RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD1300769
BRANCH OF SERVICE:  Army	BOARD DATE:  20140130
SEPARATION DATE:  20060623

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a mobilized Reserve SGT/E-5 (21W/Carpentry Masonry Sergeant) medically separated for lumbar disc disease, mood disorder and bilateral knee conditions.  The CI was mobilized in December 2003 and deployed to Kuwait from February 2004 to February 2005.  He developed back pain with heavy lifting while deployed, and was diagnosed with multi-level disc disease (deemed non-surgical) after redeployment.  He sought mental health (MH) care after deployment for irritability and sleep disturbance and was subsequently diagnosed with mood disorder, not otherwise specified (NOS).  He complained of bilateral knee pain after deployment, and was diagnosed with bilateral meniscal (cartilage) disease not resulting in surgical intervention.  He complained of neck pain after deployment, and was diagnosed with degenerative cervical spine disease (non-surgical).  The orthopedic and MH conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent U3/L3/S3 profile and referred for a Medical Evaluation Board (MEB).  The conditions, characterized as “bilateral knee pain secondary to osteoarthritis and meniscal degeneration,” “low back pain due to lumbar disc bulges with radiculopathy and degenerative changes,” “cervical pain due to multilevel spondylosis” and “mood disorder NOS,” were forwarded to the Physical Evaluation Board (PEB), each considered medically unacceptable IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated the lumbar, mood disorder and bilateral knee conditions as unfitting: the lumbar spine rated 10%, citing criteria of the US Army Physical Disability Agency (USAPDA) pain policy and the VA Schedule for Rating Disabilities (VASRD); the mood disorder rated 10%, citing criteria of DoDI 1332.39 (E2.A1.5); and, the bilateral knee conditions rated 0% with presumptive application of AR 635-40 (B.24.f) and the USAPDA pain policy.  The cervical condition was determined to be not unfitting.  The CI made no appeals and was medically separated and transferred to the Retired Reserve List awaiting retired pay at age 60 pursuant to his request.

CI CONTENTION:  The applicant wrote “see attachment” and attached a one page memorandum from a VA Outpatient clinic listing 15 conditions.  This was reviewed by the Board and considered in its recommendations.  The CI elaborated no specific contention in his application.

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 chronic low back pain, mood disorder and osteoarthritis of both knees are addressed below.  Members judged that the cervical pain due to multilevel spondylosis, which was determined to be not unfitting by the PEB, was specified sufficiently in the application to meet the DoDI 6040.44 scope requirements; and is accordingly addressed below.  The CI was notified that his case qualifies for review of his MH condition in accordance with the Secretary of Defense directive for a comprehensive review of Service members who were referred to the military Disability Evaluation System (DES) between 11 September 2001 and 30 April 2012, and whose MH diagnoses were unfavorably changed or eliminated during that process.  Accordingly, the case file was reviewed regarding unfavorable diagnosis change (specifically with reference to posttraumatic stress disorder [PTSD] or downgrade of MH conditions to non-rated adjustment disorder); applicability of VASRD §4.129; and, rating (via §4.129 or §4.130 as appropriate) of MH conditions.  Under the Terms of Reference of the MH Review Project , the Panel considers the criteria for diagnosis of PTSD as specified in the Diagnostic and Statistical Manual for Mental Disorders IV - Text Revision (DSM IV-TR): 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), and presence of significant distress or impairment in social, occupational or other important area of functioning (criterion F).  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 IPEB – Dated 20060515	VA - (3 - 3.5 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain 	5299-5242	10%	Mild Bulging Discs Lumbosacral and LBP 	5243	10%	20060929	
Mood Disorder NOS	9435	10%	Adjustment Disorder w/Mixed Anxiety and Depressed Mood	9440	30%	20061005	
Osteoarthritis Bilateral Knees	5003	0%	Left Knee Lateral Meniscal Tear; Osteoarthritis	5257	20%	20061010	
			Right Knee Medial and Lateral Meniscus Tear; Osteoarthritis	5003	10%	20061010	
Cervical Pain	Not Unfitting	DJD Cervical Spine	5003	10%	20060929	
No Additional MEB/PEB Entries	Other x 3	20061010	
Combined Rating:  20%	Combined:  70%	
Derived from VA Rating Decision (VARD) dated 20070227 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Lumbar Spine Condition.  The CI experienced an onset of back pain while changing a tire in July 2004 (mid-deployment), and was treated conservatively in-theater.  His first treatment note in the available service treatment record (STR) was a month after redeployment in medical hold.  He developed bilateral lower extremity radiation and magnetic resonance imaging (MRI) of April 2005 demonstrated degenerative disc disease (DDD) with mild bulging at L3/4, L4/5, and L5/S1.  Electromyography (EMG) a month later was consistent with “chronic left L4-L5-S1 polyradiculopathy.”  A neurosurgical consultant in July 2005 documented normal motor and reflex findings, diagnosed DDD and did not recommend surgery.  The CI underwent physical therapy (PT), epidural injections and pain management intervention with limited success.  A repeat EMG in March 2006 (3 months prior to separation) was normal.  Earlier STR entries (greater than 12 months prior to separation) record modestly impaired range-of-motion (ROM) with (flexion of 80 degrees), and later entries note only grossly “decreased” ROM.  The CI ambulated with the use of a cane, although the narrative summary (NARSUM) commented that this was indicated for the left knee.  There are no STR entries documenting abnormal spinal contour or abnormal neurological findings.  There are separate entries prescribing supervised bed rest for a cumulative 10 days in the 12 months preceding separation.  The NARSUM (3 months prior to separation) noted “back pain almost all day with worsening after prolonged standing or sitting,” and did not comment on active radicular symptoms.  The physical exam noted lower lumbar tenderness without comment on other findings, but a probative MEB evaluation was performed by PT (dated 3 days after the NARSUM).  This documented moderate paralumbar spasm, and commented on scoliosis (opined by PT as due to gait/posture changes with use of the cane).  Full goniometric range-of-motion (ROM) measurements were provided and recorded at 60 degrees flexion and 150 degrees combined ROM.  A VA Compensation and Pension (C&P) spine evaluation was performed 3 months after separation.  This characterized the back pain as “severe” and noted bilateral radiation to the knees.  It documented a cumulative history of a month of prescribed bed rest over the preceding 12 months (not corroborated by the cumulative 10 days evidenced in the STR).  The VA physical exam specified the absence of spasm, atrophy, guarding, painful motion, tenderness and weakness, and opined that there was not spasm or guarding sufficient to cause abnormal gait or contour.  A detailed lower extremity neurologic examination was normal.  The VA examiner did not perform ROM measurements, stating that “although…very cooperative” the CI was too “jumpy and hyperactive” to permit reliable evaluation.  No VA ROM measurements within 12 months of separation are in evidence.  The VARD granting 10% under 5243 (Intervertebral disc syndrome) cited criteria of the formula for rating incapacitating episodes (consistent with less than 2 weeks of incapacitation as per the objective STR evidence).

The Board directs attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating was supported by the USAPDA pain policy; but, under VASRD §4.71a criteria, the MEB flexion of 60 degrees meets the threshold for a 20% rating.  Members deliberated the probative value of this single data point for recommending an increased rating, but must recognize that this is the only probative (within 12 months preceding or following separation) ROM evidence which complies with VASRD §4.46 (accurate measurement).  It is also noted that abnormal gait or abnormal contour are each a stand-alone criterion for a 20% rating IAW §4.71a; and, although there is ample evidence that these criteria were more directly related to the knee condition, some contribution from the spine condition was likely a factor.  After due deliberation, with dissenting opinion and conceding VASRD §4.3 (reasonable doubt), the Board majority recommendation is a disability rating of 20% for the lumbar disc condition.  

The Board considered whether additional rating could be recommended under a peripheral nerve code for the associated radiculopathy in this case.  Firm Board precedence requires a functional impairment linked to fitness to support a recommendation for addition of a peripheral nerve rating to disability in spine cases.  In the absence of any demonstrable weakness (EMG confirmed at separation), all members agreed that no link to fitness is supported.  The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a.

Mood Disorder.  There is no STR evidence of MH complaints or evaluation during deployment.  There is a comment in an orthopedic note of March 2005 (a month after redeployment) that the CI was requesting an MH referral.  Early MH entries cite difficulty sleeping, mood swings, anxiety and irritability with aggressive impulses.  He was started on an antidepressant and sleep medication (Celexa and Doxepin), and a psychiatrist in June 2005 made an Axis I diagnosis of “adjustment disorder with depressed mood.”  Symptoms improved after some adjustment of medications.  There is no STR evidence of alcohol or substance abuse.  None of the MH entries associate symptoms with any deployment related stressor.  An entry in August 2005 documents association of mood swings with “family problems;” and, the CI underwent a 3-day psychiatric admission in the same time frame (9 months prior to separation).  This was for severe depression and suicidal ideation in the setting of marital turmoil and divorce proceedings.  He responded well to inpatient intervention; was discharged with a Global Assessment of Functioning (GAF) score of 70 (slight to mild impairment); and, received Axis I discharge diagnoses [Spanish translation from Puerto Rico VA records] of “major depression” and “rule-out bipolar disorder” (criteria for latter not clear from record).

The psychiatric addendum to the NARSUM was performed 8 months prior to separation.  The examiner cited some traumatic experiences from deployment, but did not associate them with psychological response or link them to the psychiatric diagnosis.  This documented “periods of depression that can last from two days to two weeks interspersed with periods of impulsivity, arguing, and socially inappropriate behavior.”  The only example of impulsivity cited was punching the dashboard during arguments with his wife.  There is no STR evidence of behavioral lability or violence surfacing in a military context.  Medications at this time included lithium (generally directed at bipolar mood cycling), which had apparently been added during the one month interval since hospitalization.  The examiner noted that the CI was “more serene and less agitated since the addition of lithium;” and, additional medications were Cymbalta (antidepressant) and Restoril (sleep).  The mental status exam (MSE) noted a “sometimes sad” mood, and an “anxious, at times bordering on the inappropriate” affect, with “moderate” psychomotor agitation.  It was otherwise normal without homicidal/suicidal ideation, delusions, hallucinations or other acute features.  The only Axis I diagnosis was mood disorder, NOS.  The examiner did not provide a GAF assignment, but the (rescinded) DoDI 1332.39-derived assessment of social and industrial impairment was “moderate.”  The examiner also added that “Given his mental status, he will not be able to participate in Physical Evaluation Board proceedings.” The commander’s performance statement did not address cognitive or behavioral performance issues, noting only that the CI’s “physical ability” to perform was compromised; but listed mood disorder from the profiled conditions.

There is in evidence a probative VA C&P MH evaluation performed 4 months after separation.  The CI reported that “he has been irritable, severely anxious” with continued domestic strife and endorsed ongoing depression with loose suicidal ideation (no plans, attempts).  No service or deployment stressors were cited.  Medications were unchanged from separation except for the substitution of Paxil for Cymbalta.  He was working as a teacher (his profession), but significant workplace accommodations were elaborated (reduced course load, need for an assistant).  The MSE noted an “extremely restless and anxious” mood with “constricted” affect.  Subjective poor memory was documented, but there were pertinent negatives for active suicidal ideation, delusions, hallucinations, panic attacks and impulsive behavior.  The GAF assignment was 60 (mild to moderate impairment), but the examiner opined that there was “severe impairment in his social, laboral [sic] and marital functioning.”  The Axis I diagnosis was “adjustment disorder with mixed anxiety and depressed mood,” and there was no entry for bipolar disorder or other Axis I diagnosis.  Post-separation VA evidence documents that the CI continued full-time employment as a teacher until retirement in 2009, with conflicting accounts regarding the need for accommodation or whether any occupational impairment was attributable to MH vs. non-MH factors.  The CI was formally diagnosed with bipolar disorder in 2009.

The Board directs attention to its recommendations based on the above evidence.  The Board first assessed whether a diagnosis of PTSD was changed or eliminated to the disadvantage of the applicant.  There is no MH entry in the STR or VA file documenting a psychiatric opinion in support of a diagnosis of PTSD.  In addition, all members agreed that DSM IV-TR Criteria A – F for a diagnosis of PTSD were not well supported by the evidence.  There was likewise no evidence that the service diagnosis of the MH condition was unfavorable to the applicant.  This case does not meet the inclusion criteria in the Terms of Reference of the MH Review Project.

Members next considered whether VASRD §4.129 was applicable to the unfitting MH condition; noting that §4.129 does not specify a diagnosis of PTSD, but rather any “mental disorder due to a highly stressful event” severe enough to result in release from military service.  Although the deployment stressors may have played some role in the evolution of the CI’s psychiatric disorder, the evidence is clear that non-service-connected domestic stressors were the primary underlying issues.  Furthermore it is noted that the totality of evidence supports a conclusion that evolving bipolar disorder was a significant driver of the psychiatric condition in service; and, this is an endogenous disorder which is not “due to” external stressors (although it may be exacerbated by them).  Members agreed therefore that the requirements for application of §4.129 were not satisfied in this case.
The Board was left with the assessment of the fairness of the separation rating for mood disorder NOS, applying criteria of VASRD §4.130.  All members agreed that §4.130 criteria for the 70% or 100% ratings were not met, and deliberated whether the 50% criteria were met, i.e., “occupational and social impairment with reduced reliability and productivity” (referencing typical symptoms of flat affect, stereotyped speech, frequent panic attacks, deficits in comprehension and memory, impaired judgment, mood disturbance, and difficulty with establishing relationships).  Although the CI had required a brief psychiatric hospitalization in the period leading up to separation, he stabilized and improved significantly following that intervention.  There is not a strong base of evidence for military functioning (from a MH standpoint) at the time of separation, although there is no evidence that he was significantly incapacitated by psychiatric impairment and, it is clear that the he transitioned rapidly into a fairly high level of civilian occupational functioning.  There were no acute psychiatric symptoms which would significantly interfere with occupational demands.  Members agreed that a 50% rating recommendation was not adequately supported; and, deliberated 30% (“occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks”) vs. 10% (“occupational and social impairment due to mild or transient symptoms which decrease work efficiency … only during periods of significant stress, or; symptoms controlled by continuous medication”) recommendations.  Although the CI was able to step back into his career as a teacher, he clearly was not able to resume his prior level of occupational functioning.  The necessity of his employer to accommodate his limitations is more than adequate support for decreased work efficiency and inability to perform some occupational tasks as cited in the 30% rating description.  It is likewise difficult to fairly characterize the MH symptoms at separation as “transient” or “controlled by continuous medication” as cited in the 10% description.  After due deliberation, with dissenting opinion and conceding reasonable doubt, the majority Board recommendation is a 30% rating for the mood disorder under VASRD code 9435.

Bilateral Knee Condition.  A 1999 entry in the STR documents a complaint of left knee pain (no positive -ray findings).  The next knee complaint evidenced in the STR is from December 2004 (mid-deployment) which documents an onset of left knee pain while running, with meniscal tear considered.  The first complaint of right knee pain (no injury) was April 2005 (2 months after deployment), and an MRI of each knee was obtained 2 weeks later.  These demonstrated a meniscal tear (with possible loose fragment), a joint cyst of the left knee, degenerative meniscal tears of the right knee, and bilateral osteoarthritis.  It was determined that surgery was not indicated (NARSUM indicated that future joint replacements was a possibility), and a bilateral knee profile was issued 12 months prior to separation.  STR entries document normal ROM measurements; and no instability, signs of cartilage impingement, locking, persistent effusions, or comment regarding painful motion.  No STR entry elucidating the indication for a cane is in evidence.  The NARSUM documented the left knee history described above, did not elaborate for the right knee and did not elaborate symptom acuity or limitations for the bilateral knee condition.  The physical exam recorded “bilateral knee crepitus with discomfort on palpation and apprehension with range of motion secondary to pain, mainly with flexion.”  There was no documented stress testing for instability (although no ligament pathology by MRI).  The MEB ROM measurements performed by PT documented flexion of 120 degrees (normal 140 degrees) for the right knee and 125 degrees for the left.  The VA C&P evaluation (3+ months after separation) noted bilateral knee pain exacerbated by prolonged walking, standing, sitting, kneeling, lifting and stair climbing.  A VA outpatient note 3 days later noted “unbearable bilateral knee pain left greater than right.”  The C&P physical examination noted bilateral joint tenderness without crepitance (crackles), effusion or instability.  The ROM measurements recorded normal bilateral flexion (140 degrees), but minus 15 degrees extension of the left knee.  No limitation of knee extension is documented elsewhere in service or VA records, nor reasonably explained by the confirmed pathology.  Painful motion was not stipulated.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB’s bilateral rating of 0% analogously to 5003 (degenerative arthritis) does not comport with the VASRD §4.71a 10% rating under 5003 for two or more major joints, the latter without regard to ROM limitation or other factors.  Although §4.71a permits combined ratings of two or more joints under 5003, it allows separate ratings for separately compensable joints.  If supported under §4.71a, the Board may recommend separate ratings for PEB bilateral joint adjudications; provided that members agree that each joint is reasonably justified as separately unfitting and thus eligible for service rating.  The Board thus first considered the fitness implications for each knee.  It is noted that, although the left knee was more clinically dominant than the right, both knees were associated with significant pathology by imaging and the onset of acute symptoms for each knee was temporally proximate.  Both knees were considered to fail retention standards and both were implicated in the L3 profile.  The commander’s statement and other STR evidence did not provide any information which would permit the Board to discriminate the performance limitations attributable to either knee over the other.  Since undue speculation would be required to conclude that left knee impairment would not have unacceptably interfered with MOS performance, members agreed that each knee was reasonably justified as separately unfitting.

The Board then turned to appropriate coding and rating options for each knee.  A bilateral 10% rating under the provisions of 5003 was considered, but it was concluded that the NARSUM provided satisfactory evidence for painful motion of each knee; thus, separate joint ratings are indicated IAW §4.71a.  There is no evidence for compensable ROM impairment, ligamentous laxity, frequent effusions or locking which would support a rating higher than 10% under any applicable code.  The VA’s 20% rating decision for the left knee referenced the significant limitation of extension noted in the C&P evaluation, but all members concurred that the probative weight of this discordant finding was insufficient to support the higher rating.  A minimum 10% rating for each knee IAW VASRD §4.59 (painful motion) is well supported by the NARSUM and clinical expectation.  After due deliberation, conceding reasonable doubt, the Board recommends a 10% rating for each knee separately coded 5003.

Contended Cervical Spine Condition.  The VA C&P examiner documents a history of onset of cervical pain concurrent with the lumbar strain injury during deployment, although this is not corroborated in the STR.  There is no line of duty documentation for the cervical condition, unlike the remaining orthopedic conditions.  The NARSUM states that the CI complained of neck pain during the lumbar work-up.  The earliest STR entry for the condition is a pain clinic note 5 months after redeployment with a complaint of trapezial/rhomboid spasm (upper thoracic muscles) and bilateral hand paresthesias.  An MRI was obtained which revealed osteophytes and spondylosis (degenerative facet disease), and a follow-up MRI (near separation) confirmed the absence of disc disease.  An initial EMG was suggestive for left carpal tunnel syndrome, but no cervical nerve root involvement and a follow-up EMG (near separation) was normal.  No abnormal neurological findings or significant physical findings are evidenced in the STR, NARSUM or C&P.  No specific limitations attributable to the cervical spine condition can be gleaned from any of the evidence, including the commander’s statement and, the profile did not include Kevlar proscription or other limitations solely attributable to the cervical spine.  The MEB cervical ROM was flexion 35 degrees (normal 45 degrees) and combined 175 degrees (normal 340 degrees), and the CI could not cooperate for C&P measurements (as per the lumbar exam).

The Board directs attention to its recommendation based on the above evidence.  The Board’s main charge is to assess the fairness of the PEB’s determination that the cervical spine condition was not unfitting.  The Board’s threshold for countering fitness determinations is higher than the reasonable doubt standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Although this condition was profiled and judged to fail retention standards, an established principle for fitness determinations is that they are performance-based.  The Board is confronted in this case with the lack of any evidence that the limitations imposed by the cervical condition prohibited the performance of the duties required of the MOS.  It is also relevant that the cervical condition appears to have surfaced after DES referral for the lumbar condition; and, if so, is subject to DoDI 1332.38 (E3.P3.3.3 - Adequate Performance Until Referral).  This stipulates, “If the evidence establishes that the Service member adequately performed his or her duties until the time the Service member was referred for physical evaluation, the member may be considered fit for duty even though medical evidence indicates questionable physical ability to continue to perform duty.”  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 cervical spine condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB reliance on the USAPDA pain policy, AR 635-40, and DoDI 1332.39 for rating various conditions was operant in this case and those conditions were adjudicated independently of that guidance by the Board.  In the matter of the lumbar spine condition, the Board by a vote of 2:1 recommends a disability rating of 20%, coded 5299-5242 IAW VASRD §4.71a.  The single voter for dissent did not elect to submit a minority opinion.  In the matter of the mood disorder MH condition, the Board by a vote of 2:1 recommends a disability rating of 30%, coded 9435 IAW VASRD §4.71a.  The single voter for dissent did not elect to submit a minority opinion.  In the matter of the service-combined bilateral knee condition, the Board unanimously recommends that each joint be rated as separately unfitting at 10%, coded 5003, IAW VASRD §4.71a. In the matter of the contended cervical spine condition, the Board unanimously recommends no change from the PEB determination 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; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Degenerative Disc Disease, Lumbar Spine	5299-5242	20%	
Mood Disorder, Not Otherwise Specified	9435	30%	
Osteoarthritis, Left Knee	5003	10%	
Osteoarthritis, Right Knee	5003	10%	
Cervical Pain Due to Multilevel Spondylosis	Not Unfitting	
COMBINED (w/ BLF)	60%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130530, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
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 XXXXXXXXXXXXXXXXXX, AR20140006939 (PD201300769)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 60% effective the date of the individual’s original medical separation for disability with Reserve retirement.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with Reserve retirement.

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

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for payment of permanent retired pay at 60% effective the date of the original medical separation for disability with Reserve retirement.

	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