ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS IN THE CASE OF: BOARD DATE: 2 August 2019 DOCKET NUMBER: AR20180013822 COUNSEL’S REQUESTS: the applicant record be corrected to show he was unfit for continued service and permanently medically retired for PTSD at a 30 percent or higher disability rating. In the alternative, he request to be retroactively placed on the Temporary Disability Retired List (TDRL) He further request his DD Form 214 (Certificate of Release or Discharge from Active Duty) be corrected to reflect a medical retirement instead of an administrative separation for a personality disorder. He also request Section 13 (Decorations, Medals, Badges, Citations and Campaign Ribbons Awarded or Authorized) of his DD Form be amended to include the Armed Forces Expeditionary Medal with Arrowhead Device for his service in Panama in support of Operation Just Cause. APPLICANT'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * 14 page Counsel’s Memorandum in Support of Application * 95 pages of the applicant’s service record * 341 pages of Department of Veterans Affairs (VA) Claim Folder FACTS: 1. The applicant did not file within the three year time frame provided in Title 10, United States Code (USC), section 1552 (b); however, the Army Board for Correction of Military Records conducted a substantive review of this case and determined it is in the interest of justice to excuse the applicant's failure to timely file. 2. Counsel states: a. The applicant joined the Army out of a sense of service and duty to his country. He wanted to be among the best the Army had to offer and he wanted to challenge himself. He aspired to serve as an Army Ranger. He enlisted in the Army on 5 July 1989. Prior to his enlistment he underwent a medical examination to determine his physical and mental health for enlistment. He was found to be in good health and no psychiatric problems were noted. After attending basic training at Fort Benning, Georgia, and Airborne School, he was selected and passed the Ranger Indoctrination Program ("RIP"). During RIP, he was challenged both physically and mentally. He experienced immense physical and mental fatigue, as a result of sleep deprivation, hunger, and other hardships of simulated combat. Throughout the course, he maintained a positive attitude and never gave up. Following successful completion of RIP, he was assigned to Company B, 3rd Battalion, 75th Ranger Regiment. He enjoyed being in his new unit and got along with everyone. Everyone seemed to be in good spirits and possessed an aggressive warrior mentality. b. In December of 1989, his battalion was deployed to Panama in Support of Operation Just Cause. While much of his battalion parachuted into Panama, he landed via C-130 with support vehicles. During the landing, he found himself under attack when his plane began taking enemy fire. The fighting continued after his battalion landed on the Rio Hato airfield and began engaging the enemy. His platoon was tasked with establishing a blocking position along a main highway. His task as part of his platoon's mission was to gather enemy prisoners and civilians. While occupying that the blocking position, a vehicle accelerated at the platoon at a high rate of speed and did not show signs of stopping. The platoon was forced to engage the vehicle with rifle and machine gun fire to halt its advance. In his role of gathering enemy prisoners and civilians, was tasked to investigate the vehicle once stopped and check to see if there were any survivors. When he approached the vehicle he found it occupied by three women, each of whom had been killed by the fire sustained from the platoon. He also found a baby on the back seat of the vehicle. The baby was alive and screaming. To this day, the sound of a screaming baby makes him anxious and reminds him of his time in Panama. The following day, his platoon was involved in a friendly fire incident, which left a squad leader from his platoon dead. A friendly helicopter mistook the applicant’s platoon as enemy combatants and fired upon them, using rockets. He witnessed the explosion, the death of the squad leader, and the dismemberment of a member of the platoon who had his leg blown off from the explosion. c. The applicant and his battalion returned to the U.S. January 1990. Less than two weeks after returning from Panama, he witnessed a member from his company commit suicide. After witnessing this incident, he began to question what he had done in Panama and his role in the Army. Despite these terrible events, and as a result of performance during operations in Panama, he had been selected to attend, and accepted a slot for, Ranger School. As a prerequisite to attending the course, he was required to undergo a second medical examination to once again determine his physical and mental health. Just as with his initial medical examination, his medical examination for Ranger School did not identify any psychiatric problems and was consistent with a normal psychiatric profile. Before leaving to attend Ranger School however, he became depressed; however, he did not say anything about the issues he was having until October. At this point, he reached out to his company leadership for help. After reaching out to his company leadership regarding the feelings he was having, he was told he could either go to regular infantry unit, leave the Ranger battalion, or he could leave the Army all together. He did not want to leave a unit that he had worked so hard to get into. On 10 October 1990, he requested voluntary termination of his airborne duty. Two weeks later the Army began processing him for administrative separation. He was officially separated from the Army on 6 December 1990, less than three months after seeking help. The narrative reason for his separation, and the justification provided in the documentation that was part of his administrative separation was "Personality Disorder." During the period between hiss request for help and separation, he received no counseling or medical evaluations for post-traumatic stress disorder (PTSD), personality disorder, or any other psychological condition. He filed a disability claim with VA for PTSD and was awarded a 70 percent service-connected rating for PTSD effective 5 February 2001. d. The Army has prescribed specific procedures for discharges relating to personality disorders of Soldiers. As a matter of law, the Army must diligently follow these procedures in order to ultimately separate a solider for personality disorder. In the applicant's case, the Army failed to adhere to these guidelines and the applicant was subsequently denied a meaningful evaluation of his correct discharge status and eligibility for future benefits. Even if the Army asserts he suffered from both PTSD and a personality disorder, the Army was required to explore the debilitating effects of the PTSD before considering a personality disorder discharge. Had the Army followed applicable regulations, the outcome for the applicant would have been very different. e. Counsel goes on to outline the requirements of Army Regulation 636-200 (Personnel Separations – Enlisted Personnel), as it pertains to separation for personality disorders. Specifically the requirement that for any Solider to be separated for personality disorder, a diagnosis of personality disorder must be established. Such diagnosis can only be established by a physician trained in psychiatry and psychiatric diagnosis and in accordance with the Diagnostic and Statistical Manual of Mental Disorders. He therefore contends, the Army is required to have a Solider evaluated by a trained psychiatrist before diagnosing the solider with a personality disorder. According to the applicant's statements, he received no medical evaluation before being discharged for having a personality disorder. Additionally, his medical and service records contain no medical evaluation diagnosing him with a personality disorder. With the exception of two references from his commanding officers to a "mental evaluation"- without any documentation thereof, there is simply no evidence of a real medical evaluation having been performed. f. Counsel also contends governing regulation requires that separation processing may not be initiated until a Soldier has been formally counseled and had ample opportunity to overcome any deficiencies reflected in his counseling. The applicant was notified on 25 October 1990, he was being recommended for administrative separation. He was discharged from the Army on 6 December 1990, less than two months after being notified of his commanding officer's recommendation. His records contain no evidence of him ever receiving a formal counseling as part of his administrative separation. Additionally, his declaration explicitly states he never received any counseling prior to his separation. Even if he had received a formal counseling notifying him of his deficiencies, the less-than-two months he was given before being discharged can hardly be seen as "ample opportunity" to overcome these deficiencies. The Army failed to adhere to its own guidelines in administratively separating him and depriving him of an opportunity overcome any deficiency. g. Counsel goes on to contend, according to governing regulation a Solider cannot be separated for personality disorder if separation is warranted because of a physical disability, which in the applicant's case is PTSD. He suffered, and continues to suffer, from PTSD as a result of his military service. Even with a diagnosis of personality disorder, the Army was required to medically retire him because of his PTSD. The Army failed to follow its own guidelines regarding his discharge because it failed to have a trained psychiatrist diagnose him with a personality disorder. He was not given a counseling regarding his deficiencies, nor ample opportunity to correct them. Even if he had been properly diagnosed with a personality disorder, his PTSD necessitated a medical retirement rather than an administrative separation. The Army's failure to adhere to its procedures in this instance has stigmatized the applicant and had the effect of depriving him of benefits to which he is entitled. h. Counsel states the applicant’s records support a medical retirement based on PTSD. This conclusion is reinforced by findings in the medical evaluation conducted by Dr. R.M., the medical evaluation conducted by Dr. J.S., and a review of records conducted by Dr. M. M. By contrast, the Army's finding of a personality disorder is not supported by any evaluation. The record shows that, leading up to, during his administrative separation processing, and after, the applicant suffered from PTSD. As such, he should have been evaluated by a medical evaluation board (MEB) and medically retired. i. Counsel states Army Regulation 40-501(Standards of Medical Fitness), requires that any Soldier who is determined to have conditions listed under Chapter 3 will be evaluated by a medical board and referred to a Physical Evaluation Board (PEB). One of the conditions found in Chapter 3 is "Anxiety somatoform, or dissociative disorders (alternatively, may be addressed as neurotic disorders). This condition is described as "persistence or recurrence of symptoms sufficient to require extended or recurrent hospitalization, necessity for limitations of duty or duty in protected environment or resulting in in interference with effective military performance." As identified by Dr. M, this is the condition from which the applicant suffers. j. According to the incident report filed by sergeant (Sgt) K, the applicant had confessed to him that he suffered from suicidal ideations and that he had held a gun to his head on multiple occasions and that he did not want to live most of the time. The applicant also informed Sgt. K that he was a very depressed person. The applicant’s admission to Sgt. K that he was depressed and had held a gun to his head on several occasions indicates that the symptoms from which he suffered were persistent and recurring. The fact that the Army processed him for administrative separation as a result of these issues demonstrates that his symptoms were of such a severe nature as to require limitations of his duty and resulted in the interference with effective military performance. The applicant’s symptoms as described in the medical evaluations of Dr. M and Dr. S, along with the statements the applicant made to Sgt. K, clearly demonstrate the applicant meets the description under paragraph 3-33 of the Army Retention Standards, and should have been referred to a PEB. A PEB would have had to determine whether he was unfit for continued military service as a result of his PTSD. According to Army Regulation 635-40, paragraph 4-19, "a determination of physical fitness will be made by relating the nature and degree of physical disability of the Soldier to the requirements and duties that the Soldier may reasonably be expected to perform in his or her primary MOS. " In other words, a PEB would have determined whether the applicant could have performed his duties. k. The applicant was an infantryman. Much of his duties involved carrying a rifle. As noted by Dr. M and Dr. S, he could no long perform this duty. He was unfit to continue in the Army as he could no longer perform his duty. The fact that he could no longer perform his duty is further reinforced by the fact that the Army administratively separated him from service. If the Army still thought he could perform his duties, he would not have been administratively separated. With a finding that he was unfit to perform his duties as an infantryman, the PEB would next have had to determine the degree of disability, if any, to which he would have been entitled. Such a determination would be found using VA's disability rating schedule. In order to qualify for retirement from the military, a service member needs only a disability rating of 30 percent. The applicant was granted a 70 percent rating by VA. A PEB should have found he was unfit to perform his duties as a result of his PTSD and such a finding required a rating sufficient enough to medically retire him, and provide him benefits, as well as TRICARE for the rest of his life. In the alternative, if a PEB did not believe his condition was of a permanent nature, it should have placed him on the TDRL. The requirements for placement on the TDRL are the same as for permanent retirement. According to regulations governing the VA, when a mental disorder that develops in service as a result of a highly stressful event is severe enough to bring about the veteran's release from active military service, the rating agency shall assign an evaluation of not less than 50 percent and schedule an examination within the sixth month period following the veteran's discharge to determine whether a change in evaluation is warranted. The Army never properly evaluated the applicant's psychological condition. Had it done so, the facts show that it would have inevitably concluded he suffers from PTSD. This finding would result in at least a 50 percent disability rating and an award of medical retirement benefits. l. Counsel finally contends the applicant should be awarded the Armed Forces Expeditionary Medal (AFEM) with Arrowhead Device for his service in support of Operation Just Cause. Counsel’s complete brief is available for the Board’s review. 3. The applicant’s DA Form 2-1 (Personnel Qualification Record) shows in item 35 (Record of Assignments) he served with Company B, 3rd Battalion, 75th Ranger Regiment, from 1 December 1989 to 5 December 1990. There is no evidence the applicant was awarded or authorized the AFEM with Arrowhead Device. 4. Headquarters, Joint Task Force – South, Fort Bragg, NC, awarded the applicant the Combat Infantryman Badge (CIB) for the period 20 December 1989 to 7 January 1990. 5. The applicant’s record contains a sworn statement by SGT K, dated 9 October 1990, in which he states, in part, the applicant told him that he wanted to kill himself. The applicant stated he could not take the Army any longer. The applicant further stated he was a very depressed person. 6. On 25 October 1990, the applicant's commander notified him that he was initiating action to discharge him because of a personality disorder. The commander further notified the applicant he was recommending that the applicant’s period of service be characterized as honorable. The notification indicated there was a Mental Evaluation; however, it is not available for the Board’s review. The commander advised the applicant of his available rights. The applicant acknowledged receipt of notification of the proposed separation against him on the same date. 7. After consulting with counsel, the applicant indicated that he was not submitting statements in his own behalf. He acknowledged that he would be ineligible to apply for enlistment in the Army for 2 years after discharge. He further acknowledged he understood if he received a discharge/character of service that is less than honorable, he may make application to the Army Discharge Review Board (ADRB) or the Army Boards of Correction for Military Records (ABCMR) for upgrading; however, an act of consideration by either board does not imply his discharge would be upgraded. 8. On 29 November 190, the appropriate authority directed the applicant be discharged and furnished an Honorable Discharge Certificate. 9. On 6 December 1990, the applicant was discharged due to personality disorder, under the provisions of Army Regulation 635-200 (Personnel Separations – Enlisted Personnel), paragraph 5-13. He completed 5 years, 5 months, and 29 days of net active service this period. He was awarded or authorized the following: * Army Service Ribbon * Parachutist Badge * Combat Infantryman Badge * Sharpshooter Marksmanship Qualification Badge with Rifle Bar (M-16) * First Class Qualification Badge with Hand Grenade 10. On 5 June 2019, the Army Review Boards Agency (ARBA) medical advisor provided an advisory opinion. The ARBA medical advisor states, in part, based on the available documentation, there is no evidence to support a diagnosis of personality disorder. His military record does indicates he was experiencing significant depression with suicidal ideation to include a plan. His symptoms were more consistent with a mood disorder and/or PTSD. His administrative separation for personality disorder was improper and unequitable. It is likely that he failed to meet medical retention standards at the time of his discharge. Board should consider referral of this case to the Integrated Disability Evaluation System (IDES). A copy of the complete medical advisory was provided to the Board for their review and consideration. 11. On 14 June 2019, the applicant was provided a copy of the advisory opinion and given an opportunity to submit comments. He did not respond. 12. Army Regulation 635-200 provides the basic authority for the separation of enlisted personnel. Paragraph 5-13 provides that a Soldier may be separated for personality disorder, not amounting to disability under Army Regulation 635-40, which interferes with assignment to or performance of duty. The regulation requires that the condition is a deeply ingrained maladaptive pattern of behavior of long duration that interferes with the Soldier’s ability to perform duty. The regulation also directs that commanders will not take action prescribed in this chapter in lieu of disciplinary action and requires that the diagnosis concludes the disorder is so severe that the Soldier’s ability to function in the military environment is significantly impaired. 13. Army Regulation 635-40 (Disability Evaluation for Retention, Retirement, or Separation) establishes the Army Disability Evaluation System and sets forth policies, responsibilities, and procedures that apply in determining whether a Soldier is unfit because of physical disability to reasonably perform the duties of his office, grade, rank, or rating. Only the unfitting conditions or defects and those which contribute to unfitness will be considered in arriving at the rated degree of incapacity warranting retirement or separation for disability. 14. Army Regulation 40-501, chapter 3, establishes the Army Physical Disability Evaluation System and sets forth policies, responsibilities, and procedures that apply 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. 15. DTM 11-015, 19 December 2011, provides for the Integrated Disability Evaluation System (IDES). The IDES is the joint Department of Defense (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. 16. Title 10, U.S. Code, chapter 61, provides the Secretaries of the Military Departments with authority to retire or discharge a member if they find the member unfit to perform military duties because of physical disability. 17. 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. 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. 18. The Army Center for Military History shows 3rd Battalion, 75th Ranger Regiment received campaign participation credit for Armed Forces Expeditions in Panama. 19. Army Regulation 600-8-22 (Military Awards) states the AFEM is awarded for qualifying service after 1 July 1958 in U.S. military operations, U.S. operations in direct support of the United Nations, and U.S. operations of assistance for friendly foreign nations. Qualifying service for this award includes participation in Panama in support of Operation Just Cause from 20 December 1989 through 31 January 1990. The Arrowhead Device denotes participation in an amphibious assault landing combat parachute jump, helicopter assault landing or combat glider landing. BOARD DISCUSSION: 1. The Board carefully considered the applicant’s request, supporting documents, evidence in the records and a medical advisory opinion. The Board considered the applicant’s service, his statement regarding his separation, the reason for his separation and the conclusions of the advising official. The Board reviewed the available medical evidence and concurred with the conclusion of the advising official in that there was insufficient evidence to show the applicant had a personality disorder and sufficient evidence to show that he should have been evaluated for processing by the IDES prior to separation. Based on a preponderance of evidence, the Board determined that the applicant should have been afforded consideration of processing through the integrated disability evaluation system and a correction is required to correct an injustice. 2. After reviewing the application and all supporting documents, the Board found that partial relief was warranted. BOARD VOTE: Mbr 1 Mbr 2 Mbr 3 : : : GRANT FULL RELIEF :X :X :X GRANT PARTIAL RELIEF : : : GRANT FORMAL HEARING : : : DENY APPLICATION BOARD DETERMINATION/RECOMMENDATION: 1. The Board determined the evidence presented is sufficient to warrant a recommendation for partial relief. As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by referring his records to the Office of The Surgeon General for review to determine if the conditions that led to his separation warranted consideration for IDES processing. a. If a review by the Office of The Surgeon General determines the evidence supports it, the individual concerned will be afforded due process through the Disability Evaluation System for consideration of any diagnoses identified as having not met retention standards prior to his discharge. b. In the event that a formal PEB becomes necessary, the individual concerned may be issued invitational travel orders to prepare for and participate in consideration of his case by a formal PEB. All required reviews and approvals will be made subsequent to completion of the formal PEB. c. Should a determination be made that the applicant should be separated or retired for disability, these proceedings serve as the authority to issue his the appropriate medical separation with pay retroactive to his original separation date or entitlement to all back pay and allowances associated with medical retirement. 2. The Board further determined the evidence presented is insufficient to warrant a portion of the requested relief. As a result, the Board recommends denial of so much of the application that pertains to any relief without benefit of the review described above. 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. ADMINISTRATIVE NOTE(S): Not Applicable REFERENCES: 1. Title 10, USC, section 1552(b), provides that applications for correction of military records must be filed within three 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 three-year statute of limitations if the ABCMR determines it would be in the interest of justice to do so. 2. Army Regulation 635-200 (Personnel Separations – Enlisted Personnel), provides the basic authority for the separation of enlisted personnel. Paragraph 5-13 provides that a Soldier may be separated for personality disorder, not amounting to disability under Army Regulation 635-40, which interferes with assignment to or performance of duty. The regulation requires that the condition is a deeply ingrained maladaptive pattern of behavior of long duration that interferes with the Soldier’s ability to perform duty. The regulation also directs that commanders will not take action prescribed in this chapter in lieu of disciplinary action and requires that the diagnosis concludes the disorder is so severe that the Soldier’s ability to function in the military environment is significantly impaired. 3. Title 10, U.S. Code, chapter 61, provides the Secretaries of the Military Departments with authority to retire or discharge a member if they find the member unfit to perform military duties because of physical disability. The U.S. Army Physical Disability Agency is responsible for administering the Army physical disability evaluation system and executes Secretary of the Army decision-making authority as directed by Congress in chapter 61 and in accordance with DOD Directive 1332.18 and Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation). a. Soldiers are referred to the disability system when they no longer meet medical retention standards in accordance with Army Regulation 40-501 (Standards of Medical Fitness), chapter 3, as evidenced in an MEB; when they receive a permanent medical profile rating of 3 or 4 in any factor and are referred by an MOS Medical Retention Board; and/or they are command-referred for a fitness-for-duty medical examination. b. The disability evaluation assessment process involves two distinct stages: the MEB and PEB. The purpose of the MEB is to determine whether the service member's injury or illness is severe enough to compromise his/her ability to return to full duty based on the job specialty designation of the branch of service. A PEB is an administrative body possessing the authority to determine whether or not a service member is fit for duty. A designation of "unfit for duty" is required before an individual can be separated from the military because of an injury or medical condition. Service members who are determined to be unfit for duty due to disability either are separated from the military or are permanently retired, depending on the severity of the disability and length of military service. Individuals who are "separated" receive a one-time severance payment, while veterans who retire based upon disability receive monthly military retired pay and have access to all other benefits afforded to military retirees. c. The mere presence of a medical impairment does not in and of itself justify a finding of unfitness. 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. Reasonable performance of the preponderance of duties will invariably result in a finding of fitness for continued duty. A Soldier is physically unfit when a medical impairment prevents reasonable performance of the duties required of the Soldier's office, grade, rank, or rating. 4. Army Regulation 635-40 establishes the Army Disability Evaluation System and sets forth policies, responsibilities, and procedures that apply in determining whether a Soldier is unfit because of physical disability to reasonably perform the duties of his office, grade, rank, or rating. Only the unfitting conditions or defects and those which contribute to unfitness will be considered in arriving at the rated degree of incapacity warranting retirement or separation for disability. a. Paragraph 3-2 states disability compensation is not an entitlement acquired by reason of service-incurred illness or injury; rather, it is provided to Soldiers whose service is interrupted and who can no longer continue to reasonably perform because of a physical disability incurred or aggravated in military service. b. Paragraph 3-4 states Soldiers who sustain or aggravate physically-unfitting disabilities must meet the following line-of-duty criteria to be eligible to receive retirement and severance pay benefits: (1) The disability must have been incurred or aggravated while the Soldier was entitled to basic pay or as the proximate cause of performing active duty or inactive duty training. (2) The disability must not have resulted from the Soldier's intentional misconduct or willful neglect and must not have been incurred during a period of unauthorized absence. 5. 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. 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. 6. DTM 11-015, 19 December 2011, provides for the Integrated Disability Evaluation System (IDES). The IDES is the joint Department of Defense (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. a. Appendix 10 to Attachment 4 states within 15 days of receiving proposed disability ratings from the (D-RAS), the PEB would apply the ratings using the diagnostic code(s) provided by the D-RAS to the Service member’s unfitting conditions and publish the disposition recommendation. b. Appendix 11 to Attachment 4 (D-RAS Procedures), in effect at the time, stated: 1) Upon receipt of the case files (request for rating and service treatment record) of unfit Service members from PEB administration, the D-RAS determines whether the VA C&P disability examination report is adequate for disability rating purposes. 2) The D-RAS will rate the service member’s referred and claimed service- connected disabilities and provide a proposed rating decision, with rationale, to the PEB within 15 days of notification by the PEB administration staff that a service member is unfit. 3) Once the D-RAS has rated all unfitting conditions, the D-RAS will provide their proposed rating decision to the PEB. The D-RAS will defer rating all other conditions that require additional claim development in accordance with VA business practices and regulations. 4) Within 15 days of receipt from the PEB of a service member’s written request for a one-time reconsideration of a proposed disability evaluation assigned for unfitting conditions by VA, the VA decision review officer will consider any new documentation or information from the Service member and provide the PEB updated proposed ratings, if any. 5) This is a one-time “request for reconsideration” of the rating(s) from the D- RAS. Subsequent appeals of ratings to VA must occur when the Service member has separated, attained veteran status, and has been formally notified of the rating decision. 7. Army Regulation 40-501 (Standards of Medical Fitness), chapter 3, provides the various medical conditions and physical defects which may render a Soldier unfit for further military service and which fall below the standards required for the individuals. These medical conditions and physical defects, individually or in combination, are those that significantly limit or interfere with the Soldier's performance of his or her duties, may compromise or aggravate the Soldier's health or well-being if they were to remain in the military service (this may involve dependence on certain medications, appliances, severe dietary restrictions, or frequent special treatments, or a requirement for frequent clinical monitoring), may compromise the health or well-being of other Soldiers, and/or may prejudice the best interests of the government if the individual were to remain in the military service. 8. Army Regulation 600-8-22 (Military Awards) states the AFEM is awarded for qualifying service after 1 July 1958 in U.S. military operations, U.S. operations in direct support of the United Nations, and U.S. operations of assistance for friendly foreign nations. Qualifying service for this award includes participation in Panama in support of Operation Just Cause from 20 December 1989 through 31 January 1990. The Arrowhead Device denotes participation in an amphibious assault landing combat parachute jump, helicopter assault landing or combat glider landing.