BOARD DATE: 27 June 2017 DOCKET NUMBER: AR20160000727 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: 27 June 2017 DOCKET NUMBER: AR20160000727 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: 27 June 2017 DOCKET NUMBER: AR20160000727 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: a. his DA Form 199 (Physical Evaluation Board (PEB) Proceedings), dated 23 November 2011, to show his diagnosis of post-traumatic stress disorder (PTSD) was incurred and his left knee injury was aggravated while performing his duties on active duty in Iraq, and were combat-related by changing the following entries: * item 8d: while entitled to basic pay (incurred or aggravated) – "Y" * item 8e: in the line of duty, in the time of national emergency or after 14 September 1978 (incurred or aggravated) – "Y" * item 8f: proximate result of performing duty – "Y" b. Orders 069-0119, issued by Headquarters III Corps and Fort Hood, Fort Hood, TX, dated 10 March 2009, to show: * Disability is based on injury or disease received in the line of duty as a direct result of armed conflict or caused by an instrumentality of war and incurring in the line of duty during a period of war as defined by law: "YES" * Disability resulted from a combat related injuries as defined in Title 26 U.S. Code, section 104: "YES" 2. The applicant states: a. His DA Form 199, states that both of his conditions (PTSD and left knee injury) resulted in ending his military career and should be considered service connected. b. His injuries occurred while he was entitled to basic pay (incurred or aggravated), were in the line of duty, were the direct result of his duties in Iraq from 2006 to 2008, a tour that consisted of 15 months; and were combat related. c. Orders 069-0119, dated 10 March 2009, do not correspond with his PEB, which is causing a delay in receiving all of his benefits. His orders state, that his disabilities were not caused by an instrumentality of war, but were incurred in the line of duty during a period of war as defined by law, and that his disabilities were not received from a combat related injury as defined in Title 26, U.S. Code section 104, which is incorrect. d. Both of his service-connected injuries that ended his career are a direct result of his duties in Iraq. While stationed in Iraq, his left knee injury was aggravated while performing his duties in a combat zone, and he was diagnosed with PTSD as a result of his combat tour. He does not know exactly why the two forms contradict each other, but he would like these errors corrected. 3. The applicant provides: * DA Form 199, dated 24 February 2009 * Orders 069-0119, issued by Headquarters III Corps and Fort Hood, Fort Hood, TX, dated 10 March 2009 * Department of Veterans Affairs (VA) Disability Rating Decision, dated 29 June 2009 * a letter from U.S. Army Human Resources Command (HRC), Fort Knox, KY, to the applicant regarding his request for CRSC, dated 16 December 2009 * a letter from HRC, Fort Knox, KY, to the applicant regarding his reconsideration request for CRSC, dated 30 July 2010 CONSIDERATION OF EVIDENCE: 1.  Title 10, U.S. Code, section 1552(b), provides that applications for correction of military records must be filed within 3 years after discovery of the alleged error or injustice. This provision of law also allows the Army Board for Correction of Military Records (ABCMR) to excuse an applicant's failure to timely file within the 3-year statute of limitations if the ABCMR determines it would be in the interest of justice to do so. While it appears the applicant did not file within the time frame provided in the statute of limitations, the ABCMR has elected to conduct a substantive review of this case and, only to the extent relief, if any, is granted, has determined it is in the interest of justice to excuse the applicant's failure to timely file. In all other respects, there are insufficient bases to waive the statute of limitations for timely filing. 2.  On 14 June 2000, the applicant enlisted in the Regular Army. After initial training, he was awarded military occupational specialty 63B (Wheeled Vehicle Mechanic.) 3.  The applicant served in Iraq from 30 October 2006 to 13 January 2008. 4.  On 24 February 2009, a PEB convened at the Carl R. Darnall Army Medical Center, Fort Sam Houston, TX. The PEB found the applicant unfit for continued military service based on the following conditions: a. PTSD with associative major depressive disorder. The applicant deployed to Iraq in 2006 to 2008, but was not engaged in direct combat. His symptoms included depression, irritability, insomnia, nightmares, flashbacks, avoidance behavior, and hypervigilance. He developed PTSD in October 2008. He received a 50 percent disability rating for PTSD. b. Chronic, left knee pain, rated as analogous to arthritis, degenerative. The applicant experienced aggravation to his left knee, while deployed to Iraq in 2006. He had prior fractures of the tibia in childhood and x-rays showed cortical thickening, which is consistent with prior trauma. As a result, he was unable to perform common Soldier tasks. He was rated for a limited range of motion of a single major joint and was granted a 10 percent disability rating. 5.  The PEB noted that the medical evaluation board (MEB) found the applicant's diagnosis of sleep apnea met medical retention standards because the condition did not interfere with his duty performance. 6.  The PEB found the applicant physically unfit for military service, recommended a combined disability rating of 60 percent, and that he be placed on the temporary disability retirement list (TDRL) with a reexamination in November 2009. 7.  On 2 March 2009, the applicant concurred with the PEB's findings and waived a formal hearing of his case. 8.  Orders 069-0119, issued by Headquarters III Corps and Fort Hood, Fort Hood, TX, dated 10 March 2009, show, in pertinent part: * temporary disability * percentage of disability – 60 percent * date placed on retired list – 28 May 2009 * "Disability is based on injury or disease received in the line of duty as a direct result of armed conflict or caused by an instrumentality of war and incurring in the line of duty during a period of war as defined by law: "NO" * Disability resulted from a combat related injury as defined in Title 26, U.S. Code, section 104: "NO" 9.  On 27 May 2009, the applicant was retired due to physical disability and placed on the TDRL effective 28 May 2009. His DD Form 214 (Certificate of Release or Discharge from Active Duty) shows, in part: * item 12c (Net Active Service This Period) – 8 years, 11 months and 14 days * item 23 (Type of Separation) – Retirement * item 24 (Character of Service) – Honorable * item 25 (Separation Authority) – Army Regulation 635-40, Paragraph 4-24b(2) * item 26 (Separation Code) – SFK * item 28 (Narrative Reason for Separation) – Disability, temporary 10.  On 29 June 2009, the VA rendered a rating decision for the following medical conditions that were deemed service-connected for the Gulf War: * PTSD – 30 percent * osteochondritis dessicans, left knee – 10 percent * residual paresthesia and tinea pedis dermatophytosis, right foot – 10 percent * residual paresthesia and tinea pedis dermatophytosis, post-cold weather injury, left foot – 10 percent * distal radius fracture, left wrist – zero percent * lumbar strain – zero percent * genital warts – zero percent * pseudofollicultis barbae – zero percent 11.  On 20 November 2009, the applicant submitted a DD Form 2860 (Claim for CRSC) to HRC for the following medical conditions: a.  PTSD based on his combat-related experiences in Iraq during the period 2006-2008. He stated that while serving in Iraq, he experienced numerous traumatic events while in charge of a security detail and as part of a quick reaction force for his base. He conducted convoy escort missions and was able to avoid exposure to improvised explosive devices (IED). He conducted numerous explosive ordnance disposal details and cleaned the remains of dead Soldiers out of unit vehicles. He also saw the dead bodies of insurgents. Due to the emotional stress of combat, he was unable to reconnect with his family and engage in social life post-deployment. b.  lumbar strain – while wearing full body armor and carrying a full battle load, he was constantly injuring his left knee; getting in and out of armor vehicles, having to run with all of his gear on, and having to stand up for long periods of time and prolonged wearing of combat boots in extreme hot weather conditions. c. for distal radius fracture, left wrist – reinjured his wrist while in combat by having to open doors on the armored vehicles in Iraq, causing him constant pain. 12.  On 16 December 2009, HRC denied the applicant's claim for CRSC stating they were unable to verify the following disabilities as combat-related: * limited flexion of left knee * limited motion of left wrist * lumbosacral or cervical strain of left spine * PTSD * residuals of frostbite of right foot * residuals of frostbite of left foot 13.  In March 2010, the applicant submitted a second application for CRSC based on new evidence. a. In an undated self-authored statement he states during his deployment he routinely conducted convoy operations, where he was subjected to improvised explosive devices (IEDs), small arms fire, mortar rounds, and rocket attacks. At times his mission was to provide security to explosive ordnance disposal (EOD) teams who detonated IEDs or unexploded ordnances. In addition, he was assigned as the "Sergeant of the Guard" for the Iraqi Army and the Allied Forces gate, where dead bodies were hauled in and out through this point. He lived on the edge for 15 months and did not believe he would make it out alive or back in one piece. His daily activities are now limited due to his mental illnesses including PTSD, and he feels he has lost everything. b. A PTSD Clinic Initial Assessment, issued by the Central Texas Veterans Health Care System, Temple TX, dated 18 March 2010, shows the applicant's PTSD score of 44 was indicative of a severe level of depressive symptoms with PTSD. c. A letter from his clinical psychologist, dated 19 March 2010, states: [Applicant] is 30%... for PTSD. [He] was seen on February 25, 2010[,] at the Temple Veterans, PTSD Clinical Team… to initiate treatment for PTSD. During this appointment[,] he described multiple situations in which his life was threatened; multiple convoys, and regular contact with dead bodies. In addition to these stressors, he routinely provided security for EOD missions as well as having mortar/rocket attacks striking near his living quarters. He completed two tours – one in [Operation Enduring Freedom] during 02/01/2003 to 08/20/2003[,] and a second tour – during OIF which lasted 15 months, 10/31/2006 to 02/20/2008. [The applicant] is currently diagnosed with PTSD and Major Depression. His diagnosis of PTSD is directly connected to his combat tours. 14.  On 30 July 2010, HRC responded to the applicant's second application and denied CRSC for all claimed medical conditions including PTSD. 15.  A DA Form 199, dated 23 November 2011, shows a PEB reconvened and made the following determinations: a. PTSD – not combat related. The applicant requires multiple psychotropic medications and outpatient treatment. He does not have daily structured activities. He was unemployed while on the TDRL. His condition is unfitting because it continues to render him unable to return to military service, due to irritability, sleep disturbance, panic attacks, nightmares, and social isolation. The psychiatrist indicates reduced reliability and productivity due to this condition with difficulty in establishing and maintaining effective work and social relationships. Disability rating continued at 50 percent. b.  Osteoarthritis, left knee. Range of motion zero degrees to 90 degrees with pain at 90 degrees. This condition is unfitting because it continues to render the applicant unable to perform military functional activities. Disability rating continued at 10 percent. 16.  The reconvened PEB found the applicant physically unfit for military service, recommended a combined disability rating of 60 percent, and permanent retirement. 17.  On 5 January 2012, the applicant concurred with the reconvened PEB's findings and waived a formal hearing of his case. 18.  Order 017-10, issued by U.S. Army Physical Disability Agency, Arlington, VA, dated 17 January 2012, removed the applicant from the TDRL and permanently retired him. In addition, the Orders listed "Not Applicable" to the following statements: a. Disability is based on injury or disease received in the line of duty as a direct result of armed conflict or caused by an instrumentality of war period as defined by law. b. Disability resulted from a combat related injury as defined in Title 26, U.S. Code, section 104. 19.  In processing this case, an advisory opinion was obtained from the Army Review Board Agency (ARBA), Staff Psychiatrist, dated 16 December 2016, who stated: a. A review of the Armed Forces Health Longitudinal Technology (AHLTA) records indicates that the Soldier underwent post-deployment screening after returning from Iraq. In the screening assessment, dated 6 May 2008, the applicant endorsed anxiety, high irritability, poor sleep, hypervigilance, nightmares, and jumpiness. The assessment indicates that the trauma he experienced was "military combat, terrorist attack[s], [and that the] forward operating base [was] being mortared at night." b. On 22 October 2008, the applicant underwent a psychiatric examination for his MEB where he described the traumas he endured while he was deployed to Iraq. His chief complaint was being emotionally unavailable to his family since returning from Iraq and he reported his wife was divorcing him because of his unavailability. During the appointment, the applicant endorsed increased irritability, road rage, poor sleep, hypervigilance, impaired memory, and social withdrawal. He stated, "I used to be a gate guard, [and] the Iraqi police officers brought a truck full of arms to the gate-dead insurgents in the back-looked into the back of the truck and seen them-lifeless, ten piled on each other-first time to see unwanted death, reminded me of my parents mainly. That image haunts me to this day." He scored positively (75/85) on the PTSD Checklist-Monitor (PCL-M), a screening tool for PTSD, and was prescribed medication for his symptoms. c. Documentation exists in the applicant's military medical record that indicates, his reported symptoms are suggestive of PTSD during his post-deployment screening assessment. Review of the military and VA medical records also indicates the applicant, while not engaged in direct combat in Iraq, was consistently exposed to multiple traumatic stressors. 20.  On 28 December 2016, the applicant was provided a copy of the advisory opinion for an opportunity to respond. He did not. 21.  In processing this case, a second advisory opinion was obtained from the ARBA, Senior Medical Advisor on 31 May 2016, who stated, in pertinent part: a. a series of left knee x-rays on 28 February 2006, revealed a history of two surgeries, which were completed on the applicant's his left knee with significant reconstruction with reports of locking and giving out; b. a magnetic resonance imaging (MRI) on left knee on 24 July 2008, for chronic knee pain, with two prior surgeries. The anterior horn of the medial meniscus has a slight irregularity medially possibly representing postsurgical changes; the medial femoral condyle also has mild cortical irregularities consistent with prior osteochondritis dessicans; other unremarkable; c. lumbar spine x-ray series completed 3 October 2008, showed normal lumbar spine series; d. the applicant's PEB proceedings, dated 24 February 2009, show he was deployed to Iraq from 2006 to 2008, and was diagnosed with PTSD with associated major depressive disorder (not engaged in direct combat), and given a disability rating of 50 percent. The applicant received a 10 percent disability rating for chronic left knee pain rated as analogous to arthritis, degenerative, which was aggravated while deployed to Iraq in 2006. His MEB for sleep apnea shows he met retention standards. The PEB found his sleep apnea not to be unfitting. The applicant received a combined disability rating of 60 percent and he was placed on the TDRL; e. the PEB made a recommendation that if the applicant was to be retired because of a disability, that his retirement not be based on a disability from an injury or disease received in the line of duty, as a direct result of armed conflict or caused by an instrumentality of war in line of duty during a period of war as defined by law; f. the applicant submitted a request to HRC for CRSC on 16 December 2009. HRC officials stated, "Unable to verify as a Combat-Related Disability – limited flexion of knee (left knee) at 10%; limited motion of wrist (left) 0%; lumbosacral or cervical strain (lumbar) at 0%; PTSD at 30%; Residuals of frostbite (right foot) at 10%; Residuals of frostbite (left foot) at 10%. Justification/comments: No evidence in claim to show that a combat-related event caused condition"; g. the applicant appealed HRC's decision and requested reconsideration of his CRSC claim; on 30 July 2010, HRC again denied his request. They stated, "[Applicant] did not provide us with the necessary evidence to properly adjudicate your [his] claim. To award a condition as combat-related[,] you must provide this office with official documentation that shows how each condition is combat-related as defined by CRSC program guidance; h. the PEB proceedings dated 23 November 2011, found the applicant had PTSD – not combat related at 50 percent, and with osteoarthritis for his left knee at 10 percent since it continues to render him unable to perform his military functional activities. The PEB found the Soldier physically unfit and recommended a combined rating of 60 percent; and i. he is currently rated by the VA with a service-connected disability rating of 100 percent for the following conditions: PTSD (50 percent), limited flexion of knee at (10 percent), cold injury residual for left and right foot (10 percent each foot), limited motion of wrist (0 percent), infections of skin (0 percent), and lumbosacral or cervical strain at (0 percent). 22.  The advisory official opined that the applicant's disabilities (PTSD/knee injury) were not based on an injury or disease that was received in the line of duty, as a direct result of armed conflict or caused by an instrumentality of war; and that it was not incurred in the line of duty during a period of war, as defined by law. Furthermore, he also opined that the applicant's injuries did not result from a combat-related injury as defined by Title 26 U.S. Code, section 104. 23.  On 31 May 2017, the applicant was provided a copy of the second advisory opinion with an opportunity to respond. He did not. REFERENCES: 1.  Army Regulation 635-40 (Disability Evaluation for Retention, Retirement or Separation), establishes 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 office, grade, rank, or rating. a. The regulation defines instrumentality of war as a device designed primarily for military service and intended for use in such service at the time of the occurrence of the injury. It may also be a device not designed primarily for military service if use of or occurrence involving such a device subjects the individual to a hazard peculiar to military service. This use or occurrence differs from the use or occurrence under similar circumstances in civilian pursuits. b. Occurrence during a period of war is not required. A favorable determination is made if the disability was incurred during any period of service as a resolve of such diverse causes as wounds caused by a military weapon, accidents involving a military combat vehicle, injury, or sickness caused by fumes, gases or explosions of military ordinance, vehicles, or material. There must be a direct causal relationship between the use of the instrumentality of war and the disability and the disability must be incurred incident to a hazard or risk of the service. c. The same regulation states the PEB liaison officer will counsel the Soldier and make him or her fully aware of the election options available, the processing procedures, and the benefits to which he/she will be entitled if separated or retired for physical disability. 2. Title 26, U.S. Code, section 104 (Compensation for Injuries or Sickness), paragraph 3 (Special Rules for Combat-Related Injuries) states, for purposes of this subsection, the term "combat-related injury" means personal injury or sickness: a. which is incurred: * as a direct result of armed conflict * while engaged in extra-hazardous service; or * under conditions simulating war; or b. which is caused by an instrumentality of war. 3. Department of Defense Instruction 1332.38 (Physical Disability Evaluation), paragraph E3.P5.2.2, states combat related covers those injuries and diseases attributable to the special dangers associated with armed conflict or the preparation or training for armed conflict. A physical disability shall be considered combat related if it makes the member unfit or contributes to unfitness and was incurred under any of the circumstances listed below: * as a direct result of armed conflict * while engaged in hazardous service * under conditions simulating war * caused by an instrumentality of war 4. Title 38, U.S. Code, sections 1110 and 1131, permit the VA to award compensation for disabilities, which were incurred in or aggravated by active military service. However, an award of a higher VA rating does not establish error or injustice in the Army rating. An Army disability rating is intended to compensate an individual for interruption of a military career after it has been determined that the individual suffers from an impairment that disqualifies him or her from further military service. The VA, which has neither the authority nor the responsibility for determining physical fitness for military service, awards disability ratings to veterans for conditions that it determines were incurred during military service and subsequently affect the individual's civilian employability. 5. Title 10, U.S. Code, section 1413a, (CRSC), states the Secretary concerned shall pay to each eligible combat-related disabled uniformed services retiree who elects benefits under this section a monthly amount for the combat related disability of the retiree. Paragraph 3, special rules for chapter 61 disability retirees, for retirees with fewer than 20 years of service. In the case of an eligible combat-related, disabled uniformed services retiree who is retired under chapter 61 (Retirement or Separation for Physical Disability) of this title with fewer than 20 years of creditable service, the amount of the payment, for any month may not, when combined with the amount of retired pay payable to the retiree after any such reduction under sections 5304 and 5305 of Title 38, cause the total of such combined payment to exceed the amount equal to 2 1/2 percent of the member's years of creditable service multiplied by the member's retired pay base. DISCUSSION: 1. The applicant contends, in effect: a. his DA Form 199, dated 23 November 2011, should be corrected to show his diagnoses of PTSD and his left knee injury were incurred or aggravated while performing his duties on active duty in Iraq, and were combat-related by changing the following entries: * item 8d: while entitled to basic pay(Incurred or aggravated) – "Y" * item 8e: In the line of duty in the time of national emergency or after 14 September 1978 (Incurred or aggravated) – "Y" * item 8f: proximate result of performing duty – "Y" b. Orders 069-0119, issued by Headquarters III Corps and Fort Hood, Fort Hood, TX, dated 10 March 2009, be corrected to show: * Disability is based on injury or disease received in the line of duty as a direct result of armed conflict or caused by an instrumentality of war and incurring in the line of duty during a period of war as defined by law: "YES" * Disability resulted from a combat related injuries as defined in Title 26, U.S. Code, section 104: "YES" 2.  The evidence of record shows the applicant underwent a PEB on 24 February 2009. The PEB determined he was physically unfit due to PTSD with associated major depressive disorder, which developed in October 2008, after he was separated from his wife, and for chronic left knee pain. The board recommended that he be placed the TDRL with a combined disability rating of 60 percent. 3.  The PEB also noted he was deployed to Iraq in 2006 to 2008, but was not engaged in direct combat; however, he had symptoms including depression, irritability, insomnia, nightmares, flashbacks, avoidance, behavior, and hypervigilance. His chronic left knee pain was degenerative and was aggravated while deployed to Iraq in 2006. 4.  The applicant's DA Form 199, items 8d, e, and f, lists "Y[es]" to both of his diagnoses for PTSD and his knee injury, to show they were incurred or aggravated, while entitled to basic pay, were in the line of duty, in the time of national emergency or after 14 September 1978, and was the proximate result of performing his duty; 5.  However, in item 10a of his DA Form 199, it clearly states, "The Soldier's retirement is not based on disability from injury or disease received in the line of duty as a direct result of armed conflict or cause by an instrumentality of war and incurring in line of duty during a period of war as defined by law. In addition, it also states, in item 10c, "The disability did not result from a combat-related injury as defined in Title 26, U.S. Code, section 104." On 2 March 2009, the applicant concurred with the PEB's findings and recommendations and waived his right to a formal hearing. 6.  Orders 069-0119, issued by Headquarters III Corps and Fort Hood, Fort Hood, TX, dated 10 March 2009, placed the applicant on the TDRL effective 27 May 2009. The orders state, in pertinent part: a. "Disability is based on an injury or disease received in the line of duty as a direct result of armed conflict or cause by an instrumentality of war and incurring in line of duty during a period of war as defined by law: No." b. "Disability resulted from a combat-related injury as defined in 26 USC 104: No." 7.  After the applicant was placed on the TDRL, he submitted a request to HRC requesting CRSC for combat-related injuries twice; however, both requests were denied, based on "no evidence in claims to show that a combat-related event caused condition." 8.  On 23 November 2011, the applicant received a second PEB for a final determination on his TDRL status. The second PEB found that the applicant's PTSD was not combat-related, but continued in severity. He was given psychotropic medication and received outpatient treatment. His knee pain continued to render him unable to perform his military duties. The Board recommended a combined disability rating of 60 percent and that he be permanently retired. No entries were made to items 8d, e, and f, of his DA Form 199. 9.  Order 017-10, issued by U.S. Army Physical Disability Agency, Arlington, VA, dated 17 January 2012, removed the applicant from the TDRL and permanently retired him. In addition, the Orders listed "Not Applicable" the statements, "Disability is based on injury or disease received in the line of duty as a direct result of armed conflict or caused by an instrumentality of war period as defined by law" and "Disability resulted from a combat related injury as defined in Title 26 U.S. Code, section 104." 10.  The ARBA psychiatrist, a resident expert on PTSD, confirms that documentation exists in the applicant's military medical record that indicates his reported symptoms are suggestive of PTSD, due to his deployments to Iraq from 2006 to 2008. Furthermore, she states that his records provide evidence which links specific and documented instances or occurrences during the applicant's service in Iraq to his PTSD, which was combat-related (i.e., seeing dead bodies come through the gates while deployed in Iraq.) This causal relationship of his PTSD to a specific incident, also indicates, that although he was not engaged in direct combat in Iraq, he was consistently exposed to multiple combat stressors. 11.  The ARBA Senior Medical Advisor addressed the applicant's issue of chronic knee pain. He notes the PEBs, dated 24 February 2009 and 23 November 2011 list that the applicant was deployed to Iraq from 2006 to 2008, was diagnosed with chronic knee pain, rated as analogous to arthritis, degenerative, which was aggravated while deployed to Iraq in 2006. However, he referred to the ARBA psychiatrist's medical advisory opinion, dated 19 December 2016, regarding the applicant's behavioral health conditions and the causal relationship. 12.  According to Title 26, U.S. Code, section 104, the term "combat-related injury" means personal injury or sickness, which is incurred and/or caused by an instrumentality of war while engaged in extra-hazardous service. Based on the applicant's medical records, post-deployment screening, and the advisory opinion from the ARBA psychiatrist, all documents and records suggest that due to his deployments to Iraq, he was exposed to "traumatic stressors" that were combat-related. He experienced anxiety, high irritability, poor sleep, hypervigilance, nightmares, and jumpiness due to the direct trauma he experienced by "military combat, terrorist attack[s], mortar and rocket attacks." 13.  The applicant provides a letter from a clinical psychologist, which states that applicant was diagnosed with PTSD with major depression, which is directly connected to his combat tours in Iraq. The applicant described multiple situations in which his life was threatened by mortar and rocket attacks near his living quarters and being in regular contact with dead bodies and having to clean up trucks after the bodies were removed. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20160000727 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20160000727 14 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2