 10% 10%
Compression fracture T3/T4 & T10 5235 10% 10%
PTSD 9411 50% 30%
COMBINED
 60% 40%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120501, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for AR20130018161 (PD201200399)
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 retirement 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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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