IN THE CASE OF: BOARD DATE: 8 April 2019 DOCKET NUMBER: AR20170000567 BOARD VOTE: 2 Enclosures 1. Board Determination/Recommendation 2. Evidence and Consideration 1. IN THE CASE OF: BOARD DATE: 8 April 2019 DOCKET NUMBER: AR20170000567 APPLICANT'S REQUEST AND STATEMENT: 1. The applicant requests he be awarded the Purple Heart. 2. The applicant states: a. He received a letter from the U.S. Army Human Resources Command (HRC) on 11 July 2016, denying his request for a Purple Heart due to injuries he received as a result of his exposure to an improvised explosive device (IED). He is appealing that decision. In the determination letter he received from Colonel XXXXX X. XXXXX, she stated that following his exposure to an IED on 2 March 2007, he was treated for "chronic lower back pain." b. The reason behind the disapproval ruling per Colonel RXXXX's letter was that he was treated for "chronic back pain" from exposure to an IED and that soft tissue injuries do not qualify for award of the PH. However, "chronic back pain" was a single symptom of what was later diagnosed as a narrowed urethra from stricture damage caused by the IED. c. He was treated multiple times by the Army, the Department of Veterans Affairs (VA), and private civilian doctors for the stricture damage. This medical care culminated after almost a decade of ineffective treatment and continued pain and complications with the urethral stricture diagnosis, which required surgical repair. This surgery took place on 22 February 2016, when he underwent an urethroplasty with skin graft procedure at a private hospital. d. While he did state that he had lower and middle back pain at the time of the IED, he felt it was normal. He now knows that his exposure to the blast caused an injury more severe. During that treatment, it was also put in the record that he felt his insides shake during the explosion. e. He was treated on 25 March 2007 for another exposure to an IED. This time, multiple explosions occurred on the same day. He was treated for acute Enclosure 2 stress disorder and tightness of the chest. This treatment was again placed on record and showed the severity of the blasts his body was exposed to. f. He was seen and treated for severe lower back pain on 7 June 2007. The records incorrectly stated the problems started in January 2007. His severe lower back pain, pain while urinating, and blood in his urine started in April 2007, after his exposures to multiple IEDs. g. Prior to his exposures to IEDs, he did not have any of the above complaints, as he would have sought treatment them. During his treatment starting on 7 June 2007, it was determined that he had a narrowed urethra. He had no history of kidney stones or infection and none were found during treatment. He was treated by wearing a Foley catheter for 72 hours. He was told by the Army urologist that the narrowed urethra was most likely caused from scar tissue built up due to blast concussions from exposure to IEDs. h. Upon his exiting the Army in 2008, he continued to have complications caused by the narrowed urethra. The complications included excessive bleeding from inside the penis, pain while urinating, and severe lower back pain. He was seen and treated at the VA hospital in Loma Linda, California. He was unable to find his records regarding that visit. i. He was admitted to the emergency room at a private hospital on 10 January 2016. He was treated for full urethra stricture blockage. It was determined that excess scar tissue in his urethra had formed and was causing his urethra to narrow. This continued until there was full blockage and he was unable to void his urine. Because of the blockage, he had severe pain to his lower back. His urologist explained that the lower back pain was due to excessive stress on his kidneys due to the stricture in his urethra. He was told that his kidneys were failing due to the stress. j. He had an urethroplasty with skin graft surgery at a private hospital on 22 February 2016. The surgery removed the section of his urethra that was built up with scar tissue. k. Scar tissue in his urethra can only be caused from a cut or tear to the tissue. To cause such an injury to that internal area of the body would have to come from a violent action to the body. This would include passing of kidney stones, but it was documented that he had no signs or history that had occurred. It is documented that he was exposed to multiple IED blasts, that he felt his insides shake during the blasts, and that he had severe back pain in the months after the exposures. While chronic back pain in of itself does not qualify a cut or a. tear to internal tissue does. This injury is not as simple as a bullet wound or a broken extremity, but it is an injury caused by an enemy combatant. He engaged the enemy, he was exposed to multiple IED blasts from the enemy and he suffered extreme pain for almost a decade due to the blasts. He only asks that his injury and the pain it has caused him be recognized. THE BOARD CONSIDERED THE FOLLOWING EVIDENCE: 1. Application for correction of military records with supporting document(s): * DA Form 1594 (Daily Staff Journal or Duty Officer's Log) (9 pages), dated 25 March 2007, from Company E, 2nd Battalion, 5th Cavalry Regiment * 17 pages of military medical records * 43 pages of private medical records * application to HRC for Purple Heart with supporting documents * HRC denial letter, dated 11 July 2016 2. Evidence from the applicant’s service record and Department of the Army and Department of Defense records and systems: * DD Form 214 (Certificate of Discharge or Release from Active Duty) 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 600-8-22 (Military Awards) provides: a. The Purple Heart is awarded for a wound sustained while in action against an enemy or as a result of hostile action. When contemplating this award authorization officials must take into consideration the degree to which the enemy caused the injury. Substantiating evidence must be provided to verify that the wound was the result of hostile action, the wound must have required treatment by medical personnel, and the medical treatment must have been made a matter of official record. a. b. A wound is defined as an injury to any part of the body from an outside force or agent sustained under one or more of the conditions listed above. A physical lesion is not required. However, the wound for which the award is made must have required treatment, not merely examination, by a medical officer. Additionally, treatment of the wound will be documented in the Servicemember’s medical and/or health record. c. Examples of enemy-related injuries which clearly justify award of the Purple Heart include concussion injuries caused as a result of enemy-generated explosions. d. Examples of injuries or wounds which clearly do not justify award of the Purple Heart include abrasions and lacerations (unless of a severity to be incapacitating); bruises (unless caused by direct impact of the enemy weapon and severe enough to require treatment by a medical officer); and soft tissue injuries (for example, ligament, tendon or muscle strains, sprains, and so forth). 3. WebMD describes: a. A urethral stricture is a narrowing or blockage of the urethra that is more common in men than in women. The urethra is the passage that carries urine out of the body, in a man, it is at the tip of the penis. The blockage of the urethra is usually caused by the formation of scar tissue within the urethra due to surgery, sexually transmitted diseases, or long-term chronic catheter use. The symptoms of urethral stricture include: * Slow urine flow or a urine stream that is split or a spray * Urine leakage or dribbling (incontinence) * Inability to empty bladder completely * Pain when urinating or pain in the pelvis or lower abdomen * Frequent urge to urinate * Blood in the urine * Urinary tract infection b. Urethral calculi (stones) usually originate from the bladder and rarely from the upper tracts. Most ureteral stones that pass spontaneously into the bladder can pass through the urethra unimpeded. Urethral stones may develop secondary to urinary stasis, secondary to a urethral diverticulum, near urethral strictures, or at sites of previous surgery. a. DISCUSSION: 1. While the applicant did not file within the time frame provided in the statute of limitations, the ABCMR has elected to conduct a substantive review of this case and, only to the extent relief, if any, is granted, has determined it is in the interest of justice to excuse the applicant's failure to timely file. In all other respects, there are insufficient bases to waive the statute of limitations for timely filing. 2. The applicant enlisted in the Regular Army on 15 January 2003 and served through 27 April 2008. He was honorably released from active duty due to completion of his required active service. 3. The applicant served in Iraq on two occasions: from on or about 12 March 2004 through on or about 15 March 2005 and from on or about 30 October 2006 through on or about 16 November 2008. 4. The applicant applied to HRC on 11 March 2016, to receive the Purple Heart for internal injuries that resulted from several IED incidents. 5. The DA Forms 1594 provided to HRC show, on 25 March 2007, a unit identified as "White 6", was hit by IEDs on two occasions. The reports do not name any specific Soldier as being involved or injured. 6. The statements provided on the applicant's behalf verify that the applicant was involved in at least three IED incidents. During one blast he was slammed into both the roof of the vehicle and against the steering wheel. Following this blast, he vomited and was nauseated. 7. The service medical records provided to HRC show treatment as follows on: a. 2 March 2007, the applicant was exposed to IED blast on right side of vehicle 30 minutes earlier. The vehicle was disabled and both back tires were blown out, the applicant was driver. He did have not (sic) have any injuries and is not experiencing any symptoms. The applicant stated he feels like his insides were shaken up. He states middle/low back pain but is "normal from wearing gear and prolong sitting in vehicle". He was not experiencing any loss of bowel/bladder control, weight loss, night sweats, numbness, tingling or radicular pain. The diagnosis was chronic back pain. b. 25 March 2007, the applicant reported he was the driver in his vehicle when was hit by an IED, twice – once four hours ago and then an hour ago. He stated he is really shook up and couldn't stop shaking. He denies any trauma. a. He had no head trauma, loss of conscience but feels tightness in his chest and it is hard to breath. He denies numbness, tingling, dizziness, or nausea. He states his hearing is a little muffled on his left side and he has a headache. He denies any vomiting and states he has no visual impairments from blast. He is angry and scared was angry at first, but now he mainly just scared. He has been in IED blasts in the past, LED incidents during this deployment, which did not affect him this way, but he very anxious. He is alert, jumpy, and irritable. He continues to scan for IEDs even after returning to the Forward Operating Base and even when walking to the Post Exchange. His hands are trembling and he could not stop them from shaking. He also reports fast heartbeat, some trouble breathing when anxious. He has been able to sleep before today. He was diagnosed with an acute stress disorder and was having many symptoms of post-traumatic stress disorder (PTSD) but at least a 3-month duration is necessary to diagnosis PTSD. c. 26 March 2007, he was seen for an anxiety attack. d. 7 June 2007, the applicant complained of pain in the left side (kidney area) when urinating. He states the symptoms started in January 2007. He states it does not burn when urinating, but approximately once a month there is a small amount of blood in urine. When the pain is at its worst, he states he cannot take a full breath and is bent over double. He states he has no history of kidney stones/infections. A CT was negative but laboratory results found moderate blood in the urine and he to have a consult with urologist. e. 13 June 2007, the applicant was seen for continuation of his pain in the left flank with some blood in the urine. A narrowing of the urethral was found and a Foley catheter was inserted (for 3 days). He was give Percocet for pain. f. 17 June 2007, the applicant had a follow-up appointment for possible ureteral stones. The applicant had a Foley catheter removed, was placed on light duty for 2 weeks with a follow-up appointment with urology in 4-6 weeks. The diagnosis was urethral stricture. 8. The private medical records provided to HRC show treatment as follows on: a. 10 January 2016, the applicant was seen in the emergency room for urethral stricture and urinary retention. b. 12 January 2016, for a follow-up of his urethral stricture and urinary retention. a. c. 18 January 2016, he was placed off work for the period 19 – 28 January 2016. d. 28 January 2016, he underwent a cystoscopy. e. 17 February 2016 and 22 February 2016, he underwent a presurgical evaluation. f. 6 March 2016 , the applicant was seen for Urethral Stricture and Prostatitis (Inflammation of Prostate). The following day he underwent a cystoscopy. g. 14 March 2016, the applicant was seen for urethral stricture and urinary tract infection due to indwelling urinary catheter. h. The available records do not include the surgical procedure described by the applicant. 9. The applicant applied to HRC for award of the Purple Heart based on the medical documentation provided above. 10. HRC denied the applicant's request for the Purple Heart on 11 June 2016, stating in accordance with Army Regulation 600-8-22 (Military Awards), paragraph 2-8h (16), the associated medical documentation from 2 March 2007 reflects that he were evaluated following exposure to an IED and treated for chronic lower back soft tissue injuries (muscle strains) that do not qualify for award of the Purple Heart. 11. The applicant was treated for pain in the lower back initially with subsequent treatment for urethral stricture, blood in the urine, and possible urethral stones. He was prescribed the use of a Foley catheter both while on active duty and post service. Eight years after surgery, he underwent surgical intervention for urethral restriction due to a build-up of scar tissue. //NOTHING FOLLOWS// ROP BOARD RECOMMENDATION IN THE CASE OF: BOARD DATE: 8 April 2019 DOCKET NUMBER: AR20170000567 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. 4/15/2019 X CHAIRPERSON Signed by: