BOARD DATE: 5 January 2018 DOCKET NUMBER: AR20170003713 BOARD VOTE: ____x_____ _______ ___x_____ GRANT FULL RELIEF ________ ________ ________ GRANT PARTIAL RELIEF ________ ________ ________ GRANT FORMAL HEARING ________ ____x____ ________ DENY APPLICATION 2 Enclosures 1. Board Determination/Recommendation 2. Evidence and Consideration BOARD DATE: 5 January 2018 DOCKET NUMBER: AR20170003713 BOARD DETERMINATION/RECOMMENDATION: The Board determined the evidence presented is sufficient to warrant a recommendation for relief. As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by showing she was retired by reason of permanent physical disability on 12 October 2000 with a disability rating of 40 percent and placed on the Permanent Disability Retired List the following day. ______________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. BOARD DATE: 5 January 2018 DOCKET NUMBER: AR20170003713 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 reconsideration of her earlier request for correction of her records to show she was permanently retired by reason of physical disability. 2. The applicant states she believes her records are in error and unjust because her medical condition was noted as unstable on 18 August 2000, but her medical condition had stabilized on 29 February 2000 according to the medical report. She was placed on the Temporary Disability Retired List (TDRL) because her condition was unstable for a final rating. Her condition had stabilized 6 months prior to the medical evaluation board (MEB) findings. 3. The applicant provides: * self-authored letters to the Army Board for Correction of Military Records (ABCMR), dated 11 February 2016 and 11 April 2017 * letter from the Office of the Chief of Legislative Liaison (OCLL) to a Member of Congress, dated 23 January 2015 * medical record, dated 29 February 2000 * undated medical record CONSIDERATION OF EVIDENCE: 1. Incorporated herein by reference are military records, which were summarized in the previous consideration of the applicant's case by the ABCMR in Docket Number AR20150005365 on 17 December 2015. 2. The medical records provided by the applicant are new evidence that was not previously considered by the Board and warrant consideration at this time. 3. The applicant enlisted in the Regular Army on 7 April 1988. She was promoted to the rank of staff sergeant effective 1 April 1995. 4. She provided a rheumatology medical record, dated 29 February 2000, stating her inflammatory polyarthritis was stable with medications. 5. On 10 August 2000, an MEB found her unfit for further military service due to the following diagnoses: * inflammatory polyarthritis * hypercholesterolemia * history of atypical chest pain with a negative work-up for asthma and negative work-up for cardiac etiology * history of internal hemorrhoids with rectal bleeding with a negative lower gastrointestinal work-up * history of chronic right lower quadrant pain secondary to adhesive pelvic disease * recurrent major depressive disorder 6. The MEB recommended referral of her records to a physical evaluation board (PEB). On 14 August 2000, she concurred the MEB findings and recommendation. 7. On 18 August 2000, an informal PEB found her physically unfit due to inflammatory polyarthritis with associated depression. The PEB recommended a disability rating of 40 percent and her placement on the TDRL. On 22 August 2000, she concurred with the PEB findings and recommendation and waived a formal hearing of her case. 8. On 12 October 2000, she retired by reason of temporary disability and was placed on the TDRL effective 13 October 2000 with a 40-percent disability rating. 9. On 25 March 2003, an informal PEB found her physically unfit due to inflammatory polyarthritis with associated depression and definite social/industrial impairment. The PEB found the applicant's impairment was not sufficiently stabilized to permit final adjudication at the time. The PEB recommended her retention on the TDRL with reexamination during May 2004. The PEB findings and recommendation were approved on behalf of the Secretary of the Army on 26 March 2003. 10. An outpatient TDRL evaluation was conducted during the period 13-16 June 2005. The examining psychiatrist provided the following diagnosis: "Major depressive disorder, recurrent, as manifested by a history of depressed mood, insomnia, diminished energy and concentration, and social withdrawal. Predisposition: None known. Precipitating stress: None known. Degree of impairment for military duty: Marked. Impairment for social and industrial adapt ability: Definite. Line of duty: Yes. Existed prior to service: No. Service aggravated: Not applicable." The mental status examination shows "She reported her mood as, 'OK.' Her affect was shallow but reactive. Her though [sic] processes were logical, coherent and goal directed. Her thought content was devoid of suicidal/homicidal ideation or intent. There was no current evidence of hallucinations or other psychotic processes. Her memory was grossly intact with spontaneous recollection of recent and remote events. Insight into her condition was fair. Her judgment was not impaired at the time of the interview." The psychiatrist noted the applicant had the capacity to understand and participate in PEB proceedings. a. On 2 September 2005, the applicant submitted a letter to the PEB in which she disagreed with the psychiatrist's findings. She offered the following reasons: not being able to motivate herself to get out bed on a lot of days, fix food for the family or herself, or wash or clean on a daily basis; not remembering a lot of things; and forgetting that she said or did things. However, she also added she had improved because 16 months ago her husband resigned his job and was available to assist her with personal and household responsibilities. b. On 28 November 2005, the psychiatrist reviewed the applicant's statement. He noted she contradicted her presentation at the time of her outpatient examination. He concluded his initial findings were appropriate and do not require modification for the PEB. 11. On 13 December 2005, an informal PEB found her physically unfit due to "Chronic inflammatory polyarthritis without clinical evidence of active synovitis, but with laboratory evidence of a chronic inflammatory process (ESR [electron spin resonance] [rating] is 42, C-reactive protein [rating] is 0.833, and SPEP [serum protein electrophoresis] [measurement was] consistent with chronic inflammatory process); has fatigue and complaints of elbow pain. Takes Advil only. Rated as one or two exacerbations in a well established diagnosis. The depression has resolved, has been training to become a pharmacy tech[nician] and has graduated. Denied depressed mood, insomnia, social withdrawal. Has not seen a psychiatrist since August 2004 and does not use psychotropic medications. Depression is considered to be in remission and not requiring treatment. (TDRL psychiatric evaluation, TDRL rheumatology evaluation, email from Dr. E____ to Dr. D____ regarding Soldier's rebuttal, rheumatology evaluation of 26 Nov 05 [26 November 2005] after laboratory studies completed.)" The PEB recommended her separation with severance pay with a disability rating of 20 percent. On 15 December 2005, she concurred with the PEB findings and recommendation and waived a formal hearing of her case. 12. She provided a letter from OCLL to a Member of Congress, dated 23 January 2015, which stated: a. Soldiers are placed on the TDRL when their disability rating is 30 percent or higher and their medical conditions are unstable for final rating purposes. Tenure on the TDRL is limited to 5 years. While on the TDRL, a reevaluation of a veteran's case is made by a PEB after completion of a periodic reexamination. If the medical conditions have not stabilized, and the 5-year term has not been reached, the veteran remains on the TDRL pending the next medical reexamination. If the medical conditions have stabilized, the PEB assesses whether the medical conditions have improved or worsened. In either case, a change in rating, higher or lower, can result. b. On 22 November 2002, the applicant was notified she would be scheduled for a reexamination by December 2002. The results of her December examination determined her condition had not stabilized enough for final adjudication. The applicant was retained on TDRL subject to additional reexaminations. c. The applicant's reexamination on 26 November 2005 determined that her condition had stabilized and her case was forwarded for final adjudication. On 13 December 2005, the PEB directed her removal from TDRL and separation with a 20-percent disability rating with severance pay. 13. U.S. Army Physical Disability Agency Orders D364-02, dated 30 December 2005, removed her from the TDRL and discharged her effective 12 October 2005 with a 20-percent disability rating and entitlement to severance pay. 14. On 17 December 2015, the ABCMR denied her request for correction of her records to show she was diagnosed with additional unfitting medical conditions and placed on the Permanent Disability Retired List. 15. An advisory opinion was rendered by the Army Review Boards Agency Senior Medical Advisor, dated 28 June 2017, wherein he stated: a. The available records reasonably support a diagnosis of major depressive disorder existed at the time of the applicant's military service. This condition did not meet medical retention standards. b. She did not meet medical retention standards for inflammatory polyarthritis and major depressive disorder. c. She met medical retention standards for hypercholesterolemia, history of atypical chest pain with a negative work-up for asthma and negative work-up for cardiac etiology, history of internal hemorrhoids with rectal bleeding with a negative lower gastrointestinal work-up, history of chronic right lower quadrant pain secondary to adhesive pelvic disease, and recurrent major depressive disorder. d. Her medical conditions were duly considered during medical separation processing. At the time of the 29 February 2000 rheumatology evaluation, the applicant was assessed as inflammatory polyarthritis, stable with medications. At that time she was clinically stable (not experiencing a major flare or exacerbation), but the condition was not stable from a clinical management perspective. She was on a prednisone (corticosteroid) taper schedule initiated for treatment of a flare/exacerbation. She was also on a methotrexate (an immunosuppressive drug and chemotherapeutic agent also used to treat rheumatoid arthritis) taper schedule for the same indication. From the medical perspective, her clinical exacerbation was stable but not the overall underlying condition for permanent disability determination purposes. e. A review of the available documentation found no evidence of a medical disability or condition that would support a change to the character, reason, or TDRL and/or Permanent Disability Retired List determination for her discharge. 16. A copy of the advisory opinion was provided to the applicant for comment and/or rebuttal. She did not respond. REFERENCES: 1. Title 10, U.S. Code, chapter 61, provides for disability retirement or separation for a member who is physically unfit to perform the duties of his or her office, rank, grade, or rating because of disability incurred while entitled to basic pay. 2. Title 10, U.S. Code, section 1201, provides for the physical disability retirement of a member who has at least 20 years of service or a disability rating of at least 30 percent. 3. Title 10, U.S. Code, section 1203, provides for the physical disability separation of a member who has less than 20 years of service and a disability rating of less than 30 percent. DISCUSSION: 1. The applicant contends her records should be corrected to show she was permanently retired by reason of physical disability in lieu of separation with severance pay. 2. The evidence of record shows the PEB initially found her physically unfit due to inflammatory polyarthritis with associated depression with a disability rating of 40 percent. She concurred with the PEB findings and recommendation on 22 August 2000 and she was placed on the TDRL. 3. There is no evidence showing the unfitting condition of inflammatory polyarthritis with associated depression was improperly rated by the PEB in 2000. 4. The applicant contends that although she was placed on the TDRL because her condition had not stabilized for a final determination, her condition was, in fact, stable according to her rheumatology medical record, dated 29 February 2000 (inflammatory polyarthritis stable with medications). Therefore, there was no need for reevaluation of her condition. 5. The Army Review Boards Agency Senior Medical Advisor determined the applicant was clinically stable (not experiencing a major flare or exacerbation) but the condition was not stable from a clinical management perspective at the time of the 29 February 2000 rheumatology evaluation. From the medical perspective, her clinical exacerbation was stable but not the overall underlying condition for permanent disability determination purposes. 6. Her PEB reexamination on 26 November 2005 determined that her condition had stabilized and her case was forwarded for final adjudication. 7. The evidence of record indicates she was removed from the TDRL in 2005 and separated with severance pay because her condition had stabilized and was then rated as 20-percent disabling. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20170003713 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20170003713 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2