ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS IN THE CASE OF: BOARD DATE: 31 March 2020 DOCKET NUMBER: AR20170001770 APPLICANT REQUESTS: in effect, reconsideration of her medical evaluation board (MEB), physical evaluation board (PEB) and her Department of Defense (DoD) Physical Disability Review Board (DoD PDRB) due to new medical evidence not considered or included in her MEB. Her ultimate request is correction of her record to show she was medically retired, not medically separated. APPLICANT'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * Applicant’s personal statement with list of evidence dated 8 December 2016 * Applicant Statement of Appeal to DoD PDRB dated 8 December 2016 * DA Form 3340 (Request for Reenlistment or Extension in the Regular Army) dated 19 June 2005 * DA Form 4789 (Statement of Entitlement to Selective Reenlistment Bonus) dated 20 June 2005 * DA Form 3286 (Statements for Enlistment) dated 20 June 2005 * DD Form 4 (Enlistment/Reenlistment Document Armed Forces of the United States) dated 20 June 2005 * Standard Form (SF) 600 (Chronological Record of Medical Care) dated 13 July 2005 * SF 600 dated 18 July 2005 * DA Form 4700 (Medical Record Supplemental Medical Data) undated * DA Form 199 (Physical Evaluation Board (PEB) Proceedings) dated 6 January 2006 * Department of Radiology Appointment Schedule for Applicant dated 23 February 2006 * Motorplex Department of Radiology Exam Report for Applicant dated 6 March 2006 * DD Form 214 (Certificate of Release or Discharge from Active Duty) for the period ending 2 April 2006 * A set of photos showing a hip arthroscopy dated 27 February 2013 * Preliminary Operative Report for Applicant dated 27 February 2013 * Department of Veterans Affairs (VA) Request for Outpatient Services for Applicant dated 8 March 2013 * VA Request for Outpatient Services for Applicant dated 10 January 2014 * A set of photos of hip arthroscopy dated 20 February 2014 * Final Operative Report for Applicant dated 25 February 2014 * DoD PDRB Army Docket Number AR20160013047 dated 18 August 2016 for Number FACTS: 1. The applicant states, in effect, that she underwent a magnetic resonance imaging (MRI) arthrogram of her right hip on 6 March 2006 and these results were not viewed by the MEB and subsequently the PEB. The MRI confirms she suffered an injury to her right and left hips. She also injured her right acetabular labrum (cartilage). She also submits evidence that her left hip pain and strain should be included into her MEB evidence to show an accurate account of her training injury because it affected both her hips and back. Her training injury physically altered her life. She discovered this error when she received the decision of the DoD PDRB identified as rendered in 2016 which did not contain evidence it reviewed the 2006 MRI arthrogram. (Her PDRB decision is recorded in Army Docket Number AR20160013047.) It is noted, she shows her psychologist as her counsel. 2. In a separate letter dated 8 December 2016, she states her last year in the military was one of disbelief and it set the stage for the longest fight of her life trying to find a doctor who would help her with her pain. She experienced pain and received physical therapy, medical treatment and she tried a holistic approach to healing. She felt betrayed and was angry when members of the U.S. Army abruptly dismissed her from service. She was told to seek assistance from the VA upon her medical separation. She had to move back home. In 2011, she was a participant at the War Related Illness Center in Palo Alto, California which showed her the truth of her pain. Within the VA, she received a doctor’s consult to a major university medical center where during exploratory surgery a surgeon identified she had an acetabular labral tear. A year later she underwent surgery on her other hip for the same reason. During the years of trying to address her pain she also received a diagnosis of Chari 1 malformation (condition in which brain tissue extends into the spinal canal, normally a birth defect) and she also has a cyst in the middle of her brain. She prays the Board will see that her training injury was a life altering event that changed everything she knew about life. 3. The applicant enlisted in the Regular Army on 23 September 1997. She was trained in and qualified as a light wheeled vehicle mechanic. 4. She served twice Iraq in support of Operation Iraqi Freedom from 3 March 2003 (presumably initially in Kuwait) to 31 August 2003 and again from 15 December 2003 to 6 March 2004. 5. On 1 July 2004 she was promoted to staff sergeant/pay grade E-6. 6. She reenlisted multiple times including on 20 June 2005 for a selective reenlistment bonus and continued service as a light wheeled vehicle mechanic. Her reenlistment contract shows she reenlisted for 4 years. 7. The applicant’s official military personnel file (OMPF) contains three DA Form 2166-8 (NCO [Noncommissioned Officer in Charge] Evaluation Reports (NCOER)) for the periods ending on August 2003, August 2004, and August 2005. There were no derogatory comments noted on these reports and her raters stated, in effect: * Outstanding company maintenance service program resulted in 98 percent convoy completion rate for 109 vehicles deployed to Southwest Asia * Demonstrated exceptional stamina and willingness to excel; routinely worked in excess of 12 hour days with superb productivity * Maintained accountability and maintenance of over $50,000 worth of unit equipment with zero losses * Performed a successful five-ton vehicle turn in post deployment * Great physical and mental endurance, rock solid leadership during combat operations * As Human Resources Sergeant augmenting battalion S-1, managed the processing of over 1,000 awards, 90 NCOERs and countless personnel and finance actions during combat * Managed the distribution of over 40,000 pounds of mail and packages during combat * Accomplished or exceeded all missions while in garrison and the field * Worked best under pressure; has the stamina to go the distance on and off the battlefield 8. On each of the three NCOERs, her senior raters stated she should be selected for promotion ahead of her peers, she was the best staff sergeant in the squadron with tactically and technically superior skills and her abilities also far exceeded her peers. 9. The applicant’s MEB and PEB are not filed in her OMPF. 10. On 27 February 2006, Headquarters III Corps and Fort Hood published Orders 058- 0144 discharging the applicant from the Regular Army effective 2 April 2006. The orders stated her percentage of disability was 10 percent and that she was authorized disability severance pay. 11. Accordingly, on 2 April 2006 she was honorably discharged and issued a DD Form 214 documenting her service. Her DD Form 214 shows she completed 8 years, 6 months and 10 days of active service. It also stated the following: * Block 18 (Remarks) – disability severance pay $48,330 * Block 25 (Separation Authority) – Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation), paragraph 4-24b(3) * Block 28 (Narrative Reason for Separation) – disability, severance pay 12. Army Docket Number AR20160013047 is filed in her OMPF. On 18 August 2016 the Deputy Assistant Secretary of the Army (DASA) (Review Boards (RB)) stated by letter she had reviewed the applicant’s DoD PDRB recommendation and its record of proceedings. Under the authority of Title 10, U.S. Code, section 1554a she accepted the DoD PDRB recommendation and denied the applicant relief. In a separate letter to the applicant the DASA (RB) stated her separation disability rating and her separation with disability severance pay was accurate. The DASA (RB) further stated, "This decision is final. Recourse within the Department of Defense or the Department of the Army is exhausted; however [the Applicant had] the option to seek relief by filing suit in a court of appropriate jurisdiction." a. The scope of the DoD PDRB is limited to those conditions determined by the PEB to be unfitting for continued military service and when specifically requested by the applicant, those conditions identified by the PEB, but determined to be not unfitting. It states, "Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records [BCRM]." The Board’s authority is limited to assessing the fairness and accuracy of the PEB rating determinations and recommending corrections, where appropriate. b. The Board reviewed the applicant’s medical records and all available evidence for application of VA Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The applicant’s rated PEB medical condition was sacroiliitis (inflammation of pelvis) with chronic low back pain (VASRD Code 5236) which was assigned a 10 percent rating. On 5 October 2004, the VA stated the applicant’s medical conditions were low back strain (VASRD Code 5237) and right sacroiliac strain, also claimed as right hip and sacroiliac (SI) joint pain (VASRD Code 5236) with a rating of 10 percent. Her combined rating of all VA conditions was 30 percent. (1) The MEB narrative summary and her service treatment records show her right hip conditions began in February 2005 after she jumped from a vehicle while participating in military training. At the time radiographic evaluations of the lower back and hips were normal. She received treatment for her chronic lower back pain but she could not be adequately rehabilitated to meet the physical requirements of her military occupational specialty. Therefore, she was referred for MEB. The MEB forwarded "sacroiliitis" and "sacral ankyloses" for PEB adjudication. (2) During the MEB examination in November 2005, there was right hip tenderness to palpation, painful decreased motion and a popping/clicking sensation with motion. The SI joints were tender to palpation and tests for sacroiliac joint pathology were positive on the right. Her gait was antalgic (walking in a way to avoid pain) and she ambulated with crutches. She had lumbosacral paraspinous tenderness (low back muscle) to palpation and pain limited flexion and extension. Her radiculopathy testing (nerve) was negative. (3) Sixteen days prior to her separation (on or about 17 March 2006), she underwent an examination where is was noted she had an antalgic gait and pain limited back flexion, extension and lateral bending. Her records show she was in constant severe pain interfering with her activities of daily living including her sleep. (4) In May 2006 (post separation), during her VA Compensation and Pension examination she reported constant lower back sacroiliac pain which worsened with activity. Upon examination, her spine and hips were normal and without evidence of painful motion or additional limitation by pain, fatigue, weakness, lack of endurance or incoordination. Her gait was normal and she did not require assistive devices for ambulation. Radiographic evaluation of the lumbar spine and right hip were normal. 13. The applicant provides the following evidence for the Board’s consideration. a. Reenlistment and bonus documents showing her was allowed to contract for 4 years of continued military service on 20 June 2005. (There is a presumption that she was medically qualified to reenlist on this date.) b. SF Form 600 showing she was physically seen by a medical provider on 13 July 2005 for hip pain. This form also shows the reason for her medical appointment was due to a pending unit deployment. Her current medications included 800 milligrams of Motrin. There is handwriting on this form that is of very poor quality and illegible. c. On 18 July 2005 she was seen at physical medicine at a military hospital. Her appointment and its results were electronically recorded. The reason for her appointment was because she had a right snapping hip with SI joint dysfunction. At the time she had a prescription for Vicodin to treat her severe pain. Her injury was restated and she had been referred to physical therapy and appeared to be making improvement with conservation measures. Recently during physical fitness training she noticed an increase in her pain and now she was using crutches to ambulate so as to not put weight on her right hip. The medical provider notations state she was referred to a chiropractor who ordered x-rays. The provider also noted that the applicant’s pain was in her entire right leg (i.e. hip, knee, and ankle) and she was developing pain in her left groin. She had pain and pressure in her lower back. (The applicant only provided page 1 of 4.) d. Her PEB dated 26 January 2006 shows she was found unfit for scroiliitis with chronic low back pain without neurologic deficit. Her range of motion was limited by pain. Her VASRD Code was 5236 and her rating was 10 percent. (The applicant only provided page 1 of her PEB.) e. On 23 February 2006 she received written notification she was scheduled to undergo a right hip MRI on 3 March 2006 at a civilian provider’s location. f. The MRI was done after right hip arthrography with placement of the contrast in the hip joint. The provider stated her glenoid labrum looked quite well with no labral tear. He stated, "There is a single slice in which the superior labrum looks a little irregular, but I do not see any definite tear or displacement." He further stated, "I note no definite free bodies in the joint." There was no adenopathy (lymph node disease) or mass in the groin, the marrow signal intensities were normal and there was no sign of aseptic necrosis (bone death). He noted no definite defect in the hyaline cartilage of the femoral head, no significant osteoarthritis or any hip dysplasia of the right hip joint. g. An undated supplemental medical data sheet shows she was experiencing pain in both her right and left hips and lower back. This form is undated with annotations a chiropractor ordered x-rays. h. On 27 February 2013 she underwent right hip arthroscopy after an MRI showed acetabular labral tearing. She provides the photographic images of the arthroscopy and the operative report which states, in effect, the diagnostic arthroscopy demonstrated a large acetabular labral tear from the 11 o’clock to the 2 o’clock region of the right acetabular. There was some evidence of a deformity of the femoral head anteriorly and laterally. He then surgically trimmed the acetabular rim and debrided it too. (The applicant only provided page 2 of 3 of this operative report.) i. The VA coordinated physical therapy for her with a civilian provider for the period from 8 March to 6 June 2013. j. On 25 February 2014 she underwent left hip arthroscopy. She provides the "Final Report" and its narrative stating the postoperative diagnoses was left acetabular labral tear from 11 o’clock to 2 o’clock, a grade 3 chondromalacia acetabular rim and femoral acetabular impingement. 14. In the processing of this application a medical advisory was obtained on 7 February 2020 from the Army Review Boards Agency senior medical officer, a medical doctor. The record shows the applicant was separated from the Army following a MEB/PEB on 2 April 2006. Despite the applicant's reported training injury occurring in February 2005, she still received the highest ratings attainable on her NCOER demonstrating that she was still fully capable of performing her military occupational specialty and all required tasks as a NCO to a high degree of standards, at least through August 2005. A prior PDBR concluded there was insufficient cause to recommend a change in the PEB adjudication for the right hip condition. The additional medical documentation submitted by the applicant does not demonstrate any new evidence that would have changed the outcome of the MEB or PEB were it available prior to their convening dates. He concludes by opining there is insufficient evidence warranting relief. a. Documentation reviewed included the applicant’s ABCMR application, applicant- provided medical records that she states were not previously considered in her prior case, the applicant’s Armed Forces Health Longitudinal Technology Application (AHLTA) electronic medical record, the VA Joint Legacy Viewer (JLV) electronic medical record, the applicant’s Interactive Personnel Electronic Records Management System (iPERMS), and the applicant’s report from the PDBR. b. The applicant submitted evidence she states was not considered by the MEB (November 2005) or PEB (January 2006). Upon review of her new evidence, the right hip MRI arthrogram completed on 6 March 2006, the report shows arthrographically there were no obvious abnormalities noted. In February 2013 she underwent a diagnostic and therapeutic arthroscopy of her right hip ordered by the VA. The medical doctor found a large acetabular labral tear from the 11 o’clock position to the 2 o’clock position which was partially debrided and repaired at the time of surgery, femoral acetabular impingement, and chondromalacia of the acetabular rim were identified. A "cam" deformity of the femoral head anteriorly and laterally was identified and was also treated surgically which was felt to be the cause of the applicant’s hip impingement. It is the medical advisor’s opinion that a hip labral tear to the extent reported in her right hip surgical report of February 2013 would have been identified on the MRI arthrogram of the right hip performed on 6 March 2006, if it had been present at that time. c. Reviewing her AHLTA record, she did present herself for evaluation of her left hip pain once. There are no radiographic studies in AHLTA or any other documentation submitted by the applicant to indicate that any condition regarding her left hip would have been considered unfitting by the MEB/PEB. Post separation, she did undergo therapeutic arthroscopy of her left hip on 25 February 2014 as requested by the VA. The findings were similar to the findings noted above. A copy of the complete medical advisory was provided to the Board for their review and consideration. 15. On 19 February 2020 the applicant was sent a copy of the medical advisory providing her an opportunity to respond. The applicant responded by email on 28 February 2020. She acknowledges her March 2006 MRI showed she had no real problems with her hip joint. It was a VA medical doctor who sent her to a civilian orthopedic surgeon who after performing exploratory surgery informed her she should have had surgery on her hips years ago. She does not know why the pain she was experiencing in 2005 and 2006 did not show up on the MRI or X-rays. She opines that if her unit was not on orders to deploy, she would have had more time to heal while still an active member of the U.S. Army as she had no intention of leaving military service. She reinforces her statement with the fact she had reenlisted in June 2005 for 4 years. Upon receipt of unit deployment orders she was declared nondeployable and the medical evaluation process started fairly quickly. Her military career ended when she was medically separated. She opines if the noted "slice" in her right hip was repaired when it was noted, while she was still in service, she would still be in service today. She provided another copy of her DD Form 214 and her units' temporary change of station orders for Kuwait/Iraq (U.S. Central Command). BOARD DISCUSSION: 1. The Board carefully considered the applicant’s request, supporting documents and evidence in the records. The Board considered the applicant’s statement, her record of service, the evaluations in her records, MEB and PEB proceedings and the reason for her separation. The Board considered the review and conclusions of the PDBR consideration and the decision of the Deputy Assistant Secretary of the Army (RB). The Board considered the review and conclusions of the medical advising official as well as the response from the applicant. The Board found insufficient evidence of an additional condition that was not properly considered during the applicant’s medical disability separation proceedings or that would warrant medical disability retirement. Based on a preponderance of evidence the Board determined that the applicant’s medical separation was not in error or unjust. 2. After reviewing the application and all supporting documents, the Board found that relief was not warranted. BOARD VOTE: Mbr 1 Mbr 2 Mbr 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. X 9/28/2020 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. REFERENCES: 1. Congress passed the Dignified Treatment of Wounded Warriors Act in January 2008 under the Fiscal Year 2008 National Defense Authorization Action requiring the military services, upon request, to review certain separations for medical conditions where the rating was 20 percent or less and the member did not otherwise retire. The review evaluates where, under the applicable guidance in effect at the time, the rating awarded was fair and accurate. The DoD PDRB was established to review specified discharges for members discharged between 11 September 2001 and 31 December 2009. 2. DoD Instruction 6040.44 (PDRB) establishes policies, assign responsibilities, and provide procedures for the PDRB operation and manage as required by Title 10, USC, section 1554a. It was initially published on 27 June 2008 and amended with on 4 December 2017. It is DoD policy that the PDRB will reassess the accuracy and fairness of the combined disability ratings assigned form Service members who were separated with a combined disability rating of 20 percent or less during the period 11 September 1022 through 31 December 2009 due to unfitness for continued military service, resulting from a physical disability as described in Chapter 61 of the U.S. Code. A review will be conducted upon the Service members' request. The PDRB will review covered individuals’ appeals pertaining to conditions identified but not determined to be unfitting by the PEB. a. The Secretaries of the Military Departments will comply with Chapter 61, U.S. Code, this instructions, any implementing guidance. The Secretaries will establish procedures to obtain written agreement from individuals covered acknowledging that as a result of requests for PDRB review, the covered individual may not seek relief from the BCMR operated by the Secretary of the Military Department concerned and the recommendation of the PDRB, once accepted by the respective Military Department, is final. b. The PDRB may, upon its own motion, review the findings and decisions of the PEB with respect to the covered individual. The PDRB will review the PEB record of findings and the combined disability rating decision regarding the specific military unfitting medical condition(s) of the covered individual. The review will be based on the records of the Military Department concerned and such other evidence as my be presented to the PDRB, in accordance with the information requirements of this instruction. The VA Schedule for Rating Disabilities (VASRD) in effect at the time the covered individual’s disability rating was assigned will be used for recommendations, along with applicable statues, and any directives in effect at the time of the contested separation. c. The PDRB will make a recommendation to the Secretary of the Military Department as follows: (1) Do no re-characterize the separation of the covered individual or modify the combined disability rating previously assigned. (2) Re-characterize the separation to retirement for disability. (3) Modify the combined disability rating previously assigned by the PEB. The modified combined disability rating many not be a reduction of the disability rating previously assigned by the PEB. (4) Issue a proposed new combined disability rating for the covered individual. d. The PDRB will review the complete case record that served as the basis for the final Military Department PEB rating determination, to the extent feasible, collect all the information necessary for competent review and recommendation. //NOTHING FOLLOWS//