BOARD DATE: 2 June 2017 DOCKET NUMBER: AR20160002950 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: AR20160002950 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: AR20160002950 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 DD Form 214 (Certificate of Release or Discharge from Active Duty) to show she was honorably discharged due to medical reasons. 2. The applicant states she was informed and believed she was being discharged due to medical reasons. After she returned home, she found out her DD Form 214 shows her service is uncharacterized. Additionally, the medical officer told her that it would be best if she separated because her injuries would become worse over time. 3. The applicant provides: * DD Form 214 * Basic Combat Training Diploma * multiple DD Forms 689 (Individual Sick Slip) * multiple counseling forms * multiple DA Forms 705 (Army Physical Fitness Test Scorecard) CONSIDERATION OF EVIDENCE: 1. The applicant enlisted in the Regular Army on 19 August 2013. She completed basic combat training at Fort Sill, OK. On 5 March 2014, she was reassigned to the 95th Adjutant General Battalion for administrative purposes. 2. During training, she complained about the congenital deformity of her right arm with persistent pain. Her records contain a DA Form 4707 (Entrance Physical Standard Board (EPSBD) Proceedings), dated 7 February 2014, which shows: a. During training, she sustained a tibial stress fracture that had healed. She was seen several times for chronic pain in her right elbow, upper arm, and shoulder region that had been present off and on since childhood and continued throughout adolescence. The pain became more persistent after coming to Fort Sill, especially with activities such as pushups and lifting. She indicated she had an injury to her right arm at birth which resulted in her not being able to fully extend her right elbow. All this history was reported to the Military Entrance Processing Station (MEPS) and since she was not having any current problems; a waiver to enlist was given. She sustained no injury to her right arm since being at Fort Sill, but the repetitive use of the arm due to required activities of training resulted in increased pain. b. The pain went away for a while when she was in the Warrior Trainee Rehabilitation Program (WTRP) recovering from the stress fracture to her leg due to decreased activities. But the pain returned when her activity level increased in preparation to go to advanced individual training. Due to her past history, along with her current symptoms which were preventing satisfactory completion of training, discharge for a condition that existed prior to service (EPTS) was recommended. She was in agreement with this plan. c. After careful considerations of medical records, laboratory findings, and medical examinations, the board found the applicant was medically unfit for appointment or enlistment in accordance with current medical fitness standards and in the opinion of the evaluating physicians the condition(s) EPTS. The applicant had medical conditions and/or physical defect of contracture of the right elbow due to birth trauma, right elbow pain. d. Her disposition was that she did not meet medical fitness standards for enlistment or induction under the provisions of paragraphs 2-9a(2)(b) and 2-9b(8), chapter 2, Army Regulation (AR) 40-501 (Standards of Medical Fitness), and paragraphs 18a(2)(b) and 18c. The applicant understood that she would need follow up after discharge from the military for these chronic pre-existing conditions. 3. On 10 February 2014, the medical approving authority approved the findings shown on the DA Form 4707. The medical approving authority forwarded the EPSBD Proceedings to the applicant's unit for appropriate action in accordance with paragraph 5-11 of AR 635-200 (Personnel Separations – Enlisted Personnel). 4. The applicant acknowledged that she was informed of the medical findings. Additionally, she understood that legal advice of an attorney employed by the Army was available to her and that she could consult with civilian counsel at her own expense. She waived consulting counsel. She further acknowledged she understood she could request a discharge from the Army without delay or request retention on active duty. After counseling, the applicant concurred with the proceedings and requested to be discharged from the Army without delay. 5. The discharge authority approved the applicant's separation from the Army under the provisions of AR 635-200, paragraph 5-11, by reason of failure to meet procurement medical fitness standards. 6. On 11 March 2014, Headquarters, U.S. Army Garrison, Fort Sill, published Orders 070-1308 reassigning her to the U.S. Army Transition Center for separation processing effective 15 March 2014. 7. On 15 March 2014, the applicant was discharged from active duty. Her DD Form 214 shows she was discharged under the provisions of AR 635-200, paragraph 5-11. The narrative reason for separation shows "DID NOT MEET PROCUREMENT MEDICAL FITNESS STANDARDS – NO DISABILITY" and her service was uncharacterized. She completed 6 months and 26 days of net active service during this period. 8. She provided multiple sick call slips and counseling statements. A staff member of the Army Review Boards Agency (ARBA) requested a medical review of her records. As a result, on 10 April 2017, the ARBA senior medical advisor rendered an advisory opinion in her case. The medical advisor stated: a. The Case Management Division requested a medical review of this case for a determination if an alleged medical condition(s) warranted separation through medical channels or if medical condition(s) were not considered during medical separation processing. The applicant is petitioning for change to her discharge certificate. "I was informed and believe that I was being discharged due to medical reasons, only to find (after I returned home) that my DD Form 214 stated otherwise…" and provided medical records for details. b. A review of the applicant's records was conducted. Her Medical Prescreen of Medical History Report (DD Form 2807-2), dated 29 November 2012, was unremarkable (tonsillectomy – age 4 or 5; stitches on knee from cut (June 2006). Report of Medical History (DD Form 2807-1), dated 6 December 2012, with medication (birth control Depo-Provera) with "yes" for ear, nose, and throat explained in item 29: tonsil removed age 4-5; stitches in knee; reviewed with provider Depo-Provera shots for 3-4 years; negative behavioral health screen. Report of Medical Examination (DD Form 2808), dated 6 December 2012, with clinical evaluation unremarkable (tonsils removed; decreased extension right elbow to 32 degrees versus 5 degrees on left (no history of injury; was on dance line and Junior Reserve Officers' Training Corps x 2 years); scar left knee; tattoo; initial PULHES rating of "131111" due to decreased right elbow extension (asymptomatic, good function), waiver granted (19 December 2012). Her Security Clearance Application (Standard Form 86), dated 19 August 2013, was unremarkable. c. A review of the applicant's electronic medical record revealed clinical encounters from August 2013 through February 2014. There were no clinical notes. Radiology reports were reviewed from October and November 2013. Laboratory results were reviewed from August 2013. Clinic visit on 5 September 2013 for "right arm doesn't extend fully" at the direction of the applicant's drill sergeant. Exam with applicant able to do pushups within regulation, but unable to fully extend her right upper extremity – she has a medical waiver on file for this from the MEPS. Copy of medical waiver was provided to her on 6 September 2013. d. First clinic visit on 30 September 2013 for left leg pain x 3 days when marching and running. Follow-up visits regarding left leg on 2 and 19 October 2013 (emergency room), 21 October, 29 October, 13 November, 19 November, 20 November, 4 and 16 December 2013, and 7 February 2014 (EPTS evaluation of right elbow and upper arm pain, chronic). Left leg x-ray series (19 October 2013) for left leg pain off and on for a few weeks (worse today after physical training test with no known injury) – negative left tibia and fibula. Left leg x-ray series (19 November 2013) for left medial lower leg pain concerning for stress injury – periosteal reaction to moderate degree is seen posterior medially at the junction of the middle and distal one thirds of the tibia. Conclusion: Healing stress fracture. e. Her EPSBD Proceedings (DA Form 4707), dated 7 February 2014, for complaint: congenital deformity to right arm with persistent pain. She was in the WTRP due to a tibial stress fracture that had healed. f. Two interval visits for upper respiratory infection symptoms on 8 and 13 January 2014. No other visits noted, except for immunizations and/or screening. The applicant's Army Physical Fitness Test Scorecards (DA Form 705) were reviewed. (Date, pushups/sit-ups/2-mile run time/total points 20130831-0/18/11: 07/111 (Fail/Pass/Fail); 20130917-5/50/21: 51/115 (Pass/Pass/Pass) 20130930 – Sick call; 20131017-10/70/20: 39/169 (Fail/Pass/Fail); 20130716-8/21/10: 10/(Go/Go/Go pass); and 20131019-20/60/20: 10/177 (Pass/Pass/Fail). Additionally, a limited review of Department of Veterans Affairs (VA) records through the Joint Legacy Viewer with 11 problems listed (no VA entered) with several assessment visits noted. The applicant is not currently service connected by the VA. g. Based on this review, the applicant met medical retention standards for stress fracture left tibia in accordance with chapter 3, AR 40-501, and following the provisions set forth in AR 635-40 (Physical Evaluation for Retention, Retirement, or Separation) that were applicable to the applicant's era of service. The applicant did not meet medical accession standards in accordance with chapter 2, AR 40-501, and following the provisions set forth in AR 635-40 that were applicable to the applicant's era of service. EPTS right elbow problem (with medical waiver approved for enlistment), asymptomatic before enlistment, became symptomatic during basic combat training. The applicant's medical conditions were duly considered during medical separation processing. 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 discharge in this case. The applicant had nearly 7 months of military service. 9. The applicant was provided a copy of this advisory opinion to give her an opportunity to submit a rebuttal. She did not respond. REFERENCES: 1. AR 635-200 sets forth the basic authority for separation of enlisted personnel. a. Paragraph 5-11 specifically provides that Soldiers who are not medically qualified under procurement medical fitness standards when accepted for enlistment, or who became medically disqualified under these standards prior to entry on active duty, active duty for training, or initial entry training will be separated. A medical proceeding conducted by an EPSBD, regardless of the date completed, must establish that a medical condition was identified by appropriate medical authority within 6 months of the Soldier's initial entrance on active duty, the condition would have permanently or temporarily disqualified the Soldier for entry into the military service had it been detected at the time of enlistment, and the medical condition does not disqualify the Soldier from retention in the service under the provisions of AR 40-501, chapter 3. The characterization of service for Soldiers separated under this provision will normally be honorable, but will be uncharacterized if the Soldier has not completed more than 180 days of creditable continuous active duty service prior to the initiation of separation action. b. An uncharacterized separation is an entry-level separation. A separation will be described as an entry-level separation if processing is initiated while a member is in entry-level status, except when characterization under other than honorable conditions is authorized by the reason for separation and is warranted by the circumstances of the case or when the Secretary of the Army, on a case-by-case basis, determines that characterization of service as honorable is clearly warranted by the presence of unusual circumstances involving personal conduct and performance of duty. c. Paragraph 3-7a states an honorable discharge is a separation with honor and entitles the recipient to benefits provided by law. The honorable characterization is appropriate when the quality of the member's service generally has met the standards of acceptable conduct and performance of duty for Army personnel or is otherwise so meritorious that any other characterization would be clearly inappropriate. 2. AR 635-40 governs the evaluation of physical fitness of Soldiers who may be unfit to perform their military duties because of physical disability. It states that according to accepted medical principles, certain abnormalities and residual conditions exist that, when discovered, lead to the conclusion that they must have existed or have started before the individual entered the military service. Examples are manifestation of lesions or symptoms of chronic illness from date of entry on active military service (or so close to that date of entry that the illness could not have started in so short a period) will be accepted as proof that the illness existed prior to entrance into active military service. 3. AR 40-501 governs medical fitness standards for enlistment, induction, appointment, retention, and separation. Chapter 2 provides the physical standards for enlistment/induction. DISCUSSION: 1. The evidence of record shows medical authorities determined the applicant suffered from a disqualifying medical condition (contracture of the right elbow due to birth trauma, right elbow pain) that EPTS immediately after reporting for active duty. According to accepted medical principles, the manifestation of a chronic illness from the date of entry into active military service (or so close to that date of entry that the illness could not have started in so short a period) is accepted as proof the illness existed prior to entrance into active military service. 2. Her records were evaluated by an EPSBD that found her medically unfit for a condition that was neither incurred in nor aggravated by her active service. There was compelling evidence to support a finding that she had a preexisting condition. Accordingly, the EPSBD recommended separation. She was counseled and advised of her rights, and she elected a discharge from the Army without delay. Her rights were fully protected throughout the separation process. 3. As for the characterization of her service, a member's service is under review during the first 180 days of continuous active military service. When separation action is initiated within the first 180 days, service is usually not characterized unless the circumstances of the separation warrant a discharge under other than honorable conditions. An honorable characterization may be issued only if the service clearly warrants that characterization by unusual circumstances of personal conduct and performance of military service and is approved by the Secretary of the Army. 4. In all other circumstances, an uncharacterized separation is issued regardless of the reason for separation. An uncharacterized discharge is neither positive nor negative; it is not derogatory. It simply means the Soldier did not serve on active duty long enough for his or her service to be rated. The characterization of service she received was in compliance with the governing regulation. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20160002950 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20160002950 7 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2