BOARD DATE: 22 August 2017 DOCKET NUMBER: AR20150018995 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: 22 August 2017 DOCKET NUMBER: AR20150018995 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: 22 August 2017 DOCKET NUMBER: AR20150018995 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, in effect, correction of her records to show she was evaluated under the Integrated Disability Evaluation System (IDES) and was medically retired from the Army, based on the outcome of the IDES process. 2. The applicant states, in effect, she received a permanent brain injury while in an active duty status in December 2013. This injury was diagnosed by magnetic resonance imaging (MRI). She redeployed back to her home unit in March 2014 after the completion of her tour of duty without being evaluated by a medical board for physical fitness to continue in service. 3. The applicant provides copies of: * DD Form 214 (Certificate of Release or Discharge from Active Duty) for the period ending 27 April 2014 * 427 pages of medical records from her Department of Veterans Affairs (VA) "My HealtheVet" account, dated between 11 May 2014 and 11 November 2015 * 7 DA Forms 2173 (Statement of Medical Examination and Duty Status) with enclosures * VA Form 21-4138 (Statement in Support of Claim), dated 11 May 2014 * Social Security Administration (SSA) Retirement, Survivors and Disability Insurance Notice of Award, dated 7 November 2014 * 2 VA Forms 21-526EZ (Application for Disability Compensation and Related Compensation Benefits), dated 2 April and 1 September 2015 * VA Form 21-8940 (Veteran's Application for Increased Compensation Based on Un-employability), dated 31 August 2015 * VA Form 21-4192 (Request for Employment Information in Connection with Claim for Disability Benefits), dated 9 October 2015 * U.S. Army Human Resources Command (HRC) Form 249-E (Chronological Statement of Retirement Points), undated CONSIDERATION OF EVIDENCE: 1. The applicant was appointed as a Reserve commissioned officer of the Army on 22 December 1998. She was appointed as a first lieutenant in the Army Nurse Corps. She held Area of Concentration 66H (Medical - Surgical Nurse). 2. The applicant was ordered to active duty on 22 March 2003 in support of Operations Enduring Freedom and Iraqi Freedom. She was promoted to captain (CPT) on 25 June 2003. She served in Iraq and Kuwait from 30 May 2003 through 13 June 2004 and was released from active duty on 20 July 2004. 3. After periods of service with the U.S. Army Reserve (USAR), she entered a second period of active service on 10 May 2011. 4. The applicant's record contains numerous DA Forms 2173 that show: a. On 24 September 2013, a line of duty (LOD) investigation (LODI) approved her for bilateral cataracts only. b. On 2 October 2013, an LODI approved her for degenerative spondylosis/ intervertebral at C5-C6 and C6-C7 only. c. On 2 October 2013, an LODI approved her for central pontine myelinolysis (CPM) only. d. On 15 October 2013, an LODI was returned without action stating it was not required. e. On 12 November 2013, an LODI approved her for myofascial pain syndrome only. f. On 5 December 2013, an LODI approved her for osteoporosis only. g. On 6 March 2014, an LODI approved her for hyperlipidemia only. 5. The applicant was honorably released from active duty on 27 April 2014 and transferred to Company B, 801st Combat Support Hospital, St. Lawrence, IN, a troop program unit of the U.S. Army Reserve (USAR). Her DD Form 214 shows she was released upon the completion of her required active service under the provisions of Army Regulation 600-8-24 (Officer Transfers and Discharges), paragraph 2-7. 6. Orders 14-126-00012, issued by Headquarters, USAR Command (USARC), Fort Bragg, NC, on 6 May 2014, shows she was honorably discharged from the USAR on 30 June 2014. 7. The applicant's record is void of evidence that shows she was not able to perform the duties required of her career field and rank/grade during her period of service. In addition, her record is void of evidence that shows she was referred to a medical evaluation board (MEB) to be evaluated for fitness for further service. 8. The applicant provides: a. Extensive medical documentation (427 pages) related to her medical history reported to the VA between 11 May 2014 and 11 November 2015 for medical issues and/or injuries she contends occurred during her periods of active service. These documents show she sought treatment or was treated for a variety of medical concerns. b. SSA Retirement, Survivors and Disability Insurance Notice of Award, dated 7 November 2014, which shows they found the applicant became disabled under their rules on 20 March 2014. She became entitled to monthly disability pay effective 1 September 2014. 9. In connection with the processing of this case, an advisory opinion was obtained on 16 December 2016 from the Army Review Boards Agency (ARBA) Senior Medical Advisor. The medical advisory opinion states: a. A review of the applicant's electronic medical record (AHLTA) revealed clinical encounters between February 2012 through March 2014. b. In reference to the CPM LOD and diagnosis, she did not have CPM. CPM is an incorrect interpretation of the radiology report. This was not the clinical neurological diagnosis. CPM presents with encephalopathy (altered mental status, usually coma or coma-like state) or seizures with subsequent transient improvement followed by rapid deterioration including quadraparesis (4 limb paralysis), dysarthria (slurred speech), dysphagia (difficulty swallowing), and occasionally oculomotor abnormalities (abnormalities of eye movements) – this is typically a devastating condition resulting in intensive care hospitalization for days to weeks, and serious neurological disability in most cases. c. The applicant met medical retention standards in accordance with (IAW) Army Regulation 40-501 (Standards of Medical Fitness), chapter 3, and following the provisions in Army Regulation 635-40 (Disability Evaluation for Retention, Retirement, or Separation) which were applicable to the applicant's period of service. d. The applicant's medical conditions were duly considered. e. A review of the available documentation found no evidence of a medical disability or condition that would support a change to the reason for discharge in this case. 10. The advisory opinion was provided to the applicant on or about 19 December 2016, to provide her an opportunity to comment or rebut the opinion. Unfortunately, the Board was notified by her next of kin that she passed away on 11 April 2016. REFERENCES: 1. Army Regulation 40-501 provides that for an individual to be found unfit by reason of physical disability, he or she must be unable to perform the duties of his or her office, grade, rank or rating. Performance of duty despite impairment would be considered presumptive evidence of physical fitness. 2. Army Regulation 635-40 establishes the Physical Disability Evaluation System (PDES) and sets forth policies, responsibilities, and procedures that apply in determining whether a Soldier is unfit because of physical disability to reasonably perform the duties of his or her office, grade, rank, or rating. It provides that an MEB is 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 qualifications for retention based on the criteria in Army Regulation 40-501. Disability compensation is not an entitlement acquired by reason of service-incurred illness or injury; rather, it is provided to Soldiers whose service is interrupted and who can no longer continue to reasonably perform because of a physical disability incurred or aggravated in service. a. Paragraph 2-1 provides that the mere presence of impairment does not of itself justify a finding of unfitness because of physical disability. In each case, it is necessary to compare the nature and degree of physical disability present with the requirements of the duties the member reasonably may be expected to perform because of his or her office, rank, grade, or rating. The Army must find that a service member is physically unfit to reasonably perform his or her duties and assign an appropriate disability rating before he or she can be medically retired or separated. b. Paragraph 2-2b(1) provides that when a member is being processed for separation for reasons other than physical disability (e.g., retirement, resignation, reduction in force, relief from active duty, administrative separation, discharge, etc.), his or her continued performance of duty (until he or she is referred to the PDES for evaluation for separation for reasons indicated above) creates a presumption that the member is fit for duty. Except for a member who was previously found unfit and retained in a limited assignment duty status in accordance with chapter 6 of this regulation, such a member should not be referred to the PDES unless his or her physical defects raise substantial doubt that he or she is fit to continue to perform the duties of his or her office, grade, rank, or rating. c. Paragraph 2-2b(2) provides that when a member is being processed for separation for reasons other than physical disability, the presumption of fitness may be overcome if the evidence establishes that the member, in fact, was physically unable to adequately perform the duties of his or her office, grade, rank, or rating even though he or she was improperly retained in that office, grade, rank, or rating for a period of time and/or acute, grave illness or injury or other deterioration of physical condition that occurred immediately prior to or coincidentally with the member's separation for reasons other than physical disability rendered him or her unfit for further duty. 3. Directive-Type Memorandum (DTM) 11-015 explains the IDES. It states: a. The IDES is the joint DOD-VA process by which DOD determines whether wounded, ill, or injured service members are fit for continued military service and by which DOD and VA determine appropriate benefits for service members who are separated or retired for a service-connected disability. The IDES features a single set of disability medical examinations appropriate for fitness determination by the Military Departments and a single set of disability ratings provided by VA for appropriate use by both departments. Although the IDES includes medical examinations, IDES processes are administrative in nature and are independent of clinical care and treatment. b. Unless otherwise stated in this DTM, DOD will follow the existing policies and procedures requirements promulgated in DODI 1332.18 and the Under Secretary of Defense for Personnel and Readiness memoranda. All newly initiated, duty-related physical disability cases from the Departments of the Army, Air Force, and Navy at operating IDES sites will be processed in accordance with this DTM and follow the process described in this DTM unless the Military Department concerned approves the exclusion of the service member due to special circumstances. Service members whose cases were initiated under the legacy DES process will not enter the IDES. c. IDES medical examinations will include a general medical examination and any other applicable medical examinations performed to VA C&P standards. Collectively, the examinations will be sufficient to assess the member’s referred and claimed condition(s) and assist VA in ratings determinations and assist military departments with unfit determinations. d. Upon separation from military service for medical disability and consistent with BCMR procedures of the Military Department concerned, the former service member (or his or her designated representative) may request correction of his or her military records through his or her respective Military Department BCMR if new information regarding his or her service or condition during service is made available that may result in a different disposition. For example, a veteran appeals VA’s disability rating of an unfitting condition based on a portion of his or her service treatment record that was missing during the IDES process. If VA changes the disability rating for the unfitting condition based on a portion of his or her service treatment record that was missing during the IDES process and the change to the disability rating may result in a different disposition, the service member may request correction of his or her military records through his or her respective Military Department BCMR. e. If, after separation from service and attaining veteran status, the former service member (or his or her designated representative) desires to appeal a determination from the rating decision, the veteran (or his or her designated representative) has 1 year from the date of mailing of notice of the VA decision to submit a written notice of disagreement with the decision to the VA regional office of jurisdiction. 4. Title 38, U.S. Code, sections 1110 and 1131, permits the VA to award compensation for a medical condition which 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. The VA can evaluate a veteran throughout his or her lifetime, adjusting the percentage of disability based upon that agency's examinations and findings. However, these changes do not call into question the application of the fitness standards and the disability ratings assigned by proper military medical authorities during the applicant’s processing through the Army IDES. DISCUSSION: 1. The applicant requests correction of her records to show she was evaluated under the IDES and was medically retired from the Army based on the outcome of the IDES process. 2. The applicant's DD Form 214 shows she maintained her primary specialty as a medical surgical nurse for the entire three years of her last period of active service. There is no evidence she failed to meet retention criteria in accordance with Army Regulation 40-501, nor any evidence she was diagnosed with a physical disability that prevented her from reasonably performing her military duties. 3. The applicant was released from active duty upon reaching her completion of required active service. A thorough review of her military record reveals no indication that she was referred for processing through the IDES prior to her discharge as a result of any unfitting medical conditions. 4. The ARBA Senior Medical Advisor opined, after a thorough review of her medical records, that her chronic pain and additional medical concerns did not require referral to an MEB. The Senior Medical Advisor no evidence of a medical disability or condition that would support a change to the reason for discharge in this case. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20150013978 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20150018995 7 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2