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AF | PDBR | CY2014 | PD-2014-00654
Original file (PD-2014-00654.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-00654
BRANCH OF SERVICE: Army  BOARD DATE: 20150414
DATE OF PLACEMENT ON TDRL: 20050823
Date of Permanent SEPARATION: 20070620


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve O-2 (Medical-Surgical Nurse) medically separated for headaches and a right eye problem. The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent P3L3E3 profile and referred for a Medical Evaluation Board (MEB). The “post concussive syndrome with headache” and “right eye shrapnel injury with ocular ischemia syndrome,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded five other conditions (cognitive disorder, posttraumatic stress disorder [PTSD], right peroneal nerve injury, right tympanic membrane perforations and tinnitus post blast injuries) for PEB adjudication (all conditions noted as medically acceptable). The Informal PEB (IPEB) adjudicated “post-concussive headaches,” “central scotoma of varying degree dependent upon exercise/valsalva” and “right deep peroneal nerve injury” as unfitting, rated 10%, 10% and 10%, with application of Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting . The CI made no appeals and was placed on the Temporary Disability Retired List (TDRL). Approximately 22 months later, the IPEB adjudicated the “chronic post concussive daily headaches” and “central scotoma OD, exertion and Valsalva sensitive” as unfitting, rated 10% and 10%. The “right deep peroneal nerve injury” was determined to be not unfitting. The CI appealed to the Formal PEB (FPEB) which affirmed the IPEB findings and recommendations. The CI appealed to the FPEB, which affirmed the IPEB findings and recommendations. The CI rebutted the FPEB findings and the case was then reviewed by the US Army Physical Disability Agency (USAPDA) which concluded the case was properly adjudicated. The CI was then medically separated.


CI CONTENTION: “PTSD, Ankle Rt weakness, TBI, Headache, Rt/Lt leg damage weakness shrapnel-face, eyes, arm, eye damage, JOS, [Sic], ear damage.


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.
RATING COMPARISON:

Final PEB – 20070420
 VA Rating Decision1 - 20051115
TDRL Placement – 20050823
 Code Rating Condition Code Rating
Proximate
Condition
 TDRL
Placement		 TDRL Removal TDRL2
Placement
 TDRL3 Removal
Post-Concussive Headaches 8045- 9304 10% 10% Chronic Headaches, Migraine/Tension 8100 30% 30%
Central Scotoma 6081 10% 10% Right Optic Ischemic Syndrome 6009-6080 10% 10%
Right Deep Peroneal Nerve Injury 8523 10% Not Unfitting Right Peroneal Nerve Palsy 8521-8522 30% 0%
Post Traumatic stress Disorder Not Unfitting Post Traumatic Stress Disorder 9411 70% 70%
Right Tympanic Membrane Perforations Not Unfitting Perforated Right Eardrum 6211 0% 0%
Tinnitus Post Blast Injuries Not Unfitting Tinnitus 6260 10% 10%
Other x 0 (Not in Scope)
 Other x 5
RATING: 30% → 20%
 RATING: 90%
1. Most proximate to TDRL Placement
2. Rating derived from C&P exam dated 20050616 , ~ 2 mos. pre-TDRL placement
3. Rating derived from C&P exam dated 20070207 , ~ 4 mos. pre -TDRL removal


ANALYSIS SUMMARY:

Chronic Post concussive Daily Headaches. Treatment records documented that the CI began having headaches after he sustained a traumatic brain injury from an improvised explosive device (IED) blast in April 2004 while riding in a military vehicle. He received multiple shrapnel wounds to the right face/eye, both legs and left hand. The CI was awarded the Purple Heart. The neurology narrative summary (NARSUM), dated 2 September 2004, recorded the CI’s headaches began in mid-April and were generally right-sided, with characteristic severe throbbing and pressure, with nausea and initial photophobia (sensitive to light). The headaches lasted for hours, and had been present daily but had decreased to four times per week. He took abortive medication which helped, but had not started prophylactic medication. The neurologist diagnosed migraine cephalgia with pain rated slight and frequent. The neurology addendum, dated 1 November 2004, noted that the CI had started prophylactic medication which had improved the severity but not the frequency. His headache frequency was “still three to four per month.” The headaches were completely responsive to abortive therapy and there had not been a need for treatment with narcotic medication or treatment in the emergency room. The neurologist documented that the headaches were not incapacitating, and the pain was rated as slight and occasional.

At the VA Compensation and Pension (C&P) examination, dated 16 June 2005, approximately 2 months prior to TDRL placement, the CI reported daily headaches that were 5-7/10 on the pain scale during the work week and around 5/10 on weekends. The examiner noted that, “He does not have headache upon awakening; however, as the day progresses and he contemplates the tasks before him, his headache starts. Headache character consists of aching, sharp, and constant pain. He found the medications helpful.” The examiner diagnosed “chronic headaches, migraine/tension.” A neurology follow-up examination, dated 1 July 2005 and a month prior to TDRL placement, recorded headache frequency of at least five times a week and intensity of 4/10. The CI reported the headaches presented with a constant nagging pain sensation over the right temporal area, at times associated with nausea and sound sensitivity. The neurologist stated his headaches “have been quite disabling for him” but noted the CI had returned to work and was able to work safely. The physician noted the headaches had prevented him from having a good quality of life. There was no documented clinical report of incapacitating headaches, or significant loss of work secondary to headaches. The commander’s statement was not among the records in evidence. The CI was placed on the TDRL in August 2005.

At the TDRL NARSUM exam, dated 13 February 2007, the CI described frontal and right temporal headaches that were “sharp and constant.” He noted that his medication had not impacted the frequency of his headaches (daily), however, he stated that his headaches “are tolerable and I am able to function.” His headaches were associated with sensitivity to sound and light, but were not associated with nausea or vomiting. He was taking only prophylactic medication. He denied any visits to the emergency room since being on TDRL. Physical examination was normal except for decreased sensation to light touch over the dorsal aspect of the right foot, and dilated pupils from his recent ophthalmologist examination. The physician diagnosed post-concussive headaches, and noted that the CI had continued his work as a certified registered nurse anesthetist (CRNA), worked 24-hour shifts and averaged working a total of two weeks every month. He went hunting and hiking 1 to 2 days three times per year.

The Board directed attention to its rating recommendation based on the above evidence. At TDRL placement, the PEB adjudicated the CI’s headache condition at 10% coded 8045-9304 (brain disease due to trauma, purely subjective). The PEB documented that the CI’s headaches required him to go home from work twice a week, but that he was still able to work 30 hours a week. The VA rated the condition of chronic headaches, coded 8100 (migraine). The VARSD, in effect at the time of separation, captured brain injuries under the generic category of brain disease due to trauma (8045). There are two different scenarios for rating under this code: analogously with purely neurological deficits, or purely subjective symptoms. In the absence of associated neurological disabilities (seizures, nerve paralysis, etc.), rating of this condition under 8045-9304 is limited to 10%, and cannot be combined with any other rating for a disability due to brain trauma. The Board found no evidence that would support a purely neurological deficit. The Board then deliberated whether an evaluation under the 8100 would best reflect the CI’s condition. The rating options under 8100 for migraine headaches rely on the frequency of “prostrating” attacks, and VASRD §4.124a does not define “prostrating.” Board precedence has relied on the English definition of prostrating (extreme exhaustion, or powerlessness, reduced to extreme weakness). The Board carefully considered the frequency and nature of the CI’s headaches including objective and corroborating subjective evidence. The 30% rating requires prostrating attaches once monthly over several months. The higher rating of 50% requires “completely prostrating and prolonged attacks productive of severe economic inadaptability.” The Board found limited documentation describing occupational impairment related to headaches. The CI reported having headaches at least four times a week. The NARSUM documented that the headaches were not incapacitating; however, the PEB noted that his headaches had required him to leave work two times a week, thereby, reducing the amount of time available to work. The last recorded neurological evaluation, a month prior to TDRL placement, documented he had “disabling” headaches. A memorandum to the PEB, dated 26 May 2005, noted that his headaches occurred daily and required him to go home from work 2 days per week on average. All Board members agreed that the ratable threshold was met for the 30% criteria because the evidence sufficiently documented episodes of what could be considered prostrating headaches at least once a month. Therefore, after due deliberation considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30%, coded 8100, for the headache condition at TDRL placement.

At the conclusion of TDRL, the FPEB adjudicated the headache condition as unfitting rated at 10%, coded 8045-9304. The TDRL NARSUM recorded absence of clinically significant headaches with medication adherence. The CI was working full-time and reported no loss of work due to headaches. The Board noted headache frequency remained the same; however, the CI was able to work for long periods of time (24-hour shifts) and indicated his medication had helped. He took no abortive therapy, and it appeared that his headaches were controlled sufficiently with preventive medication. There was no evidence of incapacitating episodes with emergency room visits. Therefore, at the time of TDRL removal, Board members agreed that the 10% rating criteria more accurately reflected the CI’s condition. After due deliberation considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board members agreed there was insufficient cause to recommend a change in the PEB rating for the chronic post-concussive daily headache condition at permanent separation (under code 8100).

Central Scotoma OD (Right eye). The NARSUM, dated 26 August 2004, noted that the CI had received shrapnel in his orbit that was seen on CT scans, but did not require surgery. The ophthalmology clinic visit, dated 26 August 2004, documented that the CI reported fuzziness of vision in the right eye that resulted in a central scotoma (an area of loss or depressed vision surrounded by an area of less depressed or normal vision) after several minutes of strenuous exercise or Valsalva. He had not noticed these symptoms prior to his trauma. The CI was diagnosed with ocular ischemia and underwent a CT angiogram on 30 August 2004 which demonstrated thinning of the ophthalmic artery on the right side. Examination of the right eye demonstrated normal reactive pupils, normal visual acuity (corrected), and the presence of a foreign body (shrapnel) in the right sclera. There was also a “questionable” retinal break. The physician documented aerobic exercise and Valsalva-induced visual phenomenon resulting in a central scotoma that is consistent with an ocular ischemic syndrome, and noted the etiology was not clear and was pending further evaluation by vascular surgery. The vascular evaluation, dated 8 September 2004, noted that vascular surgery was not indicated and there was no evidence of extracranial carotid occlusion disease.

The VA C&P examination, 2 months prior to TDRL placement, noted the CI wore glasses but no visual field testing was in evidence. His right pupil was larger than the left and extraocular movements were intact. A visual acuity test recorded on 23 June 2005, 2 months prior to TDRL placement, documented 20/20 right eye and 20/20 left eye with current spectacle correction. His right pupil was larger than his left. At TDRL ophthalmology consult examination on 13 February 2007, the examiner documented visual acuity of 20/20 both eyes and normal extraocular movements. The right pupil was slightly larger than the left, and retinal vessels showed mild attenuation (weakening, thinning) in the right eye. The physician opined that his condition was stable and there was no plan for surgery, since the CI did not want to pursue the neurovascular surgery consult. However, the physician opined that the CI remained at potential risk for central visual loss with exertion or with exercise.

The Board directed attention to its rating recommendation based on the above evidence. At TDRL placement, the PEB coded the condition of central scotoma 6081 (scotoma, unilateral, rated on loss of central visual acuity or impairment of visual field) at 10%. This code has a minimal rating of 10% which cannot be combined with any other rating for visual impairment. The VA coded the condition of right optic ischemic syndrome 6009-6080 (impairment of visual field) at 10%. The higher rating of 20% under the 6080 code requires either a bilateral loss of the nasal half of visual field, or acuity demonstrating severe loss. The Board agreed that the evidence did not support a rating under either code greater than 10%, and found no other applicable codes. 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 central scotoma condition at TDRL placement.

The Board proceeded to a rating recommendation at permanent separation. The FPEB, under code 6081, rated the condition at 10%, and noted the condition was stable but prevented the return to active duty. The Board acknowledged there were no applicable codes resulted in a rating higher than 10%, thereupon, 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 central scotoma condition at permanent separation.

Right Peroneal Nerve Injury. Treatment records documented that the CI received shrapnel injuries to his left and right lower extremities from an IED blast. He had numbness in his right foot and several scars over the lower extremities. The orthopedic addendum to the MEB, dated 15 July 2004, documented his right leg injury resulted in mild right peroneal nerve palsy with a sense of instability of the right ankle. The CI underwent incision and drainage of the right leg secondary to infection of the shrapnel wound. Physical examination of the right leg demonstrated a wound in the process of healing. The right ankle demonstrated full range-of-motion (ROM) and residual weakness of the peroneals and tibialis anterior muscles (4/5). There was no instability of the ankle on testing. The diagnosis of “right peroneal nerve palsy with residual peroneal weakness and tibialis anterior weakness and ankle instability secondary to this” was recorded. The examiner opined that the nerve palsy was expected to resolve with minimal residuals over the “next ensuing months,” and noted his wounds were expected to heal and meet retention standards. At the follow-up orthopedic visit on 12 April 2005, 4 months prior to TDRL placement, the CI indicated he wore a brace daily which helped with his ankle pain. Physical examination documented right ankle weakness in dorsiflexion compared to the left, and a “profound weakness” in eversion of the right ankle compared to the left. There was diminished sensation in between the toes (1-2 web spaces), all opined to be consistent with peroneal nerve injury. The examiner noted his condition was static; he was unable to run, stand for prolonged periods of time or carry out a full active duty, and that no further recovery of his peroneal nerve function was anticipated.

The VA C&P examination, dated 16 June 2005, documented numbness on the dorsum of the right foot, especially between the first and second web spaces, and ankle instability. The examiner noted absence of episodes of dislocation or subluxation. Physical examination of the right foot recorded “reduced dorsiflexion, and normal plantar flexion.” Mild foot drop was noted, and there was no evidence of pain with repetitive motion. The diagnosis of right ankle instability with right peroneal nerve palsy was assessed. On 1 August 2005, a memorandum to the PEB containing additional information regarding the CI’s condition, documented motor weakness secondary to the right peroneal nerve injury which had resulted in foot drop. This finding had been recorded as medically acceptable on the initial MEB due to the physician’s opinion that it would resolve with time; however, the CI’s condition required the continued use of an ankle brace and regular management for weak right foot dorsiflexion. Therefore, the author of the memo documented that the CI’s condition did not meet retention standards and the CI entered the TDRL for the identified condition.

At the TDRL evaluation, the examiner noted that the CI had continued to wear “braces” and was under the care of his primary care provider at the VA. The examiner noted that he wore an elastic wrap that day and not a true brace. The CI noted that he wore a true brace when he was “hiking or hunting” (he participated in these activities three times a year), and stated that if he did not wear the brace his ankle would roll. He denied ankle pain. The CI used no assistive device for ambulation. Physical examination recorded normal deep tendon reflexes, absence of lower extremity atrophy, and absence of inflammation/neuromuscular deficit. Sensation was decreased to light touch over the dorsal aspect of the right foot; however, gait was normal and there was good demonstration of heel and toe walk. The physician documented that with the CI’s wearing of his braces, “he does pretty well” and could walk a maximum of two miles at his own pace and stand for a maximum of 45 minutes at a time; however, he had not been running due to his eye condition and his right ankle. Ankle ROM measurements were not recorded.

The Board directed attention to its rating recommendation based on the above evidence. The PEB, at TDRL placement, rated the condition of right peroneal nerve injury with peroneal and tibialis anterior weakness and ankle instability, at 10%, coded 8523 (anterior tibial nerve, aka, deep peroneal). The VA rated the condition of right peroneal nerve palsy and right ankle instability, coded analogously 8521-8522, at 30% (for complete paralysis with weakened eversion of the foot). The VA rating decision noted that the evaluation was based in part on the April 2005 orthopedic examination which documented “profound weakness in eversion of the right foot…diminished sensation in the 1-2 web space, consistent with peroneal nerve injury.” The Board considered whether there was sufficient evidence to support a rating higher than 10% under the 8523 code. The 20% rating required evidence of severe incomplete paralysis and the 30% rating required evidence of complete loss of dorsal flexion. The higher rating of 20% under the 8522 code is for incomplete, severe, paralysis of the superficial peroneal nerve manifested by weakened eversion of the foot; the 30% rating is for complete paralysis with weakened eversion of the foot. The higher rating under 8521 code required demonstration of incomplete moderate foot drop.

The orthopedic MEB July 2004 documented that the CI’s injury resulted in a mild right peroneal nerve palsy with a sense of instability of the right ankle, with mild residual weakness (4/5). Ankle instability was absent on examination; however, the examiner included instability in the diagnostic assessment. The follow-up orthopedic exam, on April 2005, documented right ankle weakness in dorsiflexion compared to the left, and a “profound weakness” in eversion of the right ankle compared to the left. There was diminished sensation in between the toes (web 1-2), all opined to be consistent with peroneal nerve injury. The VA exam in June 2005 recorded mild foot drop and non-ratable ankle ROM; however, weakened foot eversion was not recorded. On 1 August 2005, a memorandum to the PEB documented that the motor weakness secondary to the right peroneal nerve injury had resulted in foot drop. After deliberation, the Board members concluded that the CI met the description for incomplete foot drop, but without adequate documentation of the severity, using 8521 code was not supported. Deliberations then focused on the 8522 code. After considerable deliberation, reasonable doubt surfaced in regards to the degree of disability. There was documented evidence of significant issues with foot eversion, recorded as “profound.” The Board, after considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), and §4.7 (the higher of two evaluation) recommends a 30% disability rating, coded 8522, for the condition of right peroneal nerve injury at TDRL placement.

The Board proceeded to the rating recommendation for the removal from TDRL. The record in evidence demonstrated that the CI had continued to wear braces to prevent rolling of the ankle. He had a normal gait, with good ability to heel and toe walk. He engaged in hiking and hunting, denied ankle pain and instability was not present during examination. Neuromuscular examination was normal, and documentation of continued weakness of foot eversion was absent. The CI demonstrated the ability to do well; when he wore his braces he could walk two miles at his own pace and stand up to 45 minutes at a time. The examiner diagnosed “history of right peroneal nerve injury and right ankle instability.” The PEB’s position was that the CI could wear his ankle brace to perform his job as a CRNA. All Board members agreed that at the time of separation, there was not a preponderance of evidence to support that the condition was unfitting. Thereupon, 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 fitness determination for the right peroneal nerve condition at permanent separation.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions of PTSD, right tympanic membrane perforations, and tinnitus 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 Board reviewed the available service treatment records and found one psychiatric assessment, dated 9 July 2004 (13 months prior to TDRL placement), documenting the diagnosis of PTSD, manifested by depressive and anxiety symptoms with nightmares and flashbacks. The psychiatrist noted severe insomnia, low energy level, and poor motivation. His mental status examination was unremarkable except for a depressed and anxious mood and affect. His memory was grossly intact, although he complained of short-term memory impairment. The CI took an antidepressant medication and was on medication to treat insomnia. There were no additional mental health notes in evidence for review. The record also documented decreased hearing in the right ear with tinnitus and perforated ear drum; however, there was insufficient evidence to support that the conditions had a negative impact on duty performance. None of the above contended conditions were profiled or judged to fail retention standards. All were reviewed by the action officer and considered by the Board. There was no performance based evidence from the record that any 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 any of the 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. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the chronic post-concussive daily headache condition, the Board unanimously recommends a disability rating at TDRL placement of 30% and 10% permanent disability rating, coded 8100 IAW VASRD §4.124a. In the matter of the central scotoma condition and IAW VASRD §4.84a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the right peroneal nerve injury condition, the Board unanimously recommends a disability rating of 30% rating, coded 8522 IAW VASRD §4.124a, at TDRL placement, and no change in the PEB’s fitness determination at permanent separation. In the matter of the contended PTSD, right tympanic membrane perforations, and tinnitus 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 as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
TDRL PERMANENT
Post Concussive Headaches 8100 30% 10%
Central Scotoma 6081 10% 10%
Right Nerve Injury and Right Ankle Instability 8522 30% Not Unfitting
COMBINED
 60% 20%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140131, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record





XXXXXXXXXXXXXXX
President
DoD 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 XXXXXXXXXXXXXXX , AR20150013269 (PD201400654)


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 rather than 30% for the period 20 August 2005 to 19 June 2007 and then following this period no recharacterization of the individual’s separation or modification of the permanent disability rating of 20%.

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 as follows:

         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 separated with a permanent combined rating of 20% effective the day following the six month TDRL period with no recharacterization of the individual’s separation.

         c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will provide 60% retired pay for the constructive temporary disability retired period effective the date of the individual’s original medical separation and adjusting severance pay as necessary to account for the additional TDRL time in service.





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                                                  XXXXXXXXXXXXXXX                                                                                           Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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