IN THE CASE OF: BOARD DATE: 23 February 2012 DOCKET NUMBER: AR20120002167 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 his diagnosis of post-traumatic stress disorder (PTSD) be restored and that he be medically retired with a disability rating of at least 30%. 2. The applicant states, in effect, that the actions taken by officials at Madigan Army Medical Center (MAMC) were not in accordance with Army standards. He goes on to state that he was diagnosed as having post-traumatic stress disorder (PTSD) and was told that he could not be treated for PTSD because he had been evacuated from Iraq for psychosis. He also states that he should receive a proper evaluation and retired for permanent disability with at least a 30% disability rating. 3. The applicant provides no additional documents with his application. CONSIDERATION OF EVIDENCE: 1. The applicant was serving in the Oregon Army National Guard (ORARNG) when he was ordered to active duty as a cannon crewman in support of Operation Iraqi Freedom on 2 May 2009. He deployed to Iraq on 14 June 2009. 2. In October 2009, he was medically evacuated from Iraq with a diagnosis of psychosis. He was initially transferred to Landstuhl Army Regional Medical Center in Germany. 3. When he arrived at Landstuhl the examining mental health official opined that it did not appear that the applicant was psychotic. He deferred his diagnosis and opined that the applicant was not psychologically fit for duty. The applicant was subsequently transferred to MAMC in Tacoma, Washington 4. In March 2010, a license clinical social worker diagnosed the applicant as having an adjustment disorder with disturbance of emotions and opined that the applicant may be developing PTSD due to traumatic experiences in Iraq, which could have been triggered by retraumatization of similar events while in the Warrior Transition Battalion (WTB). 5. On 11 February 2011, the applicant was honorably released from active duty (REFRAD) due to completion of required service. He had served 1 year, 9 months, and 10 days of active service and was returned to his ORARNG unit. 6. On 22 October 2010, the applicant’s unit requested that the applicant be granted a 1-year extension on active duty to complete processing under the Physical Disability Evaluation System (PDES) for the purpose of participating in the Reserve Component Warrior in Transition Medical Retention Processing Program and completion of medical care and treatment. His request was approved to 28 October 2011. 7. On 28 October 2011, he was honorably discharged from the ORARNG due to the expiration of his term of service (ETS). 8. A review of the available records failed to show any indication that the applicant was evaluated under the PDES or that a fit for duty determination was made in his case. 9. In October 2011, complaints were received at the Office of the Secretary of the Army that Soldiers were improperly having their diagnosis of PTSD changed after undergoing behavioral health diagnosis to adjustment disorder and being returned to duty. The Office of the Surgeon General reviewed the cases and determined that the situation applied to 17 Soldiers of which the applicant is one. A determination was made to re-evaluate the 17 Soldiers identified to determine if the proper course of action was taken. 10. Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation) governs the evaluation of physical fitness of Soldiers who may be unfit to perform their military duties because of physical disability. The unfitness is of such a degree that a Soldier is unable to perform the duties of his office, grade, rank, or rating in such a way as to reasonably fulfill the purposes of his employment on active duty. It states commanders of medical treatment facilities (MTFs) who are treating Soldiers may initiate action to evaluate the Soldier’s physical ability to perform the duties of his or her office, grade, rank, or rating. The commander will advise the Soldier’s commanding officer of the results of the evaluation and the proposed disposition. If it appears the Soldier is not medically qualified to perform duty, the MTF commander will refer the Soldier to an MEB. 11. Army Regulation 635-40 states that MEBs are convened to document a Soldier’s medical status and duty limitations insofar as duty is affected by the Soldier’s status. A decision is made as to the Soldier’s medical qualification for retention based on the criteria in Army Regulation 40-501 (Standards of Medical Fitness), chapter 3. DISCUSSION AND CONCLUSIONS: 1. While it cannot be determined if the applicant was evaluated under the PDES for either PTSD or psychosis, there is insufficient evidence present to grant the applicant a 30% disability rating and permanent disability retirement. 2. However, in order to determine if any of the applicant’s conditions warrant a disability rating, the applicant should be afforded the opportunity to be properly evaluated by appropriate medical personnel and systems designed to determine the degree of disability a Soldier may have prior to separation. 3. Accordingly, the Department of the Army Office of the Surgeon General should take appropriate action to issue the applicant invitational travel orders for the purpose of undergoing the appropriate medical processing and evaluations at an appropriate medical facility (other than JBL-M without applicant’s concurrence) that has the capability to properly evaluate the applicant’s medical condition. 4. Once a determination has been made as to the appropriate disposition of the applicant’s medical condition under the PDES, the applicant will be separated in accordance with the applicable laws and regulations, with entitlement to all back pay and allowances and/or retired pay due him, if any. 5. In the event that a determination is made that the applicant should have been separated under the PDES, these proceedings will serve as the authority to void his original discharge and to issue the appropriate separation retroactive to his original separation date. BOARD VOTE: ________ ________ ________ GRANT FULL RELIEF ____X___ ____X __ ____X___ GRANT PARTIAL RELIEF ________ ________ ________ GRANT FORMAL HEARING ________ ________ ________ DENY APPLICATION BOARD DETERMINATION/RECOMMENDATION: 1. The Board determined that the evidence presented was sufficient to warrant a recommendation for partial relief. As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by the Office of the Surgeon General contacting the applicant to arrange, via appropriate medical facilities, a physical evaluation through the use of invitational travel orders to the applicant. In the event that the applicant requires a medical evaluation board and physical evaluation board, the applicant will be afforded all of the benefits normally afforded individuals on active duty who are undergoing a medical evaluation board and/or a physical evaluation board. Should a determination be made that the applicant should have been separated under the Physical Disability Evaluation System, these proceedings will serve as the authority to void his administrative separation and to issue him the appropriate separation retroactive to his original separation date, with entitlement to all back pay and allowances and/or retired pay, less any entitlements already received. 2. The Board further determined that the evidence presented was insufficient to warrant a portion of the requested relief. As a result, the Board recommends denial of so much of the application that pertains to voiding his discharge and retiring him for permanent disability without undergoing evaluation under the physical disability evaluation system. _______ _ X______ ___ 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) AR20120002167 3 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1 ABCMR Record of Proceedings (cont) AR20120002167 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1