ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS IN THE CASE OF: BOARD DATE: 8 April 2019 DOCKET NUMBER: AR20160012655 APPLICANT REQUESTS: * a Line of Duty (LOD) determination * a Medical Evaluation Board (MEB) * pay and allowances from her Release From Active Duty (REFRAD) date to her reserve retirement date or incapacitation pay from her REFRAD to her reserve retirement date * personal appearance before the Board APPLICANT’S SUPPORTING DOCUMENT CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * two supplemental statements from the applicant's attorney * letters from medical personnel * letter from the applicant's sister * medical records * Physical Evaluation Board (PEB) * orders placing applicant on active duty * Adverse Clinical Privileging Action * Adverse Action Report * LOD dated 28 January 2010 * Inspector General's (IG) response to applicant's request * Informal LOD dated 23 February 2010 * rebuttal to Informal LOD * DA Form 3349 (Physical Profile) * e-mails from Legal Assistance Attorney * Statement of Retirement Points * Letter from Army Board for Correction of Military Records (ABCMR) * advisory opinion from previous ABCMR case * legal review for formal LOD * request for reconsideration of previous ABCMR case * response to ABCMR regarding previous case * LOD appeal * excerpt from DA Pam 135-381 (Incapacitation of Reserve Component Soldiers Processing Procedures) * retirement orders * emails regarding incapacitation pay * letter from Board of Nursing * DA Forms 7574 (Incapacitation Pay Monthly Claim Form) * applicant letter to the Army Review Board Agency regarding her application * DA Form 689 (Individual Sick Slip) * Statement of Medical Examination and Duty Status * Post-Deployment Heath Assessment FACTS: 1. The applicant did not file within the three year time frame provided in Title 10, U.S. Code, section 1552 (b); however, the Army Board for Correction of Military Records conducted a substantive review of this case and determined it is in the interest of justice to excuse the applicant's failure to timely file. 2. The applicant, through her attorney, states: a. This is a classic case of a USAR Soldier being maltreated by the administrators of the Disability Evaluation System (DES). The Army failed to grant the applicant an LOD for her psychiatric and medical conditions that were aggravated by her military service, which resulted in the applicant being REFRAD improperly. b. The applicant had a diagnosis of Major Depressive Disorder Single Episode, in Full Remission on 7 November 2005 and was found fit for duty. A Non-duty Related PEB was conducted on 14 August 2007 and again found the applicant fit for duty. c. The Non-Duty Related PEB recognized the underlying depression was not developed in the line of duty. It also recognized the depression met retention standards. The applicant continued to meet retention standards and was ordered to Active Duty on 19 September 2008 for a period of 320 days. d. While on Active Duty, the applicant's mental and physical condition began to deteriorate. She was diagnosed with transient Ischemic Attack (TIA), seizure, migraine and depression. She was complaining of severe migraine headaches and gastrointestinal issues. e. The diagnosis of depression continued through July of 2009 when the applicant was placed on convalescent leave for her depression. Additionally, the applicant was diagnosed with Hemiplegic Migraine on 5 August 2009 with a notation the applicant should remain on convalescent leave because the migraines were not under control. f. The applicant was REFRAD on 15 August 2009 with no action taken to place her in the Warrior Transition Unit (WTU) or to initiate an MEB. The REFRAD took place even though the applicant had been diagnosed with major depression, moderate, recurrent in March of 2006 and major depression severe, recurrent in May of 2006 by the Department of Veterans Affairs (VA). The REFRAD action was in violation of regulation and was unjust and inequitable. g. During the applicant’s Active Duty, she became an impaired healthcare provider and on 24 September 2009, her clinical privileges were restricted due to impaired health care while at Fort Leavenworth. This is proof she did not meet retention standards. h. After her REFRAD, the applicant’s condition continued to deteriorate. She sought assistance from the Army Reserve Medical Command IG to obtain a medical retention extension on active duty to address her medical conditions. i. The applicant was treated at Bethesda Navy Hospital and Walter Reed Army Medical Center (WRAMC) after her REFRAD. She did not return to reserve duty. During her treatment at Bethesda and WRAMC, it was recommended the applicant receive an MEB; however, her reserve unit did not initiate an MEB, did not initiate incapacitation pay, and did not provide the applicant assistance in being assigned to the WTU. j. The IG incorrectly concluded the applicant's conditions pre-existed prior to her entry onto active duty and therefore DES processing in any form was foreclosed. This conclusion was derived from an opinion provided by a non-lawyer at Army Reserve Medical Command. k. The applicant's condition continued to get worse and on 24 February 2010, she was involuntarily admitted into inpatient psychiatric care at WRAMC where she received electric shock treatment. She was discharged on 16 April 2010 with a P-4 profile. Her psychiatric condition was changed to Bipolar Disorder NOS and hemiplegic migraines were noted. Her discharge noted she required a MEB due to her psychiatric diagnosis. Many of the doctors and nurses on her ward wrote letters advocating for an MEB for the applicant. The policy officer at the Physical Disability Agency stated the applicant should not have been REFRAD if she fell below medical retention standards and should be returned to Active Duty for DES processing and any LODs should be stopped. l. The applicant was found fit for duty prior to her activation by her doctor and a PEB after considering her preexisting psychiatric condition. The Army was fully aware of her condition and what it was getting in the applicant. m. The applicant's mental and physical conditions deteriorated in the Spring of 2009, she was unable to discharge her duties to the point there were restrictions placed on her privileges to practice as a nurse practitioner. She did not meet retention standards. n. These circumstances are squarely within the concept of service aggravation. The severity of her mental condition and migraines could not and was not considered to be normal progression. The conditions arose exclusively while she was on active duty. This is a service member with 19 years, 7 months, and 17 days of qualifying time for reserve retirement. Her medical condition interfered with her duty performance while on active duty at Fort Leavenworth. She should be granted relief immediately. 3. The applicant was a member of the USAR and was ordered to active duty with a report date of 29 September 2008. The period of active duty was 320 days. Prior to her activation, she had a PEB for Reserve Component Non-Duty Related Fitness for cervical spine, chronic low back pain, and lumbar spine herniation. The PEB found her fit for duty. 4. The applicant provides medical documents that indicate she has suffered from depression since her teenage years. A letter from her psychiatrist dated 7 November 2005 indicates her depression is in continued remission since her evaluation conducted in April 2005. Her diagnosis is Major Depressive Disorder, Single Episode, in Full Remission. She did not require any additional psychotherapy sessions at that time. 5. The applicant's service records include a physical profile dated 5 December 2007. One of the medical conditions for the profile was depression. The applicant provides a physical profile dated 15 April 2010 which includes the medical conditions Bipolar Disorder NOS and Post-Traumatic Stress Disorder (PTSD). 6. During the applicant's mobilization, she was hospitalized for depression. Upon release from the hospital in June 2009, she was placed on convalescent leave and was not allowed to drive. She continued to receive treatment for her depression until she was REFRAD on 15 August 2009. She had served 10 months and 20 days of Active Duty Service. 7. The applicant, through her attorney, contends she should not have been released from Active Duty while still receiving medical care for her depression. Army Regulation 135-381 (Incapacitation of Reserve Component Soldiers) states that Soldiers who incur or aggravate an injury, illness, or disease while on orders for more than 30 days may elect to extend on active duty until treatment is completed. There is no evidence in the applicant's records indicating she requested to remain on active duty to continue her treatment. 8. The applicant applied to the ABCMR requesting an LOD investigation on 28 November 2010. The ABCMR closed the case on 1 August 2011 because they had received an advisory opinion from the Army Reserve G-1, Service and Support Division, which indicated her request for LOD investigation had been approved. 9. The applicant's service record does not contain the Formal LOD; however, the applicant provides a legal review of the Formal LOD completed on 1 May 2012. The legal review states: * the LOD Investigation recommendation that the applicant's medical condition/illnesses did not occur in the line of duty is legally sufficient * all of the evidence supports the conclusion these conditions existed prior to her mobilization 10. The applicant has requested an MEB. Army Regulation 40-501, Chapter 3 provides guidance on the various medical conditions and physical defects which may render a Soldier unfit for further military service and which fall below the standards required for service. Paragraph 3-3d states, physicians who identify Soldiers with medical conditions should initiate an MEB at the time of identification. There is no evidence any of the physicians the applicant saw initiated MEB processing; however, the applicant provides a DA Form 7574-1 (Military Physician's Statement of Soldier's Incapacitation/Fitness for Duty) dated 21 October 2011, which indicates he examined the applicant on 21 October 2011 and she was not fit to perform military duties from 27 April 2009 to an indefinite date and that an MEB was initiated on 14 February 2011. There is no evidence in the applicant's service records that an MEB was initiated. 11. The applicant has requested incapacitation pay from her REFRAD to her reserve retirement date. DA Pam 135-381 states, upon learning of a Soldier’s injury, illness, or disease, the unit commander will immediately counsel Soldier to read and sign DA Form 7574–2 (Soldiers Acknowledgement of Incapacitation Pay Counseling Statement) and indicate that they may be entitled to incapacitation pay, the pay will not exceed full pay and allowances for the Soldier’s pay grade and years of service, it will be reduced by any other earned income received from other sources, it will be paid only during the period they remain not fit for military duty, it may not be paid for more than 6 months without approval by the Secretary of the Army or their designee, if they have been determined to be fit for military duty, but unable to perform their civilian duties, they will be able to attend IDT or assigned AD, but must be able to fully document his/her inability to perform civilian duties. 12. The applicant provides several DA Forms 7574 (Incapacitation Pay Monthly Claim Forms) and an email from Ms. X X X , 221st USA Medical Support Unit. The email states, the documents for the applicant’s Incapacitation Pay are incorrect and need to be corrected and the applicant needed to provide further evidence to substantiate the request. There is no evidence the applicant corrected the DA Forms 7574 or provided the requested documents to support her claim. 13. The applicant provides letters from Dr. X X , Medical Director, Mcdpsych Health Services, X X. X , Medical Director Barquest Army Health Clinic, and X X which state in part: * the applicant carries the diagnosis of Bipolar disorder and PTSD * she is currently prescribed psychotropic medications * she is also diagnosed with executive dysfunction and memory problems * the applicant had to stop working due to her mental illness * she is not able to restart working * she has undergone extensive medical evaluation to include neuropsychiatric testing * her deficits prevent her from working * she has multiple medical problems that would make it difficult for her to be employed in any capacity * the applicant was seen on 15 January 2010 * she presented as psychotically depressed with suicidal ideation * she was hospitalized at WRAMC for inpatient treatment from January 2010 to April 2010 * she was diagnosed with Bipolar Disorder * she continues to have mood switches, primarily depressive episodes of one to two weeks duration where she isolates herself at home * she is having memory problems * these symptoms keep her from being employable 14. The applicant provides a letter from Mrs. X X , her sister, which states in part: * she is writing in support of the applicant's request for incapacitation pay and the loss of her career * the applicant suffers from Traumatic Brain Injury, Depression, Amnesia, Short Term Memory Loss, Cognitive and Neurological Dysfunction, and PTSD * these injuries occurred when the applicant was on active duty and are military service related * the applicant received a head injury in August 2008 * she was treated by the doctor on duty but did not seek further medical treatment * because of the head injury, she lost memory of her head injury occurring * she found out about the head injury in 2011 after looking through her medical records * she was deployed to Fort Leavenworth, Kansas in September 2009 * within four months of her deployment she was relived of her duties as a Nurse Practitioner for being incompetent and providing substandard care * she was assigned to a minimum position of making patient care records and stapling papers together after that * she has not worked as a Nurse Practitioner since May 2009 * she has been unemployed since she was relieved from active duty in August 2009 * she became very ill and depressed in December 2009 * she was started on antidepressant medication * in January 2010 she was admitted to the hospital for self-harm, dissociate disorder, and severe depression * she remained hospitalized for 2 weeks * a week later she was admitted to WRAMC and given electroconvulsive therapy * after this therapy she experienced amnesia, cognitive and neurological impairment and short-term memory loss * she didn't remember what year it was, she didn't remember the death of her husband, she didn't know she was in the hospital, and she didn't recognize her family * this was frustrating for her family and staff * her behavior would be inappropriate at times * it is very embarrassing for her and her family members * the applicant's sister believes these symptoms are related to the untreated head injury * the applicant was in the hospital from January to April 2010 * she was discharged into the care of her sister, X * after the applicant was discharged, she was low functioning * she had difficulty with everyday tasks such as reading and writing * she continued to suffer with her symptoms * she was told it would take years for her memory to return * after 5 years she has made no significant improvement * she can no longer do back-to-back consistent daily activities * she is not consistent with dressing, bathing, or taking her medication * she has difficulty walking up and down the stairs or lifting more than 10 pounds * she has difficulty monitoring her thoughts and says inappropriate things * because of this, she does not socialize * she has appointed her sister, the writer, as her legal guardian to assist with finances * she forgets phone numbers, loses items and forgets where she puts things * she is a danger to herself and no longer able to cook for herself * she leaves the front door open at night and leaves the garage door open * she calls her every night to ensure the applicant's doors are shut and locked * the applicant can't take care of the house so she has to pay someone to clean for her * she loses track of days sometimes sleep for 24 to 48 hours at a time * she was involuntarily hospitalized in September 2014 after locking herself in the house for 2 weeks without taking her medication * she is currently on psychiatric medications and seeing a psychotherapist and psychiatrist * she is homebound because of her disabilities * she is unable to drive * she is unable to work as a Nurse Practitioner and is unemployable 15. The applicant received a memorandum from Headquarters, 99th Regional Support Command on 26 September 2016 stating she had completed 18 but less than 20 qualifying years of service. Her retention was authorized until she completed 20 qualifying years for retired pay. She was honorably retired from the USAR on 25 May 2014. 16. In the processing of this case an advisory opinion was obtained from the ARBA Senior Medical Advisor on 14 November 2018. The advisory official opined: * the applicant's available records support major depressive disorder, PTSD by history, and history of TBI * the condition clearly met medical retention standards * there were no medical waivers for enlistment found for migraines, depression, personality disorder or history of suicide attempt * there were no medical waivers for accession, appointment and/or commissioning found for depression, diagnosis of personality disorder, and/or history of two suicide attempts one at age 16 and the other associated with her first spouse, and psychiatric hospitalizations * the applicant underwent MEB/PEB non-duty related processing from 2006 through 2007 and was found fit for duty * the applicant did not meet medical retention standards for existing prior to service (EPTS) nondisclosed hemiplegic migraine * during active federal service in April 2009, the applicant's hemiplegic migraines did not reach a medical retention determination point for treatment purposes * the applicant's neurological and/or behavioral conditions were clearly not aggravated by military service * the applicant met medical retention standards * the applicant's medical conditions were duly considered during medical separation processing * a review of the available documentation found no evidence of a medical disability or condition that would support a change to the character and/or reason for discharge * the basis for the applicant's incapacitation pay request during and following demobilization is not clear * there is insufficient cause to recommend a change in the Non-duty Related PEB fitness determination * there is insufficient cause to recommend additional DES processing * the Army has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation 17. The applicant, through her attorney, was provided a copy of this advisory opinion on 20 November 2018, to provide her an opportunity to comment and/or submit a rebuttal. She nor her attorney responded. 18. AR 15-185 (ABCMR) states an applicant is not entitled to a hearing before the ABCMR. Hearings may be authorized by a panel of the ABCMR or by the Director of the ABCMR. BOARD DISCUSSION: 1. After review of the application and all evidence, the Board determined there is insufficient evidence to grant relief. The applicant’s contentions through counsel, her medical concerns, letters of support, and the medical advisory opinion were carefully considered. The medical advisory opinion provided facts that did not support her requests in which the Board used during their deliberation. The applicant and her counsel had the opportunity to rebut the advisory; however, there was no response. Based upon the preponderance of evidence, the Board agreed the applicant’s medical concerns were dully considered prior to her retirement, and further medical evaluation is not recommended; there was no error or injustice in this case. 2. The applicant's request for a personal appearance hearing was carefully considered. In this case, the evidence of record was sufficient to render a fair and equitable decision. As a result, a personal appearance hearing is not necessary to serve the interest of equity and justice in this case. BOARD VOTE: Member 1 Member 2 Member 3 : : : GRANT FULL RELIEF : : : GRANT PARTIAL RELIEF : : : GRANT FORMAL HEARING :X :X :X DENY APPLICATION 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. 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. ADMINISTRATIVE NOTE(S): N/A REFERENCES: 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. 2. Army Regulation 15-185 (ABCMR) prescribes the policies and procedures for correction of military records by the Secretary of the Army, acting through the ABCMR. The regulation provides that the ABCMR begins its consideration of each case with the presumption of administrative regularity. The applicant has the burden of proving an error or injustice by a preponderance of the evidence. It is not an investigative body. The ABCMR may, in its discretion, hold a hearing. Applicants do not have a right to a hearing before the ABCMR. The Director or the ABCMR may grant a formal hearing whenever justice requires. 3. Army Regulation 600-8-4 prescribes policies and procedures for investigating the circumstances of disease, injury, or death of a Soldier providing standards and considerations used in determining LOD status. a. A formal LOD investigation is a detailed investigation that normally begins with DA Form 2173 completed by the medical treatment facility and annotated by the unit commander as requiring a formal LOD investigation. The appointing authority, on receipt of the DA Form 2173, appoints an investigation officer (IO) who completes DD Form 261 and appends appropriate statements and other documentation to support the determination, which is submitted to the General Court Martial Convening Authority for approval. b. LOD determinations must be supported by substantial evidence and by a greater weight of evidence than supports any different conclusion. The evidence contained in the investigation must establish a degree of certainty so that a reasonable person is convinced of the truth or falseness of a fact. c. Paragraph 4-8e states the following concerning injury or disease existing prior to service. (1) The term "existed prior to service (EPTS)" is added to a medical diagnosis. It shows that there is substantial evidence that the disease or injury, or underlying condition existed before military service. Included in this category are chronic diseases with an incubation period that clearly precludes a determination that it started during short tours of authorized training or duty. (2) The doctor, during examination and treatment of the Soldier, usually determines an EPTS condition. The doctor annotates the Soldier's medical records as to whether the condition existed prior to service. If an LOD determination is required, information from the medical records will be used to support a determination that an EPTS condition was or was not aggravated by military service. If an EPTS condition was aggravated by military service, the determination will be "in line of duty." If an EPTS condition is not aggravated by military service, the determination will be "not in line of duty – not due to own misconduct." 4. Army Regulation 40-501 governs medical fitness standards for enlistment, induction, appointment, retention, separation, and retirement. a. Chapter 3 provides guidance on the various medical conditions and physical defects which may render a Soldier unfit for further military service and which fall below the standards required for service. These medical conditions and physical defects, individually or in combination, are those that significantly limit or interfere with the Soldier’s performance of their duties; may compromise or aggravate the Soldier’s health or well-being if the Soldier were to remain in the military Service (this may involve dependence on certain medications, appliances, severe dietary restrictions, or frequent special treatments, or a requirement for frequent clinical monitoring); may compromise the health or well-being of other Soldiers; or may prejudice the best interests of the Government if the individual Soldier were to remain in the military Service. b. Paragraph 3-3d states, physicians who identify Soldiers with medical conditions listed in this chapter should initiate an MEB at the time of identification. Physicians should not defer initiating the MEB until the Soldier is being processed for nondisability retirement. Many of the conditions listed in this chapter fall below retention standards only if the condition has precluded or prevented successful performance of duty. In those cases when it is clear the condition is long standing and has not prevented the Soldier from reaching retirement, then the Soldier meets the standard and an MEB is not required. c. Paragraph 7-11a(3)(e) provides that Item 4 of the DA Form 3349 will specify the profile type - temporary or permanent. If the profile is permanent, the profiling officer must assess whether the Soldier meets the retention standards of Army Regulation 40-501, chapter 3. Those Soldiers who meet retention standards but have at least a permanent 3 or 4 PULHES serial will be referred to an MOS Medical Retention Board (MMRB) in accordance with Army Regulation 600–60 (Physical Performance Evaluation System), unless waived by the MMRB convening authority. Those Soldiers who do not meet retention standards must be referred to an MEB as per chapter 3. 5. Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation) establishes the Army 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. Only the unfitting conditions or defects and those that contribute to unfitness will be considered in arriving at the rated degree of incapacity warranting retirement or separation for disability. a. Paragraph 3-4 provides that under the laws governing the Army PDES, Soldiers who sustain or aggravate physically unfitting disabilities must meet the following LOD criteria to be eligible to receive retirement and severance pay benefits: (1) The disability must have been incurred or aggravated while the Soldier was entitled to basic pay or as the proximate cause of performing active duty or inactive duty training; and (2) The disability must not have resulted from the Soldier’s intentional misconduct or willful neglect and must not have been incurred during a period of unauthorized absence. b. Paragraph 8-6 provides that when a commander believes that a Soldier not on extended active duty is unable to perform his or her duties because of physical disability, the commander will refer the Soldier for medical evaluation. The Medical Treatment Facility (MTF) commander having primary medical care responsibility will conduct an examination of a Soldier referred for evaluation. The commander will advise the Soldier’s unit commander of the results of the evaluation and the proposed disposition. If it appears the Soldier is not medically qualified to perform duty, the MTF commander will refer the Soldier to an MEB. If the Soldier is not eligible for referral to a PEB, the MTF will notify the Soldier’s unit commander for disposition under applicable regulations. c. Paragraph 8-9 provides that a Soldier not on extended active duty, who is unfit because of physical disability: (1) May be permanently retired or have his or her name placed on the TDRL, if: • he or she has at least 20 years of service • their disability is rated at 30 percent or more • his or her disability occurred in the line of duty, and is the proximate result of performing active duty or IDT (2) May be separated with severance pay if: • his or her disability is rated at less than 30 percent • he or she has less than 20 years of service • their disability occurred in the line of duty, and is the proximate result of performing active duty or IDT (3) May forfeit severance pay; be transferred to the Retired Reserve; and receive under the provisions of Title 10, U.S. Code, Section 12731, (10 USC 12731) non-disability retired pay at age 60, if at least 20 qualifying years of service for retirement have been completed and transfer to the retired Reserve is requested. According to the provisions of 10 USC 1209 and 1213 all rights to receive retired pay at age 60 are forfeited if disability severance pay is accepted instead of transfer to the Retired Reserve. Disability severance pay (unlike readjustment and separation pay) cannot be repaid for the purposes of receiving retired pay. (4) Will be separated without benefits in the following situations: • the unfitting condition results from injury that is due to intentional misconduct or willful neglect • the disability was incurred during a period of unauthorized absence • the disability was not incurred or aggravated as the proximate result of performing duty as specified in paragraph 8–2 6. Army Regulation 135-381 (Incapacitation of Reserve Component Soldiers) applies to Soldiers of the USAR and the Army National Guard of the United States, including those serving on active duty under the provisions of Title 10. Paragraph 7-2a states that Soldiers who incur or aggravate an injury, illness, or disease while on orders for more than 30 days may elect to extend on active duty until treatment is completed. Chapter 2 states that Reserve Component (RC) Soldiers who incur or aggravate an injury, illness, or disease while participating in training may be treated in a medical treatment facility or be provided medical care elsewhere at Government expense. Soldiers are authorized follow up medical care for injury, illness, or disease incurred or aggravated in line of duty after completion of active or inactive duty training. 7. An Office of the Army Deputy Chief of Staff, G-1 memorandum dated 16 September 2002, USAR Soldiers may be retained on active duty when the injury or illness was incurred in line of duty and prevents the Soldier from performing his or her normal military duty. The request will consist of the member's consent to remain on active duty, the physician's statement that medical treatment is required for more than 30 days, the line of duty determination, and a DA Form 4187 (Personnel Action) signed by the commander. 8. DA Pam 135-381 (Incapacitation of Reserve Component Soldiers Processing Procedures) governs incapacitation of USAR Soldiers. Paragraph 2–2 states, upon learning of a Soldiers injury, illness, or disease, the unit commander or designated representative will immediately: a. Ensure medical care is provided to the Soldier. Depending upon the type of injury, illness, or disease, and the location of the MTF, coordinate with the MTF to determine if appropriate treatment is available. b. Initiate action to ensure a line of duty investigation (LDI) is completed in accordance with AR 600–8–4 and included in the Soldiers request for incapacitation pay. The unit commander or designated representative will issue an interim line of duty determination within sufficient time to ensure that military pay and allowances will commence within 30 days of the date the injury, illness, or disease was reported, unless there is clear and convincing evidence that the injury, illness, or disease was not incurred or aggravated in a duty status or was due to the members own misconduct. d. Counsel Soldier to read and sign DA Form 7574–2 (Soldiers Acknowledgement of Incapacitation Pay Counseling Statement) and indicate that: (1) Military medical treatment is limited to this injury, illness, or disease only. The Soldier does not receive full military medical treatment as if he/she were on active duty. If the LDI determines that the injury was not in line of duty, (NLD) the Soldier may be liable for Government-incurred medical costs associated with the incident. (2) He/she may be entitled to incapacitation pay. (3) Any such pay will not exceed full pay and allowances for the Soldier’s pay grade and years of service, and will be reduced by any other earned income received from other sources. (4) Incapacitation pay under DODD shall be paid only during the period a member remains not fit for military duty and/or demonstrates a loss of earned income as a result of the incapacitation. Payment in any particular case may not be made for more than 6 months without approval by the Secretary of the Army or their designee. (5) If the Soldier has been determined by an MTF to be fit for military duty, but still cannot perform his/her civilian duties, he/she will be able to attend IDT or assigned AD, but must be able to fully document his/her inability to perform civilian duties. //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20160012655 9