IN THE CASE OF: BOARD DATE: 21 March 2017 DOCKET NUMBER: AR20150015980 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: 21 March 2017 DOCKET NUMBER: AR20150015980 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: 21 March 2017 DOCKET NUMBER: AR20150015980 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 records to show she was evaluated under the Integrated Disability Evaluation System (IDES) and was either medically discharged or retired from the Army, based on the outcome of the IDES process. 2. The applicant states, in effect: a. Prior to her expiration term of service (ETS), she was speaking with an ombudsman out of California by the name of Mr. DS. She was seen for many years for multiple medical issues. She was recently looked at for an MEB, but was told that there was not enough evidence to warrant one. That is when Mr. DS told her what the doctors were looking at and she realized it was only part of her medical records. b. After she sent Mr. DS all of her medical records, the doctors at Fort Irwin said she should send in this application because there was a new program she qualified for, even though she was still in the Army at that time. She was put on Stelara by her dermatologist but she picked up her records before being placed on the medication. She has Tricare, so she is being seen by specialist on and off-post. 3. The applicant provides over 1,700 documents from various military and civilian medical providers, dated between approximately 29 August 2007 and 22 August 2016. CONSIDERATION OF EVIDENCE: 1. A DD Form 2807-1 (Report of Medical History), dated 14 August 2007, shows the applicant reported no health concerns in preparation for her enlistment in the Regular Army. 2. A DD Form 2808 (Report of Medical Examination), dated 14 August 2007, shows the applicant received an appropriate medical waiver to enlist after initially receiving a PULHES [the acronym used to address factors comprising the Military Physical Profile Serial System] of "3-1-1-1-1-1," meaning she had a medically recorded deficiency concerning her physical capacity or stamina (P), but no medically recorded deficiencies concerning her upper extremities (U), lower extremities (L), hearing and ears (H), eyes (E), and/or her psychiatric condition (S). 3. The applicant enlisted in the Regular Army on 27 August 2007, following 1 year, 8 months, and 15 days of prior inactive service in the Air National Guard. She completed advanced individual training (AIT) and was awarded military occupational specialty (MOS) 31B (Military Police). 4. The applicant performed military police duties at Fort Stewart, GA, from on or about 19 February 2008 through on or about 30 March 2013. 5. The applicant was reassigned to the 6th Recruiting Brigade, Las Vegas, NV on or about 10 May 2013, after a permanent change of station (PCS) move was approved for compassionate reasons. A DA Form 1695 (Oath of Extension of Enlistment), dated 7 April 2014, shows she requested and was granted a one year enlistment extension to her seven year contract, in order to reach her retention control point (RCP) for the rank of CPL/E4 (eight years). 6. The applicant was honorably discharged on 26 August 2015, under the provisions of Army Regulation 635-200 (Active Duty Enlisted Administrative Separations), chapter 4, upon reaching her RCP. Her DD Form 214 shows she served as a Military Policewoman for 7 years and 6 months, completed 8 years of net active service, separated in the rank/grade of corporal (CPL)/E-4, and received full separation pay in the amount of $23,535.38. 7. The applicant's enlisted record brief (ERB), dated 27 August 2015, shows her immediate reenlistment eligibility/prohibition code as "9G," reaching her RCP for current grade. The ERB also shows she maintained a PULHES of "1-1-1-1-1-1" at her time of discharge. There is no evidence in her record that shows she received a DA Form 3349 (Physical Profile) listing any unfitting medical condition(s) that warranted her referral to, or was referred for processing through, the Army's IDES prior to being honorably discharged from active duty. 8. The applicant's record does not contain a separation physical/medical examination. In addition, there is no evidence she is receiving benefits from the Department of Veterans Affairs (VA) for service-connected conditions. 9. The applicant provides over 1,700 documents pertaining to her medical history during her period of active duty. These documents show she was treated and sought treatment for a variety of medical concerns to include headaches, and chronic pain to her head, neck, shoulders, back and arms. 10. In connection with the processing of this case, an advisory opinion was obtained on 29 September 2016 from the Army Review Board Agency's (ARBA) Senior Medical Advisor. The medical advisory opinion states: a. A review of the applicant's electronic medical record (AHLTA) revealed approximately 300 patient encounters between 29 August 2007 and 22 August 2016. b. No physical profiles (DA Form 3349) were submitted with the applicant's request, and limited review of the Department of Veterans Affairs (VA) records through the Joint Legacy Viewer (JLV) held no VA entered diagnosis. c. The applicant met medical retention standards in accordance with (IAW) Army Regulation 40-501 (Standards of Medical Fitness), chapter 3, and following the provision in Army Regulation 635-40 that were applicable to the applicant's period of service. d. Despite the start of injection therapy for psoriasis, for referral to an MEB the psoriasis must be extensive and not controllable by treatment. e. For patients chronic pain syndrome (neck/thoracic/back), referral to an MEB requires non-radicular pain involving the cervical, thoracic, lumbosacral, or coccygeal spine, whether idiopathic or secondary to degenerative disc or joint disease, that fails to respond to adequate conservative treatment and necessitates significant limitation of physical activity. Based on the review of the available documentation, the applicant's chronic pain syndrome was controlled with medication therapy and intermittent injection therapy. f. For the applicant's headaches requiring BOTOX therapy, referral to an MEB requires migraine, tension, or cluster headaches, when manifested by frequent incapacitating attacks. Based on the review of the available documentation, the applicant's headaches were controlled with medication and prophylactic injection therapy. g. For the applicant's history of chronic narcotic/opioid medication use for pain control, chronic medication use by itself is not a specific indication for referral to an MEB. Note: certain types of medication for serious and/or complex medical conditions may be deployment limiting or may disqualify Soldiers for certain duty assignments. h. The applicant's medical conditions were duly considered during medical separation processing. The applicant clearly has significant medical issues but there is no evidence of significant occupational impairment or limitation noted in the available documentation. i. A review of the available documentation found no evidence of a medical disability or condition which would support a change to the reason for discharge in this case. 11. The advisory opinion was provided to the applicant on or about 30 September 2016, to provide her an opportunity to comment or rebut the opinion. She did not respond. REFERENCES: 1. Army Regulation 40-501 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. Performance of duty despite impairment would be considered presumptive evidence of physical fitness. a. Paragraph 7-3 provides an individual having a numerical designation of "1" under all PULHES factors is considered to possess a high level of medical fitness. b. Paragraph 7-4 provides profiles are considered permanent unless a modifier of "T" (temporary) is added. A permanent profile may only be awarded or changed by the authority designated in paragraph 7–6, below. All permanent "3" and "4" profiles, for Soldiers on active duty, will be reviewed by an MEB physician or physician approval authority. An MEB physician is an MTF dedicated subject matter expert trained to perform disability evaluations. c. Paragraph 7-6 provides medical treatment facility commanders may designate one or more profiling officers who are physicians, dentists, optometrists, podiatrists, audiologists, nurse practitioners, nurse midwives, licensed clinical psychologists, and physician assistants as profiling officers. The commander will assure that those designated are thoroughly familiar with the contents of Army Regulation 40-501. 2. Army Regulation 635-40 establishes the Physical Disability Evaluation System (PDES) and sets forth policies, responsibilities, and procedures that apply in determining whether a Soldier is unfit because of physical disability to reasonably perform the duties of his or her office, grade, rank, or rating. It provides that an MEB is convened to document a Soldier's medical status and duty limitations insofar as duty is affected by the Soldier's status. A decision is made as to the Soldier's medical qualifications for retention based on the criteria in Army Regulation 40-501. Disability compensation is not an entitlement acquired by reason of service-incurred illness or injury; rather, it is provided to Soldiers whose service is interrupted and who can no longer continue to reasonably perform because of a physical disability incurred or aggravated in service. a. Paragraph 2-1 provides that the mere presence of impairment does not of itself justify a finding of unfitness because of physical disability. In each case, it is necessary to compare the nature and degree of physical disability present with the requirements of the duties the member reasonably may be expected to perform because of his or her office, rank, grade, or rating. The Army must find that a service member is physically unfit to reasonably perform his or her duties and assign an appropriate disability rating before he or she can be medically retired or separated. b. Paragraph 2-2b(1) provides that when a member is being processed for separation for reasons other than physical disability (e.g., retirement, resignation, reduction in force, relief from active duty, administrative separation, discharge, etc.), his or her continued performance of duty (until he or she is referred to the PDES for evaluation for separation for reasons indicated above) creates a presumption that the member is fit for duty. Except for a member who was previously found unfit and retained in a limited assignment duty status in accordance with chapter 6 of this regulation, such a member should not be referred to the PDES unless his or her physical defects raise substantial doubt that he or she is fit to continue to perform the duties of his or her office, grade, rank, or rating. c. Paragraph 2-2b(2) provides that when a member is being processed for separation for reasons other than physical disability, the presumption of fitness may be overcome if the evidence establishes that the member, in fact, was physically unable to adequately perform the duties of his or her office, grade, rank, or rating even though he or she was improperly retained in that office, grade, rank, or rating for a period of time and/or acute, grave illness or injury or other deterioration of physical condition that occurred immediately prior to or coincidentally with the member's separation for reasons other than physical disability rendered him or her unfit for further duty. 3. Directive-Type Memorandum (DTM) 11-015 explains the IDES. It states: a. The IDES is the joint DOD-VA process by which DOD determines whether wounded, ill, or injured service members are fit for continued military service and by which DOD and VA determine appropriate benefits for service members who are separated or retired for a service-connected disability. The IDES features a single set of disability medical examinations appropriate for fitness determination by the Military Departments and a single set of disability ratings provided by VA for appropriate use by both departments. Although the IDES includes medical examinations, IDES processes are administrative in nature and are independent of clinical care and treatment. b. Unless otherwise stated in this DTM, DOD will follow the existing policies and procedures requirements promulgated in DODI 1332.18 and the Under Secretary of Defense for Personnel and Readiness memoranda. All newly initiated, duty-related physical disability cases from the Departments of the Army, Air Force, and Navy at operating IDES sites will be processed in accordance with this DTM and follow the process described in this DTM unless the Military Department concerned approves the exclusion of the service member due to special circumstances. Service members whose cases were initiated under the legacy DES process will not enter the IDES. c. IDES medical examinations will include a general medical examination and any other applicable medical examinations performed to VA C&P standards. Collectively, the examinations will be sufficient to assess the member’s referred and claimed condition(s) and assist VA in ratings determinations and assist military departments with unfit determinations. d. Upon separation from military service for medical disability and consistent with BCMR procedures of the Military Department concerned, the former service member (or his or her designated representative) may request correction of his or her military records through his or her respective Military Department BCMR if new information regarding his or her service or condition during service is made available that may result in a different disposition. For example, a veteran appeals VA’s disability rating of an unfitting condition based on a portion of his or her service treatment record that was missing during the IDES process. If VA changes the disability rating for the unfitting condition based on a portion of his or her service treatment record that was missing during the IDES process and the change to the disability rating may result in a different disposition, the service member may request correction of his or her military records through his or her respective Military Department BCMR. e. If, after separation from service and attaining veteran status, the former service member (or his or her designated representative) desires to appeal a determination from the rating decision, the veteran (or his or her designated representative) has 1 year from the date of mailing of notice of the VA decision to submit a written notice of disagreement with the decision to the VA regional office of jurisdiction. 4. Title 38, U.S. Code, sections 1110 and 1131, permits 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. The VA can evaluate a veteran throughout his or her lifetime, adjusting the percentage of disability based upon that agency's examinations and findings. However, these changes do not call into question the application of the fitness standards and the disability ratings assigned by proper military medical authorities during the applicant’s processing through the Army IDES. DISCUSSION: 1. The applicant's request for correction of her records to show she was evaluated under the IDES and was either medically discharged or retired from the Army, based on the outcome of the IDES process, was carefully considered. 2. The applicant's ERB confirms she maintained a high level of physical fitness during her period of active military service, as evidenced by her PULHES of "1-1-1-1-1-1." 3. The applicant's DD Form 214 shows she maintained MOS 31B from the completion of her AIT throughout her date of separation. There is no evidence she failed to meet retention criteria in accordance with Army Regulation 40-501, Chapter 3, nor any evidence she was diagnosed with having a physical disability that prevented her from reasonably performing her military police duties. 4. The applicant was honorably discharged upon reaching her RCP. A thorough review of her military record reveals no indication that she was referred for processing through the IDES prior to her discharge as a result of any unfitting medical conditions. 5. The ARBA Senior Medical Advisor opined, after a thorough review of her medical records, that her chronic pain and additional medical concerns did not require referral to an MEB; therefore, there is no evidence to support correcting her record by allowing her to undergo the IDES process. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20150013978 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20150015980 8 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2