RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01308
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Food Service Specialist) medically separated for a neck, shoulder, back and allergic conditions.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).   The profile allows for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent P3/U3/L3 profile and referred for a Medical Evaluation Board (MEB).  The “cervical disc disease,” “right shoulder pain,” “chronic low back pain,” and “shellfish allergy,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded 2 other conditions (bilateral knee pain and right median neuropathy/wrist pain) meeting retention standards for PEB adjudication.  The Informal PEB adjudicated “cervical spine strain,” “painful right (dominant) shoulder,” “lumbar strain,” and “shellfish allergy” as unfitting, rated 10%, 0%, 0% and existed prior to service (EPTS) respectively, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated. 

CI CONTENTION:  His conditions continue to worsen and negatively impact his daily activities.  Additionally, he was not evaluated for his sleep disorder.  The applicant’s 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 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:  

IPEB - Dated 20080728	VA* - (~3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Spine Strain	5237	10%	Degenerative Joint and Disc Disease Involving the
Cervical Spine	5242-5243	10%	20090310	
Painful Right  (Dominant) Shoulder	5099-5003	0%	Right Shoulder Tendonitis	5024	10%		
Lumbar Strain	5237	0%	Chronic Low Back Sprain	5237	10%		
Shellfish Allergy (EPTS)	7899-7825	---%	No VA Entry				

Bilateral Knee Pain
	Not Unfitting	Patellofemoral Syndrome, Right Knee	5099-5024	10%		
		Patellofemoral Syndrome, Left Knee	5099-5024	10%		
Other MEB/PEB Conditions x 1 (Not In Scope)	Other x 6	
RATING: 10%	RATING:  80%	
*Derived from VA Rating Decision (VARD) dated 20090819 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

CERVICAL SPINE STRAIN.  The earliest noted in the service treatment record (STR) dated 17 September 2007 indicated the CI was referred to the primary care clinic for placement on a limited duty profile because of neck pain.  The CI reported being in a motor vehicle accident 1 month prior to joining the military for which he received treatment and had an MRI; however, he did not complete treatment of the neck injury prior to entering the military.  The CI believed he mentioned neck pain during the MEPS physical, although there is no annotation on the MEPS physical documents.  On examination the sternocleidomastoid muscle (from the front of the neck to behind the ear) was tender on palpation as was the trapezius muscle.  Cervical pain was elicited by motion, but there was no tenderness on palpation of the spinous or transverse processes.  Motion was normal with no instability and no weakness.  X-rays showed minimal degenerative changes at C4-C5 level.  An MRI in September 2007 demonstrated disc desiccation and annular bulge at C4-C5 with mild disc desiccation at C6-C7.  There was no significant central canal stenosis or neural foraminal (sites of nerves traversing the vertebral column) stenosis.  A physical therapy report dated 4 September 2007 noted the CI’s pain started after being thrown to the ground during training.  He did have right shoulder and back pain prior to being admitted to the military as a result of a motor vehicle accident where he was rear-ended and the vehicle turned 360 degrees a few times and hit a wall.  Range-of-motion (ROM) measurements were flexion 42 degrees, extension 54 degrees, side bending bilaterally 28 degrees with pain on opposite sides, and rotation to the left 50 degrees and to the right 68 degrees.  X-rays of the cervical spine in May 2008 showed changes at the C4-C5, which were likely degenerative or chronic post traumatic.  In June 2008 the CI was seen in neurological consultation for symptoms of pain and numbness involving the right upper limb that began in June 2007 during combative training.  The CI stated he was flipped on his back with his right arm held behind him.  The pain, brought on by lifting heavy items, carrying any kind of weight on the shoulder or back, sweeping, mopping and typing, seemed to start in the right upper trapezius and radiated into the dorsum of the right forearm with numbness in the same distribution.  Neurological evaluation was unremarkable and non-focal, although a report indicated a central disc protrusion at C4, but there was no evidence of a myelopathic (neurologic deficit related to the spinal cord) process.  There was no electrophysiological evidence of a cervical radiculopathy on the right, but there was evidence of a mild median neuropathy at the wrist on the right.

At the MEB examination dated 20 May 2005, the CI reported on the DD Form 2807-1 he had back pain since the first few weeks of basic training; it increased after combative[s]; and he felt numbness in his arms and fingers.  The MEB physical examiner did not note any findings related to the neck pain condition on the DD Form 2808 dated 17 June 2008.  A permanent U3 profile was issued in May 2008 and approved in June 2008 with limitations of all military functional activities except wearing a protective mask and all chemical defense equipment and no physical fitness testing or wearing individual body armor or carrying a rucksack.  The commander’s performance and functional statement dated 1 July 2008 indicated the CI was not performing and could not perform his assigned duties in his MOS due to his profile.  The MEB narrative summary (NARSUM) dated 7 July 2008 noted the CI’s history of an automobile accident prior to military service as well as his report of his assigned fight during combatives where a hyperflexion maneuver was performed that caused severe pain, which he continued to experience.  Physical examination revealed cervical flexion 45 degrees, extension 10 degrees, left and right lateral rotation 45 degrees each with mild pain at the limit of rotation.  He had localized tenderness to the posterior cervical spine with no muscle spasm and no guarding. 

At the VA Compensation and Pension (C&P) examination dated 10 March 2009, performed 3 months after separation, the CI reported pain with a severity of 8/10 (10 being the worst pain).  He denied any radicular pains or paresthesias in the extremities or weakness and had no incapacitating neck pain in the prior 12 months.  On examination, he stood erect without support.  The cervical spine alignment appeared normal without tenderness and no paraspinal muscle spasm.  ROM measurements were flexion 35 degrees, extension 30 degrees, right and left lateral flexion 35 degrees each and right and left rotation 60 degrees.  Individual motions were not painful nor were they painful on repetition.  He had no obvious tender points over the cervical spine and he did not have a cervical collar.

The ROM evaluations 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 ~5 Mo. Pre-Sep	VA C&P ~3 Mo. Post-Sep	
Flex (45 Normal)	45	35	
Extension (45)	10	30	
R Lat Flexion (45)	45	35	
L Lat Flexion (45)	45	35	
R Rotation (80)	80	60	
L Rotation (80)	80	60	
Combined (340)	305	255	
Comment	Extension with pain, mild pain at the limit right and left lateral flexion; localized tenderness	No painful motion with or without repetition; no cervical tenderness; no muscle spasm	
§4.71a Rating	PEB 10%	VA 10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating using code 5237 for cervical spine strain.  The VA assigned a 10% rating using code 5242-5243 (Degenerative arthritis of the spine-Intervertebral disc syndrome) for degenerative joint and disc disease involving the cervical spine.  The Board sought a route for a higher rating, but was unable to do so in the absence of ankylosis, a further diminished ROM, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour or incapacitation.  The Board then considered whether an additional rating could be recommended under a peripheral nerve code.  Functional impairment linked to fitness is required to support a recommendation for addition of a peripheral nerve rating to disability in spine conditions.  Although the pain component of the neuropathy is appropriately subsumed in the spine rating IAW VASRD §4.71, which states that “rating is performed with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease,” there was no sensory component with any significant functional implications and no motor weakness was in evidence.  Therefore, a radiculopathy could not be recommended for additional disability rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the cervical spine strain condition.  

Painful Right (Dominant) Shoulder.  A note dated 24 August 2007 indicated the CI complained of pain of the right shoulder as well as other joint pain for 2-3 months after wrestling with a friend; however, later in the note, the history was that the pain began after being thrown to the ground at AIT (advanced individual training) combatives training.  X-rays of the right shoulder showed a lucency at the glenohumeral joint, possible reflecting a recent prior subluxation and an equivocal finding at the clavicle.  Physical therapy evaluation on 4 September 2007 revealed ROM measurements for flexion 145 degrees, abduction 145 degrees with pain in the glenohumeral joint, external rotation 85 degrees, and internal rotation 90 degrees.  Tests for impingement and anterior instability were positive.  Pain continued to worsen despite physical therapy where the CI admitted he did have right shoulder and back pain (see below) as a result of a motor vehicle accident in September 2006 approximately 4 months prior to enlistment.  Repeat X-rays of the right shoulder on 12 October 2007 demonstrated no fracture lucency and the lucency of the mid-clavicle was determined to be a normal variant of the foramen (opening) for the supraclavicular nerve.  Examination in December 2007 indicated the ROM was limited in abduction and the CI could not raise his shoulder above 90 degrees; and, no laxity was noted.  In February 2008 the assessment was right shoulder pain impingement.  X-rays of the right shoulder in May 2008 were normal.  A permanent U3 profile, which according to the NARSUM was based on the CI’s statement that he was unable to carry and fire his assigned weapon and he was unable to dig a fighting position was issued and included the cervical pain (see above) with the same limitations.  By June 2008, after approximately 6 months of physical therapy, there did not appear to be any significant change in the CI’s condition.  At the VA C&P examination in March 2009, performed 3 months after separation, there was no swelling, tenderness, redness, warmth, drooping, or crepitus of the right shoulder joint.  Abduction was 110 degrees, adduction 30 degrees, forward elevation 140 degrees, internal rotation 40 degrees, and external rotation 70 degrees.  None of the motions were painful and repetitive movements were normal.  There was no wasting or atrophy of the muscles around the joint and muscle power was normal.  

The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Shoulder ROM
(Degrees)	MEB ~5 Mo. Pre-Sep
	VA C&P ~3 Mo. Post-Sep
	
Flexion (180 Normal)	180	140	
Abduction (180)	180	110	
Comments	Fatigue after repetition	DeLuca negative	
§4.71a Rating	0%	VA 10%	

The Board directed its attention to its rating recommendation based on the above evidence. The PEB assigned a 0% rating using code 5099-5003 (degenerative arthritis) for a painful right (dominant) shoulder. The VA assigned a 10% rating using code 5024 (tenosynovitis) for right shoulder tendonitis based on limited motion.  The Board sought a route to a higher rating and noted physical therapy visits on multiple occasions indicated the CI could not raise his shoulder above 90 degrees, but that was inconsistent with MEB and VA examination ROM measurements.  However, at the MEB examination fatigue after repetition was reported in the presence of noncompensable ROMs thereby raising a possible 10% rating using DeLuca criteria, although at the VA examination, there was diminution of adduction, internal rotation and external rotation, but repetitive movements were normal.  The Board was unable to proffer a higher rating than 10% in the absence of ankylosis, further arm limitation, humerus impairment, or clavicle or scapula impairment.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the painful right shoulder condition.  

LUMBAR STRAIN.  A physical therapy note dated 21 September 2007 indicated the CI was referred with pain in multiple joints.  Examination revealed he was able to touch the top of his distal legs, was able to side bend to the mid-knee joints bilaterally, and had normal extension and rotation with increased pain with rotation. A trial of physical therapy was offered along with instructions for an in home exercise program.  Radiology reports of the lumbar and thoracic spine dated 19 May 2008 indicated a normal lumbar spine and mild spondylosis in the lower and mid portions of the thoracic spine.  A physical therapy note dated 2 June 2008 indicated the pain began after combatives training in June 2007.  However, the NARSUM noted the CI had low back pain since a MVA (motor vehicle accident), which occurred several months prior to entering the military and was exacerbated during the combatives training.  There was little documentation related to the lower back pain prior to the physical therapy evaluation or subsequent to it, but the CI stated he was unable to carry a fighting load or wear his body armor, which was reflected in the permanent L3 profile issued in May 2008.  At the VA Compensation and Pension (C&P) examination dated 10 March 2009, performed 3 months after separation, examination revealed the ROM measurements of the dorsolumbar spine were flexion 80 degrees, extension 20 degrees, and right and left lateral flexion and rotation were 25 degrees each.  Movements were not painful and were unchanged with repetition.  Coordination was normal and there was no evidence of nerve root irritation.       

The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	MEB ~5 Mo. Pre-Sep	VA C&P ~3 Mo. Post-Sep	
Flexion (90 Normal)	90	80	
Extension (30)	20*	20	
R Lat Flexion (30)	30	25	
L Lat Flexion (30)	30	25	
R Rotation (30)	30	25	
L Rotation (30)	30**	25	
Combined (240)	230	200	
Comment	*With pain to LS spine; **pain to thoracic spine at limit	DeLuca negative	
§4.71a Rating	PEB 0%	VA 10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating using code 5237 (lumbosacral sprain) for lumbar strain.  The VA assigned a 10% rating using code 5237 for chronic low back sprain.  The Board sought a route to a higher rating cognizant that the CI had limited treatment.  The Board first considered whether pain on extension and or left rotation was IAW VASRD §4.59 (painful motion).  However, there was no recorded facial expression, wincing, or pressure on manipulation nor was there any muscle spasm.  The Board then noted that the ROM of flexion at the VA would warrant a 10% rating since it was performed within 12 months of separation, but there was no medical evidence that could explain the decrement in the ROM.  The Board was unable to find a route to a higher rating than 10% in the absence of ankylosis, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, or incapacitation.  The Board then considered whether an additional Service rating could be recommended under a peripheral nerve code.  Firm Board precedence requires a functional impairment linked to fitness to support a recommendation for addition of a peripheral nerve rating to Service disability in spine conditions.  Although the pain component of the neuropathy is appropriately subsumed in the spine rating IAW VASRD §4.71, which states that “rating is performed with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease,” there was no sensory component with any significant functional implications and no motor weakness was in evidence.  Therefore, a radiculopathy could not be recommended for additional disability rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the lumbar strain condition.  

Shellfish Allergy.  A note in October 2007 indicated the CI was discovered to have an allergy to shellfish.  He became itchy and developed a rash whenever he came near sea food or prepared it.  The MEB narrative summary (NARSUM) noted that although there was “no documentation of severe reaction to fish or shellfish,” it was clear the CI “was unable to perform his duties as a cook as a result of the rash that occurs upon any type of exposure to these products.”  The Board directed its attention to its rating recommendation based on the above evidence.  The PEB did not assign a rating, but used code 7899-7825 (Urticaria (hives)) for shellfish allergy, which was determined to be an EPTS condition following a natural course.  The VA did not address the condition either at the C&P examination or in the VA Rating Decision (VARD).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the shellfish allergy condition.  

Contended PEB Conditions-Bilateral Knee Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that bilateral knee pain was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The bilateral knee pain was profiled and was implicitly implicated in the commander’s statement by referring to the CI’s profile; however, the bilateral knee pain was determined to meet retention standards.   

Bilateral Knee Pain.  A note dated 21 March 2007 indicated the CI complained of bilateral knee pain, which was treated with Voltaren (diclofenac, a nonsteroidal anti-inflammatory drug (NSAID)).  In September 2007 a physical therapy note indicated the knees were positive for chondromalacia patella.  In October 2007 the CI complained of right knee pain since joining the army and it became worse in the preceding 2 weeks because he had to stand for long hours.  There was no swelling or deformities of the knee, but he had tenderness when pressure was placed on the knee cap.  X-rays in May 2008 of the left and right knees were normal.  A physical therapy note dated 3 June 2008 indicated the bilateral knee pain limited the CI’s ability to run.  The ROMs were full except extension lacked 20 degrees in the 90/90 position presumably due to tight hamstrings.  Strength was full with some pain; there was no instability; patellar compression was negative, but there was tenderness of the medial retropatellar surface.  Physical therapy was instituted.  The MEB narrative summary (NARSUM) noted the CI had increasing pain in his knees since basic training with no specific injury; however, the CI insisted he was unable to ruck march 2 miles or do 3-5 second rushes as a result of knee pain.  Therefore, the condition was added to the medical evaluation board.  A permanent L3 profile was issued in May 2008 but it included not only the bilateral knee condition, but also the lumbar strain with the same limitations.  At the MEB examination, the examiner reported on DD form 2808 in June 2008, the ROM of the right knee was 0-120 degrees and noted “pain with locking and unable to squat without pain.”  The left knee ROM was 0-130 degrees without pain.  
At the VA Compensation and Pension (C&P) examination dated 10 March 2009, performed 3 months after separation, the CI reported knee pain of 5-6/10 (10 being the worst pain) with frequent popping sensations.  There was no giving out, locking sensation, or instability.  The CI used braces intermittently, and there were no episodes of incapacitation.  Examination of the knee joints revealed no obvious swelling, tenderness, redness, warmth, or crepitus.  There was no genu varus or valgus deformity.  The patellar apprehension test was positive on both sides.  There was no joint effusion. The ROM movements of both knee joints were extension 0 degrees and flexion to 130 degrees without pain.  Repetitive movements were normal and not painful.  Maneuvers of the joints were normal and there was no instability.  The CI did not wear any braces at the time of the examination.  X-rays showed a sclerotic density over the lateral aspect of the tibial condyle on the right, which may have been due to a bone island. 

The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Knee ROM
(Degrees)	MEB ~5 Mo. Pre-Sep
	VA C&P ~3 Mo. Post-Sep
	
	Left	Right	Left	Right	
Flexion (140 Normal)	130	120	130	130	
Extension (0 Normal)	0	0	0	0	
Comment	No pain	Increased pain with repetition	No pain; repetitive movements normal and not painful; maneuvers of the joint normal except positive patellar apprehension tests; no instability	
§4.71a Rating	PEB (Not Unfit)	PEB (Not Unfit)	VA 10%	VA 10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB found the conditions to be not unfitting and not ratable.  However, the VA assigned a 10% rating using code 5099-5024 (tenosynovitis) for the patellofemoral syndrome of the right knee and a 10% rating using code 5099-5024 for the patellofemoral syndrome of the left knee.  

Board Approach to PEB Consolidated Rating.  The PEB determined the bilateral knee pain was not unfitting.  The Board first considered whether the bilateral knee pain was reasonably justified as separately unfitting.  The bilateral knee pain was not explicitly implicated in the commander’s statement, but was added to the MEB at the CI’s insistence.  The STR did not document functional limitations of the bilateral knee pain, which based on credible medical evidence, interfered with the CI’s performance of his duties at the time of separation.  After due deliberation, members agreed the evidence does not support the bilateral knee pain could be reasonably justified as separately unfitting.  The aforementioned was reviewed and considered by the Board.   There was no performance based evidence from the record that the bilateral knee pain 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 bilateral knee pain contended conditions and so no additional disability rating is 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 cervical spine strain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the painful right (dominant) shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the lumbar strain condition, the Board unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  In the matter of the shellfish allergy condition and IAW VASRD §4.118, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral knee pain 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 re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Cervical Spine Strain 	5237	10%	
Painful Right (Dominant Shoulder)	5099-5003	10%	
Lumbar Strain	5237	10%	
Shellfish Allergy (EPTS)	7899-7825	--%	
RATING	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140312, 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 XXXXXXXXXX, AR20160003982 (PD201401308)

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 re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

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 severance pay.

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

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	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						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA