IN THE CASE OF: BOARD DATE: 13 December 2016 DOCKET NUMBER: AR20150014281 BOARD VOTE: _________ _______ ________ GRANT FULL RELIEF ___x____ ____x___ ___x____ GRANT PARTIAL RELIEF ________ ________ ________ GRANT FORMAL HEARING ________ ________ ________ DENY APPLICATION 2 Enclosures 1. Board Determination/Recommendation 2. Evidence and Consideration IN THE CASE OF: BOARD DATE: 13 December 2016 DOCKET NUMBER: AR20150014281 BOARD DETERMINATION/RECOMMENDATION: 1. The Board determined that the evidence presented was sufficient to warrant a recommendation for partial relief. As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by referring his records to the Integrated Disability Evaluation System (IDES) to determine if he should have been discharged or retired by reason of physical disability. a. In the event that a formal physical evaluation board (PEB) becomes necessary, these proceedings serve as the authority to issue the individual concerned invitational travel orders to prepare for and participate in consideration of his case by a formal PEB. All required reviews and approvals will be made subsequent to completion of the formal PEB. b. Should a determination be made that the applicant should have been separated under the IDES, these proceedings will serve as the authority to void his administrative separation and to issue him the appropriate separation retroactive to his original separation date, with entitlement to all back pay and allowances and/or retired pay, less any entitlements already received. 2. The Board further determined that the evidence presented is insufficient to warrant a portion of the requested relief. As a result, the Board recommends denial of so much of the application that pertains to his reinstatement into the U.S. Army Reserve. _____________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: 13 December 2016 DOCKET NUMBER: AR20150014281 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 his military records to show he was medically retired due to post-traumatic stress disorder (PTSD). 2. The applicant states: a. His honorable discharge should be changed to a military medical retirement due to injuries he received during his service that prevented him from doing his job and continuing his military service. b. He received multiple injuries during his deployment that prevented him from continuing his duties. He was diagnosed with an anxiety disorder and he was told by his Family Life counselor/chaplain that he was exhibiting signs of PTSD. He believes the doctor who said he had an anxiety disorder misdiagnosed him, which prevented him from being evaluated by a medical evaluation board for PTSD. c. After his discharge, the Department of Veterans Affairs (VA) awarded him a 100-percent disability rating for PTSD and a traumatic brain injury (TBI). 3. The applicant provides: * DD Form 214 (Certificate of Release or Discharge from Active Duty) * VA medical records, dated 2011, 2012, and 2015 * memorandum for record, dated 27 July 2012, requesting a bar to reenlistment * VA Rating Decision, dated 29 July 2013 * letter from his wife, dated 22 October 2016 * DA Forms 4856 (Developmental Counseling Form) * DA Form 2823 (Sworn Statement) CONSIDERATION OF EVIDENCE: 1. The applicant enlisted in the Regular Army on 27 January 2009. He served as an explosive ordnance disposal specialist in Afghanistan from 11 June 2010 to 28 May 2011. 2. He provided a memorandum for record from his company commander, dated 27 July 2012, requesting his bar from reenlistment for lack of performance and general apathy toward training and development within his career field. 3. His Enlisted Record Brief, dated 10 January 2013, shows his physical profile rating as "111121," indicating limitations under the eyes factor. 4. On 26 January 2013, he was honorably released from active duty due to completion of required active service. 5. There is no evidence showing he was diagnosed with PTSD prior to his separation. 6. He provided a VA Rating Decision, dated 29 July 2013, which stated service connection was granted for PTSD with depressive disorder (also claimed as anxiety and insomnia) with an evaluation of 100 percent effective 27 January 2013. The narrative reason for this decision stated, "This is the highest schedular evaluation allowed under the law for this condition. Since there is the likelihood of improvement, the assigned evaluation is not considered permanent and is subject to a future review examination." He was also granted service connection for the following conditions with the corresponding evaluations: * migraine headaches – 50 percent * tinnitus – 10 percent * bilateral hearing loss – 0 percent * TBI – 0 percent * hyposmia – 0 percent 7. In the processing of this case, an advisory opinion was obtained from the Chief, Behavioral Health Division, Health Care Delivery, Office of the Surgeon General, who stated: a. The applicant asserts that injuries received during his service prevented him from doing his job and continuing his military service. In August 2010, he sustained a TBI from an improvised explosive device blast while deployed. In January 2012, he presented at the TBI clinic with irritability, short-term memory problems, insomnia, headaches, and dizziness. The TBI provider did not recommend continuation with phase 3 of the TBI assessment, noting that his symptoms were better explained by anxiety. He was prescribed medication for anxiety with no reported benefit and his last visit was in April 2012. According to the applicant, he was misdiagnosed with anxiety disorder which prevented him from pursing a medical evaluation board for PTSD. On 16 January 2013, his request for reenlistment was denied due to back problems. b. VA records indicate he was been treated for PTSD and has been unemployed since his discharge. A Rating Decision, dated 29 July 2013, granted him service connection for PTSD with depressive disorder (also claimed as anxiety and insomnia) with a disability rating of 100 percent effective 27 January 2013. In a 6 May 2015 note, he continued to endorse hypervigilance, hyperstartle, avoidance, and intrusive thoughts of combat almost daily. c. Although the applicant has struggled with PTSD symptoms, there is no indication that he failed to meet retention standards based on PTSD at the time of his separation. However, the majority of VA records address physical pain in both knees and his lower back and he was prevented from reenlisting because of back problems. This suggests that his case should be reviewed through the Integrated Disability Evaluation System. 8. A copy of the advisory opinion was forwarded to the applicant for comment and/or rebuttal. He responded and provided a letter from his VA counselor to the Integrated Disability Evaluation System, dated 18 October 2016. The letter stated: a. The applicant participated in counseling related to his problems managing PTSD and TBI symptoms. During this treatment experience he worked extensively to master adaptive coping strategies for managing both sets of symptoms. It is clear that his problems with PTSD are more profound because of his diagnosis of TBI. He has extreme memory deficits, impulsivity, and problems with poor focus and concentration, which make it difficult for him to organize himself and prioritize tasks for completion. b. When he first presented for treatment, he had difficulty remembering session dates and times and difficulty remembering the session content from week to week. He suffered from unremitting pain, headaches, problems with balance, and explosive anger outbursts. These symptoms continue to be problematic for him, impacting every area of his life. c. The Veterans Center does not have a medical provider or physician on staff. He has reviewed the applicant's medical record at the VA. The applicant has also been treated at the VA Polytrauma Center for his TBI diagnosis. REFERENCES: 1. 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. 2. Title 10, U.S. Code, chapter 61, provides 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. 3. Army Regulation 40-501 (Standards of Medical Fitness), chapter 7 (Physical Profiling), provides that the basic purpose of the physical profile serial system is to provide an index to the overall functional capacity of an individual and is used to assist the unit commander and personnel officer in their determination of what duty assignments the individual is capable of performing, and if reclassification action is warranted. Four numerical designations (1-4) are used to reflect different levels of functional capacity in six factors (PULHES): * P – physical capacity or stamina * U – upper extremities * L – lower extremities * H – hearing and ears * E – eyes * S – psychiatric 4. A physical profile rating of "1" under all factors indicates an individual is considered to possess a high level of medical fitness and, consequently, is medically fit for any military assignment. A physical profile rating of "2" under any or all factors indicates an individual possesses some medical condition or physical defect, which may require some activity limitations. 5. Title 38, U.S. Code, sections 310 and 331, permit the VA to award compensation for a medical condition which was incurred in or aggravated by active military service. The VA, however, is not required by law to determine medical unfitness for further military service. The VA, in accordance with its own policies and regulations, awards compensation solely on the basis that a medical condition exists and that said medical condition reduces or impairs the social or industrial adaptability of the individual concerned. Consequently, due to the two concepts involved, an individual's medical condition, although not considered medically unfitting for military service at the time of processing for separation, discharge, or retirement, may be sufficient to qualify the individual for VA benefits based on an evaluation by that agency. 6. The Diagnostic and Statistical Manual of Mental Disorders (DSM), chapter 7, addresses trauma and stress or related disorders. The DSM is published by the American Psychiatric Association (APA) and provides standard criteria and common language for classification of mental disorders. In 1980, the APA added PTSD to the third edition of its DSM nosologic classification scheme. Although controversial when first introduced, the PTSD diagnosis has filled an important gap in psychiatric theory and practice. From a historical perspective, the significant change ushered in by the PTSD concept was the stipulation that the etiological agent was outside the individual (i.e., a traumatic event) rather than an inherent individual weakness (i.e., a traumatic neurosis). The key to understanding the scientific basis and clinical expression of PTSD is the concept of "trauma." DISCUSSION: 1. The applicant contends he was misdiagnosed with anxiety disorder which prevented him from pursuing a medical evaluation board for PTSD and that he should have been medically retired for PTSD. 2. His Enlisted Record Brief shows his physical profile rating was "111121" on 10 January 2013. The numerical designator of "1" under all factors indicates an individual is considered to possess a high level of medical fitness and, consequently, is medically fit for any military assignment. A physical profile rating of "2" under any or all factors indicates an individual possesses some medical condition or physical defect that may require some activity limitations. 3. The advisory official noted that although the applicant has struggled with PTSD symptoms, there is no indication that he failed to meet retention standards based on PTSD at the time of his separation. The majority of VA records address physical pain in both knees and his lower back and he was prevented from reenlisting because of back problems. The advisory official states this suggests that his case should be reviewed through the Integrated Disability Evaluation System. 4. There is no evidence of record and he provided no evidence showing he was diagnosed with PTSD prior to his discharge. In July 2013, the VA granted him service connection for PTSD with depressive disorder (also claimed as anxiety and insomnia) effective 27 January 2013. 5. His contention that he was rated 100-percent disabled for PTSD by the VA was noted. However, the rating action by the VA does not demonstrate an error or injustice on the part of the Army. The VA, operating under its own policies and regulations, assigns service-connected disability ratings as it sees fit. The Army, not the VA, determines which conditions are unfitting for continued military 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) AR20150014281 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20150014281 6 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2