IN THE CASE OF: BOARD DATE: 7 February 2017 DOCKET NUMBER: AR20150014199 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 IN THE CASE OF: BOARD DATE: 7 February 2017 DOCKET NUMBER: AR20150014199 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. IN THE CASE OF: BOARD DATE: 7 February 2017 DOCKET NUMBER: AR20150014199 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 correction of her military record to show she was permanently retired due to physical disabilities. 2. The applicant states procedural errors occurred in the processing of her record through the physical disability system. She defers to counsel. COUNSEL'S REQUEST, STATEMENT, AND EVIDENCE: 1. Counsel requests correction to the applicant’s military record to show she was permanently retired due to physical disabilities. 2. Counsel states: a. The Army failed to comply with Title 10, U.S. Code (USC), section 1218 (d) (Discharge or release from active duty: claims for compensation, pension, or hospitalization). The applicant's records should reflect she was retired pursuant to Title 10, USC, section 1218(d), due to these medical conditions: post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), right knee condition, and right shoulder condition with a combined 80 percent disability rating effective 5 February 2014. b. The applicant is a Reserve commissioned officer who served on active duty from 12 October 2008 to 12 October 2011. She was released from active duty (REFRAD) after deploying to Iraq without being advised of her statutory right for physical or mental disability evaluation and her statutory right to counseling concerning the consequences of terminating her active duty status without medical evaluation. c. In the applicant's official personnel records there is no evidence the applicant was advised of her rights to claim active duty disability compensation. This is an error and an injustice that the Board may remedy by correcting her records to reflect military disability retirement with an 80 percent service-connect disability rating supported by her Department of Veterans' Affairs (VA) disability rating. d. Title 10, USC, section 1218 (d), states in section d, paragraph 1, The Secretary of a military department shall ensure that each member of a reserve component under the jurisdiction of the Secretary who is determined, after a mobilization and deployment to an area in which imminent danger pay is authorized under section 310 of Title 37, to require evaluation for a physical or mental disability which could result in separation or retirement for disability under this chapter or placement on the temporary disability retired list or inactive status list under this chapter is retained on active duty during the disability evaluation process until such time as such member is (A) cleared by appropriate authorities for continuation on active duty; or (B) separated, retired, or placed on the temporary disability retired list or inactive status list. [Section d, paragraph 2] (A) A member described in paragraph (1), may request termination of active duty under such paragraph at any time during the demobilization or disability evaluation process of such member. (B) Upon a request under subparagraph (A), a member described in paragraph (1) shall only be released from active duty after the member receives counseling about the consequences of termination of active duty. (C) Each release from active duty under subparagraph (B) shall be thoroughly documented. (3) The requirements in paragraph (1) shall expire on October 28, 2014 (emphasis added by counsel). e. The Army failed to honor the applicant's statutory right to be counseled on the consequences of termination of active duty. This is equivalent to the statutory right that no military member be separated for a disability without a full and fair hearing in accordance with Title 10, USC, section 1214 (Right to full and fair hearing). As the Army failed in 2011 to comply with the applicant's statutory rights, the Army is not entitled to its normal presumption of administrative regularity. f. At the time of the applicant's first discharge on 11 November 2011, she had PTSD, TBI, and a knee impairment. Therefore, her military medical records warranted referral to a medical evaluation board (MEB) under the provisions of Army Regulation (AR) 40-501 (Standards of Medical Fitness), chapter 3. The applicant should have been referred to a physical evaluation board (PEB) in accordance with AR 635-40 (Physical Evaluation for Retention, Retirement, or Separation) for consideration by a PEB for the aforementioned unfitting medical conditions which she incurred in a combat zone. g. Although the applicant had additional ratable conditions not unfitting under military guidelines, each of the aforementioned medical conditions significantly limited and interfered with the performance of her military duties according to AR 40-501, chapter 3 and Department of Defense Instruction (DODI) 1332.39 (Application of the Veterans Administration Schedule for Rating Disability (VASRD)) explaining the difference between VA and military disability ratings that can be considered for military disability. [The VASRD is the standard for assigning percentage ratings.] As a result of her PTSD, TBI, and knee condition she was not reasonably able to perform her military duties at the time of her discharge from active duty in November 2011. h. After her discharge in November 2011, she was assigned to the U.S. Army Reserve (USAR). In 2013, she was ordered to active duty and posted to Schweinfurt, Germany, with further assignment to Romania. During that overseas assignment, she injured her right shoulder. i. In September 2014, she was ordered to active duty for a 1 year assignment. Shortly after her arrival at Fort Hood, TX, she sought medical treatment for her shoulder. She was refused evaluation and treatment and was involuntarily REFRAD within 30 days. She did not receive required medical treatment (shoulder surgery) or processing into the disability evaluation system. Her shoulder, cervical spine, and lumbosacral disabilities were also unfitting conditions within the standards of AR 40-501, chapter 3, and AR 635-40, chapters 2 and 3. Shortly after her REFRAD, the VA operated on her shoulder. j. The new integrated disability evaluation system (IDES) was being phased in during the time of her treatment for her PTSD, TBI, right knee, and right shoulder conditions. Unfortunately, she was not processed under that system. However, during that time it was the Army's policy to bring injured Reservists on active duty for evaluation and potential military disability processing. 3. Counsel provides a six page brief with 12 attachments including a compact disc containing 289 pages of the applicant's medical records, 161 pages of her military personnel records, and 389 pages of her VA medical records. CONSIDERATION OF EVIDENCE: 1. The applicant directly commissioned into the Regular Army as a captain and was ordered to active duty on 12 October 2008. She is a board certified physician assistant. She served in Iraq from 8 December 2009 to 22 November 2010. 2. On 22 March 2011, she was seen at Winn Army Community Hospital (ACH), Behavioral Health (BH) Division. She was given a provisional diagnosis of an adjustment disorder and referred to an outside BH provider. 3. A DD Form 2648 (Pre-Separation Counseling Checklist for Active Component Service Members) indicates she was voluntarily separating. 4. A memorandum, subject: Separation-Unqualified Resignation, issued by Commander, U.S. Army Human Resources Command (HRC), Fort Knox, Kentucky, dated 27 April 2011, shows her unqualified resignation from the Regular Army was approved. She had a remaining statutory military service obligation and required a Reserve appointment. 5. She received a psychological evaluation on 27 May 2011 by Coastal Psychology and was diagnosed with chronic PTSD. The medical provider stated the onset of her medical condition started during her service in Iraq. 6. On 5 August 2011, she was seen at Winn ACH, Fort Stewart, GA, for administrative purposes fulfilling out-processing requirements. It was noted she had previous BH treatment and had been seeing and continued to see an off-post provider. She was stable on medication and was encouraged to continue with therapy. She was advised to seek medical treatment from the VA upon her separation. 7. A DA Form 67-9 (Officer Evaluation Report (OER)) for the period from 24 December 2009 to 23 December 2010, signed by her rater on 9 August 2011 and by her senior rater on 27 July 2011, shows the applicant's performance and potential evaluation was rated as "Outstanding, Must Promote." In evaluating her promotion potential to the next higher grade her senior rater rated her as "Best Qualified." This evaluation noted she served in Iraq at a remote joint security station in support of an armor battalion. She had zero fatalities at the station and she provided medical care to more than 500 Iraqi citizens. 8. The available records contain no evidence showing she sustained an injury or was diagnosed with an illness of such severity that it rendered her unable to perform the duties commensurate with her grade and military occupational specialty, thereby warranting her entry into the Physical Disability Evaluation System (PDES) while she was on active duty. Additionally, there is no indication she had a permanent profile. 9. She was honorably released from active duty (REFRAD) on 12 October 2011 and transferred to the USAR Control Group (Reinforcement). Her DD Form 214 (Certificate of Release or Discharge from Active Duty) confirms her service in Iraq. 10. On 13 October 2011, she was appointed as a Reserve commissioned officer for an indefinite term. 11. On 29 July 2013, she received temporary change of station (TCS) orders deploying her in support of Operation Enduring Freedom with service in Germany. She entered active duty on 23 July 2013. 12. On 10 January 2014, she was seen at the Vilseck Chiropractic Clinic for middle to low back pain. She was seen and released without limitations. The medical examiner noted during a digital palpation that she had tenderness at the bilateral lower lumbar. 13. A DA Form 67-9 for the period from 19 July 2013 to 19 January 2014, signed by her rater and senior rater on 7 January 2014, shows the applicant's performance and potential evaluation were rated as "Outstanding, Must Promote." In evaluating her promotion potential to the next higher grade her senior rater rated her as "Best Qualified." Her rater and senior rater stated her performance was excellent. No physical limitations were noted and she had passed the Army Physical Fitness Test. 14. Medical records indicate she was seen at the William Beaumont Army Medical Center on 24 January 2014 for a Post-Deployment Health Assessment. It was noted the applicant had no current medical or BH issues and no further evaluation by the BH or TBI injury clinic was required. This form shows the MH questionnaires were assessed and discussed with the applicant. The applicant indicated she had no concerns about her health and all deployment-related concerns were addressed to her satisfaction. The medical provider stated, "I personally reviewed all responses on the DD Form 2796 (Post-Deployment Health Assessment)." 15. The available records contain no evidence showing she sustained an injury or was diagnosed with an illness of such severity that it rendered her unable to perform the duties commensurate with her grade and military occupational specialty, thereby warranting her entry into the PDES during this period of active duty. Additionally, there is no indication she had a permanent profile. 16. She was honorably REFRAD and transferred back to a USAR unit on 22 February 2014 in accordance with AR 600-8-24 (Officer Transfer and Discharges), paragraph 2-7, by reason of completion of required active service. 17. A DD Form 220 (Active Duty Report), dated 30 September 2014, shows she entered active duty on 5 September 2014. 18. A memorandum, subject: Notice of Medical Condition, issued by Carl R. Darnell Army Medical Clinic (AMC), dated 9 September 2014, shows she was to be REFRAD due to pre-existing or newly diagnosed medical conditions which prevented her from performing her military duties. A physician with the Carl R. Darnell AMC noted her REFRAD was secondary to medical conditions unlikely to be resolved in time for mobilization and she was determined to be unfit for duty. 19. On 24 September 2014, subsequent to her REFRAD, her commander requested an evaluation to determine if BH and/or physical factors played a significant role in her behavior and reaction during an encounter with a nurse. a. It was noted the applicant showed limited to no interest in psychological therapies for her reported PTSD, which was clearly not active and had remitted. b. She was diagnosed with PTSD, chronic, in remission with medication, and very mild TBI symptoms with no related cognitive impairment in her functional abilities. The provider noted "no indication of acute or chronic psychological distress." She did show some indication of very mild somatic and health complaints but nothing moderate or severe. The provider stated: "There are no indications that BH problems or pain are primary factors in her behavior." It was further noted she may or may not qualify for an MEB related to physical problems and mild TBI. 20. She was REFRAD on 1 October 2014 and transferred back to her USAR unit. She was on active duty for 27 days this period. There is no indication that she has been discharged or separated from the USAR. 21. Counsel provides: a. A compact disc containing 289 pages of the applicant's medical records, 161 pages of her military personnel records, and 389 pages of her VA medical records. The medical records documents her treatment for a variety of medical conditions to include PTSD, TBI, and shoulder/back pain. However, the records provided do not contain: * a permanent physical profile * a diagnosis of a disabling condition that rendered her unable to perform the duties required of her military occupational specialty (MOS) and grade * a medical examination that recommended her entry into the PDES b. A statement from the applicant, notarized on 19 August 2015, states, in effect: (1) She was directly commissioned into the Army as a captain in the Medical Specialist Corps. She was assigned to Fort Sam Houston, TX, for the Officer Basic Course and then assigned to Fort Stewart, GA. While assigned to Fort Stewart, GA, she completed several missions and field exercises and within 9 months was deployed to Sadir, Iraq. (2) During her deployment her unit had the highest rate of mild TBI in the brigade. They received an average of nine assault victims (rapid fire, rocket propelled grenade (RPG), etc.) each week. On two occasions mortar rounds exploded very close to her. One of the explosions was close enough to cause her ear to bleed. She was terrified and began to have memory lapses. Despite continuing combat stress she performed her duties well and received a Bronze Service Medal for her efforts. However, she began having problems concentrating and was depressed. (3) She relocated to Baghdad to provide medical support to other teams and was sent on numerous community medical outreach missions. While approaching a Blackhawk helicopter at night, she started to receive rapid fire. The Soldier at the helicopter door frantically motioned for her to run and jump into the helicopter, but due to poor visibility, uneven ground, and being in full battle gear, she slipped and took a hard direct blow to her right knee. (4) She's not exactly sure when she sustained a TBI but suspects it was while assigned to Sadir, Iraq. She redeployed 2 days before Thanksgiving in 2010. Upon her return, her knee was extremely painful and she was referred to an orthopedic surgeon and later required surgical repair. (5) By October 2011, she asked to leave active duty [unqualified resignation] due to medical problems including PTSD and TBI. She was not provided any briefing or counseling concerning her rights at that time to pursue an MEB/PEB. She received her first discharge on 10 October 2011. She sought medical assistance for PTSD from the VA within a month after her REFRAD. (6) During her convalescence leave and through the beginning of 2012, she sought help from the VA for various medical issues which began while she was on active duty. The VA rated her at a combined rating of 80 percent for service-connected disabilities. In the fall of 2012, she started her USAR career. (7) In 2013, she was mobilized with duty in Germany and was then sent to Romania. It was during her time in Romania that she injured her right shoulder and back while carrying a field surgical kit and lifting an injured Airman to a makeshift ambulance/van. The following morning she felt/heard the pop in her shoulder; as the pain worsened, and while still on active duty, she went to see a chiropractor. It was believed her shoulder pain was referred pain from her back and was advised to continue care upon her return to the States. In January 2014, she redeployed to Fort Bliss, TX, and REFRAD on 22 February 2014. Prior to her discharge in 2014, she was not provided with any briefing or counseling concerning her right to pursue an MEB/PEB or a temporary or permanent retirement from active duty. (8) In July 2014, she received another set of orders mobilizing her for a year. She voiced her concerns that her shoulder had been injured during her prior deployment and it was now a major issue and she possibly needed surgery. When she was mobilized in March, it effectively canceled her prior mobilization insurance under Tricare, thus she was not able to receive continued treatment for her shoulder. She reported for duty on 4 September 2014. It was determined she was not medically fit to perform her duties. She requested an MEB/PEB and it was denied. Subsequently she was REFRAD on 29 September 2014. She did not receive a DD Form 214 or any other benefits of a medically discharged Soldier from a mobilization because she was not activated for more than 30 days. (9) She is currently scraping by with her parents' financial support and VA services. Her nightmares have returned, her anxiety has worsened, her back pain is disturbing her sleep, and her energy has disappeared. She should have been properly counseled and medically evaluated in 2011 after her first deployment and again after her second deployment. Counseling and medical evaluations would have led her to seek an MEB/PEB. The seriousness of her conditions in 2011 and 2014 rendered her physically unfit to perform her duties. She should have been medically retired. 22. The applicant’s application, counsel statement and evidence were forward for an advisory opinion. On 7 September 2016, the Chief, Behavioral Health Division, Health Care Delivery, Medical Command, Office of The Surgeon General (OTSG), rendered an advisory opinion. a. The applicant most recently entered active duty on 13 July 2013 and received an honorable discharge on 5 February 2014 in accordance with AR 600-8-24, paragraph 2-7. She deployed to Iraq from December 2009 to November 2010 and [to Germany] from 2 August 2013 to January 2014. b. The applicant requested medical retirement with a disability rating of 80 percent for her service-connected injuries. OTSG was asked to determine her eligibility for a medical discharge based on a BH condition. This opinion is based on the information provided by the Board and records available in the Department of Defense (DOD) electronic medical record (AHLTA). c. In February 2011, the applicant was seen by BH for an off-base referral to Coastal Psychiatry in Savannah, GA, where she was diagnosed with adjustment disorder. A psychological evaluation dated 27 May 2011 concludes with a diagnosis of PTSD based on problems sleeping, concentrating, irritability, anger, and social isolation. In November 2011, she began receiving services at the VA for PTSD and other injuries incurred during her first deployment. In March 2012, she received 30 percent service-connected disability for PTSD. d. On 25 September 2014, her commander requested an evaluation to determine if BH and/or physical factors played a significant role in her behavior. She was diagnosed with PTSD, chronic, in remission with medication, and "very mild TBI" symptoms with no related cognitive impairment in her functional abilities. The provider observed "no indication of acute or chronic psychological distress," which he noted was consistent with her clinical presentation and Behavioral Health Data Platform self-report measures. A 29 September 2014, pre-deployment assessment concluded her PTSD is controlled with trazadone and Zoloft and her non-deployable status is secondary to right shoulder pain from her prior deployment. e. There is no evidence that she met criteria for a psychiatric condition that fell below retention standards and would have warranted referral to an MEB for possible medical retirement. 23. On 9 September 2016, the Case Management Division of the Army Review Boards Agency provided the applicant a copy of the advisory opinion for her review and comment. She did not respond. REFERENCES: 1. Title 10, USC, chapter 61, provides the Secretaries of the Military Departments with authority to retire or discharge a member if they find the member unfit to perform military duties because of physical disability. The U.S. Army Physical Disability Agency, under the operational control of the Commander, HRC, is responsible for administering the PDES and executes Secretary of the Army decision-making authority as directed by Congress in chapter 61 and in accordance with Department of Defense Directive 1332.18 (Disability Evaluation System) and AR 635-40. a. The objectives of the system are to: * maintain an effective and fit military organization with maximum use of available manpower * provide benefits for eligible Soldiers whose military service is terminated because of service-connected disability * provide prompt disability processing while ensuring that the rights and interests of the government and the Soldier are protected b. Soldiers are referred to the PDES when they: * no longer meet medical retention standards in accordance with AR 40-501, chapter 3, as evidenced by an MEB * receive a permanent medical profile, P3 or P4, and are referred by an MOS Medical Retention Board * are command-referred for a fitness-for-duty medical examination * are referred by the Commander, HRC c. The PDES assessment process involves two distinct stages: the MEB and PEB. The purpose of the MEB is to determine whether the service member’s injury or illness is severe enough to compromise his/her ability to return to full duty based on the job specialty designation of the branch of service. A PEB is an administrative body possessing the authority to determine whether or not a service member is fit for duty. A designation of "unfit for duty" is required before an individual can be separated from the military because of an injury or medical condition. Service members who are determined to be unfit for duty due to disability are either separated from the military or are permanently retired, depending on the severity of the disability and length of military service. Individuals who are "separated" receive a one-time severance payment, while veterans who retire based upon disability receive monthly military retirement payments and have access to all other benefits afforded to military retirees. d. The mere presence of a medical impairment does not in and of itself justify a finding of unfitness. In each case, it is necessary to compare the nature and degree of physical disability present with the requirements of the duties the Soldier may reasonably be expected to perform because of his or her office, grade, rank, or rating. Reasonable performance of the preponderance of duties will invariably result in a finding of fitness for continued duty. A Soldier is physically unfit when a medical impairment prevents reasonable performance of the duties required of the Soldier's office, grade, rank, or rating. 3. AR 40-501 governs medical fitness standards for enlistment, induction, appointment (including officer procurement programs), retention, and separation (including retirement). Paragraph 3-3a provides that performance of duty despite an impairment would be considered presumptive evidence of physical fitness. Paragraph 3-3b(1), as amended, 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. A physical profile rating of "3" in any of six rated categories (P-physical stamina, U-upper extremities, L-lower extremities, H-hearing, E-eyes, S-psychiatric) is a basis for referring a Soldier to the PDES. 4. Department of the Army Personnel Policy Guidance (PPG) for Overseas Contingency, dated 1 July 2009, last updated 9 August 2013, was developed to consolidate Theater and Department of the Army PPGs into one document in support of contingency operations. It provides that Reserve component (RC) Soldiers identified within the first 25-days as having a pre-existing medical condition that renders the individual non-deployable may be REFRAD immediately. The Soldier’s command will ensure that the Soldier receives appropriate medical care and follow-up upon return to home station. Care should result in either a return to duty status or MEB/PEB processing within 6 months. Upon resolution of the disqualifying medical condition, individuals are immediately subject to a subsequent order to active duty. Administrative processing of REFRAD orders, Soldier out-processing and return to home of record must be completed no later than (NLT) 30-days from Soldier’s mobilization (M)-date. 5. Title 38, USC, 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 an error or injustice on the part of the Army. The Army rates only conditions determined to be physically unfitting at the time of discharge which disqualify the Soldier from further military service. The Army disability rating is to compensate the individual for the loss of a military career. The VA does not have authority or responsibility for determining physical fitness for military service. The VA awards disability ratings to veterans for service-connected conditions, including those conditions detected after discharge, to compensate the individual for loss of civilian employability. 9. AR 635-40, paragraph 3-2b(2), provides that when a member is being separated by reasons other than physical disability, his or her continued performance of assigned duty commensurate with his or her rank or grade until he or she is scheduled for separation or retirement creates a presumption that he or she is fit. This presumption can be overcome only by clear and convincing evidence that he or she was unable to perform his or her duties for a period of time or that acute grave illness or injury or other deterioration of physical condition, occurring immediately prior to or coincident with separation, rendered the member unfit. In addition, the fact that a Soldier has a condition listed in the VASRD does not equate to a finding of physical unfitness. An unfitting, or ratable condition, is one which renders the Soldier unable to perform the duties of their office, grade, rank or rating. Chapter 8 (Reserve Components) provides that when a commander or other proper authority believes a Soldier not on extended active duty is unable to perform the duties of their office because of a physical disability, the commander or other official will refer the Soldier for a medical evaluation. DISCUSSION: 1. Counsel contends the applicant's records should be corrected to show she was permanently retired due to physical disability. 2. In reference to counsel's contention the Army failed to comply with Title 10, USC, section 1218 (d) in 2011. Title 10, USC, section 1218 (d) refers to members of the Reserve component. When the applicant was REFRAD from active duty on 12 October 2011, she was a Regular Army officer who voluntarily requested REFRAD. 3. In reference to counsel's contention the applicant's records should be changed to show she was permanently retired from active duty in 2011 due a physical disability: a. In order to be separated or retired for disability, the Army has a process that begins with entry into the PDES. Referral to the Army PDES requires a designation of "unfit for duty" before an individual can be separated from the military because of an injury or medical condition or referral from the Commander, HRC. b. On 23 March 2011, she was diagnosed with adjustment disorder and referred to an outside BH provider. She received a psychological evaluation on 27 May 2011 and was diagnosed with chronic PTSD. On 5 August 2011, she was seen at Winn ACH, Fort Stewart, GA, for administrative purposes for out-processing. It was noted she had previous BH treatment and had been seeing and continued to see an off-post provider. She was stable on medication and was encouraged to continue with therapy. c. The available records contain no evidence showing she sustained an injury or was diagnosed with an illness of such severity that it rendered her unable to perform the duties commensurate with her grade and MOS, thereby warranting her entry into the PDES while she was on active duty. Additionally, there is no indication she has been given a permanent profile. 4. In reference to counsel's contention the applicant should been permanently retired from active duty in 2014: a. The PPG provides that RC Soldiers identified within the first 25 days as having a pre-existing medical condition that renders the individual non-deployable may be REFRAD immediately. Soldier out-processing and return to home of record must be completed NLT 30 days from Soldier’s mobilization date. b. A DD Form 220 shows she entered active duty on 5 September 2014. On 9 September 2014, four days after entering active duty, a memorandum, subject: Notice of Medical Condition, issued by Carl R. Darnell, AMC, shows she was to be REFRAD due to a pre-existing or newly diagnosed medical condition which prevented her from performing military duties. c. A physician with the Carl R. Darnell AMC noted her REFRAD was secondary to medical conditions unlikely to be resolved in time for mobilization and was determined to be unfit for duty. She was REFRAD on 1 October 2014 and transferred back to her USAR unit. 5. In reference to counsel's contentions the applicant's medical conditions significantly limited and interfered with the performance of her military duties. a. Governing regulations provide that when a member is being separated by reasons other than physical disability, his or her continued performance of assigned duty commensurate with his or her rank or grade until he or she is scheduled for separation or retirement creates a presumption that he or she is fit. This presumption can be overcome only by clear and convincing evidence that he or she was unable to perform his or her duties for a period of time or that acute grave illness or injury or other deterioration of physical condition, occurring immediately prior to or coincident with separation, rendered the member unfit. b. The applicant's records contain two OERs for the periods from 24 December 2009 to 23 December 2010 and from 19 July 2013 to 19 January 2014 showing her performance and potential evaluation were rated as "Outstanding, Must Promote." In evaluating her promotion potential to the next higher grade her senior rater rated her as "Best Qualified." 6. An advisory opinion from the OTSG opinioned there was no evidence the applicant met criteria for a psychiatric condition that fell below retention standards and would have warranted referral to an MEB for possible medical separation during her periods of active duty. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20150014199 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20150014199 14 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2