RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00837
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020819

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Unit Supply Specialist, separated for “bilateral patellofemoral syndrome,” “right shoulder pain,” and “chronic low back pain,” rated at 0% each, for a combined disability rating of 0%. “Chronic right wrist pain” was determined to have existed prior to service (EPTS) and was not rated.

CI CONTENTION:  She was given a higher rating for her conditions by the VA.  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 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:  

SERVICE PEB – 20020429	VARD - 20040409	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5201	0%	Residuals of Right Shoulder Arthroscopic Decompression / Mumford procedure with Degenerative Joint Disease	5010-5211	20%	20030512	
Bilateral Patellofemoral Syndrome	5009-5003	0%	Right Knee Patellar Arthrosis with Associated Fibromyalgia 	5025-5024	10%		
			Left Knee Patellar Arthrosis with Associated Fibromyalgia		10%		
Chronic Low Back Pain	5299-5295	0%	Degenerative Changes of the Lumbar Spine	5242	10%		
Chronic Right Wrist Pain	5215	EPTS	Residuals of Ganglion Cyst Removal, Ulna Shortening Osteotomy,  and Arthroscopic Debridement, Right Wrist 	5271-8515	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI complained of non-traumatic progressive discomfort of the right shoulder since 1996.  A 12 July 1999 diagnostic imaging (bone scan) study showed degenerative joint disease (DJD) of the right sternoclavicular joint.  The chronic right shoulder pain persisted for a few years despite non-steroidal anti-inflammatory drugs, physical therapy (PT), and activity modification.  The CI elected to have surgical treatment to address her acromioclavicular (AC) joint degeneration.  On 27 September 2000, the CI underwent right shoulder arthroscopic decompression and Mumford procedure (distal clavicle excision/resection to ameliorate shoulder pain).  An intraoperative right shoulder X-ray showed partial resection of the distal clavicle.  The 25 January 2001 pain-limited right shoulder active range of motion (ROM) by orthopedic surgery was flexion of 150 (180 normal) and abduction of 150 (180) degrees.  The 5 April 2001 right shoulder ROM by orthopedic surgery was flexion of 150 degrees.  The 22 May 2001 right shoulder active ROM by PT was within functional (normal) limits but there was pain with a painful arc in abduction > 125 degrees.  The 10 September 2001 NARSUM, 11 months before separation, recounted the history and interventions.  It documented, “Postoperatively, her pain has decreased but she continues to have persistent pain which is exacerbated with overhead activities.”  

The right shoulder examination revealed well healed arthroscopy sites with no erythema (redness) or edema (excess tissue fluid swelling).  There was tenderness over the coracoclavicular and subacromial bursa regions.  Pain-limited active ROM was flexion of 150 (180) and abduction of 100 (180) degrees.  Sensation, pulses, and deep tendon reflexes were normal.  The examiner recounted the findings of the X-rays and bone scan.  The assessment listed persistent right shoulder pain despite arthroscopic decompression and Mumford, pain related to fibromyalgia, and post-operative bursitis.  At a 27 March 2003 orthopedic surgery follow-up the CI complained of chronic right shoulder pain since her Mumford procedure.  The right shoulder examination revealed posterior joint, subcorocoid, and AC joint tenderness with no atrophy.  Right shoulder ROM was flexion of 180 degrees and strength was normal at 5/5.  The tests for impingement (rotator cuff impingement) and crossover (AC joint integrity) were positive.  The assessment listed rotator cuff tendonitis.  The 27 March 2003 right shoulder X-ray was normal.  

The 13 May 2003 VA Compensation and Pension (C&P) examination recounted the history and interventions.  It documented, “The veteran subsequently underwent arthroscopic repair in the year 2000 without surgical or post-surgical complications.  However, she does note continued difficulty with activities such as brushing her hair, dressing, and compression of the right side during sleep.  She denies any known secondary trauma or recent exacerbating symptomatology.”  The musculoskeletal examination revealed no atrophy, joint erythema or edema.  Right shoulder pain-limited active ROM was flexion of 90 (180) and abduction of 90 (180) degrees.  There was no further limitation of ROM from fatigue, weakness, lack of endurance, or incoordination.  Sensation, deep tendon reflexes (DTRs), and strength were normal except for 4+/5 right hand grip strength.  The right shoulder X-ray showed degenerative change.  The diagnosis listed status post-surgical intervention of rotator cuff repair with residual symptomatic arthrosis. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 5201 code (arm, limitation of motion of) citing right shoulder pain for 5 years without trauma/injury, had surgery, absence of distal clavicle by X-ray consistent with surgery, flexion to 150 degrees, abduction to 100 degrees, and does not meet minimal rating criteria.  The VA assigned a 20% rating under the 5010-5201 codes (arthritis, due to trauma-arm, limitation of motion of) based on the C&P examination 9 months after separation, citing residuals of right shoulder arthroscopic decompression/Mumford procedure, degenerative joint disease, interchangeable diagnoses of fibromyalgia and myofascial pain syndrome on the right side throughout service, flexion to 90 degrees, abduction to 90 degrees, and arm motion that is limited at shoulder level (90 degrees).  There was no evidence of scapulohumeral ankylosis (5200) or recurrent dislocation, loss of humeral head, nonunion, fibrous union, or malunion of humerus (5202) for consideration under the respective codes.  Recognizing that excision of the distal clavicle was an intended consequence of the Mumford procedure, there was no evidence of non-union or mal-union of clavicle or scapula (5203) for consideration under this respective code.  Based upon the multiple proximate examinations (orthopedic surgery and NARSUM) there was no compensable limitation of motion for consideration under 5201.  The C&P examination ROM was consistent with the 20% rating under 5201 (at shoulder level [90 degrees]).  The Board assigned more probative value to the multiple proximate examinations (orthopedic surgery and NARSUM) with no compensable limitation of motion other than the isolated C&P examination.  The Board agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  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 shoulder condition, coded 5201.  

Bilateral Patellofemoral Syndrome.  The PEB combined the right and left knee conditions under a single disability rating, coded analogously to 5003 and rated them together at 0%.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The Board also noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the Board considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

According to STRs and the NARSUM, the CI complained of non-traumatic bilateral knee discomfort since 1999.  The 5 February 2001 knee X-rays were normal.  In the NARSUM the CI complained of bilateral knee pain that developed while she was pregnant.  Symptoms were associated with weakness and popping and were exacerbated depending on the type of shoes worn.  The bilateral knee examination revealed very tight hamstrings, pes anserinus bursae and medial femoral condyle tenderness.  There was no erythema, edema, or ligamentous laxity.  Bilateral knee ROM was full.  Sensation, pulses, and DTRs were normal.  The examiner recounted the findings of the X-rays.  The assessment listed bilateral knee pain secondary to patellofemoral syndrome [PFS], an anterior knee pain symptom complex involving patella.  The VA C&P examination documented the CI’s history since 1999 of non-traumatic associated bilateral knee discomfort exacerbated with climbing and descending stairs, standing and sitting for long periods of time, ambulating long distances, and running, “which she currently notes she is unable to perform.”  She denied any known specific trauma and noted that evaluation by her medical department suggested associated bilateral knee discomfort with fibromyalgia disease.  The physical examination documented normal gait and posture, no signs of abnormal weight-bearing, and no devices for ambulation.  The musculoskeletal examination revealed no atrophy or joint erythema or edema.  The bilateral knee examination revealed joint line and popliteal fossa tenderness (left greater than right).  Notes revealed that the patient did not tolerate manipulation for evaluation of drawer and McMurray's tests due to guarding for discomfort.  Pain-limited right knee ROM was flexion of 100 (140) and extension of 0 (0) degrees.  Pain-limited left knee ROM was flexion of 110 and extension of 0 degrees.  There was no further limitation of ROM from fatigue, weakness, lack of endurance, or incoordination.  Sensation, DTRs, and strength were normal.  The diagnosis listed symptomatic patellar arthrosis with fibromyalgia. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5003 code (arthritis, degenerative) citing bilateral PFS without trauma/injury, first noted while pregnant, normal X-rays, joint line tenderness, full ROM, no ligamentous laxity, and rated for no X-ray evidence of disease nor limitation of motion.  The VA assigned a 10% rating for the right knee, and a 10% rating for the left knee under the 5025-5024 codes (fibromyalgia-tenosynovitis) based on the C&P examination citing patellar arthrosis with fibromyalgia, PFS, findings of fibromyalgia alternating with myofascial pain syndrome, ROM, and painful and limited motion.  Patellofemoral pain syndrome analogizes to 5003 per the Alphabetical Listing of Analogous Codes.  The ROM values in the proximate examinations did not support a minimum rating under the limitation of knee flexion (5260) or knee extension (5261) codes.  There was no dislocated meniscus (5258), symptomatic removed meniscus (5259), knee ankylosis (5256), knee recurrent subluxation/lateral instability (5257), tibia and fibula nonunion/malunion (5262), or genu recurvatum (5263) for consideration under these respective codes.  The Board agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  The Board carefully considered the option of rating both knees together, noting that the VA rated each knee separately.  The Board concluded that the evidence did provide sufficient grounds for recommending separate knee disability ratings in this case.  A rating of 10% for the left and 10% for the right, coded 5099-5003, is a good analogy to both the pathology and disability.  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 condition and 10% for the left knee condition, each coded 5099-5003.  

Low Back Pain (LBP).  According to STRs and the NARSUM, the CI complained of recurrent LBP since 1996.  A 20 March 2001 lumbosacral spine X-ray was normal.  A 17 April 2001 lumbar spine MRI was unremarkable except for mild bilateral facet and ligamentum flavum hypertrophy.  At a 20 March 2001 outpatient encounter the CI complained of recurrent LBP since 1996 attributed to running.  She reported associated radicular (nerve root irritation or injury) pains to both lower extremities (LEs) past the knees with paresthesias (abnormal sensation, tingling, burning, prickling) and weakness.  The lumbosacral spine examination revealed paravertebral muscle tenderness but no spasm.  Lumbosacral spine active ROM was full.  The bilateral straight leg raise (SLR) tests (to determine if a herniated disc is causing sciatic nerve root [L5-S1] radiculopathy) were positive.  Strength, sensation, and DTRs were normal.  The diagnosis listed mechanical LBP.  

In the NARSUM the CI reported associated bilateral LE radicular pain, paresthesias, and weakness.  Symptoms were exacerbated by running, jumping, marching, sit-ups, and heavy lifting and were incompletely relieved by PT (lumbar stretches, hip rotations, heat ultrasound, and cycling).  The lumbosacral spine examination revealed paravertebral muscle tenderness, no spasm, and full active ROM.  Bilateral SLR tests were positive and Patrick tests (assesses hip and sacroiliac joint pathology) were negative.  Strength, sensation, and DTRs were normal.  The examiner recounted the findings of the X-rays and MRI.  The assessment listed recurring LBP secondary to mild degenerative changes of the lumbosacral spine.  

The VA C&P examination documented, “The veteran gives a history since 1996 of low back non-traumatic discomfort exacerbated with bending, twisting, heavy lifting, standing for long periods of time, and sitting for long periods of time.  She denies lower extremity paresthesias, bowel or bladder dysfunction, decreased muscle strength, or gait disturbance.”  The physical examination documented no signs of abnormal weight-bearing, no devices for ambulation, and normal gait and posture.  The musculoskeletal examination revealed no atrophy or joint erythema or edema.  The lumbar spine examination revealed “appreciable radiating pain without muscle spasm or tenderness...”  Pain-limited lumbar spine active ROM was flexion of 80, extension of 20, bilateral lateral flexion of 30, and bilateral rotation of 35 degrees.  There was no further limitation of ROM from fatigue, weakness, lack of endurance, or incoordination.  Bilateral SLR tests were negative with no signs of radiculopathy.  Sensation, DTRs, and strength were normal except for 4+/5 right-hand grip strength.  Lumbar spine X-rays were normal.  The diagnosis listed intermittent symptomatic lumbar paraspinal spasm activity without neurovascular association. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5295 code (lumbosacral strain) citing chronic LBP, no history of trauma/injury, full active ROM, 5/5 strength, intact sensation, and normal  X-rays and MRI.  The VA assigned a 10% rating under the 5242 code (degenerative arthritis of the spine) based on the C&P examination citing lumbar spine degenerative changes, low back non-traumatic discomfort since 1996, negative SLR tests, no signs of radiculopathy, X-ray and MRI findings, ROM, and mild limitation of motion.  

In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation.  The Board noted that the 2002 VASRD standards for the spine, which were in effect at the time of separation, were changed to the current §4.71a rating standards in 2004.  The Board must correlate the above clinical data with the 2002 rating schedule and applicable diagnostic codes.  There was no vertebral fracture (5285), complete spine ankylosis (5286), lumbar spine ankylosis (5289), limitation of lumbar spine motion (5292), or sacro-iliac injury/weakness (5294) for consideration under the respective codes.  There was no neuropathy, characteristic pain, muscle spasm, absent DTR, neurological findings appropriate to disc site, or recurring attacks for consideration under intervertebral disc syndrome (5293).  Board members agreed a 10% rating was supported under lumbosacral strain (5295) based on characteristic pain on motion.  The Board agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  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 low back condition, coded 5295.  

Contended PEB Condition: Right Wrist. The PEB determined the right wrist condition was EPTS based on the MEB addendum by orthopedic surgery. 

According to STRs and the NARSUM, a dorsal wrist mass was noted at sick call in the first week of basic training.  On 26 November 1996, the CI underwent excision of a right dorsal wrist outpouching of the wrist capsule consistent with a small ganglion (non-neural benign cystic tumor).  She developed persistent pain with ROM and lifting that was felt to be secondary to an ulnar positive deformity (long ulna relative to radius).  The CI underwent a right ulnar shortening procedure in 1997.  A 27 April 1998 right wrist MRI showed a possible scapholunate ligament disruption.  Postoperatively, she continued to have pain and underwent right wrist arthroscopy and debridement of a triangular fibrocartilage complex ([TFCC] major ligamentous stabilizer that suspends carpals against ulna and radius) tear in 1998.  A 24 June 1999 right wrist X-ray showed an old healed distal ulna fracture with four screws affixing a plate.  A bone scan showed changes from a distal ulnar shortening procedure and possible right ulnar-carpal joint DJD.  The NARSUM recounted the history and interventions.  The CI complained of 6 years of persistent right wrist pain and decreased ROM.  The right wrist examination revealed two well healed surgical scars (2 ½ cm transverse and 8 cm longitudinal) with diffuse tenderness.  There was no erythema or edema.  Right wrist ROM was dorsiflexion of 55 (70), palmar flexion of 65 (80), ulnar deviation of 40 (45), and radial deviation of 15 (20) degrees.  Right forearm ROM was supination of 70 (85) and pronation of 65 (80) degrees.  Sensation and pulses were normal.  The examiner recounted the findings of the X-rays and bone scan.  The assessment listed chronic right wrist pain secondary to ulna carpal wrist degeneration.  A 2 April 2002 MEB addendum for the wrist by orthopedic surgery documented, “… observed dorsal wrist mass when on sick call the first week of her Basic Training.  This was later determined to be a ganglion cyst and was later surgically excised as noted in the [MEB].  This condition most likely existed prior to entering the military service. … was later found to have an ulnar positive variance which … was most likely developmental as there was no documented history, clinical evidence or radiographic evidence of distal radius fracture with mal-rotation, malunion or nonunion which also could have resulted in ulnar positive variance.”    A 
27 March 2003 right wrist X-ray revealed fixation of the distal ulna, anatomic alignment, and an otherwise unremarkable appearance. 

The VA C&P examination recounted the history and interventions.  The CI denied surgical or postsurgical complications but complained of discomfort with right wrist ROM.  She reported associated stiffness, intermittent fingers numbness (bilaterally), decreased grip strength, and difficulty with grasping, twisting, heavy lifting, and prolonged writing.  The musculoskeletal examination revealed no atrophy or joint erythema or edema.  The right wrist examination revealed a mildly hypo-pigmented longitudinal scar (8 cm) with no underlying tissue loss, keloid formation, adherence, or tenderness.  The Tinel (percussing carpal tunnel elicits tingling over median nerve distribution) and Phalen (wrist volar flexion compresses median nerve and elicits tingling over nerve distribution) tests were positive.  Pain-limited right wrist ROM was dorsiflexion of 70 (70), palmar flexion of 80 (80), ulnar deviation of 10 (45), and radial deviation of 20 (20) degrees.  There was no further limitation of ROM from fatigue, weakness, lack of endurance, or incoordination.  Sensation, DTRs, and strength were normal except for 4+/5 right hand grip strength.  The examiner recounted the findings of the X-rays.  The diagnosis listed status post hardware placement with symptomatic right wrist arthrosis with carpal tunnel. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB determined that according to the medical evidence, the right wrist cyst was removed because it probably was EPTS. The PEB applied the 5215 code (wrist, limitation of motion of) citing chronic right wrist pain secondary to ulnar carpal wrist degeneration, and noted the ulnar wrist variation, according to the medical testimony, was most likely developmental as there is no evidence that would support development while on active duty.  The VA assigned a 10% rating under the 5271-8515 codes (ankle, limited motion of-paralysis of median nerve [carpal tunnel]) based on the C&P examination citing residuals of a ganglion cyst removal, ulna shortening osteotomy, and arthroscopic debridement, interchangeable diagnoses of fibromyalgia and myofascial pain syndrome on the right side throughout service, ROM, 4+/5 right grip strength, positive Tinel's and Phalen's tests, and findings consistent with carpal tunnel syndrome.  While the CI underwent a ganglion excision, ulnar shortening, and TFCC debridement, there was no ulna or radius flail false joint (5210), significant loss of bone substance, marked deformity, nonunion, or malunion (5211 and 5212), or impairment of supination or pronation (5213) for consideration under these respective codes.  Physical examinations, and diagnostic imaging, did not demonstrate the characteristic anatomical deformities of wrist ankylosis, unfavorable palmar flexion, ulnar deviation, or radial deviation (5214) for consideration under the respective code.  The limitation of motion (5215) in the proximate (NARSUM and C&P) examinations did not attain a minimum rating.  

The Board next considered whether or not there was evidence of service aggravation.  A presumption of service aggravation may only be overcome by a preponderance of competent medical evidence and accepted medical principles that the natural progression of a pre-existing condition was clearly unaltered by any consequence of military service.  The Board could find no competent medical evidence established by a preponderance of evidence that the disorder was clearly neither incurred nor aggravated while serving on active duty or authorized training.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that the right wrist condition was permanently aggravated by service.  The Board agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  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 wrist condition, coded 5215.  

BOARD FINDINGS:  In the matter of the right shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5201 IAW VASRD §4.71a.  In the matter of the right knee condition, the Board unanimously recommends a disability rating 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the left knee condition, the Board unanimously recommends a disability rating 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the LBP condition, the Board unanimously recommends a disability rating of 10%, coded 5295 IAW VASRD §4.71a.  In the matter of the contended right wrist condition, the Board agrees that it was permanently service aggravated and unanimously recommends a disability rating of 10%, coded 5215 IAW VASRD §4.130.  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	5201	10%	
Right PFS	5099-5003	10%	
Left PFS	5099-5003	10%	
Chronic LBP	5295	10%	
Chronic Right Wrist Pain	5215	10%	
COMBINED	50%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170015487, XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:  

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

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by 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-DO), XXXXXXXXXXXXXXXXXXX.

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

Sincerely,					      
Enclosure