IN THE CASE OF: BOARD DATE: 7 March 2017 DOCKET NUMBER: AR20160019516 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 March 2017 DOCKET NUMBER: AR20160019516 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 March 2017 DOCKET NUMBER: AR20160019516 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 his records to show he was diagnosed with unfitting medical conditions and placed on the Permanent Disability Retired List (PDRL). 2. The applicant states, in effect, that he should have been processed through the Integrated Disability Evaluation System (IDES) based on his unfitting medical conditions. 3. The applicant provides copies of his – * DD Form 214 (Certificate of Release or Discharge from Active Duty) * Department of Veterans Affairs (VA) rating decision (1 page) COUNSEL'S REQUEST, STATEMENT, AND EVIDENCE: 1. Counsel requests, in effect, correction of the applicant's records as specified by the applicant. 2. Counsel, in effect, defers to the applicant. 3. Counsel provides no additional documentary evidence. CONSIDERATION OF EVIDENCE: 1. The applicant enlisted in the Regular Army (RA) on 13 July 2005 for a period of 3 years and 24 weeks. Upon completion of training he was awarded military occupational specialty 91M (Bradley Fighting Vehicle System Maintainer). a. He was promoted to specialist four on 1 August 2011. b. He served in Iraq from: * 6 August 2006 to 28 October 2007 * 27 November 2008 to 1 November 2009 2. Through a series a reenlistments, he continued to serve on active duty. 3. A DA Form 2648 (Pre-Separation Counseling Checklist) shows the applicant's anticipated separation date was 9 February 2013. Item 15 (Physical and Mental Health Well-Being) shows the applicant declined information on all aspects of military healthcare services and benefits. The applicant and transition counselor signed the form on 5 March 2012. 4. A DA Form 4991-R (Declination of Continued Service Statement) shows the applicant was assigned to Company C, Warrior Transition Battalion, and his expiration term of service (ETS) was 9 February 2013. He was advised at the Madigan Healthcare System that in order to comply with the operational commitment (i.e., assignment to Fort Irwin, CA) he must have a minimum of 24 months to ETS as of 4 May 2012. The applicant acknowledged the counseling and the effect his refusal would have on his Army career and on future decision he might make concerning reenlistment or enlistment after separation. The applicant and his commander signed the form on 14 May 2012. 5. A DA Form 4187 (Personnel Action), dated 17 May 2012, shows the applicant requested voluntary separation under the provisions of (UP) Army Regulation (AR) 635-200 (Active Duty Enlisted Administrative Separations), paragraph 16-4, for non-retention on active duty with a separation date of 25 June 2012. The company commander recommended approval and the separation authority approved the applicant's request. 6. His Enlisted Record Brief, dated 6 June 2012, shows in Section IV (Personal/ Family Data): PULHES: 111111, Physical Category: A. 7. Joint Base Garrison, Joint Base Lewis-McChord, WA, Orders 159-0001, dated 7 June 2012, discharged the applicant from the RA effective 25 June 2012. 8. The applicant's DD Form 214 shows he entered active duty this period on 13 July 2005 and he was honorably discharged on 25 June 2012 UP AR 635-200, paragraph 16-4a, non-retention on active duty. He had completed 6 years, 11 months, and 13 days of total active service this period. 9. A review of the applicant's military personnel records failed to reveal a copy of a Line of Duty investigation or any Medical Evaluation Board (MEB)/ Physical Evaluation Board (PEB) proceedings. 10. In support of his application the applicant provides a copy of Portland VA Regional Office, Rating Decision (page 1 of 2 pages), dated 15 March 2014, that show the VA granted the applicant service-connected disability compensation with a combined rating of 60 percent (%), effective 26 June 2012 for: * post-traumatic stress disorder (PTSD) – 50% * posterior fusion secondary to thoractic compression fracture – 10% * history of bimalleolar left ankle fracture with open reduction internal fixation – 10% * hypertension – 0% * bilateral mandible fracture – 0% 11. In the processing of this case, an advisory opinion was obtained from the medical staff, Army Review Boards Agency (ARBA), dated 21 December 2016. a. The ARBA staff psychologist noted that he was asked to determine if the available records reasonably support PTSD (or other boardable behavioral health (BH) conditions) existed at the time of the applicant's military service; if the condition(s) failed medical retention standards in accordance with AR 40-501 (Standards of Medical Fitness) warranting separation through medical channels; was the required medical examination, which includes a BH component, conducted prior to administrative separation; and any additional information deemed appropriate. b. The opinion is based on the information provided by the Army Board for Correction of Military Records (ABCMR) and the applicant (in his application with enclosures), medical records available in the Department of Defense (DOD) electronic medical record, and the limited review of VA records through the Joint Legacy Viewer. c. The staff psychologist noted the applicant's service in Iraq. He also noted the applicant had BH, Family Advocacy Program, and Army Substance Abuse Program (ASAP) involvement during his time in service. d. The applicant's diagnoses were alcohol dependence, alcohol dependence in remission, intermittent explosive disorder (three visits), marital problem, partner relationship problem, and relationship problem. Prior to discharge, the applicant was cleared by a psychologist from his ASAP participation and diagnosed as having his alcoholism in remission. A VA note indicated that, during his terminal leave, he was in a serious automobile accident that caused serious injuries to him and the death of an uncle and cousin. e. The ARBA psychologist found no grounds in the record that supports his request for medical retirement. He noted that none of the BH providers who saw the applicant during his service diagnosed PTSD. Additionally, even if one were to grant that he had PTSD, he would not have been referred to the IDES until he received and failed to respond to an attempt to provide treatment of adequate strength and dose. Nothing in the available BH records at the time of his discharge would have called for a referral to the IDES. Also, the VA rating does not determine whether he should or should not have been medically retired from the Army. f. He found the available records do not reasonably support the applicant having had a boardable medical condition at the time of discharge. The applicant did meet standards in AR 40-501 and AR 635-40 (Physical Evaluation for Retention, Retirement, or Separation); the available case material included an appropriate medical examination prior to discharge; and the applicant did not meet standards for a referral to the IDES for a BH condition at the time of discharge. g. The ARBA staff psychologist concluded that the applicant met medical retention standards in accordance with AR 40-501, chapter 3, and following the provisions of AR 635-40 that were applicable to the applicant's era of service. The applicant's medical conditions were duly considered during his medical separation processing. It is noted he also (apparently incorrectly) wrote, "A review of available documentation did [sic] find evidence of a mental-health condition or conditions that justify medical retirement, rather than honorable discharge." 12. On 21 December 2016, the applicant was provided a copy of the advisory opinion to allow him the opportunity (21 days) to submit comments or a rebuttal. A response was not received from the applicant. REFERENCES: 1. PTSD can occur after someone goes through a traumatic event like combat, assault, or disaster. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA) and it provides standard criteria and common language for the classification of mental disorders. In 1980, the APA added PTSD to the third edition of its DSM-III nosologic classification scheme. Although controversial when first introduced, the PTSD diagnosis has filled an important gap in psychiatric theory and practice. From an 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." 2. PTSD is unique among psychiatric diagnoses because of the great importance placed upon the etiological agent, the traumatic stressor. In fact, one cannot make a PTSD diagnosis unless the patient has actually met the "stressor criterion," which means that he or she has been exposed to an event that is considered traumatic. Clinical experience with the PTSD diagnosis has shown, however, that there are individual differences regarding the capacity to cope with catastrophic stress. Therefore, while most people exposed to traumatic events do not develop PTSD, others go on to develop the full-blown syndrome. Such observations have prompted the recognition that trauma, like pain, is not an external phenomenon that can be completely objectified. Like pain, the traumatic experience is filtered through cognitive and emotional processes before it can be appraised as an extreme threat. Because of individual differences in this appraisal process, different people appear to have different trauma thresholds, some more protected from and some more vulnerable to developing clinical symptoms after exposure to extremely stressful situations. 3. The DSM Fifth Revision (DSM-5) was released in May 2013. This revision includes changes to the diagnostic criteria for PTSD and Acute Stress Disorder. The PTSD diagnostic criteria were revised to take into account things that have been learned from scientific research and clinical experience. The revised diagnostic criteria for PTSD include a history of exposure to a traumatic event that meets specific stipulations, along with symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The sixth criterion concerns duration of symptoms; the seventh assesses functioning; and the eighth criterion clarifies symptoms as not attributable to a substance or co-occurring medical condition. 4. DOD Directive–Type Memorandum (DTM) 11-015 provides that 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. 5. AR 635-40 sets forth policies, responsibilities, and procedures 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. 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. Separation by reason of disability requires processing through the IDES. 6. Title 10, United States Code shows: * section 1201 provides for the physical disability retirement of a member who has a disability rated at least 30 percent * section 1203 provides for the physical disability separation with severance pay of a member who has less than 20 years of service and a disability rated at less than 30 percent 7. AR 635-200 sets forth the policy and prescribes the procedures for the administrative separation of enlisted personnel. Chapter 16, paragraph 16-4, shows that Soldiers denied or ineligible for continued active duty service may be separated, upon request, based on a declination of continued service. Soldiers serving on a second or subsequent enlistment who refuse to take action to meet military service remaining requirements by signing a DA Form 4991-R pursuant to AR 601–280 (Army Retention Program) may request voluntary separation. Separation will occur no later than 90 days after the Soldier receives pre-separation counseling as required by law, which must be scheduled as soon as separation is approved. Any existing service obligation that cannot be fulfilled by the separation date will be waived, and overseas tours will be curtailed to the extent necessary to permit separation. Approved requests for separation cannot be withdrawn. The service of Soldiers separated under this paragraph will be characterized as honorable. 8. Title 38, U.S. Code, 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 VA rating does not establish error or injustice on the part of the Army. An Army disability rating is intended to compensate an individual for interruption of a military career after it has been determined that the individual suffers from an impairment that disqualifies him or her from further military service. The VA, which has neither the authority nor the responsibility for determining physical fitness for military service, awards disability ratings to veterans for conditions that it determines were incurred during military service and subsequently affect the individual's civilian employability. Accordingly, it is not unusual for the two agencies of the Government, operating under different policies, to arrive at different disability ratings. Furthermore, unlike the Army, the VA can evaluate a veteran throughout his or her lifetime, adjusting the percentage of disability based upon that agency's examinations and findings. The Army rates only conditions determined to be physically unfitting at the time of discharge, thus compensating the individual for loss of a career; while the VA (and some other government agencies) may rate any service-connected impairment, including those that are detected after discharge, in order to compensate the individual for loss of civilian employability. DISCUSSION: 1. The applicant contends, in effect, that his military service records should be corrected to show he was diagnosed with unfitting medical conditions with a combined disability rating of at least 30% and placed on the PDRL because the VA granted him a combined rating of 60%. 2. The applicant was assigned to the Warrior Transition Battalion, Madigan Army Medical Center, when he declined to acquire sufficient remaining service to satisfy an operational commitment. By virtue of him completing the Declination of Continued Service Statement, it may be concluded that he was fully eligible to extend or reenlist in the Army to fulfill the operational commitment. a. The applicant received pre-separation counseling and declined information on physical and mental health well-being pertaining to military healthcare services and benefits. b. The ARBA staff psychologist indicated the applicant was cleared by a psychologist from ASAP participation. In addition, he indicated the case material included an appropriate medical examination prior to the applicant's discharge. 3. There is no evidence of record to show that the applicant had any medical conditions (individually or in combination) that were found to be medically unfitting by an MEB/PEB under the provisions of AR 40-501. 4. The ARBA staff psychologist failed to find evidence that a diagnosis of PTSD or any other BH condition existed during the applicant's military service. He also found nothing in the available BH records at the time of his discharge that would have called for referral to the IDES. He concluded that the applicant met medical retention standards in accordance with AR 40-501, chapter 3, and following the provisions of AR 635-40 that were applicable to the applicant's era of service. 5. The evidence of record shows that the applicant's request for discharge UP AR 635-200, paragraph 16-4, for non-retention on active duty was both voluntary and administratively correct. All requirements of law and regulations were met and the rights of the applicant were fully protected throughout the separation process. In addition, the reason for and type of discharge directed were appropriate and equitable. 6. The evidence of record shows the VA has granted the applicant disability compensation for several service-connected medical conditions. However, both the statutory and regulatory guidance provide that the Army rates only conditions determined to be physically unfitting that were incurred or aggravated during the period of service. Furthermore, the condition(s) can only be rated to the extent that the condition(s) limit(s) the performance of duty. The VA, on the other hand, provides compensation for disabilities which it determines were incurred in or aggravated by active military service, including those that are detected after discharge, and which impair the individual's industrial or social functioning. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20160019516 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20160019516 8 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2