RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01986
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050818

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve, O3, All-Source Intelligence Officer, medically separated for “neck, bilateral knee, foot, and hip pain,” with a disability rating of 10%.

CI CONTENTION:  “Please consider all conditions.”  The CI’s complete submission is at Exhibit A. 

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 PEB – Dated 20050516	VARD - 20051219	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neck Pain…	5237	10%	Residuals Cervical Spine Injury	5237-5010	10%	20051219	
Bilateral Knee… 	5099-5003	0%	Right Knee Condition, ACL Tear	5257	10%		
			Left Knee Condition	5099-5257	10%		
Bilateral Foot and Hip Pain…	5299- 5278	---%	Club Foot/Pescavus, Bilateral	5278	50%		
			Left Hip Dysplacia	5255	30%		
Low Back Pain	Not Unfitting	Residuals of Low Back Injury	5237	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY: 

Neck.  The service treatment record (STR) documents a history of a motor vehicle accident with a whiplash injury (1998).  The CI sustained another neck injury (2002) when he fell into a ravine during a training exercise.  The 27 September 2002 cervical spine X-ray and head/brain CT were normal.  A 13 January 2004 cervical spine magnetic resonance imaging (MRI) showed disc bulging (C3-4, C6-7), disc annular tear (C6-7), osteophyte (bony outgrowth reaction to repeated minor trauma/chronic inflammation) complex (C5-6, C6-7), degenerative changes (C4-5, C6-7), with mild/moderate neural foraminal (nerve root opening) narrowing (C6-7).  The 14 January 2005 orthopedic spine clinic assessment listed cervical spine spondyloarthropathy (vertebral joint disease) without radiculopathy (nerve root irritation or injury) and degenerative disc disease (DDD).  No surgical intervention was recommended.  The narrative summary (NARSUM) by orthopedic surgery, 6 months before separation, documented that the CI fell into a ravine during a field exercise.  He had temporary loss of consciousness, acute neck pain, and was medically evacuated.  Multiple studies revealed no fractures and he was diagnosed with a major concussion.  The CI complained of intermittent, sharp, shooting, burning neck pain up to 7-10/10 pain.  The physical exam recorded normal neck range-of-motion (ROM) with average flexion of 55, extension of 60, lateral flexion (R/L) of 35 and rotation (R/L) of 60 degrees.  Upper extremity motor, sensory, and deep tendon reflex (1+ except for 2+ right brachioradialis) exams were normal.  The diagnosis listed chronic neck pain.

In the spine compensation and pension (C&P) exam, 4 months after separation, the CI complained of shooting, burning, posterior neck pain, with average intensity of 7/10, and maximum of 9/10.  Flare-ups occurred about once a week and lasted 30 minutes to an hour.  They were precipitated by sitting, driving, walking, lifting, and repeated bending; and relieved by stopping activity, rest, medications, and heat/cold treatments.  There were no incapacitating episode during the past 12-month period.  The physical exam revealed a mildly antalgic gait with no abnormal spinal curvature.  There was no postural abnormality, fixed deformity (ankylosis), or abnormality of cervical spine musculature.  The cervical spine ROMs (goniometer), with mild pain, were flexion 0-45, extension 0-40, lateral flexion (R/L) 0-35, and rotation (R/L) 0-75 degrees.  The ROM was additionally limited by pain following repetitive use.  After greater than five repetitions, the CI felt neck pain with mild posterior lower neck tenderness.  There was no weakness and no comment on fatigue or lack of endurance.  There was normal strength (5/5), intact sensation, and symmetrical and diminished reflexes (1+).  The diagnosis listed cervical (C6-7) spondyloarthropathy without radiculopathy.

The Board directed attention to its rating recommendation based on the above evidence.  The formal PEB, 3 months before separation, rated the neck condition at 10% (VA code 5237; cervical strain).  The PEB cited neck pain, tenderness, ROM, DDD by imaging, foraminal narrowing, and radicular symptoms.  The VA rating decision (VARD), 4 months after separation, rated the neck condition at 10% (5237-5010; cervical strain-degenerative arthritis).  The VARD cited neck pain, ROM, degenerative changes by MRI, and painful or limited motion of a major joint or group of minor joints.  The ROM values in proximate exams (MEB and C&P) were consistent with the 10% rating based upon the general rating formula for diseases and injuries of the spine.  The Board considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  While the CI complained of intermittent tingling and numbness of the ulnar aspect of hands, there was no evidence of ratable peripheral nerve impairment.  Serial exams demonstrated no muscle atrophy, normal strength, intact sensation, and physiologic reflexes.  There was no evidence that motor weakness or sensory loss existed to any degree that could be described as functionally impairing.  The Board therefore concluded that additional disability rating was not justified on this basis.  There was no evidence of incapacitating episodes that would justify a minimum rating under the alternative formula for rating intervertebral disc disease.  The Board agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or VASRD §4.59 (painful motion).  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 neck condition.

Bilateral Knee.  The PEB’s bilateral rating of 0% analogously to 5003 (degenerative arthritis) does not comport with the VASRD §4.71a stipulation for a 10% rating under 5003 for “2 or more major joints,” the latter without regard to ROM limitation or other factors.  While the bilateral knee conditions were not specifically implicated in the commander’s statement or profile, they were deemed unacceptable per the NARSUM, medically unacceptable by the MEB, and unfit by the PEB.  It remains that both knees were considered to fail retention standards.  The disability attendant to only the left or right knee cannot be isolated by the clinical evidence, or extricated from the fitness implications of the bilateral limitations.  Members agreed that the left and right knee conditions should be considered as separately unfitting.

Left Knee.  The STR documents a 28 August 2001 orthopedic surgery evaluation.  It recorded the CI injured his left knee in roadmarch yesterday without trauma or twisting.  The impression listed medial collateral ligament (MCL) sprain, doubt medial meniscus tear.  The follow-up documented a healing MCL sprain and a stable, partial anterior cruciate ligament (ACL) injury.  A 26 September 2002 left knee X-ray was normal.  The 13 January 2004 MRI of the left knee showed a minimal joint effusion and a possible venous occlusion.  The NARSUM recorded the CI always had some discomfort on the medial aspect of his left knee with associated swelling.  Left knee pain was rated as 3-6/10 with activity.  He had been treated with physical therapy (PT), evaluated by orthopedists, and surgery had not been recommended.  Physical exam showed normal alignment and patellofemoral tracking with no effusions or demonstrable instability (McMurray, Lachman, and drawer tests were negative).  The diagnoses listed bilateral knee pain, unacceptable.  In the C&P exam, the CI complained of daily, moderate joint pain from walking, standing, sitting, or climbing stairs.  The CI reported infrequent episodes of subluxation (incomplete or partial dislocation) or the sensation of the joint giving way.  Left knee pain was 4/10, with flare-ups of 9/10, a couple of times per week.  Pain was precipitated by weather changes, activity, and prolonged standing and sitting and alleviated by rest, medications (NSAIDs), exercise, and hot/cold therapy.  The physical exam showed mild patellar tenderness with no edema, warmth, erythema (redness), joint line tenderness, or effusion.  There was occasional buckling of the left knee.  There was no evidence of ligamentous laxity.  Left knee ROM was flexion of 0-90 (pain at 90) and extension of 0-0 degrees.  Repetitive ROM of the left knee resulted in worsening of pain otherwise ROM or joint function was not additionally limited by fatigue, weakness, or lack of endurance.  The diagnosis listed bilateral knee strain.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee condition at 0% (VA code 5099-5003; rating by analogy, degenerative arthritis).  The PEB cited left knee injury, periodic non-narcotic pain medication, no joint laxity, and no meniscal or ligamentous injuries on imaging.  The VARD rated the left knee condition at 10% (5099-5257; rating by analogy-knee, other impairment of: slight).  The VARD cited ROM; knee occasionally gives way, and minimal joint effusion by MRI.  The MEB and C&P exams did not demonstrate limitation of motion to support a minimum rating under VA codes for limitation of flexion or extension (5260, 5261).  There was no instability, dislocated meniscus, or removed meniscus to support minimum ratings under the respective codes (5257, 5258, and 5259).  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 left knee coded 5003.

Right Knee.  The STR documents that the CI sustained a right knee injury during training.  In the 9 January 2004 primary care encounter the CI reported chronic pain in his knees and right patellar grinding and popping.  A 13 January 2004 MRI of the right knee showed a partial ACL tear and small joint effusion.  The NARSUM recorded the CI injured his right knee in training in 2001 and again in 2003.  The CI complained of right medial knee pain and felt as though it would go out of place.  Right knee pain was rated as 7/10 and ranged between 5 and 10/10 with activity.  Physical exam showed normal alignment and patellofemoral tracking with no effusions or demonstrable instability.  The right knee was sore to manipulation with no localized tenderness.  The diagnoses listed bilateral knee pain, unacceptable.  In the C&P exam, the CI complained of daily, moderate joint pain from walking, standing, sitting, or climbing stairs.  The CI reported his right knee may occasionally lock infrequent episodes of subluxation, and the sensation of the joint giving way.  Right knee pain was 4/10, with flare-ups of 9/10, a couple of times per week.  Pain was precipitated by weather changes, activity, and prolonged standing and sitting and alleviated by rest, medications (NSAIDs), exercise, and hot/cold therapy.  The physical exam showed mild patellar tenderness with no edema, warmth, erythema, joint line tenderness, or effusion.  There was occasional buckling and locking symptoms of the right knee.  There was no evidence of ligamentous laxity.  There was no evidence of ligamentous laxity.  Right knee ROM was flexion of 0-120 (mild pain with grinding/crepitus at 120) and extension of 0-0 degrees.  Repetitive ROM of the right knee resulted in worsening of pain otherwise ROM or joint function was not additionally limited by fatigue, weakness, or lack of endurance.  The diagnosis listed bilateral knee strain.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral knee condition at 0% (VA code 5099-5003; rating by analogy, degenerative arthritis).  The PEB cited partial tear of the right knee ACL, periodic non-narcotic pain medication, no joint laxity, and no meniscal or other ligamentous injuries on imaging.  The VARD rated the right knee condition at 10% (5257; knee, other impairment of: slight).  The VARD cited ROM, partial ACL tear, occasional locking, instability, and pain.  The MEB and C&P exams did not demonstrate limitation of motion to support a minimum rating under VA codes for limitation of flexion or extension (5260, 5261).  The MEB and C&P exams did not demonstrate any ligamentous laxity and there was no instability, dislocated meniscus, or removed meniscus to support minimum ratings under the respective codes (5257, 5258, and 5259).  The Board concluded that both knees were separately unfitting.  Board members agreed that there was sufficient evidence of pain with use prior to separation, as well objective exam findings, to support a 10% rating considering functional loss and painful motion (§4.40, §4.59).  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 right knee coded 5003

Bilateral Foot and Hip Pain.  The PEB stated the bilateral foot and hip pain conditions existed prior to service (EPTS), were not permanently service aggravated, and therefore not rated.  While the bilateral foot and hip pain conditions were not specifically implicated in the commander’s statement, they were profiled, deemed unacceptable per the NARSUM, medically unacceptable by the MEB, and unfit by the PEB.  It remains that the foot and hip pain conditions were considered to fail retention standards.  Members agreed was that the foot and hip pain conditions should be considered as separately unfitting.  The NARSUM orthopedic surgeon documented “Soldier's left hip is his most symptomatic joint.”

Bilateral Foot.  The STR documents a history of congenital defects (bilateral pes cavus) corrected with surgery.  The 16 November 1991 enlistment history and physical exam listed congenital (inborn disease or physical abnormality) claw foot (forefoot plantar flexion with longitudinal arch elevation and clawing of the toes) which were corrected with surgery.  It documented that the CI was able to walk on toes, minimally on heels, and had good strength, and ROM of the lower extremities.  The summary of defects and diagnoses listed claw foot, which did not interfere with walking, running, etc.  The 8 January 2004 bilateral foot X-rays showed findings consistent with his previous club foot surgery with cavus deformity and mild arthritic changes.  The NARSUM reported the CI was born with congenital club foot deformities and was treated with casts and multiple surgical procedures between infancy and age 16.  The CI always had some foot discomfort but they were relatively asymptomatic until 2 years ago.  Symptoms worsened and made it impossible for him to participate in sports.  The CI complained of foot pain, between 5-10/10, with standing and activity.  The physical exam revealed a mildly antalgic gait.  Ankle ROM in degrees was 0-35 of plantar flexion, 35 of inversion, and 0 of eversion.  The foot exam revealed multiple healed scars consistent with soft tissue releases, Achilles tendons lengthening, and muscle transfers.  There were bilateral cavus deformities, multiple hammertoes, and excess callus under the metatarsal heads.  The lower extremity motor examination was intact, reflexes (1+) were equal, and there were no sensory deficits noted.  The surgeon opined that the CI “has received maximum benefits of conservative treatment … has … multiple orthopedic problems … stem primarily from his left hip disease and … bilateral foot deformities ….”  The diagnoses listed residual of congenital equinovarus deformities of both feet, unacceptable.  

The C&P exam recounted the history of congenital conditions and surgical corrections.  It recorded the CI was able to participate in sports and completed his basic training.  In 1992 he started to experience left hip and foot pain, which progressively worsened in 2003, and eventually became unbearable.  The CI complained of daily, moderate joint pain from activity.  The physical exam revealed a mildly antalgic gait.  Ankle ROM in degrees was limited with 0<10 of dorsiflexion and 0-10 of flexion.  There was moderate atrophy of the left foot.  The foot exam revealed multiple residual scars and severe bilateral pes cavus.  The diagnoses listed residuals of congenital equinovarus feet and multiple corrective surgeries for club foot deformities.

The Board directed attention to its recommendations based on the above evidence.  The Board does not challenge service EPTS determinations, but does exercise the prerogative of assessing the service aggravation element.  Members agreed that the baseline (and clearly EPTS) bilateral foot condition was contributory to the disability.  The PEB determined the bilateral foot condition not ratable (5299-5278).  The PEB cited pre-service correction of equinovarus club foot, cavus feet, claw toes, hammertoes, and bunions.  The PEB documented the condition “Existed prior to service, not permanently service aggravated, not rated, separated without benefits.”  The VARD rated the bilateral foot condition at 50% (5278) and cited service aggravation, pain, difficulty with ambulation, and severe club foot deformities.  The NARSUM foot exam documented multiple healed scars, bilateral cavus deformities, multiple hammertoes, and excess callus under the metatarsal heads.  The C&P exam documented limited ankle ROM, moderate left foot atrophy, multiple residual scars, and severe bilateral pes cavus.  The Board determined that the evidence showed that during service the bilateral foot condition, worsened over and above the natural progression for this condition.  Board members agreed a 30% rating was justified under 5278 (claw foot [pes cavus], acquired) based upon the objective physical findings documented in the MEB and C&P exams.  A 20% rating was also justified under 5284 (foot injury other).  A 10% rating was also justified under 5277 (weak foot, bilateral) and IAW §4.40 (functional loss) and §4.59 (painful motion).  There was no evidence of disability for consideration of a higher rating under 5276 (flatfoot, acquired), 5279 (metatarsalgia), 5280 (hallus valgus), 5281 (hallux rigidus), 5282 (hammer toe), 5283 (tarsal/metatarsal mal-/nonunion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the bilateral foot condition (5278).

Hip.  The STR documents a history of congenital defects (left hip dysplasia) corrected with surgery.  The 16 November 1991 enlistment history and physical exam listed surgery in infancy to repair congenital hip dislocation bilaterally which was characterized as well healed with no sequelae.  The 8 January 2004 bilateral hip X-ray showed the sequelae of left congenital hip dysplasia with moderate to severe osteoarthritic changes.  The NARSUM reported the CI was born with left hip developmental dysplasia and was treated with casts and multiple surgical procedures.  The left hip seemed to do well and during his childhood and teens he was able to participate in sports.  In 1992, he completed basic training and noted intermittent discomfort in his left hip.  Symptoms gradually worsened, and he developed constant pain in his left hip with a noticeable limp 2 years earlier.  While deployed to Iraq in 2003, symptoms increased from strenuous field duty, and became severe in December 2003.  The CI complained of lateral left hip pain, aggravated by activity, and associated with a “grinding and popping” feeling.  The CI reported his left hip was his most symptomatic joint, with pain between 7-10/10, and aggravated by activity, cold, and weather changes.  The physical exam revealed a mildly antalgic gait with his left hip in slight flexion.  The hip exam showed left hip and thigh healed surgical incisions and visible left thigh atrophy.  Goniometer measured left hip ROM in degrees was from full extension to 55 of flexion.  The left hip was fixed in 20 degrees of internal rotation and neutral abduction/adduction (about 5 degrees of motion in each direction).  The lower extremity motor examination was intact, reflexes (1+) were equal, and there were no sensory deficits noted.  The surgeon opined that “Because of his age, surgeons have been reluctant, as has patient, to consider a total hip replacement at this time … multiple orthopedic problems … stem primarily from his left hip disease and … bilateral foot deformities … his hip disease … very significantly aggravated by … military service….”  The diagnoses listed osteoarthritis left hip, severe, secondary to congenital hip disease, subsequent surgery, and possibly avascular necrosis of the hip, aggravated by 4 years of military service and active participation in vigorous physical activity, unacceptable.  

The C&P exam recounted the history of congenital conditions and surgical corrections.  It recorded the CI was able to participate in sports and completed his basic training.  In 1992 he started to experience left hip pain, which progressively worsened in 2003, and became constant with an associated limp.  The CI complained of daily joint pain ranging from 4/10 to 9/10 with flare-ups.  Pain was precipitated by weather changes, excessive activity, and prolonged standing and sitting and alleviated by rest, medications (NSAIDs), exercise, and hot and cold therapy.  The physical exam revealed a mildly antalgic gait.  The hip exam revealed mildly tender left hip healed surgical incisions.  There was moderate atrophy of the left thigh, leg, and foot.  The left hip ROM in degrees was 0-70 (with pain from 50) of flexion.  The left hip was fixed in 20 degrees of internal rotation and neutral abduction/adduction (about 5 degrees of motion in each direction).  The diagnoses listed severe left hip DJD (secondary to congenital hip disease and subsequent surgeries, possibly avascular necrosis, aggravated by years of military service and vigorous physical activity).

The Board directed attention to its recommendations based on the above evidence.  The Board does not challenge service EPTS determinations, but does exercise the prerogative of assessing the service aggravation element.  Members agreed that the baseline (and clearly EPTS) left hip condition was contributory to the disability.  The PEB found the left hip condition not ratable (VA code 5299-5278; rating by analogy- claw foot [pes cavus] acquired).  The PEB documented the condition “Existed prior to service, not permanently service aggravated, not rated, separated without benefits.”  The VARD rated the left hip condition at 30% (5255; femur, impairment of) and cited service aggravation, ROM, and X-ray findings.  The NARSUM documented “Because of his age … reluctant … to consider a total hip replacement … his hip disease … very significantly aggravated by … military service….”  The C&P examiner documented “severe DJD left hip … aggravated by years of military service and vigorous physical activity.”  The Board determined that the evidence showed that the left hip condition, worsened over and above the natural progression for this condition.  Board members agreed a 10% rating was justified under 5253 (thigh impairment of abduction, adduction, rotation of) based upon the limitation in rotation documented in the MEB and C&P exams.  A 10% rating was also justified IAW §4.40 (functional loss) and §4.59 (painful motion).  There was no compensable limitation of motion for consideration under 5251 (thigh, limitation of extension of) or 5252 (thigh, limitation of flexion of).  There was no evidence of disability for consideration of rating under 5250 (hip, ankylosis of), 5254 (hip, flail joint), or 5255 (femur fracture nonunion/malunion of).  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 chronic left hip condition (5253).

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the low back condition was 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 STR documented the CI sustained a low back injury when he fell into a ravine during a training exercise.  The NARSUM documented the CI always had some discomfort in his low back, worse for the previous 2 years.  The physical exam showed an antalgic gait related to his left hip injury.  Thoracolumbar average ROM was flexion of 50, extension of 40, lateral flexion to right of 35, to left of 45, rotation to right of 60 and to left of 70 degrees.  The surgeon opined that the back pain stemmed primarily from his left hip disease and bilateral foot deformities.  The spine C&P exam documented intermittent low back pain without radiation, tingling or numbness of the extremities.  The physical exam revealed a mildly antalgic gait, a somewhat elevated right hemipelvis, and no abnormal spinal curvature.  The thoracolumbar spine ROMs, with mild pain, were recorded as flexion 0-80, extension 0-25, lateral flexion (R/L) 0-30 and rotation (R/L) 0-30 degrees.  There was normal right lower extremity strength (5/5), decreased left lower extremity strength (3-4/5), intact sensation, and symmetrical and diminished reflexes (1+).  The diagnosis listed low back strain.  While the low back condition was profiled and found to be medically unacceptable by the MEB, it was not implicated in the commander’s statement and found not unfitting, and therefore not rated, by the PEB.  There was no performance based evidence from the record that this condition 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 contended low back condition.  Therefore, no additional disability ratings can be recommended.

BOARD FINDINGS:  In the matter of the neck condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the bilateral knee condition the Board unanimously recommends a disability rating of 10% for the left knee and 10% for the right knee, coded 5003 IAW VASRD §4.71a.  In the matter of the bilateral foot condition, the Board unanimously recommends a disability rating of 30%, coded 5278 IAW VASRD §4.71a.  In the matter of the hip condition, the Board unanimously recommends a disability rating of 10%, coded 5253 IAW VASRD §4.71a.  In the matter of the contended low back 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.  
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	
Neck Pain 	5273	10%	
Bilateral Knee Pain	Left	5099-5003	10%	
	Right	5099-5003	10%	
Bilateral Foot Pain	5278	30%	
Left Hip Pain	5253	10%	
COMBINED (w/ BLF)	50%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140506, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160011462, XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 50% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board's recommendation and record of proceedings for your information.

The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.

The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mailas soon as the directed corrections
·	have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXX.

A copy of this decision has also been provided to the Department of Veterans Affairs and to the couns I you listed on your application, XXXXXXXXXXXXXXXXXXX.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Deputy Assistant Secretary of the Army