RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2015-00068
BRANCH OF SERVICE:  Army  		SEPARATION DATE:  20070209

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E5, Indirect Fire Infantryman, medically separated for “chronic left shoulder pain,” “chronic metatarsalgia,” and “obstructive sleep apnea,” rated 10%, 10%, and 0%, respectively, with a combined disability rating of 20%.  The CI’s chronic low back pain (LBP) was considered a condition that existed prior to service (EPTS) and was not rated.

CI CONTENTION:  “Please consider all conditions.” His 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 based on 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:  

IPEB - Dated 20060906	VARD – 20070730*	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	10%	Left Shoulder Distal Clavicular Resection with Chronic
Decreased ROM	5299-5203	10%	20070628	
Chronic Metatarsalgia	5279	10%	Left Foot Metatarsal Contusion	5284	0%	20070628	
Obstructive Sleep Apnea…	6847	0%	Sleep Apnea	6847	50%	20070628	
Chronic LBP	5299-5237	---%	Lumbosacral Strain	5237	10%	20070628	
Anxiety Disorder Not Otherwise Specified	Not Unfitting	Posttraumatic Stress Disorder	9411	50%	20070628	
Asthma	Not Unfitting	Restrictive Lung Disease of Unknown Etiology Claimed
as Asthma	8866-6602	10%	20070628	
Post-Concussive Syndrome	Not Unfitting	Closed Head Injury with Hx of Post-Concussion Syndrome and Benign Positional Vertigo	8045	10%	20070627	
Dizziness	Not Unfitting					
Bilateral Carpal Tunnel Syndrome	Not Unfitting	Carpal Tunnel Syndrome Left Wrist…	8615	10%	20070628	
		Carpal Tunnel Syndrome Right Wrist…	8615	10%	20070628	
Sensorineural Hearing Loss	Not Unfitting	Bilateral Hearing Loss	6100	NSC	20070713	
Tinnitus	Not Unfitting	Tinnitus	6260	10%	20070713	
Hypertension	Not Unfitting	No VA Placement	
Right Shoulder Impingement	Not Unfitting	Right Shoulder Strain	5299-5203	10%	20070628	
Left Elbow Lateral Epicondylitis	Not Unfitting	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  90%	
Note:  There are two additional VARDs within 12 months of separation, dated 20071023 and 20071126. 

ANALYSIS SUMMARY:  

Chronic Left [Non-Dominant] Shoulder Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI initially injured the left shoulder in June 2004 in Iraq during an IED blast and reinjured it after a jarring incident during combat operations.  Ongoing pain and impingement led to an open distal clavicle resection (Mumford procedure) in July 2005.  Surgery and physical therapy failed to adequately improve the condition and did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left shoulder pain, chronic status post Mumford procedure” for PEB adjudication.  

At the 9 February 2006 MEB examination (documented on DD Form 2808), 12 months pre-separation, the physical examination showed tenderness of the acromioclavicular (AC) joint, decreased range of motion (ROM), and “painful crepitus with circumduction.”  There was no evidence of rotator cuff injury, biceps tendonitis, or instability.  During the 27 April 2006 physical examination performed 9 months prior to separation for the MEB NARSUM, the CI showed pain with extremes of flexion and abduction.  Testing showed signs of impingement (Neer and O’Brien) but no signs of instability (apprehension and relocation).  Strength and sensation testing were normal.  Eight months prior to separation, an orthopedic MEB NARSUM addendum examination was performed on 24 May 2006.  The CI reported chronic intermittent pain, taking an occasional narcotic, and an inability to perform more than 15 push-ups.  The physical examination showed tenderness of the AC joint and posterior shoulder.  Flexion and abduction was to 150 degrees with painful motion.  There was evidence of chronic shoulder injury (AC joint pathology and biceps tendonitis) with no evidence of rotator cuff injury.  Radiographic evaluation documented a “well decompressed AC joint… with no significant degeneration or other abnormalities.”  Measurements performed by physical therapy 8 June 2006 were as follows: flexion that decreased to 120 degrees (normal 180), and abduction that decreased to 108 degrees (normal 180) after repetition; both with painful motion.  

At the 28 June 2007 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported chronic daily pain, difficulty with overhead work, and limited ability to lift greater than 20 pounds.  He denied recurrent dislocation and flare-ups.  The physical examination showed tenderness throughout the shoulder, and crepitus, with no evidence of instability or effusion.  Flexion and abduction were to 160 degrees each with painful motion.  Repetition increased the pain but produced no further decrements in ROM.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the analogous 5099-5003 code (degenerative arthritis), citing pain, limitation of motion, and continued signs of impingement with no evidence of instability.  The VA also assigned a 10% rating using an analogous 5299-5203 code (clavicle, impairment of) for pain and limitation of movement.  

The May 2006 orthopedic addendum, June 2006 physical therapy, and June 2007 VA C&P examinations documented ROMs above shoulder level for both forward flexion and abduction (120-160 degrees).  These ROMs, in addition to the documented intermittent painful motion, supported a 10% rating analogously coded 5099-5003.  There was no evidence of ankylosis of the scapulohumeral articulation (5200) for a higher rating.  There was no evidence to support a higher rating under 5201 as there was no limitation of motion at or below the shoulder level.  Nor was there was documentation of recurrent dislocation or nonunion with loose movement for a higher rating under 5203 (impairment of clavicle or scapula).  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the left shoulder condition was appropriately recommended in this case.  The Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left foot condition.

Chronic Left Foot Metatarsalgia.  According to the STR and the MEB NARSUM, the CI reported a left foot hyperextension injury in December 2003 and a reinjury (crushed by treadmill) in December 2004.  Conservative treatment (pain medications, crutches, boot) failed to adequately improve the condition and did not result in sufficient improvement to allow unrestricted duty.  The MEB forwarded “chronic metatarsalgia” for PEB adjudication.  

At the February 2006 MEB examination the physical examination showed tenderness at the dorsal midfoot with full ROM and normal strength.  Radiographic evaluation (X-rays) on 22 February 2006 documented a normal foot on weight bearing.  At the April 2006 MEB NARSUM examination the physical examination showed normal strength of ankle dorsiflexion and plantar flexion.  At an August 2006 podiatry visit the CI reported chronic discomfort.  The physical examination showed no foot or digital deformities, and a flexible foot with well-formed longitudinal arch.  There was discomfort during midfoot ROM testing at the 3rd and 4th metatarsal base and no pain on passive ROM of the ankle.  

At the June 2007 VA C&P examination the CI reported chronic daily pain of the dorsal metatarsal area with weight bearing.  He was able to walk up to a mile with some intermittent weakness and fatigability and denied functional limitations with standing or walking.  The physical examination showed tenderness of the dorsal mid-metatarsal area with no visible abnormalities, no plantar tenderness, and no evidence of abnormal weight bearing.  Radiographic evaluation (X-rays) were negative.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB assigned a 10% rating under code 5279 (metatarsalgia, anterior, unilateral, or bilateral) citing metatarsal tenderness with normal flexibility, ROM, and strength.  The VA assigned a 0% rating using code 5284 (foot injuries, other) citing no evidence of weakness or instability, and no loss of ROM with repetition.  

There was no evidence of limitation of dorsiflexion at the ankle, shortened plantar fascia, or marked tenderness of the metatarsal heads for a higher rating under 5278 (claw foot [pes cavus], acquired).  There was no objective evidence of marked deformity, severe pain on manipulation, indication of swelling on use, or characteristic callosities for a higher rating under an analogous 5276 code (flatfoot, acquired).  And there was no evidence describing a “moderately severe” disability for a higher rating under 5284 (foot injuries, other).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left foot condition.  

Obstructive Sleep Apnea.  According to the STR and the MEB NARSUM, the CI was diagnosed with obstructive sleep apnea (OSA) in March 2005.  Treatment with continuous positive airway pressure (CPAP) did not result in sufficient improvement to allow unrestricted duty.  The MEB forwarded “obstructive sleep apnea” for PEB adjudication.  

At the February 2006 pulmonary MEB consultation (12 months pre-separation), the examiner documented noncompliance with the CPAP machine and that the OSA failed retention criteria.  At a visit with otolaryngology, the CI reported “good benefit” using the CPAP machine.  During an inpatient hospitalization in August 2006, the examiner documented use of the CI’s personal CPAP equipment during the stay.  At the April 2006 MEB NARSUM examination the OSA was not addressed other than to state that a CPAP machine was issued and that the condition failed retention criteria.  

At the June 2007 VA C&P examination the CI denied fatigue and daytime somnolence with use of the CPAP machine.  The physical examination showed normal heart and lungs.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 6847 code (sleep apnea syndromes), citing a rating for mild industrial impairment IAW DoDI 1332.39.A2.A1.2.21.  The VA assigned a 50% rating using the same code citing the required use of a breathing assistance device (CPAP machine).  The OSA condition was documented in the STR, a permanent profile for OSA was issued, and CPAP was identified by the NARSUM examiner as a required treatment.  The VASRD §4.97 provides for a minimum rating of 50% for OSA requiring a breathing assistance device, and the evidence establishes that this criterion was met in this case.  There was no evidence of chronic respiratory failure with carbon dioxide retention, cor pulmonale, or requirement for a tracheostomy to support a 100% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a service disability rating of 50% for the OSA condition, coded 6847.  

Chronic LBP.  According to the STR and the MEB NARSUM, the CI had denied any history of back pain at the service entrance examination in July 1992 and at an interim service examination in July 1999.  Both physical examinations of the spine at the time were normal.  The back pain began in early 2004 after a hard landing during fast-rope training while wearing full combat gear.  He denied seeking treatment as he had other pressing medical issues.  The MEB forwarded “functional low back pain” for PEB adjudication.  

At the February 2006 MEB examination the physical examination showed no evidence of tenderness or spasms.  There was full ROM and normal strength and sensation bilaterally.  At the March 2006 MEB orthopedic consultation, 11 months pre-separation, the CI reported 18 months of back pain since being thrown from a vehicle after an explosion.  He reported occasional numbness of the left lower extremity and denied any weakness or changes in his bowel or bladder habits.  He denied seeking treatment, undergoing physical therapy, and taking medications.  The physical examination showed tenderness of the paraspinal muscles, with normal sensation, strength, and reflex testing.  Balance issues during heel and toe walk were attributed to balance issues with an inner ear condition.  Gait, spasm, and abnormal curvature were not addressed.  Radiographic evaluation showed a partially fused L5-S1 vertebrae (congenital lesion) with disc space narrowing.  

At the April 2006 MEB NARSUM examination the physical examination showed tenderness of the L5-S1 paraspinal musculature, full ROM, and normal sensation, strength and reflexes.  There was no evidence of radiculopathy on nerve tension testing.  Gait, spasm, and abnormal curvature were not addressed.  A permanent profile was issued in June 2006.  

At the June 2007 VA C&P examination the CI reported no limitations in walking but avoided repetitive heavy lifting.  He denied flare-ups, radicular symptoms, and incapacitating episodes.  The physical examination showed tenderness with no evidence of spasms or abnormal curvature.  Forward flexion was to 70 degrees (normal 90), extension to 10 degrees (normal 30), and both with discomfort.  There was normal bilateral flexion and rotation and a normal gait.  Repetition increased pain but caused no further decrements in ROM.  The strength and sensory examination was normal.  Radiographic evaluation was “negative.”  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB did not rate the condition but chose an analogous 5299-5237 code (lumbosacral strain), citing the existence of a congenital lesion (EPTS) with no permanent service aggravation.  The VA assigned a 10% rating using 5237 code, citing limitation of forward flexion and functional impairment.  

The Board first deliberated the factors in evidence for an EPTS deduction for disability which may have existed at the time of entrance into active service.  The July 1992 military entrance examination was negative for any history or finding of any disability at the time of entry to active duty and again in July 1999.  The CI’s first report of back pain was in 2004, after a hard fall during training and after 12 years of service.  Although the PEB stated that there was a congenital back deformity as the basis for the EPTS deduction, symptoms did not occur until after 8 years in service.  IAW §4.9 of the VASRD, mere congenital or developmental defects “… are not diseases or injuries in the meaning of applicable … for disability compensation purposes.”  The Board members unanimously agreed that there was no ascertainable degree of disability existing at the time of entrance into active service; and, therefore, IAW §4.22 of the VASRD (Rating of Disabilities Aggravated by Active Service), no rating deduction for EPTS factors should be recommended.  

The Board next considered the rating.  The VA examination was considered more probative to rating as it was the closest to separation and the examination was IAW VASRD specifications regarding goniometric measurements and repetition.  The VA examiner documented painful motion with a flexion of 70 degrees in support of a 10% rating.  All other examinations were greater than 10 months pre-separation and deemed to be a less likely depiction of the disability at the time of separation.  There was no additional pre- or post-separation evidence of muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour in support of a 20% rating.  There was no evidence of intervertebral disc syndrome or incapacitating episodes requiring physician-prescribed bed rest for rating under that formula.  There was no evidence of a radiculopathy that rose to the level of separately unfitting for additional disability rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously determined that the evidence did not support an EPTS determination and recommends a 10% disability rating for the low back condition coded 5237 (lumbosacral strain).  

Contended PEB Conditions: Asthma, Anxiety, Post-Concussion Syndrome, Dizziness, Bilateral Carpal Tunnel Syndrome, Sensorineural Hearing Loss, Tinnitus, Hypertension, Right Shoulder Impingement, and Left Lateral Elbow Epicondylitis. The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  

Asthma:  The asthma was considered to fail retention standards by the pulmonary consultant in February 2006, who cited a “profound” impact on duty, and that the CI could not run or deploy.  It was implicated in the April 2006 commander’s statement with specific restrictions that prohibited 3-5 second rushes under fire, moving with a fighting load, wear of a protective mask and chemical defense equipment, and restricted deployment to dust-free environments.  It was also considered to fail retention standards by the NARSUM examiner in April, citing daily exertional and non-exertional shortness of breath, with frequent wheezing and chest tightness, being “greatly improved” since medications were started.  The June 2006 profile prohibited running and walking, and allowed alternative aerobic events.  However, it was considered to be not separately unfitting by the PEB citing no profile limitations regarding alternate fitness testing and wear of chemical mask.  
The STR and MEB NARSUM reported that 3 years pre-separation the CI was first treated with inhalational bronchodilators for shortness of breath while deployed to Iraq in 2004.  He was diagnosed in February 2005, 2 years pre-separation, with reactive airway disease.  Inhaled anti-inflammatory medications were prescribed in March 2005 and continued through separation.  A prescription for systemic steroids was given in February 2006, 1 year pre-separation, after pulmonary function testing (PFT) documented a forced expiratory volume in 1 second (FEV1) of 57% (normal over 80%).  Follow up PFTs dated 8 March and 21 March 2006 documented an FEV1/ FVC (forced vital capacity) of 84% (normal over 80%), and an FEV1 of 78%, respectively.  

At the June 2007 VA C&P examination, 5 months post-separation, the CI reported intermittent shortness of breath and wheezing with exertion and during the night; and denied chronic cough.  He was taking an inhaled anti-inflammatory medication twice daily among other medications.  The physical examination showed no evidence of wheezing.  PFTs showed a restrictive lung defect and reduced diffusion capacity that responded to bronchodilators.  Testing resulted in an FEV1 of 78% and an FEV1/ FVC (forced vital capacity) of 75% (both normal over 80%).  The examiner concluded that the PFTs were “normal” and the CI has a “mild” restrictive lung defect, requiring multiple medications.  

After due deliberation, the Board agreed that the preponderance of the evidence with regard to the functional impairment of the asthma condition favors its recommendation as an unfitting condition for disability rating.  However, IAW VASRD §4.96 (special provisions regarding evaluation of respiratory conditions), a single rating will be assigned under the diagnostic code which reflects the predominant [respiratory] disability with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation.  

The Board discussed which respiratory condition was predominant in this case.  In this regard, it was considered that 1) the complications of OSA are typically more wide-ranging and significant than asthma; 2) the treatment of OSA is considerably more burdensome than that for asthma; and, 3) the available evidence indicated that the OSA was well controlled on CPAP, while the asthma required multiple medications and was still intermittently symptomatic.  The Board thus concluded that the OSA coded 6847, was the predominant respiratory disability.  

The Board then deliberated if the next higher 100% rating under the 6847 code was warranted due to additional disability imposed by the asthma condition.  However, all Board members agreed that the evidence of disability from asthma in this case could not be reconciled with an additional 50% in rating beyond the 50% already warranted for OSA alone.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a final single disability rating of 50% for the predominant OSA condition coded 6847-6602 (sleep apnea; asthma) and agreed that the asthma condition IAW VASRD §4.96 did not impose significant disability to elevate the OSA condition to a disability rating of 100%. 

Anxiety:  The anxiety disorder was considered to fail retention standards by the psychiatric consultant in March 2006.  The psychiatric examiner imposed no geographic assignment restrictions; however stated that the profile that should reflect “slowed mental processing and anxiety, with no duties that require mental processing of complex information and rapid decision making.”  The anxiety condition was not implicated in the April 2006 commander’s statement.  Although there were no mental health conditions specifically profiled in June 2006, restrictions did include those requested by the psychiatric examiner regarding mental processing and decision making.  The anxiety condition was found not unfitting by the PEB dated 6 September 2006 stating that anxiety was diagnosed in Iraq and treated successfully resulting in normal functioning and completion of deployment; furthermore, post-deployment evaluation had found mild symptoms that did not interfere with deployment duties and that the current profile did not prohibit weapons handling.  A temporary S3 profile dated 4 October 2006 included anxiety disorder and posttraumatic stress disorder; and prohibited access to weapons and deployment.  

At the 25 October 2006 Psychiatric NARSUM addendum, the examiner opined that the CI functioned quite well during his deployment to Iraq despite significant anticipatory anxiety, and stated that the CI regarded himself as highly competent without severe anxiety.  The examiner further opined that anxiety and sleep apnea may be playing a role in his cognitive complaints and irritability.  The anxiety disorder was considered to fail retention standards by the NARSUM examiner in October 2006.  

All was reviewed and considered by the Board.  There was no performance-based evidence from the record that this condition significantly interfered with satisfactory duty performance.  After due deliberation, and 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 anxiety condition and so no additional disability ratings are recommended.  

Post-Concussion Syndrome:  The post-concussion syndrome was profiled in June 2006.  It was considered to fail retention standards by the NARSUM examiner; however, it was not implicated in the commander’s statement.  The PEB stated that there was no information in the records that the condition interfered with military training and duty and therefore was considered not separately unfitting by the PEB.  The condition was reviewed and considered by the Board.  There was no performance-based evidence from the record that the post-concussion syndrome significantly interfered with satisfactory duty performance.  After due deliberation, and 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 post-concussion syndrome condition and so no additional disability rating is recommended.  

Dizziness, Bilateral Carpal Tunnel Syndrome, Sensorineural Hearing Loss, Tinnitus, Hypertension, Right Shoulder Impingement, and Left Lateral Elbow Epicondylitis.  None of these contended conditions were profiled or implicated in the commander’s statement and none were judged to fail retention standards.  All were reviewed and considered by the Board.   There was no performance-based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation, and 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 these conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left shoulder pain and left foot metatarsalgia conditions and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the OSA condition, the Board unanimously recommends a disability rating of 50%, coded 6847 IAW VASRD §4.96.  In the matter of the LBP condition, the Board unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.   In the matter of the contended asthma, condition, the Board unanimously agrees that it cannot be recommend for additional disability rating IAW VASRD §4.96.  In the matter of the contended anxiety, post-concussion syndrome, dizziness, bilateral carpal tunnel syndrome, sensorineural hearing loss, tinnitus, hypertension, right shoulder impingement, and left lateral elbow epicondylitis 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 his prior medical separation:  

CONDITION	VASRD CODE	RATING	
OSA	6847	50%	
LBP	5237	10%	
RATING	60% 	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150113, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB																		

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

06 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170000657  (PD201500068)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 60% effective the date of the individual’s original medical separation for disability with severance pay.  

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

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

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

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 60% effective the date of the original medical separation for disability with severance pay.

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

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

BY ORDER OF THE SECRETARY OF THE ARMY:

						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA