BOARD DATE: 23 June 2016 DOCKET NUMBER: AR20150010666 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: 23 June 2016 DOCKET NUMBER: AR20150010666 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: 23 June 2016 DOCKET NUMBER: AR20150010666 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 a medical discharge. 2. The applicant states: * he was supposed to be medically discharged * he was not given Department of Veterans Affairs (VA) benefits * he was healthy and passed his entrance physical examination * he left the service with two bad knees that still hurt today 3. The applicant provides: * service medical records * service personnel records * VA documentation 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. The applicant provided a Standard Form 88 (Report of Medical Examination), dated 28 September 1998, showing he was qualified for enlistment. He was assigned a physical profile rating of 1 in all factors of functional capacity, indicating a high level of medical fitness. 3. He enlisted in the Regular Army on 15 October 1998 for a period of 3 years. 4. He provided a DA Form 3349 (Physical Profile), dated 17 November 1998, showing he was issued a 30-day temporary physical profile rating of 3 in the lower extremities factor for bilateral tibial plateaus stress fractures. 5. During basic combat training, he was attached to the extended Fitness Training Unit (FTU) from 17 November 1998 to 11 January 1999. 6. He provided a Medical 200 Board (U.S. Army Basic Training Operations Medical Conditions Discharge – commonly referred to as a MED 200) report, dated 20 January 1999, showing he was diagnosed with bilateral anterior knee pain that prevented the performance of duty despite adequate conservative care. It noted the areas of healing and increased activity on the scans were not where he was tender. Healed stress fractures – mild of proximal medial tibial plateaus – were now asymptomatic. 7. He provided a DA Form 3349, dated 21 January 1999, showing he was assigned a 90-day temporary physical profile rating of 3 in the lower extremities factor for bilateral stress fractures. 8. He provided a DA Form 4707 (Entrance Physical Standards Board Proceedings), dated 5 February 1999. a. Item 8 (Findings by Evaluating Physicians) states: "SEE ATTACHED NARRATIVE SUMMARY" and "A WAIVER IS/IS NOT RECOMMENDED." The narrative summary is not attached or available for review. b. Item 9 (State Profile and Assignment Limitations) states: "T3 UNDER L [temporary physical profile rating of 3 in the lower extremities factor]." 9. He provided a memorandum from his troop commander, dated 8 April 1999, who stated: a. The applicant came to his unit after an extensive stay at the FTU for stress fractures of both tibias. He was then assigned to Troop D to continue training. b. On 21 January 1999, he was sent to the FTU due to an extensive physical profile for pains in both knees. Bone scans and repeated x-rays were done to determine the cause of pain. The results showed increased sclerosis in the subchondral area of his medial left tibia. Unit medical providers recommended issuance of a MED 200 discharge. c. Since week 2 of the current cycle, the applicant has been unable to conduct physical training. His observation of the applicant is a Soldier who is unable to accomplish basic tasks, such as push-ups, sit-ups, running, carrying a weapon, carrying a rucksack, or any tasks that require stressed use of the left knee. Based on the recommendation of the applicant's unit medical providers and his observation of the applicant's physical fitness training, he concurs with the recommended MED 200 discharge. 10. His records are void of the specific facts and circumstances surrounding his discharge action. However, his DD Form 214 (Certificate of Release or Discharge from Active Duty) shows he was discharged on 16 April 1999 under the provisions of Army Regulation 635-200 (Personnel Separations – Enlisted Personnel), paragraph 5-11, due to failed medical/physical/procurement standards. He completed 6 months and 2 days of total active service. His service was uncharacterized. 11. An advisory opinion was obtained from the Integrated Disability Evaluation System Medical Officer, dated 7 January 2016, who recommended disapproval of the applicant's request and further stated: a. All electronic medical records and the available medical records were reviewed. b. The applicant served on initial active duty from late Fall 1998 to 13 April 1999, for a total of approximately 6 months. His past medical and surgical history was unremarkable, his entrance physical examination was normal, and he was cleared for entry without a waiver or exception. Within a few weeks of training, he started experiencing bilateral knee pain. There was no fall, twist, blow, or other trauma involving the knees, just routine physical training. He sought medical care the first time on 5 November 1998. He was assigned a limited physical profile. The next clinical encounter notes written in mid-November summarize his follow-up with recurrent knee pains, subsequent x-rays, and a bone scan revealing bilateral upper tibial, non-displaced stress fractures. He was treated and referred to the extended FTU. c. He was seen by a physician assistant on 4 January 1999 who recorded the applicant demonstrated "improvement and stress fractures are resolved, recommend gradual return to duty" and also noted the orthopedic clinic reviewed the case and deemed him fit for duty. A temporary physical profile limiting activity was issued, but he began experiencing knee pain again within a short time of returning to full activity. He was reevaluated and the unit medical providers referred him for a MED 200, which is distinctly different from a medical evaluation board (MEB). d. He was evaluated for a medical separation and a report, dated 20 January 1999, explained the applicant was unable to march, run, jump, or squat without pain. The doctor's examination revealed some crepitus of the knees, but otherwise full range of motion with stable, intact ligaments and some superficial tenderness around the kneecaps and the lower thigh. Of particular importance noted by the doctor, was that the areas where the stress fractures had been identified were not the areas of tenderness. Repeat x-rays of the right knee were normal. The left knee revealed some mild subchondral sclerosis of the medial tibia, but no stress fracture. The doctor noted the applicant had been diagnosed with stress fractures in November, but these had since healed/resolved and were asymptomatic. Anterior knee pain bilateral was the diagnosis. e. The applicant was evaluated by the orthopedic clinic in March 1999 and they noted he wanted an evaluation by an MEB instead of a MED 200 and advised following up with the initiating providers. f. A memorandum from the applicant's commanding officer notes the applicant had been sent to his unit after an extensive stay in the FTU, he recovered, he was returned to duty, but he was quickly sent back to the FTU. Repeat radiologic studies did not reveal persistence of the stress fractures. The commanding officer noted the unit medical providers recommended a MED 200, not an MEB. g. The applicant's knee problem was discovered on 5 November 1998 and determined not to meet procurement standards by 25 January 1999, well within a 6-month window. h. Stress changes and fracture of bone are extremely common. The vast majority of cases heal and resolve with activity reduction, gradual return to activity, and reconditioning. They resolve without any long-lasting sequelae, pain, or problems. i. A second important topic pertinent to this analysis involves the definitions of MEB versus U.S. Army Basic Training Operations Medical Conditions Discharge (also known as MED 200(a) or MED 200(b)). An MEB dictates how a fully-trained, qualified, and indoctrinated Soldier on active duty with more than 6 months in service, who develops a new medical illness or sustains an injury that fails to be corrected with all available medical resources and continues to impair successful discharge of his or her duties is eventually medically discharged through a physical evaluation board (PEB) and Army/VA disability personnel and administrative actions. j. MED 200 applies to a new recruit who has entered the initial 10-week basic training or gone on to advanced individual training. A medical problem identified during the entrance physical and allowed in through waiver that later proves incompatible with service many lead to a MED 200(a) administrative discharge not involving the PEB/Department of the Army or VA disability bodies. k. A new medical condition that precludes successful basic training (or advanced individual training) performance during the first 6 months of training that fails to resolve with all available medical treatment and rest in a Fitness Training Company may also lead to a purely administrative release from duty without involving the PEB/Department of the Army or VA disability bodies, termed a MED 200(b). In the vast majority of cases, a discharge through MED 200 (a or b) is uncharacterized. l. The doctor noted functional overlay in his MED 200 report, dated 20 January 1999. This is a term used in medicine to describe emotional aspects of an organic disease, characterized by symptoms that continue long after clinical signs of the disease have ended. All objective evidence at the time of the applicant's medical separation examination revealed no evidence of the initial stress fracture problem – by history, examination (symptoms didn't match location, or tenderness) or radiographs. m. The applicant is not eligible for an MEB for his knee problems. The knee problems as noted and described fail to meet procurement standards. These same problems developed well within 6 months of entering active duty. 12. A copy of this advisory opinion was provided to the applicant for comment and/or rebuttal. He did not respond. REFERENCES: 1. Army Regulation 635-200 sets forth the basic authority for separation of enlisted personnel. Paragraph 5-11 states Soldiers who were not medically qualified under procurement medical fitness standards when accepted for enlistment or who became medically disqualified under these standards prior to entrance on active duty, active duty training, or initial entry training will be separated. A medical proceeding, regardless of the date completed, must establish that a medical condition was identified by the appropriate medical authority within 6 months of the Soldier's initial entrance on active duty, that the condition would have permanently or temporarily disqualified the Soldier for entry in the military service had it been detected at that time, and that the medical condition does not disqualify the Soldier from retention in the service under the provisions of Army Regulation 40-501 (Standards of Medical Fitness), chapter 3. The character of service for Soldiers separated under this provision will normally be honorable, but will be uncharacterized if the Soldier is in an entry-level status. Entry-level status is defined as the first 180 days of continuous active duty or the first 180 days of continuous active service after a service break of more than 92 days. 2. 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. The unfitness must be of such a degree that a Soldier is unable to perform the duties of his or her office, grade, rank, or rating in such a way as to reasonably fulfill the purposes of his or her employment on active duty. 3. 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. DISCUSSION: 1. The evidence of record shows: * the applicant enlisted in the Regular Army on 15 October 1998 * a month later he was issued a temporary physical profile for bilateral tibial stress fractures * he was attached to the FTU on two occasions * a MED 200 diagnosed him with bilateral anterior knee pain in January 1999 * the knee problems as noted and described failed to meet procurement standards * these same problems developed well within 6 months of entering active duty 2. Paragraph 5-11 of Army Regulation 635-200 provides that Soldiers who become medically disqualified under procurement medical fitness standards will be separated. A medical proceeding, regardless of the date completed, must establish that a medical condition was identified by the appropriate medical authority within 6 months of the Soldier's initial entrance on active duty, that the condition would have permanently or temporarily disqualified the Soldier for entry in the military service had it been detected at that time, and that the medical condition does not disqualify the Soldier from retention in the service under the provisions of Army Regulation 40-501. The character of service for Soldiers separated under this provision will be uncharacterized if the Soldier is in an entry-level status. 3. In the absence of evidence to the contrary, it must be presumed that the applicant's separation processing was administratively correct and in conformance with applicable regulations. Without the discharge packet to consider, it is presumed that the authority and reason for his discharge and the character of service he received were commensurate with his overall record of service. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20150010666 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20150010666 7 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2