RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02068
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Human Resources Specialist, medically separated for “chronic right shoulder pain and bilateral knee pain...” and  “chronic low back pain secondary to spondylolisthesis...,” rated 0% and 0%, respectively, with a combined disability rating of 0%.

CI CONTENTION:  “All of my conditions have worsened.  I take daily medications and am in constant pain.”  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 - 20070808	VARD - 20080724	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain and Bilateral Knee Pain...” 	5099-5003	0%	Chronic Right  Scapularthorcic Syndrome with Hypermobility	5203-5201	10%	20080211	
			Left Patellar Hyper Mobility Syndrome 	5299-5260	0%	20080211	
			Right Patellar Hyper Mobility Syndrome	5299-5260	0%	20080211	
Mild Depression	Not Unfitting	Depression with Adjustment Disorder and Insomnia	9440	NSC	20080325	
Gastritis	Not Unfitting	Gastritis, Weak Stomach, Esophageal Reflux	7399-7307	NSC	20080211	
Headaches	Not Unfitting	Chronic Daily Headaches	8199-8100	10%	20080211	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  A note dated 8 July 2005 indicated the CI was seen for right posterior shoulder/upper back pain.  On examination she had a full range of motion (ROM) with crepitus (grinding sensation) to the posterior/superior aspect (supraspinatus) on internal/external rotation with palpable trapezius (muscle) tenderness and negative winging.  The diagnosis of compression arthralgia-shoulder region was made and treatment consisted of Naproxen (a nonsteroidal anti-inflammatory drug (NSAID)).  A physical therapist noted in August 2005 the right shoulder pain was insidious in onset with increased pain and popping when she carried a medic bag with a rucksack.  Pain also increased with sit-ups, overhead lifting, and carrying.  Medication was switched to Mobic (meloxicam, an NSAID) in October 2005.  Bilateral shoulder laxity was noted along with crepitus on flexion of the right shoulder and pain in all motions in December 2005.  X-rays of the right shoulder in April 2006 were normal.  The CI was given a steroid injection for a snapping right scapula in June 2006, which provided about 6 hours of short term relief.  At an orthopedic evaluation in August 2006 a popping sound was heard with a snapping sensation in the right shoulder and the shoulder did not feel unstable nor could it be dislocated voluntarily.  There was audible crepitance with scapular retraction.  X-rays and a computed axial tomography (CT) scan of the right shoulder were normal.  A possible bursectomy/resection of the medial border of the scapula was discussed.  At an orthopedic evaluation on 30 August 2006 the CI reported that she was unable to fire her weapon due to discomfort and was diagnosed to have scapulothoracic dysfunction based on clinical findings.  X-rays of the right shoulder on 29 January 2007 were unremarkable, but for a type II acromion; and, salsalate (an NSAID) was prescribed.  An MRI of the right shoulder was normal in February 2007.  Orthopedic physical examination on 9 May 2007, ordered for a painful arc with crepitus of the right shoulder since March 2005, revealed a full active ROM of her bilateral upper extremities; hyperlaxity testing was positive.  She went into hyperextension of all of the joints of the upper extremities and had bilateral multidirectional instability without any dislocation of both shoulders.  Strength was 5/5 bilaterally with negative testing for impingement of the shoulder (Hawkins, Neer and cross-arm examination).  The MEB narrative summary (NARSUM) dated 31 May 2007 referred to the aforementioned orthopedic examination of 9 May 2007 and diagnosed the CI’s condition as chronic right shoulder pain with multidirectional instability and hypermobility.  

At the MEB examination, the CI reported on DD Form 2807-1, Report of Medical History, dated 6 April 2007 she had frequent shoulder pain.  The MEB physical examiner noted on DD Form 2808, Report of Medical Examination, dated 19 April 2007 a full ROM of the bilateral upper extremities with tenderness to pressure at the medial edge of the right scapula and for a palm-sized region; and the shoulder joint was “with instability.”  The commander’s statement dated 30 April 2007 indicated the CI was assigned a position as duty driver and was competent and assertive in all tasking, always exceeding the standards required.  Medical conditions or duty limitations were not addressed.  A permanent U3L3 profile was issued on 3 July 2007 for chronic right shoulder instability, chronic bilateral knee pain (see below) and chronic low back pain (see below) with limitations of all physical fitness testing and all military functional activities except wearing a protective mask and all chemical defense equipment.  Additional restrictions included no carrying a weapon greater in size than an M-9 pistol, no wearing of body armor, no lifting greater than 10 pounds with the right upper extremity, or greater than 20 pounds with both arms, no wearing a backpack, no flutter kicks, no overhead calisthenics, no fast-pace “speed walking,” and no marching.  

At the VA Compensation and Pension (C&P) examination dated 11 February 2008, performed 5 months after separation, the CI reported chronic daily right shoulder pain from 2/10 to 4-9/10 (10 being the worst pain) anytime she was doing anything.  She complained of weakness, heat, fatigue, and lack of endurance of the shoulder but denied stiffness, swelling, redness, instability, or locking.  She did not use any assistive device.  On examination of the upper extremities muscle bulk and tone were normal as were sensation and reflexes. There was a normal ROM of both shoulders to 180 degrees forward flexion, 50 degrees extension, 180 degrees abduction, and 90 degrees each of internal and external rotation.  There was pain along the scapulothoracic border at the upper scapular margin with crepitance of the right shoulder only and all ROMs caused discomfort in that area.  

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 ~5 Mo. Post-Sep
	
Flexion (180 Normal)	Full	180	
Abduction (180)		180	
Comments	Positive hyperlaxity	All motion caused discomfort; pain at the scapulothoracic border	
§4.71a Rating	0%	0%	

Right Knee Pain and Left Knee Pain.  In a note dated 29 January 2007 the CI noted she also had right knee pain which she claimed started during basic training in February 2005 when her kneecap popped out of place and that it still popped out even when not running.  There was tenderness on palpation of the medial patellar facet and the medial patellar retinaculum.  The CI was treated with salsalate for the knee pain as well as the right shoulder pain (see above).  X-rays of the right knee were unremarkable.  However, X-rays on 24 April 2007 of the bilateral knees performed because of hypermobility of the patella, which self-dislocated on a chronic basis, demonstrated mild bilateral medial compartment narrowing and a bone island in the superior left medial tibia.  Examination on 9 May 2007 revealed a history of bilateral lateral knee dislocations that have been unwitnessed and not medically documented.  However, the CI did not have any physical therapy or conservative therapy for her knee, which had no specific pattern to the knee dislocations.  On examination she had a “negative antalgic gait” and a full active ROM bilaterally.  There was no effusion or edema, no instability bilaterally, and no evidence of a meniscal tear in either knee.  She had trace crepitus with lateral tracking in the knees bilaterally and lateral tracking of the patella with quad setting. She had hyperextension the knees bilaterally when she rested her heels on an elevated object.  The orthopedic surgeon concluded the CI was unable to function in a military environment and would continue to have issues with the ligamentous laxities of her joints.  

At the MEB examination, the CI reported both of her “knee caps pop out of place.”  The MEB physical examiner checked off on the clinical evaluation the lower extremities were abnormal on the DD Form 2808 and noted a full ROM of the bilateral lower extremities, no tenderness to palpation, no edema or patellar grind, and positive bilateral hypermobility of the patellas laterally, but no joint instability on examination.  The MEB narrative summary (NARSUM) dated 31 June 2007 indicated the CI experienced an unusual pushing type pressure of the patella laterally, on the right side greater than the left side, with exertional activity.  When the patella dislocated laterally after short walks as well as after long exertional walking, she experienced sudden, sharp pain followed by edema with ecchymosis (black and blue marks), which occurred often along with pain of 10/10, but surgery was not indicated.  A permanent U3L3 profile was issued on 3 July 2007 for chronic right shoulder instability, chronic bilateral knee pain and chronic low back pain with limitations noted above.

At the VA Compensation and Pension (C&P) examination the CI reported discomfort over the medial aspect of the knees and reported the kneecaps would dislocate medially; however the examiner noted the service medical records indicated the kneecaps were hypermobile and would laterally sublux.  She stated the left kneecap did it three or four times and the right kneecap had done it too numerous to count.  The left knee bothered her about two times a month and the right knee two times per week.  However, she used no assistive devices.  On examination bilateral knees had a normal painless ROM to include 145 degrees flexion, 5 degrees hyperextension with 10 degrees internal and external rotation.  There was no ligament laxity to varus or valgus stress and anterior and posterior drawer signs were negative.  No meniscal tears were evident.  The patellas were hypermobile bilaterally with mild patellofemoral crepitation with flexion and extension.

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 ~4 Mo. Pre-Sep
	
VA C&P ~5 Mo. Post-Sep
	
	Left	Right	Left	Right	
Flexion (140 Normal)	Full
	145	145 	
Extension (0 Normal)		5 hyper	5 hyper	
Comment	Trace crepitus; no ligament laxity; hyperextension of knees	No ligament laxity; patellofemoral crepitation with flexion and extension	
§4.71a Rating	0%	0%	0%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating using code 5009-5003 (degenerative arthritis) for chronic right shoulder pain and bilateral knee pain due to joint laxity.  The VA assigned a 10% rating using code 5203-5201 (clavicle or scapula, impairment-arm, limitation of motion) for chronic right scapulothoracic syndrome with hypermobility.  The VA assigned a 0% rating using code 5299-5260 (leg limitation of flexion) for left patellar hypermobility syndrome and a 0% rating using code 5299-5260 for right patellar hypermobility syndrome.  
 
The Board first considered whether chronic right shoulder pain was reasonably justified as separately unfitting as established above.  The Board concluded that the bundled chronic right shoulder pain condition was reasonably supported by the record as separately unfitting.  The Board then considered its rating recommendation for the separately unfitting chronic right shoulder pain condition at the time of separation.  The Board sought a route for accurately and fairly rating the shoulder disability aware that the right shoulder full ROM is noncompensable and incompatible with arm limitation of motion (code 5201), but crepitus IAW VASRD §4.59 (painful motion) was noted on multiple examinations.  Therefore, use of analogous code 5099-5003 at 10% is a reasonable rating for the condition.  However, in the absence of ankylosis of the scapulohumeral articulation (code 5200) or humerus impairment (code 5202), although the CI did have episodes of hyperextension, but not recurrent dislocation, or clavicle or scapula impairment (code 5203) including dislocation, nonunion or malunion, a higher rating is unobtainable.  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 right shoulder pain condition.  

The Board then considered whether the bilateral knee pain was reasonably justified as separately unfitting as established above.  The Board concluded that the bundled bilateral knee pain condition was reasonably supported by the record as separately unfitting and each knee was also separately unfitting, although the right knee was more symptomatic than the left knee.  It remains, however, that both knees were considered to fail retention standards; both were implicated by the NARSUM; and, both were profiled.  Since the disability attendant to only the left knee cannot be isolated by the clinical evidence, or extricated from the fitness implications of the bilateral limitations; members agreed that the left knee condition should be likewise conceded as reasonably unfitting.  The Board then considered its rating recommendation for the separately unfitting right and left knee pain conditions at the time of separation; however while the ROMs were noncompensable, there was limited significant objective evidence of painful motion, although there was a trace crepitus in the bilateral knees with lateral tracking of the patella bilaterally, and there was no clear cut X-ray evidence of degenerative arthritis of either knee, although there was mild bilateral medial compartment narrowing and a bone island in the superior left medial tibia, thereby obviating the use of code 5099-5003.  Use of analogous code 5299-5257 (knee impairment-recurrent subluxation or lateral instability) is nearly appropriate for the CI’s knee conditions.  However, neither knee was noted to be subluxed objectively at the time of separation nor did the CI wear a brace or braces or have any physical therapy for either knee condition; nevertheless on examination there was lateral tracking of the patella bilaterally; and, the CI reported the right knee subluxed much more frequently than the left.  Therefore, a 10% rating is reasonable for a mild subluxation; however, the absence of significant medical evidence or intervention speaks against a higher rating for moderate or severe subluxation as does the absence of ankylosis (code 5256), cartilage dislocation (code 5258), cartilage removal (code 5259), or tibia and fibula impairment (code 5262).  Genu recurvatum (code 5263) was considered by Board members because of hyperflexion when the CI stood with her heels on an elevated object, but there was no trauma with weakness and insecurity in weight bearing objectively demonstrated.  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 pain condition and a disability rating of 10% rating for the left knee pain condition, each coded 5299-5257.  

Chronic Low Back Pain Secondary to Spondylolisthesis.  A note on 13 July 2005 indicated the CI had diffuse back pain without known trauma.  On examination her spine was in good alignment with deformity of step-off.  There was mild paravertebral muscle spasm including the rhomboid muscles bilaterally that were tender to palpation.  There was a full ROM of the back with an unremarkable neurological evaluation.  Treatment consisted of chlorzoxazone (a muscle relaxant).  After waxing a floor, pain returned and medication was switched to methocarbamol (a muscle relaxant); pain again developed after wearing individual body armor.  X-rays of the lumbar demonstrated a grade I spondylolisthesis at L5-S1 and mild narrowing of the L5-S1 disk space.

At the MEB examination she had frequent back pain. The MEB physical examiner noted the CI had a full active ROM of the thoracolumbar spine with no tenderness to palpation and no spasm noted in the paravertebral musculature. There were no step-offs or deviations on palpation and there was no edema, erythema, or ecchymosis noted. Straight leg testing (to determine nerve root irritation) was negative and she was able to heel- and toe-walk within normal limits.  Neurologic evaluation was unremarkable.  The MEB narrative summary (NARSUM) dated 31 May 2007 noted the CI first experienced low back pain in mid-2005, which was short lived and did not become a problem again until July 2007 when she developed a frequent, chronic tightening and cramping-like pain in the low lumbar spinal region that was worse particularly after long periods of sitting. The NARSUM referred to the 19 April 2007 MEB physical examination (see above).  The NARSUM author noted the CI experienced a chronic, constant cramping and tightening pain in the lower lumbar spinal region on a 3-9/10 pain scale, which was aggravated by running, jumping or impact active, sit-ups, flutter kicks and carrying greater than 20 pounds, and the wearing of body armor or a backpack. Since onset, the CI experienced a gradual worsening of overall pain and discomfort, but surgery was not indicated.  A permanent U3L3 profile was issued on 3 July 2007 for chronic right shoulder instability, chronic bilateral knee pain and chronic low back pain with limitations noted above.

At the VA Compensation and Pension (C&P) examination dated 11 February 2008, performed 5 months after separation, the CI reported lower central back pain that came and went.  Once a week the pain rose to a 10/10 where she could not breathe, otherwise her pain level was 0.  She denied bowel or bladder symptomatology and had no incapacitating episodes.  Physical examination of the thoracic spine revealed no tenderness to palpation of the peripheral musculature or spasm.  Forward flexion of the thoracolumbar spine was 90 degrees, extension 50 degrees, bilateral lateral flexion 40 degrees, and bilateral rotation 50 degrees.  She could walk on her tiptoes and heels without difficulty.

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 ~5 Mo. Post-Sep
	
Flexion (90 Normal)	Full 	90	
Extension (30)		 (30)50	
R Lat Flexion (30)		 (30)40	
L Lat Flexion (30)		 (30)40	
R Rotation (30)		 (30)50	
L Rotation (30)		(30)50	
Combined (240)	-	240	
Comment	No tenderness to palpation and no spasm in the paravertebral musculature; negative straight leg raise	No tenderness to palpation of the paravertebral musculature and no spasm	
§4.71a Rating	0%	0%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating using code 5239 for chronic low back pain secondary to spondylolisthesis.  The VA assigned a 0% rating using code 5239 for spondylolisthesis L5-S1 with mild degenerative disc disease.  The Board sought a route to a higher rating; however, in the absence of ankylosis, forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees or the combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees, or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour, episodes of incapacitation or vertebral body fracture with loss of 50 percent or more of the height was unable to do so.  The Board then considered whether an additional rating could be recommended under a peripheral nerve code.  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 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 chronic low back pain secondary to spondylolisthesis condition.    

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that mild depression, gastritis, and headaches were not unfitting.  The mild depression, gastritis, and headaches were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.   

Mild Depression.  A note dated 5 May 2005 indicated the CI stated she was feeling depressed and reported feeling tired (fatigue), had decreased appetite and concentrating ability with anxiety, anhedonia, and low self-esteem.  The diagnosis of an adjustment disorder with anxiety and depressed mood was made.  Treatment sessions were carried; however on 12 May 2005 the diagnosis of depression single episode without melancholia or psychotic features was made and the CI was treated with fluoxetine (an antidepressant medication) and zolpidem (for insomnia). At a follow-up visit she reported she was able to sleep, but was still depressed.  Supportive psychotherapy was given and Wellbutrin SR (bupropion SR, an antidepressant medication) was added to the medication regimen.  She was seen again in August 2007 with the diagnosis of phase of life or life circumstance problem and her General Assessment of Functioning (GAF) was 75 (If symptoms are present, they are transient and expectable reactions to psychosocial stressors; no more than slight impairment in social, occupational, or school functioning.).  At the VA examination dated 25 March 2008 the CI denied any further depressed mood since her discharge.  At the mental health examination her mood was euthymic and her affect was wide; the remainder of the examination was otherwise unremarkable.  The diagnosis was adjustment disorder with depressed mood, resolved and insomnia not otherwise specified and the FAF score was 70 (some mild symptoms).

Gastritis.  The CI complained of abdominal pain for a week on 13 September 2006, although later in the note a stomachache for 2 weeks was reported.  Treatment consisted of ranitidine (an antacid medication) and bismuth subsalicylate (for gastrointestinal irritation).  In a follow-up visit, the CI reported after starting meloxicam for low back pain.  The diagnosis of gastritis drug-induced likely due to meloxicam, which was stopped and rabeprazole (for gastroesophageal reflux or gastric or duodenal ulcers) was prescribed.  Abdominal pain persisted and an abdominal X-ray series was normal, except for increased stool in the colon, as was a test for Helicobacter pylori (an intestinal bacteria) in October 2006.  Periumbilical pain in the left lower quadrant seemed to worsen with eating in April 2007 in the prior 2 weeks.  At the VA examination the CI indicated that as long as she took her “hyperacidity pill” her symptoms seemed to be better, but she still described lower abdominal pain, not related to her menstrual cycle or bladder or bowel activities.

Headaches.  The CI complained of a headache accompanied by nausea on 29 November 2006 in conjunction with intermittent abdominal pain.  Treatment consisted of ketorolac (an NSAID) and intravenous fluids.  In May 2007 the CI reported a frontal headache over both temples, which occurred several times a week and was relieved by sleep and medication although she reported Midrin (a combination of acetaminophen, dichloralphenazone, and isometheptene to relieve pain, tension and migraine headaches) was not helpful, but it was continued at a high a different schedule in July 2007.  She was diagnosed with common migraine (without aura) and nortriptyline (an antidepressant medication and for nerve pain) was continued.  At a neurology visit on 25 July 2007 the CI reported she had a history of migraine headaches starting in childhood, which increased during basic training to a few/month and increased to 3x/week over the prior 7 weeks.  Examination was normal and the examiner opined the headaches were exacerbated by stress with possible exacerbation with rebound headache from overuse of Midrin.  Nortriptyline and Midrin were discontinued.  Topiramate for migraine prophylaxis and eletriptan (Relpax) for abortive therapy were prescribed.  At the VA C&P examination the CI noted the headaches started when she wore Kevlar all day long.  Topamax (topiramate) helped, but she was out of medication; however, the Relpax was taken.  

The aforementioned was reviewed and considered by the Board.   There was no performance based evidence from the record that mild depression, gastritis, or headaches 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:  In the matter of the right shoulder pain condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the right knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5257 IAW VASRD §4.71a.  In the matter of the left knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5257 IAW VASRD §4.71a.  In the matter of the chronic low back pain secondary to spondylolisthesis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended mild depression, gastritis, and headaches 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.    

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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Shoulder Pain 	5099-5003	10%	
Right Knee Pain	5299-5257	10%	
Left Knee Pain	5299-5257	10%	
Low Back Pain Secondary to Spondylolisthesis	5239	0%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140512, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160010887, 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 30% 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 mail as 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-00), XXXXXXXXXXXXXXXXXXX.

A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Deputy Assistant Secretary of the Army

Enclosure