ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS BOARD DATE: 8 October 2019 DOCKET NUMBER: AR20160016313 APPLICANT REQUESTS: correction of her records to show her injury was incurred in the line of duty (LOD). APPLICANT'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record under the Provisions of Title 10, U.S. Code, Section 1552) * Standard Form 507 (Clinical Record – Functional Capacity Certificate), dated 9 November 2009 * DA Form 3349 (Physical Profile), dated 4 March 2010 * DA Form 3349, dated 14 July 2011 * Memorandum, U.S. Army Human Resources Command (HRC), dated 29 November 2012, subject: Notification of Eligibility for Retired Pay at Age 60 (20-Year Letter) * Electronic Profile (e-Profile) Application, dated 17 January 2013 * DA Form 3349, dated 4 September 2013 * Letter, North Louisiana Orthopaedic and Sports Medicine Clinic, dated 6 November 2013 * Medical Note, North Louisiana Orthopaedic and Sports Medicine Clinic, dated 20 March 2014 * Magnetic Resonance Imaging (MRI) Report, North Louisiana Orthopaedic and Sports Medicine Clinic, dated 25 March 2014 * Medical Note, North Louisiana Orthopaedic and Sports Medicine Clinic, dated 9 April 2014 * MRI Report, North Louisiana Orthopaedic and Sports Medicine Clinic, dated 15 April 2014 * Letter, North Louisiana Orthopaedic and Sports Medicine Clinic, dated 25 April 2014 * DA Form 3349, dated 17 June 2014 * Standard Form 507, dated 17 July 2014 * Summary of Prescriptions Filled from 1 March 2015 through 31 March 2015 * Memorandum, Headquarters, 81st Regional Support Command, dated 2 July 2015, subject: Findings of Formal LOD Investigation * Medical Note, North Louisiana Orthopaedic and Sports Medicine Clinic, dated 9 July 2015 * MRI Report, North Louisiana Orthopaedic and Sports Medicine Clinic, dated 3 August 2015 * Letters, North Louisiana Orthopaedic and Sports Medicine Clinic, dated 30 July 2015 and 18 August 2015 * HRC Orders C02-691660, dated 25 February 2016 * Memorandum, HRC, dated 22 March 2016, subject: LOD Determination * Letter, HRC, dated 13 July 2016 FACTS: 1. The applicant states: a. In 2006, she incurred an injury in the LOD with swelling and chronic pain in her right knee. She was performing physical exercise on the concrete pavement in the parking lot of the U.S. Army Reserve unit in 2014 through 2015 due to the lack of air conditioning in the building, which caused her more pain. b. She injured her right knee during a field training exercise/combat training in 2006. c. She suffered a muscle strain across her right shoulder and lower back area in 1987, which has become worse with age. d. She knows she was injured in the LOD. She doesn't have any documentation of the LOD investigation. 2. The applicant's records contain no contemporaneous documentation showing she was injured while performing U.S. Army Reserve inactive duty training or annual training during the period 15-17 September 2006. There is no evidence indicating she sought treatment for or was treated for an injury at that time. 3. Her records contain a Functional Capacity Certificate, dated 17 November 2006, showing: a. Her self-assessment in: * item 7 (Do you have a condition that prevents you from moving at least 2 miles with a fighting load?), she indicated "Yes" and noted pain in her left shoulder and arm, and pain and weakness in her knees * item 9 (Do you have a condition that prevents you from constructing an individual fighting position?), she indicated "Yes" and noted pain in her left shoulder and arm * item 10 (Do you have a medical condition that prevents you from doing 3-5 second rushes under direct and indirect fire?), she indicated "Yes" and noted tendonitis and orthopaedic pain * item 11 (Do you have any medical condition that might prevent you from deploying?), she indicated "Yes" and orthopaedic problems * item 12 (Do you have a medical condition that prevents you from running or jogging 2 miles?), she indicated "Yes" and noted pain and weakness in the knees * item 13 (Do you have a medical condition that prevents you from doing push- ups?), she indicated "Yes" and noted pain in her left elbow * item 16 (Do you have any medical condition that prevents you from doing upper or lower body weight training?), she indicated "Yes" and noted shoulder and left elbow b. The physician found the following diagnoses contributed to her physical limitations: * patella chondromalacia * chronic epicondymitis * shoulder tendonitis 4. Her records contain a Functional Capacity Certificate, dated 4 December 2006, showing: a. Her self-assessment in: * item 11 (Do you have any medical condition that might prevent you from deploying?), she indicated "Yes" and noted left shoulder/leg (orthopaedic) arm/knees * item 12 (Do you have a medical condition that prevents you from running or jogging 2 miles?), she indicated "Yes" and noted pain and weakness in the knees * item 13 (Do you have a medical condition that prevents you from doing push- ups?), she indicated "Yes" and noted pain in her left elbow b. The examiner found the following diagnoses contributed to her physical limitations: * patella chondromalacia * left elbow lateral epicondymitis * shoulder tendonitis 5. The North Louisiana Orthopaedic and Sports Medicine Clinic Progress Note, dated 27 March 2007, states she has a history of patellofemoral chondromalacia. She had a positive patellar compression test. There is some minimal swelling, but no true effusion for the right knee. The knee tracks well without any subluxations noted. The physician assistant recorded an impression (probable disease or abnormality) of patellofemoral chondromalacia. 6. In a statement for her command sergeant major, dated 21 May 2007, regarding her chronological account of medical appointments, she stated she was injured after performing the field training exercise mission on 15-17 September 2006. 7. Her records contain a DA Form 2173 (Statement of Medical Examination and Duty Status), dated 28 May 2007, showing in: * item 5 (Accident Information), the examiner entered the date and place as 15-17 September 2006 in Bossier, Louisiana * item 6 (Individual Was Out Patient/Admitted/Dead on Arrival), no entries * item 7 (Name of Hospital or Treatment Facility), no entries * item 8 (Hour and Date Admitted), no entries * item 9 (Hour and Date Examined), no entries * item 10 (Nature and Extent of), the examiner marked "Injury" and "Disease" * item 11 (Medical Opinion), the examiner noted – * she was not under the influence of alcohol or drugs * she was mentally sound * her injury was not likely to result in a claim against the Government for future medical care * her injury was incurred in the LOD performing "combat training" * item 15 (Details of Accident or History of Disease), the examiner noted "combat training exercise – on abnormal knee" 8. Her records contain a Functional Capacity Certificate, dated 28 May 2007, showing her self-assessment in: * item 1 (Soldiers may be required to walk 12 miles in combat boots. Do you have a medical condition that prevents you from doing so?), she indicated "Yes" and noted knee pain and swelling, numbness * item 2 (Soldiers may be required to walk 12 miles with field gear. Do you have a medical condition that prevents you from doing so?), she indicated "Yes" and noted pain in knees * item 3 (Soldiers may be required to walk 6 miles with field gear and 40-pound ruck sack. Do you have a medical condition that prevents you from doing so?), she indicated "Yes" and noted orthopaedic problems * item 4 (Soldiers may be required to lift and carry 40 pounds a distance of 100 feet. Do you have a medical condition that prevents you from doing so?), she indicated "Yes" and noted knee problems * item 7 (Do you have a condition that prevents you from moving at least 2 miles with a fighting load?), she indicated "Yes" and noted problems with knees * item 12 (Do you have a medical condition that prevents you from running or jogging 2 miles?), she indicated "Yes" and noted pain and swelling in knees * item 15 (Do you have any medical condition that prevents you from doing standard aerobic and conditioning activities?), she indicated "Yes" and noted pain and swelling in knees * item 16 (Do you have any medical condition that prevents you from doing upper or lower body weight training?), she indicated "Yes" and noted pain and swelling in knees 9. Her records contain a Functional Capacity Certificate, dated 14 July 2008, showing: a. Her self-assessment in: * item 1 (Soldiers may be required to walk 12 miles in combat boots. Do you have a medical condition that prevents you from doing so?), she indicated "Yes" and noted numbness/pain in left leg and knee swelling * item 2 (Soldier may be required to walk 12 miles with field gear. Do you have a medical condition that prevents you from doing so?), she indicated "Yes" and noted pain/swelling * item 3 (Soldiers may be required to walk 6 miles with field gear and 40 pounds ruck sack. Do you have a medical condition that prevents you from doing so?), she indicated "Yes" and noted orthopaedic problems * item 4 (Soldier may be required to lift and carry 40 pounds. Do you have a medical condition that prevents you from doing so?), she indicated "Yes" and noted problem with knees * item 7 (Do you have a condition that prevents you from moving at least 2 miles with a fighting load?), she indicated "Yes" and noted problem with knees * item 9 (Do you have a condition that prevents you from constructing an individual fighting position?), she indicated "Yes" and noted orthopaedic problems * item 10 (Do you have a medical condition that prevents you from doing 3-5 seconds rushes under direct and indirect fire?), she indicated "Yes" and noted tendonitis/orthopaedic * item 11 (Do you have any medical condition that might prevent you from deploying?), she indicated "Yes" and noted orthopaedic/poor circulation * item 12 (Do you have a medical condition that prevents you from running or jogging 2 miles?), she indicated "Yes" and noted pain/swelling in knees b. The examiner found the following diagnoses contributed to her physical limitations: "[Applicant] claims physical limitations due to joint problems in history. Has DJD [degenerative joint disease] particularly in knees. States military has records on this." c. The examiner concurred with the applicant's self-assessment. 10. Her records contain Part II of a DA Form 7349 (Initial Medical Review – Annual Medical Certificate), dated 4 June 2009, showing in: * item 18 (Physician's Review Notes), the physician noted the applicant had multiple medical problems * item 19, the physician marked "Unfit (U.S. Army Reserve – refer to paragraphs 9-13 and 9-14, Army Regulation 40-501 (Standards of Medical Fitness))" * item 20 (Complete "PULHES" Using the Physical Profile Functional Capacity Guide in Table 7-1, Army Regulation 40-501), the physician assigned her a rating of "3" under the lower extremities physical capacity factor * item 21 (DA Form 3349 is attached), "Yes" * item 24 (Miscellaneous Recommendations), "Non-Deployable – Refer Medical Evaluation Board (MEB)/Physical Evaluation Board (PEB)." 11. Her records contain a letter from Dr. M____ B. B____, North Louisiana Orthopaedic and Sports Medicine Clinic, dated 7 October 2009, wherein he stated: a. He has stated on multiple occasions in the past that the applicant is not able to participate in running, field training, or long marches. b. He did not feel she would be capable of performing tasks that would be required of her because of her long-term problems with her knee with any kind of increased activity. 12. She provided a Functional Capacity Certificate, dated 9 November 2009, showing: a. Her self-assessment in: * item 1 (Soldiers may be required to walk 12 miles in combat boots. Do you have a medical condition that prevents you from doing so?), she indicated "Yes" and noted numbness/pain in left leg and swelling in knees * item 2 (Soldier may be required to walk 12 miles with field gear. Do you have a medical condition that prevents you from doing so?), she indicated "Yes" and noted knee swelling * item 4 (Soldier may be required to lift and carry 40 pounds. Do you have a medical condition that prevents you from doing so?), she indicated "Yes" and noted knees with pain/swelling * item 7 (Do you have a condition that prevents you from moving at least 2 miles with a fighting load?), she indicated "Yes" and noted knees with pain/swelling * item 9 (Do you have a condition that prevents you from constructing an individual fighting position?), she indicated "Yes" and noted orthopedic problems * item 10 (Do you have a medical condition that prevents you from doing 3-5 seconds rushes under direct and indirect fire?), she indicated "Yes" and noted orthopedic problems" * item 11 (Do you have any medical condition that might prevent you from deploying?), she indicated "Yes" and noted problem with knees * item 12 (Do you have a medical condition that prevents you from running or jogging 2 miles?), she indicated "Yes" and noted pain/swelling in knees * item 22 (Do you currently have a Permanent Profile?), she indicated "Yes" and noted no field training exercises, no long marching, and no running b. The examiner found the following diagnoses contributed to her physical limitations: * patellofemoral chondromalacia/arthritis * chronic knee pain * medal compartment chondromalacia * possible meniscal lesion c. The examiner concurred with the applicant's self-assessment. 13. The Physical Profile, dated 4 March 2010, shows in: * item 1 (Medical Condition), the profiling officer marked "Illness/Disease * item 2 (Codes), the profiling officer entered "C" * item 3 (PULHES), the profiling officer assigned a permanent physical profile rating of "3" under the lower extremities factor * item 4b (Permanent Profile), the profiling officer marked "Yes" * item 5 (Functional Activities for Permanent and Temporary Profiles), the profiling officer marked "No" for – * able to move with a fighting load at least 2 miles * able to construct an individual fighting position * able to do 3-5 second rushes under direct and indirect fire * is Soldier is healthy without any medical condition that prevents deployment * item 6 (Army Physical Fitness Test (APFT)), the profiling officer marked "No" for – * 2-mile run * APFT swim * APFT bike * item 7 (Standard or Modified Aerobic Conditioning Activities), the profiling officer marked "No" for – * unlimited running * unlimited biking * unlimited swimming * item 10 (Other), the profiling officer noted "SM [service member] needs referral to NDR [non-duty related] PEB IAW [in accordance with] AR [Army Regulation] 40-501 Chapter [should read paragraph] 3-14c Bilateral Degenerative Joint Disease of the Knees. Limit walk in combat boots to [less than] 1/2 mile. Limit walk with field gear and rucksack. Lifting or carrying max [maximum] weight 10lbs [10 pounds] or 10ft [10-foot] distance. Prolonged standing – maximum time per episode 2 hours. Marching with standard field gear except for rucksack max [maximum] distance 1/4 mile." 14. The applicant provided an e-Profile application showing an approved permanent physical profile rating of "3" under the lower extremities factor for localized osteoarthrosis effective 1 July 2011. 15. She provided a Physical Profile, dated 14 July 2011, showing in: * item 1 (Medical Condition), the profiling officer marked "Illness/Disease" * item 2 (Codes), the profiling officer entered "U" * item 3 (PULHES), the profiling officer assigned a permanent physical profile rating of "3" under the lower extremities factor * item 4b (Permanent Profile), the profiling officer marked "Yes" * item 5 (Functional Activities for Permanent and Temporary Profiles), the profiling officer marked "No" for – * evade direct and indirect fire * move 40 pounds while wearing usual protective gear at least 100 yards * live in an austere environment without worsening the medical condition * item 6 (APFT), the profiling officer marked "No" for 2-mile run * item 7 (Does the Soldier Meet Retention Standards in Accordance with Army Regulation 40-501?), the profiling officer marked "No" and noted "refer to AR [Army Regulation 40-501, Chapters 9 & 10" * item 8 (Functional Limitations and Capabilities and Other Comments), the profiling officer noted "Bilateral degenerative joint disease of the knees (L3) lower extremities, [paragraph] 3-14c. Service member can move 40 lbs [pounds] a distance of 50 yards. Information/limitations documented on previous DA Form 3349 dated 20100304 [4 March 2010] signed by COL [Colonel] P____. Limit walk in combat boots to [less than] 1/2 mile. Limit walk with field gear and rucksack. Lifting or carrying max [maximum] weight 10lbs [10 pounds] or 10ft [10-foot] distance. Prolonged standing – maximum time per episode 2 hours. Marching with standard field gear except rucksack max [maximum] distance 1/4 mile. Service member reports PEB for bilateral degenerative joint disease of the knees dated 20100304 [4 March 2010]. Service member requires evaluation for condition/limitations noted on profile. No documentation provided by the Service member at the time of the PHA [Preventative Health Assessment]/exam [examination]. Service member must provide supporting documentation to RSC [Regional Support Command]. Profile re-entered into e-Profile module due to new DA Form 3349." 16. On 29 November 2012, she was issued a Notification of Eligibility for Retired Pay at Age 60 (20-Year Letter) stating she completed the required years of qualifying Reserve service and was eligible for retired pay upon application at age 60. 17. She provided a Physical Profile, dated 4 September 2013, showing in: * item 1 (Medical Condition), the profiling officer marked "Illness/Disease" * item 4b (Permanent Profile), the profiling officer marked "Yes" * item 8 (Functional Limitations and Capabilities and Other Comments), the profiling officer noted "Bilateral degenerative joint disease of the knees [paragraph] 3-14c. There is insufficient documentation to support a permanent 3 profile. If the SM [service member] worsens, or the command feels a more restrictive profiel [profile] is required, a profile request packet with additional medical documentation can be submitted to the 81st RSC [Regional Support Command] Surgeon Office." 18. The MRI Report from the North Louisiana Orthopaedic and Sports Medicine Clinic, dated 25 March 2014, findings state: There is a small-moderate amount of joint fluid. The anterior and posterior cruciate ligaments are intact. Fusiform enlargement of the tibial collateral ligament at the femoral origin with increased intrasubstance signal but no tear. The medial meniscus has increased intrasubstance signal and mild irregularity of the articular surfaces but no overt tear. The root attachments are intact. Mild chondromalacia within the medial joint compartment. No acute osteochondral lesion. Small cyst of the semimembranosus/gastrocnemius bursa. There are mild intrasubstance changes within the lateral meniscus. There is no overt tear. Similar chondromalacia within the lateral joint compartment with several small erosions from the femoral condyle posteriorly. The fibula collateral ligament, biceps femoris, iliotibial band and popliteus are intact. Patellofemoral alignment is normal. There is moderate-severe fissuring and irregularity of the articular cartilage both within the patellar facets and through the trochlear groove. There is mild inflammation of the infrapatellar fat pad adjacent to this. There may be a small amount of debris. No distinct loose body. The medial and lateral retinacula, quadriceps and patellar tendons are intact. 19. The memorandum from the Chief, Health Services Branch, Headquarters, 81st Regional Support Command, dated 2 July 2015, informed the applicant that the findings of the formal LOD were "NOT IN LOD – NOT DUE TO OWN MISCONDUCT." The documents provided were insufficient to show the condition claimed was duty related. Due to a lack of supporting evidence, the command could not clearly declare the illness was caused or aggravated by military service. 20. Headquarters, 81st Regional Support Command, Orders 15-271-00003, dated 28 September 2015, released her from her current assignment and assigned her to the Retired Reserve effective 30 September 2015. 21. She reached age 60 . 22. U.S. Army Human Resources Command Orders C02-691660, dated 25 February 2016, retired her and placed her on the Retired List effective November 2015. 23. The memorandum from the Director, Casualty and Mortuary Affairs Operations Center, U.S. Army Human Resources Command, dated 22 March 2016, advised the applicant that the Casualty and Mortuary Affairs Operations Center completed its review of her LOD investigation in which she claimed to have suffered injuries to both knees while participating in a field training exercise during annual training on 15 September 2006. The Casualty and Mortuary Affairs Operations Center supported the original finding of "Not in Line of Duty – NOT Due to Own Misconduct." The evidence contained in the investigation indicated her condition pre-existed the exercise and was not aggravated by her military service. She was informed that the action would be made final and would become a permanent part of her records in the interactive Personnel Records Management System. 24. A review of her records in the interactive Personnel Records Management System did not reveal the LOD determination filed in the performance folder of her Army Military Human Resource Record. 25. On 13 July 2016, the Director, Casualty and Mortuary Affairs Operations Center, U.S. Army Human Resources Command, informed her in writing that the U.S. Army Human Resources Command was unable to consider her appeal of the LOD determination because no substantial new evidence was presented. The DA Form 3349 (Physical Profile) she submitted was evidence already contained in the initial investigation. 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, her claim of when the injury occurred, the available medical history, multiple self-assessments, physical profiles, the absence of an LOD in her records and the reason for her separation (retirement). The Board considered the LOD decision by Regional Command and the results of the review and appeal to Army Human Resources Command. The Board found insufficient evidence of an injury to her knees during the exercise she identified and agreed that the condition pre-existed that time period and was not aggravated by her service. Based on a preponderance of evidence, the Board determined that the LOD determination as stated by the Regional Support Command and supported by AHRC 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. 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): not applicable. REFERENCES: 1. Army Regulation 600-8-4 (LOD Policy, Procedures, and Investigations), in effect at the time, prescribed policies, procedures, and mandated tasks governing LOD determinations of Soldiers who die or sustain certain injuries, diseases, or illnesses. a. Paragraph 2-6c stated LOD determinations must be supported by substantial evidence and by a greater weight of evidence than supports a 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, considering all direct evidence, that is, evidence based on actual knowledge or observation of witnesses; and/or all indirect evidence, that is, facts or statements from which reasonable inferences, deductions, and conclusions may be drawn to establish an unobserved fact, knowledge, or state of mind. b. Paragraph 4-8e(2) stated the doctor, during examination and treatment of the Soldier, usually determines if a condition existed prior to service (EPTS). The doctor annotates the Soldier's medical records as to whether the condition EPTS. 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 the LOD." If an EPTS condition is not aggravated by military service, the determination will be "not in the LOD – not due to own misconduct." c. Paragraph 4-17(a)(1) stated that if a Soldier is assigned within the geographic area of responsibility of the original final approving authority or is a Soldier of the Army National Guard, the appeal will be sent through channels to the final approving authority. The final approving authority may change his or her previous determination of "not in the LOD" to "in the LOD" if there is substantial new evidence to warrant it. If the final approving authority determines there is no basis for a change in the determination, it will be so stated by endorsement and the appeal will be sent to Headquarters, Department of the Army. 2. Army Regulation 40-501 (Standards of Medical Fitness) governs medical fitness standards for enlistment, induction, appointment (including officer procurement programs), retention, and separation (including retirement). a. Paragraph 3-14c stated the causes for referral to an MEB included osteoarthritis with severe symptoms associated with impairment of function, supported by x-ray evidence and a documented history of recurrent incapacity for prolonged periods. b. Chapter 7 prescribed a system for classifying individuals according to functional abilities. The functions have been considered under six factors designated "P-U-L-H-E-S." Four numerical designations are used to reflect different levels of functional capacity. The basic purpose of the physical profile serial is to provide an index to overall functional capacity. Therefore, the functional capacity of a particular organ or system of the body, rather than the defect per se, will be evaluated in determining the numerical designation 1, 2, 3, or 4. An individual having a numerical designation of 1 under all factors is considered to possess a high level of medical fitness. c. Table 7-1 described a physical profile rating of "2" under the lower extremities factor as slightly limited mobility of joints, muscular weakness, or other musculo-skeletal defects that do not prevent moderate marching, climbing, timed walking, or prolonged effort. d. Table 7-2 described assignment limitations for: * code C as limitations in running, marching, and standing for long periods and noted medical criteria as orthopaedic or neurological conditions * code U as limitations not otherwise described, to be considered individually and noted medical criteria as any significant functional assignment limitation not specifically identified elsewhere e. Paragraph 9-13a(2) stated that normally Ready or Standby Reservists temporarily disqualified because of a medical defect would be transferred to the Standby Reserve Inactive List if the Soldier was currently disqualified for retention in an active U.S. Army Reserve status. ABCMR Record of Proceedings (cont) AR20160016313 4 1