RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02436
BRANCH OF SERVICE:  Army	BOARD DATE:  20140828
SEPARATION DATE:  20080108

SUMMARY OF CASE: The available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (11B/Infantryman) medically separated for Anxiety Disorder.  The condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty (MOS); he was issued a permanent S3 profile and referred for a Medical Evaluation Board (MEB).  The mental health (MH) condition, characterized as “anxiety disorder,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded three other conditions (alcohol dependence, episodic, polysubstance dependence, episodic, and cystic acne) for PEB adjudication.  The Informal PEB adjudicated “Anxiety Disorder, not otherwise specified” as unfitting, rated 10%, with probable application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting or not compensable.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting MH condition is addressed below.  The Board acknowledges the CI’s contention for ratings of his cystic acne condition, which was determined to be not unfitting, and for the alcohol dependence and episodic poly-substance dependence condition, which were determined to be not compensable by the PEB.  The Board emphasizes that disability compensation may only be offered for those conditions that cut short the member’s career.  Should the Board judge that any contested condition was most likely incompatible with the specific duty requirements; a disability rating IAW the VASRD, and based on the degree of disability evidenced at separation, will be recommended.  No additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20071105	VA - (~6 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder, NOS	9413	10%	Major Depression with Anxiety and Polysubstance Abuse and Alcohol Abuse	9434	50%	20080611	
Alcohol Dependence, Episodic	Not Compensable					
Polysubstance Dependence…	Not Compensable					
Cystic Acne	Not Unfitting	No VA Entry	
Other x 0 (Not in Scope)	Other x 0	
Rating:  10%	Rating:  50%	
Derived from VA Rating Decision (VARD) dated 20080721

ANALYSIS SUMMARY:

Anxiety Disorder.  The CI accomplished the accession history and physical on 5 June 2003 and noted a history of community service and an alcohol awareness class.  He denied other substance abuse or MH issues.  He again underwent a history and physical for Ranger and Sniper training on 7 September 2004 and no limitations were noted.  He was cleared for special training by MH on 26 January 2005.  The DD Form 214 indicates that he completed this training in 2005.  He deployed to Southwest Asia from 16 August 2005 until 1 December 2006.  On a post-deployment evaluation performed 2 days after his return, he indicated that his health remained the same and that he had no MH concerns.  He reported that he had discharged his weapon and felt in danger of being killed, but denied all the screening questions regarding both depression and posttraumatic stress disorder (PTSD) and did not request counseling.  He also denied all the symptoms under question six including headaches and ringing in the ears.  A post-deployment examination on 6 December 2006 documented that he reported no acute issues and he was cleared for full duty.  The next records in evidence are from a civilian hospital, Salina Regional Health Center, to which he was admitted on 14 June 2007 for suicidal ideation.  He was evaluated for substance abuse and endorsed binge drinking beginning at age 15.  By age 17, he drank seven shots of Jack Daniels and 12 beers before feeling the effects.  He endorsed frequent blackouts and tolerance; however, he denied seizures (from withdrawal).  He reported that he first used marijuana and cocaine at age 17.  He had been on a binge for the latter in April 2007 and last used alcohol 2 weeks earlier (prior to psychiatric hospitalization).  He stated that this had been to deal with his suicidal thoughts and depression.  Inpatient and outpatient therapy was recommended.  The CI also underwent personality testing on 15 June 2007.  He reported a history of depression and a family history of depression and schizophrenia.  His testing exceeded the cut-off for malingering, but the examiner noted that some of his responses could have been accounted for by his depression.  Suggested diagnoses included schizoid personality disorder, self-defeating personality disorder, borderline features, and depressive traits.  The latter two were thought to be most consistent with his clinical presentation, record, and behavior.  Axis I proposed diagnoses were PTSD and major depression.  After a 9-day inpatient psychiatric hospitalization, the CI was discharged on 22 June 2007 on psychotropic medications.  He was seen the day of discharge from the hospital in the emergency room at his base to “check in.”  A military record that day noted that the diagnosis was major depressive affective disorder, single episode in the problem list; however, he was diagnosed with an adjustment disorder.  A second post-deployment assessment on 26 June 2007, he reported that his health had been poor the past month.  He endorsed interpersonal conflict and responded yes to all four PTSD screening questions.  He denied excess alcohol use or the need to decrease consumption.  He did answer yes to the depression screening questions and indicated a desire for follow-up.  A 20 July 2007 case management note documented that the CI had returned to his base in Alaska following his deployment.  He then transferred to Ft Riley, KS and was living in the barracks without a local social support system.  The case manager noted that the CI had been absent without leave (AWOL) for 30 days and had been punished with pay forfeiture.  He reported exposure to a blast under his vehicle followed by headaches and ringing in his ears for 3-4 days; these symptoms were denied on the post-deployment assessment accomplished in December 2006.  He still experienced both headaches and ringing in the ears occasionally.  He endorsed nightmares and flashbacks.  He reported difficulty with authority stating “I just don’t care” and “I have a passive aggressive attitude.”  He was in counseling and taking medications (for MH), but did not think that the latter were beneficial.  He was enrolled in Jujitsu at the base gym and reported benefit from this with both his anxiety and depression.  

The MEB history and physical were accomplished on 23 July and 24 August 2007, respectively.  The CI reported anxiety, depression, trouble sleeping, and a suicide attempt the previous March while still in Alaska.  The CI was issued an S3 profile for anxiety disorder, not otherwise specified (NOS) on 1 August 2007.  The psychiatric narrative summary (NARSUM) on 9 October 2007 (3 months prior to separation), it was based on several interviews over several months as well as a review of the medical, psychiatric, and personnel records associated with the case.  The CI reported that he had always had a somewhat depressed mood, but that he never really had problems with it until about 4 or 5 months into his deployment in Iraq in 2005.  He was a sniper and always worried about being killed or injured and two of his buddies had been killed.  Following redeployment, his symptoms increased due to disappointment (his return was not as fulfilling as it should have been) and he felt isolated.  His girlfriend had broken up with him while he was deployed which added to his depression.  He went home to Texas on 40 days of leave and slept poorly.  He began to drink heavily and took over the counter sleeping aids.  He returned to Alaska and had suicidal ideation.  He continued heavy drinking and also abused cocaine for 3 or 4 days with apparent withdrawal symptoms.  On 20 April, he presented for a mental health evaluation at Brook Army Medical Center (BAMC), San Antonio, Texas, where he reported anxiety and depression with symptoms of racing heart, feeling terrible, tense, and overall unease.  He also reported nightmares.  He was prescribed medications but did not take them due to concern that his suicidal ideation could increase.  Later, he went to his hometown emergency room and was prescribed an anti-anxiety medication (Xanax) and an anti-depressant (Zoloft.)  He again went on leave in May and moved to Fort Riley Kansas where he continued heavy drinking and again abused cocaine for 4 days.  A friend suggested that he use marijuana to aid in the cocaine withdrawal; this was not successful.  He reported that he was admitted to the US Air Force Wilford Hall, San Antonio, for 5 days, but the time is not specified.  There is no record of this admission in evidence.  An appointment was made for him at Fort Riley on 24 May, but he did not keep it (he was still in Texas) and again went on a binge of alcohol and cocaine.  He stopped the medications given to him at Wilford Hall.  After 30 days of AWOL, he reported to mental health at Fort Riley at the insistence of his family. He reported reliving his experiences, avoidance, impatience, anxiety, hallucinations, fatigue, and suicidal ideation.  He stated that he had not used alcohol for 2 weeks and drugs for 30 days.  He was admitted (above) and reported improvement in his symptoms with treatment although the nightmares persisted and were intense.  Review of his past medical history showed that although he had been cleared for sniper school, he had reported on several occasions that he had felt depressed for most of his life and could not recall having “normal” emotions.  He reported that he received an Article 15 after going AWOL and was demoted, and that a promotion packet was not processed.  He noted that he did not use illicit drugs as a rule.  He had tried both marijuana and cocaine while in high school.  He was arrested for public intoxication at 17 and placed in Army Substance Abuse Program (ASAP) at age 18 in the Army.  He reported that when he did drink, he drank to get drunk.  He did not believe that he was an alcoholic and did not intend to stop drinking.  The examiner noted that the appearance of the CI varied from visit to visit, but that he was usually on time and rather disheveled.  His hair appeared to be too long.  His attitude was sullen, distant, and depressed with a slouched posture.  He always appeared tired and depressed.  His answers were vague and provided minimal detail.  He reported no hallucinations or delusions and his memory appeared intact.  He was hopeless and seriously considered suicide at one interview prior to his hospitalization, but made no attempts.  He was tense, but without hyper-startle.  Neuropsychological testing showed that he had slowed processing speed, but did not have a traumatic brain injury.  A personality disorder was inferred from testing.  He was diagnosed with an anxiety disorder NOS secondary to combat exposure.  It was noted that he had gotten into several fights and had made exceptionally poor choices with alcohol and drugs.  His predisposition was moderate secondary pre-military use, but the examiner noted that he had not had problems for several years while serving.  The alcohol dependence and poly-substance abuse were not medically disqualifying.  Under Axis II, the examiner noted that his history did not suggest a lifelong pattern of inflexible and deviant behavior.  A Global Assessment of Function (GAF) of 60 was assigned, indicative of moderate symptoms or impairment.  It was noted that he continued to have nightmares and avoided circumstances that reminded him of Iraq.  The MEB determined that the anxiety disorder did not meet retention standards.  Alcohol dependence, poly-substance abuse, and cystic acne all met retention standards.

The PEB on 5 November 2007 determined that the anxiety disorder, NOS was unfitting.  It noted that the history of alcohol and drug abuse preceded his enlistment and would partially account for his anxiety.  He was also thought to have a profile consistent with a schizoid personality disorder which would account for social interaction difficulties.  It recorded that the commander had noted a “distinct performance decrement from what would be expected of a Soldier with his rank, MOS, and experience.”  A deduction for the personality disorder and the substance abuse, which predated his service, was made, but the amount was not specified nor was the relative contribution of each condition.  

The VA Compensation and Pension (C&P) general examination was on 11 June 2008 (5 months after separation), the examiner noted that the CI had normal behavior, affect, comprehension, and memory.  No signs of tension were present.  He was not currently employed; no reason was cited.  The CI underwent a MH evaluation 2 days later.  He reported that he had been a scout/sniper while deployed and did things which he now regretted and could not get off his mind.  He reported the suicidal ideation upon return to Alaska and that he was unable to go to Fort Riley while on leave in Texas.  He then reported the admission and delayed reporting to Fort Riley (AWOL.)  Since his discharge, he reported sleep disturbance which was treated well with Ambien (a prescription sleeping aid).  He continued to be depressed all the time and ruminated over events while deployed.  He reported avoiding most people and being irritable, but did have a (new) girlfriend.  He was also irritable with her, but not physically violent.  His treatment on active duty had been beneficial, but had not resumed treatment since separation.  He reported no further hospitalizations or emergency room visits (for psychiatric reasons).  He stated that he did very little secondary to poor motivation.  He endorsed trying “all manner of drugs and alcohol in high school” and drank moderately while deployed and more heavily upon his return drinking 10-12 cans of beer “once or twice every two weeks.”  (His referral to ASAP early in his enlistment was not recorded).  He did go out with his girlfriend, but preferred to stay home.  On examination, he was neat, clean, and appropriately dressed and groomed.  Affect was adequate and thought content appropriate.  Mood was depressed and probable diminished productivity and psychomotor activity assessed.  Irritability was not demonstrated.  He needed to break something sometimes when angry.  Communication was initially guarded, but then open and comfortable.  Speech was reduced in productivity, but normal otherwise.  Concentration was poor.  Thought processes were organized and goal directed, judgment good, abstract thinking good as was memory.  He denied homicidal ideation and current suicidal ideation.  He was diagnosed with major depression, single episode, and anxiety.  The substance abuse was noted to be in sustained remission; alcohol abuse was current.  No axis II condition was diagnosed and the GAF was 48, consistent with serious symptoms or impairment.  The drug and alcohol abuse were noted to pre-date his diagnosis of depression, but were aggravated by it.  Prognosis was fair with treatment and “not good” without it.

The PEB adjudicated anxiety disorder, NOS, at 10% and coded 9413 for anxiety.  As noted, a deduction was made for both the substance abuse and personality disorder.  The VA made no deduction for the substance abuse although it was noted to pre-date his MH condition, and rated the CI at 50% for major depression, coded 9434.  The Board first considered if the provisions of VASRD §4.129 were applicable.  The PEB rating, as described above, was derived from DoDI 1332.39 and preceded the promulgation of the National Defense Authorization Act 2008 mandate for DoD adherence to VASRD §4.129.  IAW DoDI 6040.44 and DoD guidance (which applies current VASRD §4.129 to all Board cases as appropriate), the Board must consider the application of VASRD §4.129 if the psychiatric condition resulting in medical separation “develops in service as a result of a highly stressful event.”  If the Board judges that application of VASRD §4.129 is appropriate, it will recommend a minimum 50% rating for a retroactive 6-month period on the Temporary Disability Retired List (TDRL).  The Board must then determine the appropriate permanent rating with VASRD §4.130 criteria at 6 months, based on the facts in evidence which are most probative for that interval.  The Board noted that the PEB clearly stated that the “soldier suffers from symptoms of anxiety and social withdrawal subsequent to deployment to Iraq” and determined that this alone is sufficient to warrant application of VASRD §4.129.  The Board then considered the existing prior to service (EPTS) deduction made by the PEB for the drug and alcohol abuse which preceded his service and were thought to increase his anxiety as well as the social impairment partially attributed to the schizoid personality disorder.  The CI clearly indicated a history of drug and alcohol abuse beginning at age 15 to numerous examiners both prior to and after separation.  He had legal issues from public intoxication prior to accession and was entered into the ASAP program within the first year of service, however there was no record of performance deficit due to alcohol abuse prior to his MH condition becoming a performance issue.  In January 2005, he was psychiatrically evaluated and cleared for sniper school.  Alcohol and drug abuse do not constitute physical disabilities, unless secondary to an unfitting and ratable condition and are not ratable or compensable IAW DoDI 1332.38 E5.1.2.  and E5.1.3.9.1.  The DoDI further specifies:  “If there is a causative disorder it will be rated in accordance with other provisions of this Instruction.”

The Board noted that the VA examiner opined that the alcohol and substance abuse was worsened by the underlying depression (the MH diagnosis was changed), but it was not noted by this examiner that the CI had gone through ASAP prior to his deployment and development of the mental health condition.  The Board considered this and the majority determined that the PEB deduction for the alcohol and drug abuse was not appropriate.  It concluded that a separate deduction could not be ascertained as the disability from the abuse was aggravated by the underlying unfitting MH condition as determined by the VA examiner.  Further, The Board recognized that the MEB referred the condition of “alcohol dependence” as episodic and meeting retention standards.  The Board then considered the personality disorder.  The PEB also made a deduction, not specified, for the personality disorder.  Again, personality disorders do not constitute physical disabilities and are not ratable IAW DoDI 1332.38 E5.1.2. and E5.1.3.9.2.  The Board determined that a deduction for the contribution to the impairment from a personality disorder to the impairment from an unfitting MH disorder would be reasonable.  The Board then considered if this was warranted in this case.  As noted above, the CI was thought to have a possible schizoid or self-defeating personality disorder when evaluated at Salina Hospital in June 2007 by a clinical psychologist.  However, the MEB psychiatrist, with access to these records and the military records, did not diagnose an Axis II condition.  The VA psychiatrist, who also reviewed the medical records in the post-separation evaluation, did not diagnose a personality disorder either.  The Board determined that the evidence is not sufficient to support the diagnosis of a personality disorder at separation and, therefore, no deduction is warranted for this condition.

The Board then considered the ratings, independent of any deduction, for both entry into the constructive 6-month TDRL period and exit.  A minimum of 50% is mandated for entry IAW VASRD §4.129.  The Board considered if a higher 70% rating at TDRL entry.  The description of the 70% rating is “Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships.”  It also considered the criteria for the 30% and 50% ratings, respectively, “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events)” and “occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.”  The Board determined that the description for the 30% rating better fit the CI at the time of TDRL entry, but noted that a minimum rating of 50% is required as discussed above.

The Board then looked at the permanent rating at TDRL exit.  The VA C&P examination performed 5 months after the date of TDRL entry is the most proximate evaluation to the 6 month point.  The CI noted that treatment had been beneficial while he was on active duty, but that he had not continued it.  It is not clear why from the record.  It was noted, though, that he had not had further hospitalizations or sought care in the emergency department for a MH issue.  The fact that he had been in the ASAP program in his first year of enlistment was not recorded by the examiner.  The CI was not employed; it was not recorded why.  The VA general C&P examiner specifically noted that the behavior, affect, memory, and comprehension were normal.  Signs of tension were absent.  The CI reported to the MH examiner though that he had preservation of thought and did little during the day.  Nonetheless, he did have a new girlfriend and socialized with her, albeit reluctantly.  Continued alcohol abuse was noted.  He was noted to be well groomed, speech was spontaneous and clear, no irritability was shown, and memory was normal.  Concentration was described as poor, but the Board observed that a C&P examiner 2 days earlier had not noted a cognitive deficit.  The Board considered both the 30% and 50% ratings and determined that the 30% rating better described the disability at the end of the constructive TDRL period.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that cystic acne was not 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 Board noted that cystic acne was not indicated as an issue by the CI on Form 2807.  It was not profiled or implicated in the PEB’s reference to the new commander’s statement nor was it judged to fail retention standards.  It was reviewed by the action officer and considered by the Board.  There was no performance based evidence from the record that the cystic acne 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 cystic acne and so no additional disability rating is recommended.  Alcohol and polysubstance dependence, episodic and personality disorders do not constitute physical disabilities and are not ratable IAW DoDI 1332.38 E5.1.2., E5.1.3.9.1, and E5.1.3.9.2.  These are discussed in detail above.

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 anxiety disorder condition, the Board unanimously recommends a disability rating of 50%, coded 9413 IAW VASRD §4.129 and §4.130 for the TDRL time of entry and the Board majority recommended 30% at the time of TDRL exit without an EPTS deduction.  The minority voter recommended an EPTS deduction at TDRL exit for the substance abuse contribution to the rating.  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:

UNFITTING CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Anxiety Disorder	9413	50%	30%	
COMBINED	50%	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140510, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			
XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

Minority Opinion:

As noted, the Board discussed the application of an EPTS deduction for the history of substance abuse by the CI.  The abuse clearly predated both accession and his deployment.  The Board majority opined that an EPTS deduction was not warranted noting the comment by the VA C&P examiner that the substance abuse had been aggravated by the underlying mental health condition.  It should be noted though, that the VA examiner did not record the fact that the CI had been through ASAP early in his enlistment and well prior to his deployment and subsequent diagnosis of a mental health condition.  The Board majority also noted that the CI had done well while in service and had qualified for and finished sniper school.  The minority voter conceded these points, but noted that it is not unusual for an individual with substance abuse problems to do well for short periods of time, especially with a clear goal, but long term abstinence is difficult and requires sustained effort.  In industries such as the airlines in which regular testing is required as well as periodic physical examinations, individuals whose medicals have been reinstated remain subject to ongoing and random monitoring due to the risk of relapse.  Despite this monitoring and the financial consequences, relapse is not uncommon.  The CI started abuse of alcohol and illegal drugs as a young teenager and was entered into ASAP early in his enlistment.  He had problems with both alcohol and illegal drugs after return from theater.  The minority voter opines that this is more consistent with a long standing history of abuse with a short period of abstinence as opposed to a history of someone who did well and would have done well were it not from the unfitting mental health diagnosis.  In other words, in this individual, the problems with substance abuse are reflective of the chronic history of substance abuse rather than caused by the trauma suffered in theater.  The minority voter also observed that the disciplinary issues secondary to the substance abuse and absence without leave would have aggravated any mental health issues.  The minority voter noted that the CI stated that he had been depressed essentially all of his life.  Finally, the CI denied any mental health symptoms on the first post-deployment assessment as well as denying headaches and ringing in his ears, both of which were later reported and attributed to a blast under his vehicle.  These histories are not consistent.  The minority voter considered the level of deduction and determined that the impairment attributable to the long standing substance abuse, which continued at the time of the VA C&P examination, was sufficient to warrant at least a 10% deduction for “occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication.”  A 10% deduction for the contribution from the alcohol abuse results in a permanent rating of 20% which is recommended by the minority Voter.  

UNFITTING CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Anxiety Disorder	9413	50%	20%*	
COMBINED	50%	20%*	

*With EPTS contribution deducted.

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 XXXXXXXXXXXXXXXXXXXX, AR20150014438 (PD201402436)

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 
50% disability for six months effective the date of the individual’s original medical separation for disability with severance pay and then following this six month period recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30%.

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 six month TDRL period.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, provide 50% retired pay for the constructive temporary disability retired six month period effective the date of the individual’s original medical separation and then payment of permanent disability retired pay at 30% effective the day following the constructive six month 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:

Encl						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA