RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-00398	
BRANCH OF SERVICE:  Army	 DATE OF PLACEMENT ONTO TDRL:  20050528	
	Date of REMOVAL FROM TDRL:  20071211  

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, FA Meteorological Crewmember, medically separated for chronic neck pain and asthma after 2 years on the Temporary Disability Retired List (TDRL).  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The asthma and chronic neck pain conditions, characterized as “asthma – severe persistent” and “cervical disk herniation with radiculopathy,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions (see rating chart below) for PEB adjudication.  The Informal PEB (IPEB) adjudicated “right cervical radiculopathy” and “injury and surgery of the neck” as unfitting, rated 20% and 10%.  The asthma was adjudicated as unfitting, EPTS without permanent service aggravation.  The CI appealed the rating, but then withdrew his request for a formal PEB, and he was then placed on the TDRL.  Approximately 2 years subsequent to the original PEB, his conditions were reevaluated by a new IPEB which reduced his combined rating from 30% to 10%.  The CI appealed to the Formal PEB which upheld the IPEB ratings and was medically discharged with a 10% disability rating.  

CI CONTENTION:  “Conditions have gotten worse.”  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 conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the 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:  

Final Service FPEB - 20071030	VA (~5 Mos. Prior to TDRL Exit) - Effective 20070703	
On TDRL - 20050528	Code	Rating	Condition	Code	Rating	Exam	
Condition		TDRL	Sep.					
Asthma	6602	---%	---%	Asthma	6602	60%	20070703	
Chronic Neck Pain Post C6/C7 Discectomy with Fusion	5241	10%	10%	Residuals of Cervical Fusion	5238	30%	20070703	
Right Cervical Radiculopathy	5241-8512	20%	w/in 5241	Radiculopathy Right Upper Extremity With Pectoralis Atrophy …	8510	40%	20070703	
No Service Entry	Radiculopathy Left Upper Extremity …	8510	20%	20070703	
Allergic Rhinitis	Not Unfitting	Allergic Rhinitis	No VA Entry	
Bilateral Knee Pain	Not Unfitting	Degenerative Changes, Right Knee	5010-5260	10%	20070703	
		Patellofemoral Syndrome, Left Knee	5260	10%	20070703	
Other x 0 (Not in Scope)	Other x 4	
RATING:  30% → 10%	RATING:  90%	
Derived from VA Rating Decision (VARD) dated 20071025 (most proximate to date of TDRL exit).   VARD dated 20080729 decreased neck 5238 to 10% and RUE coded 8511 to 20% with LUE changed code to 8511 based on exam dated 20080117.  

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records and the MEB narrative summary (NARSUM), the CI’s asthma condition began in 2002 following an upper respiratory infection in basic training.  The entry physical (MEPS) from June 2000 was negative for any history of asthma or asthma-like symptoms.  Initial symptoms were difficulty breathing, nonproductive cough, and wheezing leading to difficulty sleeping.  The CI was started on inhaled bronchodilator therapy (Albuterol) then a daily inhalational anti-inflammatory medication (Advair - fluticasone/salmeterol) was added.  The CI continued with significant symptoms diagnosed as severe persistent asthma.  Further testing indicated multiple allergic and environmental triggers and the CI was started on additional medication of injected Xolair (omalizumab – an immunobiologic agent) every 2 weeks.  There was no history of hospitalizations or emergency department visits for his asthma.  He was on oral steroids for his asthma in May 2004 to stabilize him for general anesthesia for neck surgery.  

The MEB NARSUM exam on 22 June 2004 (11 months prior to TDRL) noted complaints of shortness of breath, wheezing, and chest tightness.  The MEB physical exam noted lungs with diffuse high pitched wheezing and prolonged expiratory phase.  Oxygen saturation on room air was 96% (normal) and chest X-ray was normal.  Pulmonary function testing (PFT) from 16 October 2003 were provided which documented moderate obstruction after bronchodilator use.  PFTs from 9 August 2004 are summarized below, but did not document post-bronchodilator test results.  The examiner diagnosed severe persistent asthma as “LOD Yes, EPTS No, Service Aggravated Yes.”  

At the VA Compensation and Pension (C&P) exam performed 28 September 2005, 4 months after TDRL placement, the CI reported asthma since 2002 in Hawaii.  The CI stated he was using Advair, Singulair, and Proventil and denied current use of oral steroids.  Exam showed clear lungs and normal chest X-ray.  The examiner noted that PFTs showed severe obstruction and a diagnosis of asthma.  Exam is summarized below.  

Multiple additional exams during the TDRL period, and the PFT examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Pulmonary Exam	PFT ~19 Mo. Pre-TDRL	MEB ~11 Mo. Pre-TDRL	VA ~ 4 Mo. Into-TDRL	PFT ~7 Mo. Into-TDRL	
FEV1 (% Predicted)	91	54%*	50%	53*	
FEV1/FVC	64	70.55%*	62%	71*	
Meds	Advair inh 24x/day; Albuterol inh 4x/day	Advair inh 2x/day; Albuterol inh 2x/day; Singulair PO 1x/day; Xolair sc 2x/month	Advair, Singulair, and Proventil	“Significant obstructive PFTs while on asthma meds.”	
§4.97 Rating	30%	30% (*60%/UNK)	60%	30% (*60%/UNK)	
*Not Post-Bronchodilator PFTs

Pulmonary Exam	Board Clerk Memo to PEB
~8 Mo. Into TDRL
~ 23 Mo. Pre-Sep	VA ~ 5 Mo. Pre-Sep	TDRL Exam ~ 4 Mo. Pre-Sep	VAMC Exam ~ 4 Mo. Pre-Sep	
FEV1 (% Predicted)	-	66%	-	66%	
FEV1/FVC	-	75%	-	75%	
Meds	“X The patient currently is not on any medications for his/her condition (This information has been confirmed by the patient)”	Advair and Proventil	Advair, Proventil 4-6/day, Singulair, Zyrtec; many nights nocturnal symptoms; “not EPTS”	(?) Xopenes	
§4.97 Rating	N/A	30% (VA 60%)	30%	30%	

The Board directed attention to its compensability and rating recommendation based on the above evidence.  The PEB at placement into TDRL assigned an unfit, but non-compensable rating under the 6602 code (asthma, bronchial), citing onset of asthma 2 weeks after starting basic training, a strong family history of asthma and that “This condition existed prior to service, without permanent service aggravation.”  The FPEB at TDRL removal explained in their response to appeal that the original PEB determination was not subject to review (by the FPEB).  The VA assigned a 60% (service connected) rating using the 6602 code citing PFT restrictions.  

The NARSUM examiner indicated that asthma was LOD-yes, EPTS-no, and was service aggravated.  The MEB indicated LOD-yes and EPTS-no.  The MEPS physical had no indication of asthma symptoms or diagnosis prior to entry.  Although the CI’s family history may have indicated a genetic predisposition to asthma, medical literature (National Institutes of Health; National Heart, Lung and Blood Institute) indicates that asthma also has environmental factors including viral and other types of infections as triggering causes.  The Board considered the tenants of DoDI 1332.38 in effect at the time for presumption of service aggravation.  The CI’s asthma condition at entry, if conceded that he had EPTS asthma, was completely asymptomatic, required no medications and would be rated at 0%.  Following an upper respiratory infection in basic training, the CI had significant and persistent symptoms of asthma which was not likely to have been natural progression of asymptomatic asthma.  The Board adjudged that there was permanent service aggravation and that the CI’s asthma condition was therefore both unfitting and compensable at placement onto TDRL.  

With regard to rating on placement onto TDRL, all proximate exams documented medication use of inhalational anti-inflammatory medication supporting the 30% rating criteria.  The PFT evidence was mixed, with the only ratable PFTs being over 1 year prior (supported 30%) and the evaluation within the year prior not recording any post-bronchodilator values (IAW VASRD §4.96, special provisions regarding evaluation of respiratory conditions).  The complete VA PFTs from 4 months after placement onto the TDRL supported the 60% rating criteria for FEV-1 of 40- to 55-percent predicted.  

With regard to rating on TDRL removal; all PFT results supported the 30% criteria of FEV-1 of 56- to 70-percent predicted.  Additionally, all treatment notes indicated inhaled medication use (at the 30% criteria level) both prior to and after the Medical Boards Clerk’s January 2006 memo indicating that the CI was not taking any medications for his condition.  

After due deliberation, considering all of the evidence and mindful of the preponderance of evidence regarding compensability and VASRD §4.3 (reasonable doubt) for rating, the Board unanimously recommends that the asthma condition be adjudged as compensable, with a majority recommending a disability rating of 60% for placement onto TDRL and then unanimously recommending a 30% disability rating for permanent separation at TDRL removal, coded 6602.  

Chronic Neck Pain Post C6/C7 Discectomy with Fusion and Right Cervical Radiculopathy.  The CI was right handed (major/dominant).  According to service treatment records and the MEB NARSUM, the CI’s neck and right upper extremity (RUE) radiculopathy condition began in December 2003 after being struck by a pole or after heavy lifting.  Neurosurgery evaluation demonstrated significant atrophy and softness in the right triceps (back of arm) and pectoralis (chest) muscles with weakness in the triceps and finger extensors.  Sensation was also decreased on the right fingers (1-4) except the pinky.  Electrophysiology studies (EMG/NCV) documented an abnormal (absent) right ulnar sensory response and abnormal right triceps muscle response neither of which aligned with the CI’s sensory deficit complaints or clinical picture of muscle atrophy of the deltoid, biceps and pectoralis muscle as well as weakness in internal shoulder rotation.  Radiographic studies (MRI) showed degeneration at C4-5 and C5-6 with a large C6-7 herniated disk that narrowed the nerve outlet and impinged on the spinal cord.  The CI underwent surgery in May 2004 (1 year prior to TDRL) with cervical C6-7 discectomy, allograft and plate (fusion).  Despite treatment, the CI’s neck and right-sided radiculopathy condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for a Medical Evaluation Board (MEB).  

The MEB NARSUM exam on 7 October 2004 (7 months prior to TDRL-entry) noted complaints of neck pain, right arm weakness (triceps and pectoralis) and numbness.  Post-surgical MRI documented resolution of the C6-7 disc protrusion with increase in the C5-6 disk bulge which contacted the cord but did not narrow the nerve outlet.  Physical exam showed well healed surgical scars.  There was atrophy of the right triceps and pectoralis muscles with mild triceps weakness.  “At this time his triceps is weak enough that he is unable to do push-ups.”  The neck exam for the NARSUM and following exams are summarized in the chart below.  

At the VA C&P examination on 28 September 2005 (4 months into TDRL), the CI reported neck pain with radiation of pain and numbness in both shoulders and upper arms with atrophy.  He complained of weakness in his arms and numbness in the right wrist and hand due to his neck.  He had flares with spasms when he had to go to bed rest, but no physician-directed bed rest.  Physical exam showed well healed scar and there was decreased sensation in both shoulders and arms, with the exception of the tips of the fingers on the left.  There was decreased sensation over the right pectoralis muscle with obvious atrophy of the right arm musculature and right pectoralis.  He was 5/5, but reduced motor strength on his dominant right upper extremity, which was less than his left side.  

At the VA C&P examination on 3 July 2007 the CI reported that he continued with neck pain and radicular symptoms including bilateral arm, shoulder and hand numbness; right pectoralis muscle twitching; and use of a soft collar to help sleep.  Medication use improved his symptoms.  The examiner stated that physical therapy had improved the CI’s muscle strength in the upper extremities, “such that there is no longer any atrophy of any of the muscle groups.  Muscle strength of the shoulder, elbows and hands are very normal and bilaterally equal.  … Grip strength is very normal bilaterally.”  

The TDRL NARSUM exam on 25 July 2007 noted complaints of neck arm numbness with complete resolution of arm pain.  The CI was taking Neurontin and Mobic.  Physical exam showed well healed neck incision and no muscle atrophy or asymmetry.  Strength was 5/5 throughout the right hand, triceps where he is only slightly less than 5/5.”  Cervical motion was described and is summarized below along with a formal PT goniometric motion measurement accomplished the same day.  The examiner stated:  “Sensory examination of his right upper extremity is somewhat confusing in that he feels there is reduced sensation in all dermatomes of the right upper extremity versus the contralateral dermatomes.  This does not particularly match with a radicular pattern.”  On appeal to the FPEB on 1 November 2007 the CI complained of persistent neck pain, weakness of the right arm, muscle spasms and numbness.  

At the VA C&P examination on 17 January 2008, the CI reported that he had neck pain 3 to 4 times a week going into both arms with numbness and weakness, still wore a soft collar and was taking Neurontin and tramadol with relief.  He was unable to run, jump or stand/sit for over 30 minutes and was unable to lift more than 30 pounds above his head.  Exam documented 5/5 motor strength in all planes and normal 2+ reflexes in the upper extremities.  There was decreased sensation in the left and right dorsal forearms and finger tips.  

The range-of-motion (ROM) examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Cervical ROM
(Degrees)	MEB ~ 7 Mo. Pre-TDRL	C&P ~4 Mo. Into TDRL	TDRL ~7 Mo. Into-TDRL	
Flex (45 Normal)	45	0	6 cm off chest	
Combined (340)	250	160	UNK	
Comment:	No repetition	Painful motion; DeLuca neg	Sl improved strength; sensory loss stable	
§4.71a Rating	10%	30%	10-30%	

Cervical ROM
(Degrees)	C&P ~ 5 Mo. Pre-TDRL EXIT	TDRL Eval ~ 4 Mo. Pre-TDRL EXIT	C&P ~ 1 Mo. Post-TDRL EXIT	
		TDRL NARSUM	TDRL PT		
Flex (45 Normal)	45	ROM is somewhat limited	20	40	
Combined (340)	225	unk	120	190	
Comment:	Painful motion; soft collar; normal gait	Incomplete / non-goniometric; discomfort with palpation	Tender; pain and mechanical limits	Pain; +tender; no spasm; normal contour and gait; Deluca neg	
§4.71a Rating	10%	10%-NR	20%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  At TDRL entry the PEB assigned a 20% rating for the RUE under 5241-8512 code (spinal fusion with lower radicular group mild incomplete paralysis), citing weakness of the right arm.  The PEB also assigned a 10% rating under the 5241 code (spinal fusion), citing mild limitation of neck motion and pain wearing military gear.  The VA assigned a 40% rating for the RUE under 8510 code (upper radicular group [fifth and sixth cervicals]); moderate incomplete paralysis, citing muscle atrophy of the right arm and pectoralis muscle and impaired sensation of the right shoulder, arm and fingers of the right hand.  The VA also assigned a 30% rating under the 5238 code (spinal stenosis), citing limitation of neck motion to 0 degrees flexion.  In addition, the VA rated the left upper extremity radiculopathy at 20% under code 8510 (mild) citing impaired sensation of the left shoulder and arm.  

The Board adjudged that the pre-TDRL exams had the highest probative value for rating.  For RUE radiculopathy rating, the lower radicular group would not encompass the muscle weakness and atrophy of the pectoralis and upper arm and the nerve level of the upper radicular group (8510) better accounted for the disability picture.  Given muscle atrophy and weakness enough that the CI could not do push-ups the Board adjudged that the RUE disability level was “moderate” (40%) at TDRL placement.  For cervical spine rating, the Board agreed that a 10% rating was justified at TDRL placement for pain-limited cervical ROM with a combined ROM (greater than 170 degrees but not greater than 335 degrees) reported on the PT and MEB exams.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, and no incapacitating episodes thus the next higher 20% rating was not justified.  The VA exam’s 0 degrees of forward flexion following TDRL placement was not consistent with the cervical ROMs and cervical spine disability picture in the preponderance of the record and no higher cervical rating was supported.  

The Board also considered if additional disability rating was justified for any left upper extremity (LUE) peripheral nerve impairment due to radiculopathy.  The CI had symptoms of radiating pain documented in the treatment records; however, examinations prior to TDRL placement did not indicate any left arm weakness of significant sensory deficit that caused functional impairment with a direct impact on fitness.  While the CI may have suffered additional pain from the left-sided 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 LUE motor weakness which would have impacted military occupation specific activities.  There is insufficient evidence in this case that left upper extremity motor weakness existed prior to TDRL placement to any degree that could be described as functionally impairing.  The Board therefore concluded that additional disability rating for the left upper extremity was not justified on this basis.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends TDRL placement disability ratings of 40% for the right cervical radiculopathy condition, coded 5241-8510 and no change in the PEB’s 10% rating for the chronic neck pain condition.  

At TDRL removal the PEB assigned a 10% rating for the chronic neck pain condition under 5241 code (spinal fusion) citing ROM limited by pain with lateral flexion to near 45 degrees each side.  The PEB disability description also documented weakness of “right hand triceps where the motor strength was slightly less than 5/5 (not independently ratable)” and noted that the RUE reduced sensations “did not particularly match with a radicular pattern.”  This was adjudged as a PEB not unfit finding for RUE radiculopathy.  

The VA ratings (40% RUE-8510; 30% cervical-5238; 20% LUE-8510) were unchanged at TDRL removal; however, based on exams 1 month and 6 months after TDRL removal, the VA decreased the RUE rating to 20% under code 8511 (middle radicular group-mild) citing symptom improvement with continued decreased sensation with full strength (no weakness) and normal reflexes.  The VA also decreased the cervical rating to 10% citing ROMs and painful motion.  The LUE 20% rating remained, but coding was changed to 8511.  

The Board agreed that the VA exams proximate to TDRL coupled with the Service TDRL exam supported a 10% cervical spine rating for either painful motion, tenderness, or limited motion.  The single PT ROMs were considered to have decreased probative value given the number and quality of consistent exams both preceding and following that exam.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  

The Board next considered if the RUE and/or LUE radiculopathy should have been additionally unfitting and ratable at TDRL removal.  The exams proximate to TDRL removal all documented absence of any muscle atrophy (fully resolved) and there was little if any remaining RUE weakness.  There was some sensory deficit noted, however there was insufficient evidence that the sensory deficit rose to the degree that could be described as functionally impairing.  

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 FPEB adjudication at TDRL removal for the neck condition and insufficient evidence for an unfitting RUE or LUE radiculopathy at TDRL removal.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended not unfitting allergic rhinitis and bilateral knee pain conditions were not unfitting.  The Board’s threshold for countering fitness determinations is preponderance of the evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The allergic rhinitis and bilateral knee pain conditions were not profiled or specifically implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed by the action officer and considered by the Board.  Although the commander’s comments and profile restrictions on the CI’s inability to run, walk, or bike for prolonged periods of time could have included the contended conditions, they appeared clearly linked to the CI’s unfitting asthma and neck conditions.  There was no performance based evidence from the record that either of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the allergic rhinitis and bilateral knee pain 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 asthma condition, the Board unanimously recommends that it be compensable with a Board majority recommending a disability rating of 60% coded 6602 for TDRL-placement and the Board unanimously recommending 30% for TDRL-removal IAW VASRD §4.97.  In the matter of the right cervical radiculopathy condition, the Board unanimously recommends a disability rating of 40%, coded 5241-8510 for TDRL placement IAW VASRD §4.124a, and a finding of not unfitting at permanent separation.  In the matter of the left cervical radiculopathy condition as a potential residual of the neck condition, the Board unanimously recommends that it not be unfitting or ratable at TDRL placement or removal.  In the matter of the cervical spine (neck pain) condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication for TDRL placement or permanent separation.  In the matter of the contended allergic rhinitis and bilateral knee pain 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; 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	
		TDRL	PERMANENT	
Asthma	6602	60%	30%	
Chronic Neck Pain Post C6/C7 Discectomy with Fusion	5241	10%	10%	
Right Cervical Radiculopathy	5241-8510	40%	Not Unfitting	
COMBINED	80%	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141115, 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 XXXXXXXXXXXXXXXXXXXXXXXXX, AR20160002351 (PD201400398)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to  constructively place the individual on the Temporary Disability Retired List (TDRL) at 
80% rather than 30% disability rating for the period 28 May 2005 to 10 December 2007 and then following this period recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 40%.

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

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

	b.  Providing orders showing that the individual was retired with permanent disability effective the day following the TDRL period.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, provide 80% retired pay for the constructive temporary disability retired period effective the date of the individual’s original medical separation and then payment of permanent disability retired pay at 40% effective the day following the constructive TDRL period.  

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA