RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX						            CASE:  PD-2013-01669
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20040113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Security Forces) medically separated for narcolepsy and a depressive disorder.  These conditions could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).  He was issued a permanent P3/S4 profile and referred for an Medical Evaluation Board (MEB).  Narcolepsy and depressive disorder not otherwise specified (NOS) were forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The MEB also identified and forwarded personality disorder, irritable bowel syndrome, headache syndrome and allergic rhinitis for PEB adjudication.  The Informal PEB adjudicated narcolepsy as unfitting, rated 20% with a 10% contributing/aggravating deduction and depressive disorder NOS as unfitting, rated 10% with a 10% contributing/aggravating deduction with cited application of DoD Instructions.  The irritable bowel syndrome, seasonal allergic rhinitis and headaches conditions were determined to be Category II (unfit but no compensable/ratable).  The personality disorder, tobacco use and sleep walking conditions were determined to be Category III (not separately unfitting and not compensable/ratable).  The CI made no appeals and was medically separated.

CI CONTENTION:  He was given a higher rating for his narcolepsy, mental health and IBS conditions by the VA.  His complete submission is at Exhibit A.

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 condition 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 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 Veterans Affairs Schedule for Rating Disabilities (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:

Service IPEB – Dated 20031103	VA*** - (~6 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Narcolepsy	8108-8910	10%*	Narcolepsy	8108-8910	10%	20040726	
Irritable Bowel Syndrome	Category II	Irritable Bowel Syndrome	7319	NSC	20040726	
Depressive Disorder	9434	0**	Depressive Disorder	9434	50%	20040726	
Personality Disorder NOS	Category III					
Other MEB/PEB Conditions x 4 (Not In Scope)	Other x 6	
Combined:  10%	Combined:  80%	
*Rated 20% then deducted 10% for contributing/aggravating factor
**Rated 10% then deducted 10% for contributing/aggravating factor
***Derived from VA Rating Decision (VARD) dated 20040116

ANALYSIS SUMMARY:

Narcolepsy:  In February 2003, the CI presented for the first time with concentration, headaches, fatigue, restless sleep and anhedonia symptoms more than a year.  He had episodes of memory disturbance, memory lapses, “zoning out”, and temper flair with no recollection of events.

In April 2003, a polysomnogram (PSG) study sufficiently ruled out obstructive sleep apnea (OSA) and restless leg syndrome (RLS).  A neurological evaluation, 23 June 2003, noted the CI reported loss of memory and possible “brain seizures” beginning in May 2002 while in Saudi Arabia.  He tended to forget where he puts things or how he navigated to places.  He “blanks out” and had body jerks at night and while standing during the day his right leg or entire body may start jerking.  He woke up with bad headaches lasting 20-30 minutes.  An electroencephalogram (EEG or test that detects electrical activity in your brain) was normal and the neurologist found no cause for his symptoms, but noted the “bouts of forgetfulness and “zoning out” were suspicious for psychological etiology (cause).

In July 2003, the CI underwent a multi-sleep latency study (MSLT) that recorded the presence of 3 out of 4 rapid eye movement (REM) episodes opined to be “very suggestive” of narcolepsy.  The sleep specialist prescribed low dose stimulant medication (Ritalin 5mg) twice a day, and his symptoms initially improved.  The CI noted he felt more awake and energetic.  The CI had reported a history of sleep walking and rapid eye movement sleep behaviors (violent during sleep).  At the follow-up neurology visit, the CI reported he continued to “zone out” 1-2 times per day, 3-4 days per week, and did not appear to be related to drowsiness.  At times he would not respond quickly to others when he “zoned out.”  The neurologist again suggested the possibility of psuedoseizures.  Treatment records did not record frequency of sleep attacks, episodes of cataplexy (strong emotion or laughter causes sudden physical collapse though remaining conscious); however, a neurology entry dated 7 November 2003, 2 months before separation noted “his bouts of zoning out are likely better on Ritalin.”  The CI was also taking a sedative medication (Klonopin) which contributed to his daytime sleepiness; however, reports of falling asleep on the job were not recorded.

The MEB narrative summary (NARSUM) dated 24 September 2003, 4 months prior to separation noted the CI had some improvement in his fatigue and concentration symptoms with Ritalin.  He remained on a profile in a non-deployable status.  He was restricted from driving and carrying a weapon and continued to have daily episodes of “spacing out.”  Physical examination was unremarkable.  The diagnosis of narcolepsy was recorded and the physician opined that his narcolepsy had improved and was not likely to resolve.  The MEB psychiatric addendum dated 3 October 2003 documented onset of sleepwalking episodes; however, he “denies being found in places other than where he was asleep”.  He reportedly stated that he often had sleep “fits” at night hitting/kicking his wife in bed, and unknowingly telephoned random people or family members and smoked during the night and day.  The physician noted none of the evaluations: polysomnogram (PSG), MSLT, EEG, MRI, or clinical observation could explain his sleepwalking and violent sleep behavior.  The psychiatrist stated, “His condition, behavior, and impulsivity raise considerable suspicion regarding his reliability, dependability, and judgment…it is likely that narcolepsy will continue to remain a critical problem in his ability to function and necessitate chronic duty restrictions.”  Impairment for further military duty was recorded as “marked” and impairment for civilian and industrial adaptability is “definite.”

The January 2004 VARD indicated a Compensation and Pension (C&P) exam was accomplished 3 days after separation.  .  The CI reported an average of 25 attacks each month; however, the VARD noted the service treatment record (STR) failed to demonstrate any evidence of attacks or seizures other than sleep walking and REM.  The VARD also noted there was no documentation that the CI was taking any medication for his condition.  A second C&P exam was accomplished 6 months after separation where the CI reported 30 attacks a month during which he is unable to wake himself up in the morning.  He was constantly tired, the attacks were sudden, his symptoms were constant, and he was unable to drive.  He lost work 2-3 times a week due to his condition.  He continued taking Ritalin twice a day but cataplexy was not documented.

The PEB applied the VASRD criterion to rate narcolepsy as epilepsy: grand mal, under the general rating formula for major seizures.  The PEB rated the condition at 20% with a 10% contributing/aggravating deduction as noted above.  The VA initially granted a 10% evaluation based on the STR and the November 2003 C&P exam; however, after the subsequent C&P exam the rating was increased to 40% based on the report of 30 attacks a month and inability to awake.  
Members then turned to deliberation of whether the PEB’s deduction for sleep walking was appropriately applied to the Board’s recommendation.  The PEB’s AF Form 356 rationale for this determination is excerpted below.
The IPEB notes member's narcolepsy, which has a definite social and industrial adaptability impairment rating IAW DoD instructions, is significantly affected by his sleep walking, a non-ratable/non-compensable condition under Disability law/policy.  The Board opines were it not for the non-ratable/non-compensable condition, the member's social and industrial adaptability impairment rating would be best described as mild.
All members agreed that the PEB’s deduction could not be upheld for the following reasons:  First of all, the foundation for a diagnosis of sleep walking, on which the PEB deduction hinges, is very tenuous.  There is no sleep walking (somnambulism) diagnosis in the STR.  The CI underwent two sleep studies and neither documented any sleep activity compatible with a parasomnia (sleep walking, violent behaviors) diagnosis, although this does not rule out the existence of the condition.  The MEB psychiatrist noted the CI reported new onset sleepwalking episodes, but the CI denied being found in places other than where he slept.  The Board determined this is inconsistent with the pure definition of sleep walking.  The psychiatrist stated that his sleep problems, “appears to be due to narcolepsy as he does have repeated irresistible attacks of refreshing sleep, recurrent intrusions of elements of REM sleep during transition between sleep and wakefulness….”  Although the CI reported sleep walking events, the MEB psychiatrist, the neurologist, and the sleep specialist, made no diagnosis of somnambulism (sleep walking) at the time of separation and that diagnosis was not forwarded to the PEB for adjudication.  The Board noted the glaring absence of documented complaints related to extreme drowsiness, inability to stay awake, and other commonly associated symptoms of narcolepsy.  However, there is an abundance of references to “zoning out” without appearing drowsy.  In one recorded instance where the CI reported he was having an episode, the examiner documented there was no change in the CI’s orientation, affect, or behavior, an observation that is not consistent with narcolepsy or seizures.  Lastly, none of the psychiatrist or sleep specialist clinically extricated a disability level attributed to the sleep versus the psychiatric disorder; thus, a deduction could not fairly be apportioned.

The Board next proceeded with the rating recommendation directed by VASRD criterion to rate narcolepsy as epilepsy which the Board determined was analogous coding 8108-8910 (Epilepsy, grand mal).  The higher rating of 20% requires evidence of at least one major or two minor seizures in “the last six months.”  The record clearly demonstrated the presence of sleep issues and other psychosocial issues that likely contributed to his sleep complaints; however, clear demonstration of occupational impairment was absent.  The CI’s profile stated the CI should not drive automobile or heavy machinery unless cleared by neurologist.  Additionally, the CI should be maintained on regular shifts without changing to mids or night shift.  There was no profile recommendation allowing the CI to take naps.  It was noted in the MEB psychiatry addendum that his duty schedule required no changing of shifts although naps during his working schedule were recommended.  The examiner also recommended the CI not drive until his narcolepsy and non-obstructive sleep disorder symptoms could be further defined and treated.  At the time of separation, there were no documented reports of the CI falling asleep on the job or while driving.  The MEB psychiatrist also wrote, “He does have repeated irresistible attacks of refreshing sleep.”  The Board determined this implied more than one attack; however, there was not one witnessed documented incident.  The commander’s statement implicated narcolepsy and pseudo seizures conditions and stated the amount of time lost by the CI is minimal.  The CI was working full shifts in a minimal capacity accomplishing non-security forces functions.  The commander opined the CI should not deploy nor carry a firearm, but might be able to accomplish light office work in the Air Force.  The commander did not mention if the CI’s conditions prevented his ability to complete tasks due to sleep attacks or episodes of “spacing or zoning out.”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board’s recommendation a 10% rating (no deduction) for the narcolepsy condition coded 8108-8910.

Depressive Disorder, Not Otherwise Specified (NOS).  Treatment record demonstrated the CI first presented to the family advocacy center in August 2000 and was assessed with a phase of life problem.  He was not seen again until July 2001 where there were allegations of family maltreatment or “minor physical” abuse by the CI upon his spouse.  He and wife participated in marital therapy for nearly 2 years.  On 5 February 2003, the CI presented to primary care reporting sleep and concentration issues, he wakes up tired and “doesn’t care.”  He noted that he had “spaced out” while driving and almost had two accidents.  He endorsed lack of pleasure and memory issues.  He was prescribed Paxil (anti-depressant) medication.  An April 2003 mental health consultation assessed the CI with depression NOS, atypical dyssomnia, atypical parasomnia, and personality disorder.  During the next MH visit, in May 2003, the CI presented as a walk-in, reported he was irritated at the lack of response to his care.  He continued to have periods of “zoning out,” difficulty with sleep, was moody, but ‘not depressed.’  He stopped taking his Paxil because, “it’s an anti-depressant right? I’m not depressed.”  The examiner documented decreased concentration ability, restless movements during sleep and vivid dream recall which did not cause sleep interference.  His mental status examination recorded psychomotor agitation, hostile attitude, irritability, anger and frustrated mood with full ranging affect.  Signs and symptoms of a major depression were absent.  The psychiatrist ruled out convulsion disorder, attention-deficit disorder (zoning out), and personality disorder as conditions causing the CI to zone out.  The MEB psychiatry addendum, dated 3 October 2003, 3 months prior to separation, documented the CI with symptoms of mood disturbance, sleep disturbance and interpersonal problems.  The CI endorsed symptoms opined by the examiner as consistent with depressed mood and anhedonia.  The CI lost motivation and drive, and had erratic sleep patterns when feeling depressive symptoms.  He had decreased libido.  He was also irritable, agitated, had angry outburst, and disturbing ruminations (to turn a matter over and over in the mind).  There was no history of suicidal or homicidal thoughts.  His symptoms lasted several hours to a few days and do not specifically reflect the pattern of major depressive disorder. He had difficulty with sleep.  He had a sense of excessive daytime sleepiness no matter what behavior he changed or how much sleep he received.  Sometimes he received a few hours of sleep and other times he achieved 10 hours but he always felt fatigue.  He had episodes of “going off” on people including his wife.  He became very angry over little things.  He stated he never assaulted anyone but broke items at home.  He often felt these urges at work.  The psychiatrist wrote, “This constellation of symptoms creates substantial impacts upon his social and occupational functioning…his sleep problems rendered him unable to operate a motor vehicle and carry a weapon...his symptoms prohibit him from successfully completing many administrative tasks in satisfactory fashion.  He is considered unreliable and manipulative in his duty section.  These same behaviors are noted in his medical and mental health treatment.”  However, it was noted there is no childhood history of conduct disorder, seizures, or sleepwalking.  The record was silent for any legal issues or accidents secondary to sleep impairment.  At the time of MEB psychiatric addendum, he was in the process of dissolving his marriage of 3 years.  The mental status exam recorded a normal mood, and full range affect, without evidence of psychosis or formal thought disorder.  He did not appear tired, and he stated he was not depressed but had problems with “sleep stuff.”  His judgment was described as ‘guarded.’  The examiner opined that his mood symptoms seemed consistent with depression NOS that is currently in partial remission status without definitive treatment, and that he met criteria for personality disorder NOS which “increases the likelihood of inconsistent and desperate behaviors as well as co-morbid psychiatric and medical conditions.”  However, the physician acknowledged that the personality disorder do not diminish the depression, anxiety or sleep problems reported by the CI.  Psychological tests suggested the presence of major depression and “strong personality disorder” with borderline, antisocial, passive-aggressive and schizoid traits.”  The NARSUM psychiatrist recorded Axis I diagnoses of narcolepsy and depressive disorder NOS, in partial remission with minimal impairment in both military duty and civilian adaptability.  A global assessment functioning (GAF) score of 40-50 (serious symptoms and or serious impairment) was documented.  The recommendations included medication trials provided the CI agrees (he had refused meds in the past), stress management, interpersonal type of individual and or group therapy, and consistent provider for managing all of his health care needs.

The VA C&P mental evaluation, 6 months post-separation, noted the CI has taken Prozac since March 2003 with minimal benefit.  The CI lost motivation, was frequently distraught, and irritable.  He had panic attacks and heavy sweats.  His response to Klonopin (a sedative used for anxiety, panic attacks, and sleep) had been good and he had no side effects.  The CI noted he received weekly psychotherapy and had a fair response.  He had no symptoms requiring ER visits nor had been hospitalized psychiatrically.  He was not working, felt threatened in “big crowds” and argued a lot more.  He had not incurred any legal problems since leaving the Service.  The CI reported he had panic attacks as often as 8 times per month.  The examiner wrote, “suicidal ideation is present including thoughts of suicide when he was divorcing and homicidal ideation is present including thoughts of killing ex-wife and her boyfriend, after daughter called the him dad.”  The mental status exam recorded depressed mood, absence of delusions and hallucinations although he reported history of paranoid ideation and hearing “voices and crickets.”  The diagnoses of major depressive disorder (MDD) and “reported history of borderline personality disorder” were recorded.  A GAF of 35 (major impairment in several areas) was recorded.

The Board directed attention to its rating recommendation based on the above evidence.  As recorded above, the PEB rated the condition of depressive disorder, NOS at 10% coded 9434 (MDD) with a 10% deduction for contributing/aggravating factors.  The VA granted a 50% rating, coded 9434.  The Board first noted there was no specific, highly stressful service related event to invoke §4.129 for a mental disorder due to traumatic stress.  The Board next considered the rating deduction.   The PEB’s AF Form 356 rationale for this determination is excerpted below.
The IPEB notes member's depressive disorder, which is described as mild, is significantly affected by his personality disorder, also a non-ratable/non-compensable condition under Disability law/policy.  The Board opines were it not for the non-ratable/non-compensable personality disorder, the member's social and industrial adaptability impairment rating would be best described as minimal or even none.
In February 2003, the CI presented to primary care reporting issues with sleep and concentration, and he stated he wakes up tired, and “doesn’t care.”  He noted that he had “spaced out” while driving and almost had two accidents.  He endorsed lack of pleasure and memory issues.  He was prescribed Paxil.  In May 2003, the CI presented to mental health as a walk-in, reporting that he is irritated at the lack of response to his care.  He continued to have periods of “zoning out,” difficulty with sleep, was moody, but “not depressed.”  He stopped taking his Paxil because, “I’m not depressed.”  The MEB psychiatry addendum, 3 months prior to separation, documented the CI presented with mood disturbance, sleep disturbance, and interpersonal problems symptoms.  He endorsed symptoms opined to be consistent with depressed mood and anhedonia.  He has lost motivation and drive, describes erratic sleep patterns when feeling depressive symptoms, and decreased libido.  He also has irritability, agitation, angry outburst and disturbing ruminations.  There is no history of suicidal or homicidal thoughts.  He had episodes of “going off” on people including his wife; he became very angry over little things.  The psychiatrist wrote, “This constellation of symptoms creates substantial impacts upon his social and occupational functioning…his sleep problems rendered him unable to operate a motor vehicle and carry a weapon…his symptoms prohibit him from successfully completing many administrative tasks in satisfactory fashion.”  The examiner opined that his mood symptoms seemed consistent with depression NOS that is currently in partial remission status without definitive treatment, and that he meets criteria for personality disorder NOS which “increases the likelihood of inconsistent and desperate behaviors as well as co-morbid psychiatric and medical conditions.”  However, the physician acknowledged that the personality disorder did not diminish the depression, anxiety or sleep problems reported by the CI, but did not the condition was in partial remission.  As discussed above, the process of clinically extricating the disability attributed to one diagnosis versus the other in cases involving psychiatric disorders is overly speculative without a directed opinion from the examiner addressing the degree of contribution from each diagnosis.  No such input from a psychiatrist was provided; thus the Board could not fairly apportion a deduction even if the competing diagnosis were not in question.  All Board members agreed, there is sufficient evidence to support a disturbance in mood in which a personality disorder may have contributed negatively; however, there was insufficient evidence to support the notion that in the absence of a personality disorder, his depressive disorder would have had no or minimal impact on occupational functioning.  All members agreed that the PEB’s deduction could not be upheld for application to the Board’s recommendation.  

The Board next proceeded with the rating recommendation IAW VARSD 4.130. The higher rating of 30% requires evidence of “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks”.  The Board noted that although the psychiatry addendum recorded that his conditions (narcolepsy, sleepwalking, depression) substantially impacts his social and occupational functioning, that statement appeared to target his sleep problems.  The Board noted the commander’s statement did implicate a mental health issue independent of narcolepsy (psuedoseizures); however, the commander did not document difficulty with concentration, or inappropriate behaviors, or difficulty with memory, or difficulty with co-workers. The MEB psychiatric addendum described a normal MSE, and stated the condition was in partial remission, and had minimal impairment for further military duty and mild impairment for civilian social and industrial adaptability. The Board also noted the absence of reports of panic attacks and suicidality in the STR, and while he reported suicidal ideation at the C&P, he was not recommended for hospitalization or further assessment in an emergency facility.  The CI’s profile restricted weapons and the operation of heavy machinery and driving; however, the restrictions were related to the narcolepsy condition.  The Board acknowledged the apparent deterioration of his condition 6 months post-separation, reflected in the newly diagnosed major depressive disorder; however, the Board considered the record in its entirety.  The STR demonstrated an absence of ER visits for mental health issues, absence of psychiatric hospitalization, absence of a legal history and the absence of documented suicidal ideation or panic attacks.  Board members concluded his condition at the time of separation most closely reflected the 10% level of disability for “Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication.”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board recommends a 10% disability rating (no deduction) for the depressive disorder NOS.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the irritable bowel syndrome (IBS) and personality disorder NOS conditions were not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (Reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The Board noted the IBS condition was investigated by gastroenterology in August 2001.  The CI reported he was having some diarrhea and rectal bleeding and sharp rectal pain intermittently.  He had about 6 watery-to soft bowel movements a day when he had diarrhea.  At that time he was prescribed an antibiotic and scheduled for a colonoscopy.  In 2005, he underwent a second colonoscopy that found internal hemorrhoids and a firm nodule in the cecum which was biopsied and confirmed as a lipoma (benign fatty tissue tumor).  Treatment records are silent for the condition from September 2001 until February 2005.  Records demonstrate he had two prescriptions for antibiotics (2001, and 2005) but no other treatment.  The condition diagnosed as personality disorder NOS was considered in the rating decision noted above for depressive disorder NOS.  The condition is non-ratable and non-compensable.  

The contended conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  Both 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 narcolepsy condition, the Board unanimously recommends a disability rating of 10% IAW VASRD §4.124a and exclusive of any deduction.  In the matter of the depressive disorder NOS condition, the Board unanimously recommends a disability rating of 10% IAW VASRD §4.130.  In the matter of the contended irritable bowel syndrome and personality disorder NOS 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	
Narcolepsy	8108-8910	10%	
Depressive Disorder NOS	9434	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130927, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

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Dear XXXXXXXXXXXXXXX,

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2013-01669.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

Attachments:
1. Record of Proceedings 
2. Directive