PROCEEDINGS

	IN THE CASE OF:      

	BOARD DATE:           26 August 2003                   
	DOCKET NUMBER:   AR2002070386

	I certify that hereinafter is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in the case of the above-named individual.  

	Mr. Carl W. S. Chun		Director	
	Mr. Edmund P. Mercanti		Analyst	

  The following members, a quorum, were present:

	Mr. Raymond J. Wagner		Chairperson	
	Mr. Robert L. Duecaster		Member	
	Ms. Marla J. N. Troup		Member	

	The applicant and counsel if any, did not appear before the Board.

	The Board considered the following evidence:

	Exhibit A - Application for correction of military 
                records
	Exhibit B - Military Personnel Records (including
	            advisory opinion, if any)

FINDINGS:

1.  The applicant has exhausted or the Board has waived the requirement for exhaustion of all administrative remedies afforded by existing law or regulations.

2.  The applicant requests, in effect, that the finding that his coronary artery disease (CAD), resulting in a cardio catherization while he was on full time training duty, was not in line of duty, existed prior to service, be corrected to a finding that it was in line of duty (LOD).

3.  The applicant states that when he had his heart attack, he had been on active duty for a total of 2 years, 8 months and 12 days.  He had no civilian job during that time.  He contends that the investigating officer that conducted the inquiry into his heart attack didn’t take into consideration the lengthy time he was performing active duty.  He continues that he was healthy before his heart attack, but ever since he has been unable to find a job because he cannot pass the physical examination for the jobs.  In support of his request the applicant submits pertinent excerpts from his official military personnel file.  These documents include the formal line of duty investigation conducted on the medical treatment he received for his chest pain, and a retirement point summary showing the number of days he performed active duty and how many unit training assemblies he attended during the time in question.

4.  The applicant’s military records could not be located.  The following information was derived from documents supplied by the applicant.

5. The applicant enlisted in the Army National Guard (ARNG) in pay grade E-5 with prior service in the Regular Navy on 18 September 1985.

6.  In the Retirement Year Ending (RYE) 17 September 1986, he served a total of 217 days of active duty and attended 64 unit training assemblies (UTA’s).  In RYE 17 September 1987, he served a total of 152 days of active duty and attended 46 UTA’s (his active duty terminated on 26 July 1987).

7.  The applicant was promoted to pay grade E-6 on 22 October 1986.  On 13 April 1987, while the applicant was performing 36 days of active duty, he reported experiencing chest pain and numbness to his right arm.  He went on sick call, was suspected of having coronary artery disease, and was scheduled for a stress test on 1 July 1987.  Following the stress test, he was scheduled for a cardio catherization on 13 July 1987.  At that time one of the arteries in his heart was found to be blocked, and he underwent nuclear ventriculography.

8.  On 14 September 1987 a formal line of duty investigation was completed on the applicant’s coronary artery disease and the treatment he received to diagnose and treat that condition.  The investigating officer recommended that the condition and treatment be considered in line of duty.  That recommendation was approved by the appointing authority and the reviewing authority of the 

formal investigation.  However, the Chief, National Guard Bureau (NGB), disapproved those recommendations and determined the condition and treatment not to have been incurred in line of duty because it existed prior to his entry on active duty.

9.  The applicant was ordered to report for a medical evaluation board, but there is no documentation showing the results of the MEB. 

10.  The applicant was honorably discharged from the ARNG and transferred to the USAR Control Group on 20 May 1988.  On 17 September 1992, the applicant was honorably discharged from the USAR.

11.  Army Regulation 600-8-1, paragraph 41-8, then in effect, states, that the term Existing Prior to Service (EPTS) is added to a medical diagnosis when there is substantial evidence that the disease or injury, or underlying condition, existed before military service, or it happened between periods of active service.  Included in this category are chronic diseases with an incubation period that clearly precludes a finding that it started during short tours of authorized training or duty.  If an EPTS condition was aggravated by military service, the finding will be in line of duty.  If an EPTS condition is not aggravated by military service, the finding will be not in line of duty, not due to own misconduct, EPTS.  Specific findings of natural progress of the pre-existing injury or disease based on well established medical principles alone are enough to overcome the presumption of service aggravation.  A member of the Army is presumed to have been in sound physical and mental condition on entering active service or authorized training.  To overcome this, it must be shown by substantial evidence that the injury or disease, or condition causing it, was sustained or contracted while neither on active duty nor in authorized training.

12.  Army Regulation 635-40 provides that the medical treatment facility commander with the primary care responsibility will evaluate those referred to him and will, if it appears as though the member is not medically qualified to perform duty or fails to meet retention criteria, refer the member to a medical evaluation board.  Those members who do not meet medical retention standards will be referred to a physical evaluation board for a determination of whether they are able to perform the duties of their grade and military specialty with the medically disqualifying condition.  For example, a noncommissioned officer who receives above average evaluation reports and passes Army Physical Fitness Tests (which have been modified to comply with the individual’s physical profile limitations) after the individual was diagnosed as having the medical disqualification may be found to be fit for duty.  The fact that the individual has a medically disqualifying condition does not mandate the person’s separation from 

the service.  Fitness for duty, within the parameters of the individual’s grade and military specialty, is the determining factor in regards to separation.  If the PEB determines that an individual is physically unfit, it recommends the percentage of disability to be awarded which, in turn, determines whether an individual will be discharged with severance pay or retired.  Paragraph 4-19b states that a PEB may decide that a soldier’s physical defect was EPTS, but must then determine whether the condition was aggravated by military service.  If the PEB determines that a soldier has an unfitting EPTS condition which was service aggravated, the PEB must determine the degree of disability that is in excess of the degree existing at the time of entrance into the service.  The method of determining the percentage of disability to be awarded in such cases is outlined in appendix B, item B-10 of this regulation.  

13.  A former soldier’s entitlement to veterans’ benefits is generally established by Title 38, U.S. Code.  Although Army regulations do not directly govern veterans’ benefits, an Army LOD investigation and determination do affect a former soldier’s veteran’s benefits administered by the Department of Veterans Affairs (DVA).  

14.  On 1 November 2000, Congress enacted the Veterans’ Benefits and Health Care Improvement Act of 2000, which expanded disability benefits to include disabilities resulting from cardiovascular and cardiac disease.  Based on this change in law, reserve component soldiers performing IDT are now eligible for veterans’ disability benefits from the DVA.

15.  Coronary heart disease (or coronary artery disease) is a narrowing of the small blood vessels that supply blood and oxygen to the heart (coronary arteries).  Coronary disease usually results from the build up of fatty material and plaque (atherosclerosis).  As the coronary arteries narrow, the flow of blood to the heart can slow or stop.  The disease can cause chest pain (stable angina), shortness of breath, heart attack, or other symptoms.  There are many factors which increase the risk for CAD.  Some of the risks are based on family history (genetics), and others are more controllable.  Risk factors include the following:  Family history of coronary heart disease (especially before age 50); male gender; age (65 and greater); tobacco smoking; high blood pressure; diabetes; high cholesterol levels (specifically, high LDL cholesterol and low HDL cholesterol); lack of physical activity or exercise; obesity; high blood homocysteine levels; menopause in women; and infection that causes inflammatory response in the artery wall. (There is some evidence that suggests this, but the theory is being studied.)  [MEDLINE Plus Encyclopedia]

CONCLUSIONS:

1.  It would appear that the NGB applied the standards of AR 600-8-1, that the term EPTS is added to a medical diagnosis when there is substantial evidence that the disease or injury, or underlying condition, existed before military service, or it happened between periods of active service, in the applicant’s case.  This determination would be appropriate when the applicant’s CAD diagnosis was viewed in isolation from his other periods of active and inactive duty.  It would be hard to imagine that CAD would develop in 36 days.

2.  However, in RYE 17 September 1986, the RYE prior to diagnosing his CAD, the applicant served a total of 281 days of active and inactive duty.  In RYE 17 September 1987, the year he was diagnosed as having CAD, he served a total of 198 days of active and inactive duty.

3.  As such, while it may be appropriate to say CAD diagnosed on 36 days of active duty was EPTS, more than likely it would be considered to have been incurred in line of duty if the soldier was diagnosed with the condition 479 days after his entry on active duty (the number of days the applicant served in the two years prior to his diagnosis).  

4.  Based on the fact that the applicant served a large portion of the two years preceding his CAD diagnosis on active or inactive duty, it may reasonably be presumed that he either incurred or aggravated his CAD while in a duty status.  In either case, his CAD would then be considered to have been incurred in line of duty.  While not reflected in the record, this may be the reason that the investigating officer, the appointing authority, and the reviewing authority all approved the applicant’s CAD as having been incurred in line of duty.

5.  The Board also considered whether he should have been separated for physical disability.  In that regard, there is no evidence or indication that the applicant was medically disqualified as a result of his coronary artery disease.  Also, contrary to the applicant’s contention, there is no evidence or indication that he had a heart attack.  However, even if the applicant did have a heart attack, he would still not have an automatic entitlement to a separation with disability benefits.  He would still have to be determined medically disqualified and physically unfit.

6.  Even if the applicant is not entitled to any benefits from the Army as a result of this correction, the correction may result in disability benefits from the DVA based upon the current laws governing Veterans benefits.

7.  In view of the foregoing, the applicant’s records should be corrected as recommended below.

RECOMMENDATION:

That all of the Department of the Army records related to this case be corrected by showing the DD Form 261, Report of Investigation, dated 14 September 1987, conducted on the arterial blockage of the individual concerned, was approved as in line of duty.

BOARD VOTE:  

___rjw___  ____mjnt  ____rld__  GRANT AS STATED IN RECOMMENDATION

________  ________  ________  GRANT FORMAL HEARING

________  ________  ________  DENY APPLICATION

		__________Raymond J. Wagner_______
		        CHAIRPERSON

INDEX

CASE ID	AR2002070386	
SUFFIX		
RECON	YYYYMMDD	
DATE BOARDED	YYYYMMDD	
TYPE OF DISCHARGE	(HD, GD, UOTHC, UD, BCD, DD, UNCHAR)	
DATE OF DISCHARGE	YYYYMMDD	
DISCHARGE AUTHORITY	AR . . . . .  	
DISCHARGE REASON		
BOARD DECISION	GRANT	
REVIEW AUTHORITY		
ISSUES         1.	122.02	
2.		
3.		
4.		
5.		
6.