RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01384
BRANCH OF SERVICE:  Army	BOARD DATE:  20150120
SEPARATION DATE:  20060615

SUMMARY OF CASE:  Data extracted from the available evidence of the record reflects that this covered individual (CI) was an active duty E-4 (Administrative Specialist) medically separated for anxiety disorder and chronic low back pain (LBP).  The CI first reported acute LBP in April 1997.  He underwent conservative treatment and therapy but his condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He deployed to Iraq in February 2004 and returned to his duty station in Germany in February 2005. He developed symptoms of anxiety upon his return.  He was issued a permanent L3 S3 profile and referred for a Medical Evaluation Board (MEB).  The anxiety and back conditions, characterized as “anxiety disorder” and “chronic low back pain without radiculopathy,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB forwarded no other conditions to the PEB.  The Informal PEB adjudicated “anxiety disorder NOS (not otherwise specified)” and “chronic low back pain” as unfitting, rated 10% and 10%.  The CI made no appeals and was medically separated.

CI CONTENTION:  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.  In addition, the CI was notified by the Army that his case may eligible for review of the military disability evaluation of any mental health (MH) condition in accordance with Secretary of Defense directive for a comprehensive review of Service members who were referred to a disability evaluation process between 11 September 2001 and 30 April 2012 and whose MH diagnoses were changed or eliminated during that process.  Since the CI responded to this mailing, it is presumed that he has elected review by the PDBR for the MH condition although he did not specifically contend for it on the DD Form 294.  In accordance with Secretary of Defense directive for a comprehensive review of MH diagnoses that were changed during the Disability Evaluation System (DES) process, the applicant’s case file was reviewed regarding diagnosis change, fitness determination, and rating of unfitting mental health diagnoses in accordance with the VA Schedule for Rating Disabilities (VASRD) §4.129 and §4.130.  The CI is also eligible for PDBR review of other conditions evaluated by the PEB and has elected review by the PDBR.  The rating for the unfitting chronic low back condition and the anxiety disorder (NOS) 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 IPEB – Dated 20060323	VA - (7 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder NOS	9413	10%	Posttraumatic Stress Disorder (PTSD)	9411	30%	20070222	
Chronic Low Back Pain	5299-5237	10%	Degenerative Disc Disease (DDD) of the Thoraco Lumbar Spine	5243	20%	20070130	
			Neurological Deficit of the Right Lower Extremity Associated w/DDD of the Thoraco Lumbar Spine	8520	10%	20070130	
			Neurological Deficit of the Left Lower Extremity Associated w/DDD of the Thoraco Lumbar Spine	8520	10%	20070130	
Other x 0 (Not in Scope0	Other x 18	20070130	
Combined:  20%	Combined:  60%	
Derived from VA Rating Decision (VARD) dated 20070509 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Anxiety Disorder NOS.  The CI deployed to Iraq from January 2004 to February 2005 where he reported serving as a gunner during convoys (the DD Form 214 reflects award of the combat action badge).  The CI completed the post-deployment health assessment (PDHA) questionnaire on 17 January 2005 and indicated “no” to having seen anyone killed dead or wounded (question 7), or engaging in direct combat (question 8).  He checked “yes” to having felt in great danger of being killed.  He checked “yes” to experiencing symptoms of feeling down or depressed loss of interest, nightmares, intrusive thoughts, and avoidance.  He indicated “no” to having thoughts of self-harm, feeling constantly on guard, easily startled, feeling numb detached, and having concerns about conflict or losing control.  The medical interview section of the PDHA recorded “Saw dead bodies while on convoy, no current problems, will follow up as needed.”  The CI returned to his home base in Europe in February 2005.  The service treatment record (STR) falls silent with regard to any complaints or treatment for MH symptoms until after initiation of the MEB process for back pain.  An orthopedic surgery evaluation for back pain on 15 February 2005, recorded, “He is now back and he wants a European out.  He wants to get out and get an army civilian job.  The retention people said he needs to get an MMRB [MOS Medical Retention Board] or MEB for that so he is here.”  Subsequent STRs reflect care for back pain but there are no entries documenting complaint of or treatment for psychological symptoms.  At the time of the orthopedic examination on 4 October 2005 which initiated the MEB for LBP, the orthopedic surgeon recorded “He denies any significant psychosocial stressors,” however the orthopedic surgeon noted that subjective symptoms appeared to be more severe than the objective medical findings would suggest.  At the time of the MEB history and physical examination on 18 October 2005, the CI reported (on DD 2807) “almost all my life I been having anxiety problems,” and “I always have to excessive worry.  I worry to much about tinny things.”  He also reported memory problems during and since returning from Iraq.  He reported sleep problems due to back pain.  The examiner noted that the CI described short term memory loss, and reported having some residual dreams about Operation Iraqi Freedom experiences.  He reported getting angry when seeing Middle Eastern people in and around bars and restaurants.  The examiner (DD Form 2808) on 21 November 2005 commented that the CI may have some “underlying anxiety DO with some component of PTSD” and suggested he seek MH services.  

The commander’s statement on 28 November 2005, referred only to physical limitation due to back pain.  The commander noted that the CI had maintained his motivation for duty and stated, “The back pain will not go away SPC____ has been an outstanding member of my command, and he has been a solid performer despite his diminished capabilities.”  The psychiatry MEB narrative summary (NARSUM) addendum on 26 January 2006, noted referral for evaluation due to back pain symptoms that were more severe than expected from objective medical findings.  A history of feeling sad or depressed throughout his life as well as anxiety was noted.  The CI denied abuse as a child.  At age 20, prior to entry into military service, the CI became very depressed for 6 to 12 months after a breakup with his girlfriend, with suicidal ideation, cutting of his wrists, insomnia, low energy, weight loss and social isolation.  The CI reported that prior to entering the military he obtained a degree in mechanical engineering but did not like his job and joined the Army.  The examiner recorded that the anxiety the CI experienced prior to deployment became worse while he was deployed.  While deployed the CI felt anxious and fearful.  He reported seeing an improvised explosive device blow up one time without physical injuries.  The CI reported nightmares when he returned from Iraq but were occurring infrequently by the time of the psychiatry NARSUM.  He reported anxiety with reminders of Iraq (places that resembled Iraq, people of Middle Eastern descent or appearance).  He stated he experienced a one second flashback when he saw the Iraq flag.  He was angry and anxious about the limitations from his back pain.  He also reported feeling stressed due to work demands and worries about his future employment after he got out of the Army.  Significant anxiety at work was clarified as meaning that he wanted “to get stuff done and get results.”  He reported occasional forgetfulness and feeling depressed.  The depressed symptoms went away during a 30-day leave to celebrate his recent engagement.  There were no panic symptoms, and no suicidal ideation.  Concentration at work remained intact.  The psychiatrist noted that the CI responded well to a prior course of anxiety treatment medication and was started on a new medication as of 23 January 2006.  The psychiatrist recorded that the CI acted and dressed appropriately, showed no signs of psychological disturbance, was cooperative and forthcoming and demonstrated the ability to think in a logical rational manner without hallucinations or delusions.  

On mental status examination (MSE), mood was depressed with a normal affect.  The remainder of the MSE was normal.  The psychiatrist diagnosed anxiety disorder (NOS) that did not meet the criteria of PTSD.  The psychiatrist stated: “The inciting stressor for the SM was reassignment as a gunner while in Iraq;” “Condition Manifested by: Distressing recollections of Iraq, flashbacks, avoidance of reminders, increased startle reflex, anger toward people of Middle Eastern descent, excessive worry about work, stress-related tachycardia, insomnia, and lower back pain.”  Major depressive disorder (MDD), a single episode in the distant past now in full remission, was also diagnosed and stated as meeting retention standards.  The psychiatrist assessed a Global Assessment of Function at the time of the psychiatry examination as 60, denoting moderate symptoms or any moderate difficulty in social, occupational, or school functioning.  The psychiatrist stated “It is likely that the SM [service member] used somatization as a defense to deal with occupational stressors” (physical expression of emotional worry, of his anxiety), noting that “the only functional impairment from the anxiety disorder is that the SM is unable to carry combat equipment due to his back pain.  Thus he is non-deployable.  His symptoms have worsened due to his anxiety over the MEB and uncertainty about his future employment.”  The PEB on 8 March 2006, stated that the CI’s anxiety disorder had improved with the use of medication and that the condition had mild impact on his social and industrial abilities.

The VA Compensation and Pension (C&P) psychological evaluation performed near his last military assignment in Europe on 22 February 2007, 6 months after separation, concluded with diagnoses of PTSD, and personality disorder NOS.  The CI endorsed symptoms of PTSD including nightmares, aggressiveness, sleep disturbance, hyperarousal, avoidance, flashbacks, and concentration problems.  He reported hating all people of Arabic descent and experiencing excessive worries over work performance.  The CI claimed he saw two US soldiers killed by improvised explosive devices which made him constantly fear for his life.  
He also described this trauma in the following manner: “RPG fire to the group that we were patrolling with, in which I was a gunner, a rocket past really closed by me.  By one meter.  I just want to kill them now.”  The CI reported a history of physical and sexual abuse as child and a degree in business administration.  The CI was employed as government civil service supply clerk.  On MSE, the CI was neatly dressed and cooperative with poor eye contact.  He appeared sad and there were some indications of psychomotor retardation but no psychomotor agitation.  Speech was normal (“non-pathological”) with thought content that was coherent, relevant and congruent with the materials discussed.  There was evidence of delusional thinking, some paranoid mentation and blocking but there were no ideas of reference, thought broadcasting, or thought insertion.  The CI reported homicidal ideation toward Arabic people and some vague suicidal ideations.  Cognitive functioning was “non-typical,” and judgment and insight appeared to be weak.  He was considered competent to handle his own financial and personal affairs without assistance.  On psychological testing the CI endorsed a very high level and wide spectrum of symptoms that suggested numerous psychiatric conditions including MDD, suicidality, PTSD, obsessive-compulsive disorder, panic disorder, bipolar disorder, psychosis, schizophrenia, social phobia, generalized anxiety disorder, hypochondriasis, malingering, borderline personality disorder, paranoid personality disorder, schizotypal personality disorder and passive aggressive personality disorder.  The examiner commented the CI’s score on the PDSQ test was over 70 (T-score), an extremely high score that “In the absence of other indications of extreme dysfunction, such scores signal the possibility that the patient is exaggerating his or her condition.  This may be done in order to influence legal proceedings or secure services or compensation, or for some other reason that may become evident during discussion with the patient or review of other available information.”  The CI endorsed items that were rarely endorsed by traumatized individuals; “He may be attempting to present himself as especially symptomatic, may be randomly responding, or may be experiencing an unusual number of atypical symptoms…There is compelling evidence of a personality disturbance that could explain the abnormality in response styles of this patient.”  The examiner commented further:

With respect to negative impression management, there are indications suggesting that the client tended to portray himself in an especially negative or pathological manner.  This pattern is often associated with a deliberate distortion of the clinical picture, and the critical items should be reviewed to evaluate the possibility of malingering. Alternative explanations include the possibility that the test results reflect a "cry for help", or an extreme or exaggerated negative evaluation of oneself and one's life.  Regardless of the cause, THE TEST RESULTS POTENTIALLY INVOLVE CONSIDERABLE DISTORTION AND ARE UNLIKELY TO BE AN ACCURATE REFLECTION OF MR. _____ ‘S OBJECTIVE CLINICAL STATUS.

The final diagnostic formulation was caveated by “The following interpretation is provided only as an indication of [CI’s] self-description”.

The Board first considered if there were any changes in mental health diagnoses during disability evaluation in accordance with the special MH review project.  The diagnosis of anxiety disorder was referred into the disability evaluation system and remained unchanged throughout the disability evaluation process.  Therefore, the case does not meet the inclusion criteria in the Terms of Reference of the MH Review Project.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB used VASRD code 9413 (anxiety disorder) and rated it 10% citing improvement with medication and mild impact on his social and industrial abilities.  The VA coded 9411 (PTSD) and rated it 30% based on the VA C&P examination from 22 February 2007 summarized above noting the CI was employed and that psychological testing indicated considerable distortion and was unlikely to be an accurate reflection of the objective clinical status.  
The Board considered whether the provisions of VASRD §4.129 (Mental disorders due to traumatic stress) was applicable.  
In accordance with VASRD §4.129, when a mental disorder that develops in service as a result of a highly stressful event is severe enough to bring about the CI’s release from active military service, the rating agency should assign an evaluation of not less than 50% and schedule an examination within the 6-month period following the Veteran’s discharge to determine whether a change in evaluation is warranted.  The Board notes that the CI experienced anxiety and depression prior to deployment; however, the MEB psychiatry NARSUM indicated the CI’s anxiety had worsened as a result reassignment as a gunner while in Iraq.  The Board notes that the stresses of deployment to a combat zone, although considerable under the best of circumstances, do not automatically equate to the §4.129 standard of “a highly stressful event” or to Criterion A stressors for PTSD – a typical mental disorder for which the provisions of §4.129 would apply.  The PDHA did not reflect a traumatic event other than potentially seeing a couple of dead bodies, while subsequent descriptions changed over time.  Although the deployment was generally stressful and the CI was fearful, the Board did not conclude there was a highly stressful/traumatic event which caused the unfitting anxiety disorder.  Therefore the Board concluded that the application of §4.129 was not appropriate in this case.

The Board next considered the §4.130 rating at the time of separation.  The MEB psychiatry NARSUM described moderate symptoms but concluded the CI was non-deployable due to his anxiety, which worsened his back pain, and prevented him from wearing combat equipment.  The Board also noted the long term history of chronic anxiety symptoms and the fact that the CI did not seek MH evaluation until after referral into the disability evaluation system for back pain.  The CI was never hospitalized for a MH condition, did not seek treatment in the emergency room, and noted improvement with medication.  Further, the commander’s statement did not reflect any impairment due to psychological symptoms.  Based on this, the Board concluded the PEB rating of 10% best described the impairment due to anxiety disorder.  The Board noted the post separation VA C&P examination recorded worsened symptoms, and the diagnosis of PTSD.  The Board undertook a careful review of the records and concluded there was insufficient evidence to support the diagnosis of PTSD, and the NARSUM psychiatrist noted full diagnostic criteria for PTSD were not met.  The Board also noted the limitations of that examination and concluded it did not confer any significant probative value to the Board’s rating recommendation at the time of separation.  This case was reviewed by a Board-certified psychiatrist and the psychiatrist’s opinion was consistent with the SRP recommendation.  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 of the anxiety disorder NOS condition.

Chronic Low Back Pain Condition.  Prior to his 2004 deployment, the CI was treated for intermittent LBP.  While deployed the CI sought care for LBP, “worsening back pain X 2 years” without any specific trauma.  Deployed clinic note performed on 29 June 2004, noted quick twisting as a gunner aggravated his back pain.  The CI reported pain radiating to his toes.  On examination, active range-of-motion (ROM) of the back was full.  He sought care again in September 2004 for recurrent pain of 2 days duration.  At the next clinic encounter for back pain on 24 November 2004, after return from R&R leave, back pain was aggravated by lifting and twisting.  The CI had not gone to physical therapy (PT) as previously advised.  On examination, ROM was indicated as normal.  At an examination on 29 November 2004, straight leg raise on the left was positive and the examiner was concerned regarding a herniated lumbar intervertebral disc and advised activity limitations.  Upon return from deployment to his home base in Europe, the CI was evaluated by orthopedics on 15 February 2005.  The orthopedic surgeon recorded chronic back pain for 6 years aggravated by duties as a gunner and sleeping on a cot but no specific injury.  The CI reported all activities aggravated his back pain.  The orthopedic surgeon also noted, “He is now back and he wants a European out.  He wants to get out and get an army European civilian job.  The retention people said he needs to get … an MEB for that so he is here.”  On examination, ROM of the back was “normal.”  Gait was normal.  Straight leg raising was “minimal on the left.”  
The surgeon recommended a P2 profile for his low back and recommended treatment.  Follow-up orthopedic examination on 14 March 2005 noted CI complaint of back pain radiating into both legs and to the toes.  On examination, strength and reflexes of the lower extremities were normal, and straight leg raising was negative for signs of radiculopathy (increased back pain without radiation).  Magnetic resonance imaging (MRI) completed on 20 March 2005 noted a small central intervertebral disc protrusion at L4-L5 that made contact with the L-5 spinal nerve roots without displacing or deforming them (indicating no compression of the nerve roots).  There was also a disc protrusion a L5-S1 which made contact with the right S1 spinal nerve root without displacing or deforming it.  At the follow-up appointment with the orthopedic surgeon on 1 April 2005, the results of the MRI were reviewed.  On examination, muscle strength, sensation, and reflexes were normal.  Straight leg raising was negative for signs of radiculopathy.  A temporary L3 profile was issued and non-surgical treatment continued.  

At a PT examination on 13 April 2005 back ROM was otherwise full without pain.  Numbness and tingling was reported at 60 degrees of flexion however straight leg raising was negative for radicular signs and strength was normal.  In May 2005, the CI was referred to the pain clinic for injections.  At the orthopedics examination performed on 4 October 2005, the CI reported back pain with most activities including lifting, bending, sit-ups, running, wearing individual body armor and combat gear.  Back pain was the predominant symptom (“100% back, 0% leg pain”).  Treatment with PT and injections were stated to be unhelpful.  The orthopedic surgeon recorded, “Soldier's unit is currently being deactivated and headed for Ft. Riley. Patient is having his MOS changed to 92A (logistics). He desires to stay in Germany (has been stationed here for several years and desires to stay.”  On examination, there was “decreased ROM spine in all planes with exaggerated pain response.”  Gait, strength, reflexes, and sensation were normal.  Straight leg raising was negative for signs of radiculopathy.  There was no tenderness or muscle spasm.  The examiner noted that his symptoms were “somewhat in excess of his objective findings” and that he denied any significant psychosocial stressors.  He was determined not to be a surgical candidate and the orthopedic surgeon initiated an MEB at this time.  The PT MEB ROM examination on 26 October 2005, indicated recording of thoracolumbar motion using an inclinometer method.  Active flexion was 18 degrees with three repetitions, extension 4 degrees, left lateral flexion 6 degrees, right lateral flexion 14 degrees, and rotation 20 degrees in both directions.  Motion was reported as limited due to pain.  

The MEB history and physical examination (DD Forms 2807 and 2808) on 21 November 2005 indicated a normal spine examination without any detail except for noting no tenderness of the spine.  The examiner noted “transient radiculopathy down legs” and listed back pain without radiculopathy in the diagnosis list.  The commander’s statement dated 28 November 2005, noted the back condition prevented the CI from taking a fitness test or participating in the unit physical training although he could do all the work required of his military occupational specialty while remaining in garrison on the base.  The MEB NARSUM on 27 January 2006, recorded a normal thoracic spine ROM (full) but limited lumbar motion accompanied by report of pain.  The examiner detected muscle spasm with motion but gait was normal (though noted to be slow).  Muscle strength, sensation, and reflexes were normal.  The MEB NARSUM concluded with diagnosis of chronic LBP without radiculopathy.  The VA C&P examination on 30 January 2007, 7 months after separation, recorded complaint of persistent chronic LBP radiating into both legs.  The CI reported going to the gym twice a week for 30 minute workouts and being able to walk a mile.  On examination, the examiner noted a slight left sided limp in one part of the report and a normal gait in another part of the report.  There was tenderness and muscle spasm but no guarding resulting in an abnormal gait.  The thoracolumbar spine contour was normal.  Flexion was 42 degrees, extension 16 degrees, left lateral bending 18 degrees, right lateral bending 10 degrees, left rotation 36 degrees, and right rotation 35 degrees, all motions with pain.  Strength and reflexes were normal.  Straight leg raising was stated to be positive bilaterally without specifying if radicular signs were noted.  
The examiner noted a repeat MRI performed the date of the examination on 30 January 2007 demonstrating abnormal findings similar to the previous MRI showing disc protrusions at L4-5 and L5-S1 contacting the L5 and S1 spinal nerve roots.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB used VASRD code 5299-5237 (lumbrosacral strain) and rated it at 10% while citing pain and limitation of motion.  The VA rated the back condition, degenerative disc disease of the thoracolumbar spine (coded 5243 intervertebral disc syndrome) 20% based on the January 2007 C&P examination.  The VA also granted VASRD code 8520 (paralysis of sciatic nerve) and rated 10% ratings for both the right and left lower extremity radicular symptoms.  The Board considered its rating recommendation based on the MEB examinations and STRs.  The MEB physical therapist reported thoracolumbar ROM using an inclinometer method; however, it is not clear if the physical therapist used the dual inclinometer method which produces measurements which are not readily comparable to the goniometric ROM specified by the VASRD.  The Board also noted the limitation of motion was not consistent with the objective findings of imaging including report of pain and limitation in motions that are functions of the thoracic spine (normal in the CI) rather than the lumbar spine.  Prior to referral for MEB, the ROM was generally normal or mildly reduced.  The CI denied any trauma within a year of the MEB PT examination and the STR was silent as to any traumatic events to explain the sudden reduction in the ROM observed.  The radiating symptoms were indicated to have resolved by the October 2005 orthopedic examination initiating the MEB and the November 2005 MEB examination also indicated absence of radiculopathy.  The Board also noted there was no reported intervening injury prior to the post separation VA examination and examination and MRI findings were stable.  The Board therefore placed more probative value on the examinations prior to the DES entry and concluded a 10% rating best described the overall disability picture.  Although muscle spasm was noted in the MEB NARSUM examination, there was not associated altered gait or spinal contour to support consideration of a 20% rating.  There were no incapacitating episodes documented within a year of separation in the STRs to support a minimum rating under the alternate formula for rating intervertebral disc syndrome based on incapacitating episodes (requires bed rest prescribed by a physician).  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had intervertebral disc protrusions making contact with nerve roots on MRI, however, examinations indicated normal strength, reflexes, sensation and gait.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation specific activities.  There is no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board therefore concludes that additional disability rating was not justified 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 of the chronic LBP 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.  In the matter of the anxiety disorder NOS condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication.  
In the matter of the chronic LBP condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.
RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20130829, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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, AR20150009910 (PD201301384)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl		
         
CF: 
(  ) DoD PDBR
(  ) DVA