BOARD DATE: 15 December 2016 DOCKET NUMBER: AR20150012997 BOARD VOTE: _________ _______ ________ GRANT FULL RELIEF ________ ________ ________ GRANT PARTIAL RELIEF ________ ________ ________ GRANT FORMAL HEARING ____X____ ____X____ ____X____ DENY APPLICATION 2 Enclosures 1. Board Determination/Recommendation 2. Evidence and Consideration BOARD DATE: 15 December 2016 DOCKET NUMBER: AR20150012997 BOARD DETERMINATION/RECOMMENDATION: The evidence presented does not demonstrate the existence of a probable error or injustice. Therefore, the Board determined the overall merits of this case are insufficient as a basis for correction of the records of the individual concerned. _____________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. BOARD DATE: 15 December 2016 DOCKET NUMBER: AR20150012997 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 correction of her disability findings to add the following medical conditions to her existing unfitting conditions and increase her disability rating: * anxiety * adjustment disorder * insomnia * overexertion/strenuous movement * piriformis syndrome (neuromuscular disorder related to the sciatic nerve) * sciatica * snapping hip syndrome * stress fracture of neck of femur * left Achilles tendonitis 2. The applicant states: a. She has service-related anxiety that was diagnosed before she was discharged and was noted in her medical records as well as in her current Department of Veterans Affairs (VA) rating. b. There were also a few other diagnoses that were made and not added to her records, such as adjustment disorder, insomnia, overexertion/strenuous movement, piriformis syndrome, sciatica, snapping hip syndrome, stress fracture of neck of femur, and left Achilles tendonitis. She was diagnosed with all of these conditions before she was discharged. c. She had hip surgery in February 2012 and she returned to duty in March 2012. Two weeks later, she was forced into the disability system. She was not given the proper time to heal and recover. When she asked for more testing and stated the doctors wanted to perform more surgeries, her medical unit refused them. These are injuries incurred while in service and she would like them added to her records. d. She had to wait to get into the VA Medical Center and she was not seen by the VA Medical Center until 1 year after she was discharged. 3. The applicant provides: * TRICARE Personal Health Details Problem List * VA letter, dated 30 July 2015 * DD Form 214 (Certificate of Release or Discharge from Active Duty) CONSIDERATION OF EVIDENCE: 1. The applicant enlisted in the Regular Army on 24 January 2011 for a period of 3 years and 27 weeks. She completed training and was awarded military occupational specialty 91C (utilities equipment repairer). 2. On 3 April 2012, a medical evaluation board (MEB) diagnosed her with the medically unacceptable condition of bilateral hip pain. 3. The MEB further found the following conditions medically acceptable: * breast pain * tooth extraction * scars 4. The MEB recommended her referral to a physical evaluation board (PEB). She concurred with the MEB findings on 1 May 2012. 5. Item 30 (Continuation) of her DA Form 3947 (MEB Proceedings) states, in part: a. "In regard to issues relating to fitness for duty and disability compensation, I understand that the PEB will consider and review only those conditions listed on the DA Form 3947." b. "The DA Form 3947 includes all my current medical conditions and whether or not they meet medical retention standards." c. "I agree that this MEB accurately covers all my current medical conditions." 6. On 8 July 2012, an informal PEB found her physically unfit for the following conditions and disability ratings: * degenerative arthritis (right), listed as bilateral hip pain – 10 percent * degenerative arthritis (left), listed as bilateral hip pain – 10 percent 7. The PEB determined the following conditions were not unfitting and were therefore not rated: * breast pain * tooth extraction * scars 8. The PEB recommended a disability rating of 20 percent and her separation with severance pay. On 10 July 2012, she did not concur with the findings, but waived a formal hearing. 9. On 27 September 2012, she was honorably discharged by reason of disability with severance pay, non-combat related, with a disability rating of 20 percent. 10. She provided a TRICARE Personal Health Details Problem List showing she was diagnosed with: * adjustment disorder * anxiety * arthropathy (joint disease) * breast pain * compression arthralgia – pelvis/hip/femur right * foot pain, soft tissue * gastroenteritis * subclinical hyperthyroidism * insomnia * joint pain, localized in the hip * mastodynia (breast pain) * overexertion/strenuous movement * piriformis syndrome * sciatica * snapping hip syndrome * stress fracture of neck of femur * left Achilles tendonitis 11. She provided a letter from the VA, dated 30 July 2015, showing her combined service-connected disability evaluation is 80 percent and she is being paid at the 100-percent rate because she is unemployable due to her service-connected disabilities. 12. She also provided VA documentation showing she was granted service-connected disability compensation for the following conditions and disability ratings: * right hip limitation of flexion from stress fracture near femoral head status post-surgery with muscle irritation – 0 percent * anxiety disorder, not otherwise specified – 70 percent * healed superficial scar with hyperesthesia, right lower extremity, residual of surgery for hip stress fracture – 0 percent * painful scars, both lower extremities, residual of surgery for hip stress fractures – 10 percent * left hip thigh impairment from stress fractures near femoral head status post-surgery (claimed as bone fracture, traumatic arthritis, pain of the joint and muscle, and orthopedic conditions of the hip, leg, and thigh) – 10 percent * left hip limitation of extension from stress fractures near femoral head status post-surgery – 0 percent * left hip limitation of flexion from stress fractures near femoral head status post-surgery with muscle irritation – 0 percent * right hip limitation of extension from stress fractures near femoral head status post-surgery with muscle irritation – 0 percent * healed superficial scar with hyperesthesia, left lower extremity, residual of surgery for hip stress fracture – 0 percent * right hip thigh impairment from stress fractures near femoral head status post-surgery (claimed as bone fracture, traumatic arthritis, pain of the joint and muscle, and orthopedic conditions of the hip, leg, and thigh) – 10 percent 13. An advisory opinion was rendered by the Army Review Boards Agency Senior Medical Advisor, dated 8 November 2016, wherein he stated: a. A review of the applicant's electronic medical records revealed clinical encounters between January 2011 and September 2012 with a single clinic visit for bilateral hip pain on 14 June 2011. No psychological symptoms were noted. b. A psychology note, dated 14 December 2011, shows she is married with four children and she was diagnosed with adjustment disorder (self-referral because husband of 6 years asked for a divorce). c. On 14 December 2011, she was screened for mental or developmental disorders and none were found. On 15 December 2011, she was diagnosed with stress-related physiological response affecting physical condition – lack of sleep, occupational problem. Social work follow-up on 28 and 30 March 2012 due to family stressors secondary to her absence; anxiety – denied. On 2 April 2012, she underwent a behavioral health clinic mental status assessment and was diagnosed with medically acceptable adjustment disorder (symptoms of depression (moderate), post-traumatic stress disorder (mild), anxiety (mild), and social/occupational functioning (poor). A mental status reassessment was conducted on 8 August 2012 with no change. d. She had a post-operative visit on 15 February 2012 with a complaint of right lower extremity sciatic-like pain. She was further evaluated with x-rays/magnetic resonance imaging of the lumbar spine. She underwent a physical therapy evaluation and treatment of symptoms. e. She had clinic visits on 9 March 2012 for left breast pain/mastodynia since October 2011 with questionable palpation of lump. She was referred and seen by a gynecologist for bilateral breast pain, left greater than right, since October 2011. She has a past history of thyroid disease in 2002. f. She had an endocrinology evaluation on 30 August 2012 for history of subclinical hyperthyroidism and multiple stress fractures of hips. She has a past history of being treated in 2007 when she was pregnant, but 3 months post-partum notes her levels were normal. The medical impression was subclinical hyperthyroidism with no indication to treat. g. Her laboratory studies were normal or unremarkable. Radiology reports were reviewed in addition to hip imaging with normal lumbar spine x-ray series, normal left heel series (left Achilles tendon region), normal magnetic resonance imaging, unremarkable mammogram, and bilateral breast sonogram with no obvious mass identified. h. The applicant did not meet medical retention standards for degenerative arthritis (right) and degenerative arthritis (left) per the MEB and PEB. Overexertion/strenuous movement, piriformis syndrome, sciatica, snapping hip syndrome, stress fracture of neck of femur, and left Achilles tendonitis were found not separately unfitting. Her combined lower extremity orthopedic conditions with bilateral hip pain (left and right) and stress fractures were rated by the PEB as degenerative arthritis (left and right). i. The applicant met medical retention standards for breast pain, tooth extraction, and scars per the MEB and PEB. She was assessed with medically acceptable adjustment disorder with manifested depressive, anxiety, and post-traumatic stress disorder symptoms associated with significant marital/spouse/ family problems (separated from family in California) – a medical condition and occupational problem (unable to work in military occupational specialty), but not meeting diagnostic criteria for a separate diagnosis. No daily antidepressant or antianxiety medical therapy is required. Insomnia, a symptom of the adjustment disorder, is treated with as needed medication. j. Her medical conditions were duly considered during medical separation processing. k. A review of the available documentation found no evidence of a medical disability or condition which would support a change to the character or reason for the applicant's discharge in this case. 14. A copy of this advisory opinion was provided to the applicant for comment and/or rebuttal. She did not respond. REFERENCES: 1. 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. It states there is no legal requirement in arriving at the rated degree of incapacity to rate a physical condition which is not in itself considered disqualifying for military service when a Soldier is found unfit because of another condition that is disqualifying. Only the unfitting conditions or defects and those which contribute to unfitness will be considered in arriving at the rated degree of incapacity warranting retirement or separation for disability. 2. Title 10, U.S. Code, chapter 61, provides for disability retirement or separation for a member who is physically unfit to perform the duties of his or her office, rank, grade, or rating because of disability incurred while entitled to basic pay. 3. Title 10, U.S. Code, section 1201, provides for the physical disability retirement of a member who has at least 20 years of service or a disability rating of at least 30 percent. Title 10, U.S. Code, section 1203, provides for the physical disability separation of a member who has less than 20 years of service and a disability rating of less than 30 percent. 4. Title 38, U.S. Code, sections 310 and 331, permit the VA to award compensation for a medical condition that was incurred in or aggravated by active military service. The VA, however, is not required by law to determine medical unfitness for further military service. The VA, in accordance with its own policies and regulations, awards compensation solely on the basis that a medical condition exists and that said medical condition reduces or impairs the social or industrial adaptability of the individual concerned. Consequently, due to the two concepts involved, an individual's medical condition, although not considered medically unfitting for military service at the time of processing for separation, discharge, or retirement, may be sufficient to qualify the individual for VA benefits based on an evaluation by that agency. DISCUSSION: 1. The applicant contends she was diagnosed with the following conditions before she was discharged and they should be added to her existing unfitting conditions: * anxiety * adjustment disorder * insomnia * overexertion/strenuous movement * piriformis syndrome * sciatica * snapping hip syndrome * stress fracture of neck of femur * left Achilles tendonitis 2. Her MEB did not list anxiety, adjustment disorder, insomnia, overexertion/strenuous movement, piriformis syndrome, sciatica, snapping hip syndrome, stress fracture of neck of femur, or left Achilles tendonitis as medical conditions/defects and her DA Form 3947 states she agreed that the MEB accurately listed all of her current medical conditions. She provided no evidence showing these conditions rendered her unfit to perform her military duties. As such, there is insufficient evidence with which to add these medical conditions as unfitting. 3. The evidence shows the PEB found her physically unfit due to: * degenerative arthritis (right), listed as bilateral hip pain * degenerative arthritis (left), listed as bilateral hip pain 4. The Army Review Boards Agency Senior Medical Advisor states her medical conditions were duly considered during medical separation processing. 5. The rating action by the VA does not demonstrate an error or injustice on the part of the Army. The VA, operating under its own policies and regulations, assigns disability ratings as it sees fit. 6. There is insufficient evidence showing the unfitting conditions of degenerative arthritis (right), listed as bilateral hip pain, and degenerative arthritis (left), listed as bilateral hip pain, were improperly rated by the PEB in 2012. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20150012997 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20150012997 8 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2