I rebooted the server twice and this the only error I see on the apache error log:
[Tue Oct 29 21:58:15 2013] [error] [client 192.168.101.4] File does not exist: /opt/otrs/var/httpd/htdocs/skins/Agent/KIX4OTRS/css-cache, referer: http://10.10.10.58/otrs/index.pl?Action ... 186b766b5;
[Tue Oct 29 21:58:34 2013] [error] mkdir /opt/otrs/var/httpd/htdocs/skins/Agent/KIX4OTRS/css-cache: Permission denied at /opt/otrs/KIXCore/Kernel/Output/HTML/LayoutLoader.pm line 602\n
It looks like a permissions issue from the get go and I checked the permissions there and it's set to the OTRS user with the group being www-data. Appropriate write access are configured as well. Again the error is only when navigating to the index.pl but navigating to the customer.pl has no such issues.
It seems to be missing some files/directories. I also received an notice on installation of the KIX4OTRS where it states that it does not recognize the 3.2.11 version.