IN THE CASE OF: BOARD DATE: 17 June 2008 DOCKET NUMBER: AR20080009325 THE BOARD CONSIDERED THE FOLLOWING EVIDENCE: 1. Application for correction of military records (with supporting documents provided, if any). 2. Military Personnel Records and advisory opinions (if any). THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE: 1. The applicant requests that her retirement be voided and she be reinstated on active duty. 2. The applicant states that she presented to the Weed Army Community Hospital (WACH) for an intrauterine device (IUD) insertion on 21 March 2008, while still on active duty. Pain began about a week after. She presented to WACH once again on 17 April 2008 and was diagnosed with a urinary tract infection (UTI). Pain worsened, and she once again presented to WACH with cramping that became extremely severe across her lower abdomen. She was then transferred to the Naval Medical Center, San Diego (on 24 April 2003) for concerns of peritoneal carcinomatosis, advanced stage carcinoma. She has been hospitalized ever since with this terminal advanced stage of cancer. 3. The applicant provides a letter, dated 12 June 2008, from her Naval Medical Center doctor; and medical records, dated 21 March, 17 April, 22 April, 24 April, and 26 April 2008. CONSIDERATION OF EVIDENCE: 1. The applicant enlisted in the Regular Army on 2 March 1984. 2. On 21 March 2008, the applicant had an appointment at WACH for insertion of an IUD. Prior to the procedure, her medical history was reviewed. It was noted that gastrointestinal symptoms included abdominal pain and reports of mild menstrual cramping. The risks of IUD insertion were discussed with her. Risks included pain and bleeding. She was discharged home in good condition with follow-up as indicated for evidence of increasing pain, heavy bleeding, or fever. 3. The applicant was released from active duty due to sufficient service for retirement on 31 March 2008 and was placed on the retired list effective 1 April 2008. 4. On 17 April 2008, the applicant reported to WACH with a complaint of severe (7/10 on the pain scale) stomach pains. The medical notes indicated that she had experienced abdominal bloating and pain in the pelvis for the past week with decreased appetite. She was diagnosed with acute cystitis (i.e., a UTI) and prescribed pain medication. 5. On 22 April 2008, the applicant reported to WACH with a complaint of increasingly severe abdominal pain. Peritoneal biopsies were performed, she was diagnosed with ovarian cancer with metastasis to the peritoneum, and she was transferred to the Naval Medical Center, San Diego, CA. Further testing in San Diego diagnosed peritoneal carcinomatosis of uncertain origin versus ovarian or other cancer. 6. Army Regulation 635-40 governs the evaluation of physical fitness of Soldiers who may be unfit to perform their military duties because of physical disability. In pertinent part, it states a Soldier whose normal scheduled date of nondisability retirement or separation occurs during the course of hospitalization or disability evaluation may, with his or her consent, be retained in the service until he or she has attained maximum hospital benefits and completion of disability evaluation if otherwise eligible for referral into the disability system. 7. Army Regulation 40-501 governs medical fitness standards for enlistment, retention, and separation. Paragraph 3-42 states that a cause for referral to an MEB is when a malignant neoplasm is discovered on evaluation for administrative separation or retirement and the observation period subsequent to treatment is deemed inadequate in accordance with accepted medical principles. 8. The National Institutes of Health internet site, medlineplus.gov, states that peritoneal cancer is a rare cancer that develops in the peritoneum. In its earliest stages, symptoms for peritoneal cancer can be very vague and difficult to spot. Like ovarian cancer, the condition often does not produce any symptoms until late in its development. When symptoms do develop, they are similar to those of ovarian cancer. Symptoms may include general abdominal discomfort and pain, such as gas, indigestion, pressure, swelling, or cramps; nausea, diarrhea, constipation, and frequent urination; loss of appetite; feeling full even after a light meal; weight gain or loss with no known reason; and abnormal bleeding from the vagina. DISCUSSION AND CONCLUSIONS: 1. While it certainly appears that the applicant’s peritoneal carcinamotosis did develop while she was still on active duty, it also appears unlikely that the condition could have been diagnosed while she was on active duty. 2. The available evidence indicates that Army doctors would have had no reason to suspect (and therefore to test) the applicant had any type of cancer while she was on active duty. A review of her medical history on 21 March 2008, 10 days before she retired, noted only that gastrointestinal symptoms included abdominal pain and reports of mild menstrual cramping, nothing out of the ordinary for a healthy, pre-menopausal female. The risks of IUD insertion were discussed with her, and those risks included pain and bleeding. Therefore, when she reported to WACH on 17 April 2008 with a complaint of severe stomach pains, the diagnosis of acute cystitis was a reasonable diagnosis. 3. The same evidence also indicated that the applicant’s severe pains had started a week earlier; i.e., on or about 10 April 2008, after she had already retired. (Although it is also noted that the applicant stated the pains began about a week after the IUD insertion, there is no evidence to show that she sought treatment from the Army until after she had already retired.) When the pain got worse shortly thereafter, the Army took appropriate steps to search for other causes of the pain. 4. Nevertheless, although there is no evidence of any error on the part of the Army, it would be equitable to grant relief in this case. It would be equitable to revoke the applicant’s retirement orders, restore her to active duty, and take the appropriate steps in accordance with Army Regulation 40-501, paragraph 3-42, and Army Regulation 635-40. BOARD VOTE: ___xx___ __xx____ ___xx___ GRANT FULL RELIEF ________ ________ ________ GRANT PARTIAL RELIEF ________ ________ ________ GRANT FORMAL HEARING ________ ________ ________ DENY APPLICATION BOARD DETERMINATION/RECOMMENDATION: The Board determined that the evidence presented was sufficient to warrant a recommendation for relief. As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by: a. voiding her 1 April 2008 retirement and restoring her to active duty with all due pay and allowances; and b. taking the appropriate steps in accordance with Army Regulation 40-501, paragraph 3-42, and Army Regulation 635-40 as soon as she is restored to active duty. _ _____xxxxxxx____________ CHAIRPERSON I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case. ABCMR Record of Proceedings (cont) AR20080009325 3 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1 ABCMR Record of Proceedings (cont) AR20080009325 4 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1