BOARD DATE: 30 April 2020 DOCKET NUMBER: AR20180016390 APPLICANT REQUESTS: that injuries he sustained in 2007 and 2013 be found to have been incurred in line of duty (LOD). APPLICANT'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * memorandum from the U.S. Army Human Resources Command (AHRC), Casualty and Mortuary Affairs Operations Division, dated 19 October 2018, subject: Appeal to Initiate an LOD Investigation (LODI) for (applicant) * memorandum from the Commander, 752nd Military Intelligence (MI) Battalion (BN), dated 24 January 2018, subject: Request for Exception to Policy for Submission of Line of Duty 055-17-00116 Determination Past 180-days for (applicant) * memorandum from the Commander, 752nd MI BN, dated 24 January 2018, subject: Request for Exception to Policy for Submission of Line of Duty 055-17- 00623 Determination Past 180-days for (applicant) * memorandum from First Lieutenant (1LT) S, LOD Investigator, dated 27 August 2018, subject: Notice of Determination LODI * memorandum from Colonel COL M, Command Surgeon, MI Readiness Command, dated 6 August 2018, subject: MSC Medical Review for Formal LOD Regarding (applicant) * memorandum from Major (MAJ) B, LOD Nurse Case Manager, U.S. Army Reserve Command (USARC), dated 5 September 2018, subject: Disapproved Consideration for LODI (applicant) * medical notes pertaining to the applicant from the Valley Orthopedic Institute, Palmdale, CA, dated 19 October 2017 * letter to the applicant from Headquarters, 63rd Readiness Division, Office of the Inspector General (IG), dated 11 April 2018 * DA Form 1559 (IG Action Request) * orders for active duty training school (ADTS), dated 24 July 2013 * applicant's treatment record from Valley Care Medical Center Emergency Department * Warrior Leadership Course (WLC) Certificate of Completion * active duty orders, dated 2 March 2007 * Army Reserves Component Overseas Training Ribbon memorandum, dated 10 May 2007 * Chronological Record of Medical Care, dated 23 April 2007 * DA Form 3349 (Physical Profile), dated 27 February 2009 * 16 pages of medical records FACTS: 1. The applicant states: a. He received insufficient follow-up medical care at the time of injury and command staff at training locations failed to properly follow the LOD process, which resulted in insufficient documentation. Command staff should have initiated an LOD but failed to do so in each circumstance. These circumstances were thoroughly documented in exception to policy memoranda. b. Department of Defense Instruction (DODI) 1241.01, Reserve Component (RC) Line of Duty Determination for Medical and Dental Treatments and Incapacitation Pay Entitlements, enclosure 3, paragraph 2 (a) (2) states: In general, an RC Service member or the Military Service concerned has up to 180 days after completion of the qualified duty status to request consideration for an in LOD determination absent special circumstances. c. Once the applicant identified the missing document discrepancy, a request to initiate LODs was passed through his chain of command. Formal LOD investigations were initiated prior to the passage of DODI 1240.01. His command and battalion failed to investigate until 1240.01 was put into effect which resulted in the closure of the LOD's. His LODs were open for over 12 months with no action. d. Special circumstances were found to have been encountered for each injury and were fully supported by the applicant's command team and applied to each of these LOD investigations which were documented via required exception to policy memoranda authored by Lieutenant Colonel (LTC) G on 24 January 2018. e. Reference LODI 055-17-00116: The applicant was assigned to the 752nd MI BN in April 2014. He injured his ankle while attending the WLC at Camp Parks, CA in August 2013. An LOD was initiated by the schoolhouse in accordance with their local policy but it was lost between the applicant's transfer from the school to the Troop Medical Clinic (TMC). His former unit failed to follow-up with the schoolhouse and the TMC to ensure the LOD was completed. It was only discovered an LOD was not completed when the unit started his Medical Evaluation Board (MEB) process. f. Reference LODI 055-17-00623: The applicant was assigned to the 752nd MI BN in April 2014. In April 2007, he participated in a three-week active duty training event in Germany as a firefighter. While attempting to secure a waterline to a hydrant, he felt a "pop" in his wrist. He went to the local hospital for treatment and was returned to his unit with medical documentation for his injury. His U.S. Army Reserve (USAR) unit processed the injury paperwork for a permanent profile but they failed to initiate an LOD. It was only discovered an LOD was not completed when the unit started the applicant's MEB process. g. The 63rd Regional Support Command (RSC) IG closely reviewed and supported the opening of these investigations to document a profiled condition which was to result in a service connected medical board action for the applicant. Additionally he was provided a service contract extension in order to complete the LODIs and medical board process. The IG was not to aid in the findings of the LODI nor the medical board action. The case was closed on 11 April 2018. h. On 8 December 2017, 1LT S was assigned as the Investigating Officer (IO) for formal LODI 055-17-00116. The IO's findings were that the injury was duty connected and not due to misconduct. This finding was further supported by the medical review conducted by COL M via his findings memorandum published on 6 August 2018, which found there was sufficient evidence to support the findings and that the recommendations were consistent with the findings and were appropriate. i. Circumstances of the applicant's injuries: On 20 August 2013, he reportedly sustained an injury while on active duty training (ADT) at Campo Parks, CA. He reportedly sustained an injury to the right foot when he stepped into a wide animal burrow during a daytime land navigation course. At the time of the reported incident, he was on a short-term active duty order (23 days) attending ADT school. He was evaluated at the Valley Care Medical Center Emergency Department on 22 August 2013 presenting with chief complaint of right ankle trauma, with no significant radiographic abnormalities, and discharged with diagnosis of "right ankle sprain with soft tissue swelling lateral malleolus." Analysis: A review of the supporting documentation supports the IO's findings and determination of "in the line of duty not due to own misconduct." j. On 5 September 2018, the applicant and his chain of command were notified by U.S. Army Webmail that MAJ B had administratively closed formal LOD investigations 055-17-00116 and 055-17-00623. MAJ B provided only a single closure memorandum pertaining to LODI 055-17 17-00623. The actions performed by MAJ B on 5 September are being disputed for the following reasons: (1) The formal investigation for LOD 055-17-00623 had not been initiated nor completed when MAJ B administratively closed the LOD. (2) At the time MAJ B made a closure action, there had not been the assignment of an IO, no sworn statements were collected and no investigation had yet taken place. (3) MAJ Battles made a linear determination to close the case without sufficient evidence and without allowing the investigation to take place. (4) MAJ B cited an incorrect diagnosis association on her memorandum for "condition of left wrist injury in 2007 and your current diagnosis of left wrist flexor carpi ulnaris dated 2017". The left wrist injury in 2007 did not result in carpal tunnel but instead per an examination on 19 October 2017, "Examination of the left wrist shows deformity along the FCU tendon with weakness on FCU testing. At this time, the patient will likely have permanent functional deficit secondary to the left ECU tear secondary to his weakness and may require surgery if he has continued numbness and tingling, possible tendon transfer." (5) On 10 September 2018, Chief Warrant Officer Two H of the 752nd MI BN contacted MAJ B via telephone and received the following verbal statements and admissions from MAJ B pertaining to the LOD review: MAJ B is reviewing 50-100 cases per day; MAJ B closed formal LODI 055-17-00116 because there was no exception to policy memorandum, this cannot be a supported finding as LTC G issued the memorandum on 24 January 2018, which was provided to MAJ B on multiple occasions; MAJ B stated that the LOD process is only to provide for funding of ongoing treatment costs associated with service injuries, not to document service connection to the injury. k. Action Requested: Each of the medical conditions identified in LOD investigations 055-17-00116 and 055-17-00623 occurred while the applicant was on active duty status and were the direct result of injuries that occurred while performing assigned duties during the course of the duty day. The findings of LODI 055-17-00116 provided a service connected link and were supported by evidence. He also received the support and assistance of the 63rd RSC IG in opening the LOD investigations and the appointment of a qualified investigator to assist. This appeal requests that Army Board for Correction of Military Records take the following actions: (1) Review/rescind the determination made by MAJ B to close formal LODI 055-17-00116; all investigation findings point towards a special circumstance to open the investigation outside the 180 window described by DODI 1240.01. This would appropriately document the treated condition as it resulted from a service connected injury not from misconduct or non-qualifying duty status. Appropriate documentation in the form of medical evidence, in addition to the exception to policy memorandum, was provided in accordance with regulations and should not have resulted in an administrative closure. (2) Re-open formal LODI 055-17-00623 and allow the IO to proceed through the normal LOD process to make a determination for/against service connection. (3) The injury treatment process that occurred while the applicant was on orders failed to appropriately document the full extent of his injury in that only urgent/immediate care was provided. Initial diagnosis by urgent/emergency room staff was incomplete in that no MRI or sufficient diagnostics were performed to identify the full extent of injury. After release from the duty period, extensive signs of injury were found during normal care routes obtained by the reservist which found more than just an evidence of sprain as indicated in initial treatment record. (4) All evidence submitted up through the LOD process has found that the injuries were in the LOD and not due to misconduct. 2. The applicant enlisted in the USAR on 20 March 2006. 3. Orders issued on 2 March 2007 ordered the applicant's unit and its members to annual training in Germany for the period 7-28 April 2007. 4. A Chronological Record of Medical Care shows the applicant was treated by military medical personnel at Landstuhl Regional Medical Center, Germany, on 23 April 2007 for a left wrist injury. The applicant stated he injured his right wrist while at work doing twisting motions with his wrist to open a fire hydrant and felt a sharp pop and pain. 5. A DA Form 3349 shows that on 27 February 2009, the applicant was issued a permanent physical profile due to a left wrist injury. 6. Orders issued on 24 July 2013 ordered the applicant to ADTS for a period of 23 days to attend the WLC. The orders show a report date of 1 August 2013. 7. Treatment record from ValleyCare Medical Center Emergency Department shows the applicant was treated on 22 August 2013 for a chief complain of ankle pain, traumatic. The record shows the applicant was marching and stepped into a hole (two days ago). He had pain and swelling to the right ankle and heel since stepping in the hole. He also had pain to the left knee. 8. A WLC Certificate of Completion shows he attended the WLC from 2 August to 23 August 2013. 9. Medical notes from the Valley Orthopedic Institute, Palmdale, CA, dated 19 October 2017, contain the following statement: The patient is here for evaluation of left wrist. He had prior right carpal tunnel injection and bracing, doing much better at this time with significantly improved symptoms. The patient has pain in the left wrist. He had a prior tear when he tried to open a fire hydrant in 2007. He was casted for two months. He has sharp and stabbing pain and weakness, 2-7/10 with quick movements. Pain with rotation and pressure. He cannot do push-ups, use a screw driver or hammer. He has numbness occasionally in the ring and small fingers. 10. A DA Form 1559 shows that on 4 December 2017, the applicant submitted a request for assistance to the IG. He stated he had two formal LODs pending at the surgeons' office which were holding up his medical board action. 11. On 24 January 2018, the applicant's battalion commander submitted a request for an exception to policy to the 180 days window for the submission of the applicant's LODIs. The commander stated the applicant injure his wrist in 2007 while in training in Germany and injured his ankle in August 2013 while attending the WLC. 12. The MI Readiness Command Surgeon conducted a medical review of the applicant's LODI 055-17-0016 and provided a memorandum to the MI Readiness Command Commanding General with his findings on 6 August 2018. The memorandum states: a. Circumstances of applicant's injuries: On 20 August 2013, he reportedly sustained an injury while on ADT at Campo Parks, CA. He reportedly sustained an injury to the right foot when he stepped into a wide animal burrow during a daytime land navigation course. At the time of the reported incident, he was on a short-term active duty order (23 days) attending ADT school. He was evaluated at the ValleyCare Medical Center Emergency Department on 22 August 2013 presenting with chief complaint of right ankle trauma, with no significant radiographic abnormalities, and discharged with diagnosis of "right ankle sprain with soft tissue swelling lateral malleolus." b. Analysis: A review of the supporting documentation supports the IO's :findings and determination of in the line of duty not due to own misconduct. 13. On 5 September 2018, the USARC LOD Nurse Casa Manager (MAJ B) provided a memorandum disapproving consideration of the applicant's LODI. The memorandum states: a. The USARC, G-1, Health Services Branch, received your request for consideration to initiate a LODI related to your condition of left wrist injury in 2007 and your current diagnosis of left wrist flexor carpi ulnaris dated 2017. b. Department of Defense Instruction (DODI) 1241.01 (Reserve Component (RC) Line of Duty Determination for Medical and Dental Treatments and Incapacitation Pay Entitlements), enclosure 3, paragraph 2 (a)(2) in general, an RC Service member or the Military Service concerned has up to 180 days after completion of the qualified duty status to request consideration for an in­LOD determination absent special circumstances. Special circumstances are those in which the covered condition pre- dated the 180 day period, e.g., latent onset symptoms of post-traumatic stress disorder was diagnosed outside the allotted 180 day time frame allowed by DODI 1241.01. There is no way to determine if the diagnosis received in the medical documentation in 2017 can be connected with a diagnosis of wrist sprain in 2007. c. The Department of Veterans Affairs (VA) may determine conditions to be service connected. The standards and purposes of the VA's Compensation and Pension Examination process and the Line of Duty Determination process are different and can lead to different determinations. d. The applicant was advised he could appeal to AHRC. 14. On 19 October 2018, the AHRC, Casualty and Mortuary Affairs Operations Division denied the applicant's appeal regarding a denial from the USARC to initiate an LODI. The denial memorandum states: a. Your request does not meet the established criteria for action in accordance with DODI 1241.01, enclosure 3, paragraph 2 (a)(2) and Army Regulation (AR) 600-8-4, Line of Duty Policy, Procedures, and Investigations, paragraph 2-3. b. Your appeal, according to medical evidence reveals a wrist sprain on 23 April 2007, and in 2017, the wrist showed weakness and deformity. You also are claiming an ankle sprain from 22 August 2013. According to AR 600-8-4, paragraph 2-3(b), in all other cases of death or injury, except injuries so slight as to be clearly of no lasting significance, an LOD investigation must be conducted. For purposes served by AR 600-8-4, sprains are medically considered not of lasting significance. Your appeal states throughout that your two diagnoses meet the special circumstances as laid out in DODI 1241.01. After consulting with Headquarters Department of the Army G-1, Director of Military Personnel Management, Medical Policy Branch, your diagnosis does not meet the intended special circumstances criteria. For the reason stated, no action will be taken by AHRC and the denial from USARC remains effective. 15. On 15 May 2019, the AHRC Adjutant General, provided an advisory opinion. It states: a. AHRC obtained a medical opinion regarding two separate USAR LOD submissions. USAR case number 055-17-00016 and 055-17- 00623 will be addressed separately. b. USAR case number 055-17-00016 is regarding an ankle injury while the applicant was attending the WLC. AHRC's opinion regarding this injury is: The applicant was seen in an emergency room (ER) on 22 August 2013. He complained he injured his right ankle three days earlier while marching when he stepped into a hole and twisted his right ankle. He stated he initially could bear full weight, but the pain has increased, and now he cannot walk on his ankle secondary to pain. He also complained of knee pain. On exam, he had some tenderness and edema over the lateral malleolus of the right ankle. An x-ray of his right ankle did not show any soft tissue swelling and no fractures. He was diagnosed with an ankle sprain and discharged home. An air splint was placed on his ankle. There is no mention that he was discharged with crutches nor with weight bearing restrictions. Based on the ER visit, this appears to have been a minor ankle sprain and not of lasting significance, thus an LOD investigation is not needed. Under AR 600-8-4, paragraph 4-4(c), this condition does not meet the criteria for the special circumstances and exception to the 180-day timeline. c. USAR case number 055-17-00623 is regarding a wrist injury while the applicant participated in a three week active duty training event in Germany. AHRC's opinion regarding this injury is: He did not get a full evaluation to determine the extent of his wrist injury in 2007. The fact that his wrist was casted (as opposed to an Ace wrap or wrist immobilizer) for two months suggests the injury was possibly more than a sprain. Medical records from after his orders in April 2007 would be helpful to review to determine the extent of his injury. He appears not to have had a wrist injury before 2007, but wrist issues are clearly evident after April 2007. Because of a lack of medical records, it is unclear whether he received the appropriate follow-up from 2008 when the bulge on his wrist along with decreased range of motion were identified. He has a condition that was not fully assessed while he was in an active duty status, nor did the U.S. Army provide follow-up care. The result was continuing wrist pain and a wrist condition that apparently still bothers him up to the present and, according to an orthopedic surgeon, would result in a permanent functional deficit in his wrist. This implies that this injury, which occurred while on orders, was of lasting significance, and an LOD investigation should have been undertaken. 16. The applicant was provided a copy of the advisory opinion on 17 June 2019 and given an opportunity to submit comments. He did not respond. 17. The Army Review Board Agency (ARBA) Medical Advisor reviewed the supporting documents and the applicant's records in iPERMS, the Armed Forces Health Longitudinal Technology Application (AHLTA), Health Artifacts Image Management Solutions (HAIMS) and the VA's Joint Legacy Viewer (JLV) and made the following findings and recommendations: According to the applicant’s Army Board for Correction of Military Records (ABCMR) application, the applicant asserts that due to insufficient follow-up care at the time he reportedly sustained injuries to his right leg and left wrist he was not afforded the opportunity to have an accurately completed Line of Duty (LOD) investigations of his alleged injuries. Although the applicant’s application indicates that his injuries were reported through formal LOD investigations, he indicates they should be corrected to state the injuries occurred in the line of duty and not due to the applicant’s own misconduct. This statement is confusing as the Agency Medical Advisor was not able to find any such documentation stating that the applicant’s injuries resulted from his own misconduct. Based on the available records the applicant sustained an injury to his right foot and ankle that was diagnosed as a right ankle sprain on 20 August 2013 while he was on Active Duty Training. This injury was determined to be in the LOD, and not due to Soldier misconduct. It is unclear as to why this is an issue since the injury was determined to have occurred in the LOD regardless if the investigation was completed formally or informally. The extent of the injury and whether the injury would be considered unfitting IAW AR 40-501, Chapter 3 would be the determining factor in determining any subsequent action to be taken. A second LOD preceded the aforementioned LOD and indicates that the applicant sustained an injury to his left wrist in April 2007 while he was attempting to secure a waterline. The applicant asserts that he felt a “pop” at the time of the injury, and he sought evaluation and treatment at the local Military Treatment Facility (MTF) The applicant’s USAR unit initiated a permanent profile that would have triggered the initiation of the Disability Evaluation Process (DES) including a Medical Evaluation Board (MEB) and a Physical Evaluation Board (PEB). However, a formal LOD was allegedly not initiated prior to the initiation of the applicant’s MEB. Again, it is difficult to ascertain the significance of whether or not a formal or informal LOD was initiated provided there was no question as to whether the applicant’s actions that created the circumstances of his injury was due to the applicant’s own misconduct. Based on a thorough review conducted by the Agency Medical Advisor there is no indication that the applicant’s injuries were ever suggested as being due to his own misconduct. Regardless whether the injuries were documented by formal or informal LOD investigations, the applicant would have still been entitled to receive care for these conditions. However, he would have been required to coordinate this care through his USAR unit following release from Active Duty Training. If the conditions were documented at the time of occurrence then the applicant would have been entitled to receive ongoing care for these conditions. It would be the applicant’s responsibility to ensure his USAR unit was aware of the injuries, and to coordinate the appropriate way to receive ongoing evaluation and treatment. The assertion that a MAJ Battles closed a formal LOD investigation would not be relevant in determining the extent of the applicant’s injuries, or influence the findings of the DES during the MEB/PEB phase of his evaluation. It is important to note that, again, regardless as to whether a formal or informal LOD investigation was completed, the injuries were documented in the applicant’s record. It is also important to understand that the VA finding of service connection does not automatically result in a military retirement or equivalent percentage ratings from the Army. The VA operates under different rules, laws and regulations when assigning disability percentages than does the Department of Defense (DoD). In essence, the VA will compensate for all conditions felt to be un-suiting. However, the DoD will only compensate for those conditions found to be unfitting. The concept of a condition being “service connected” is terminology used by the VA and not the DoD. Therefore, there is no significance in a determination of an injury or illness being “service connected” with respect to the DoD. Service connectedness would apply to conditions rated by the VA. With regard to the extent of any evaluation and treatment of a reported illness or injury, the extent of the work-up, to include any ancillary laboratory or imaging studies, are strictly at the discretion of the evaluating provider seeing the patient. A provider cannot be compelled to perform any test that he or she does not feel appropriate at the time of the evaluation. If a patient feels that an appropriate evaluation was not performed by any given provider, then this would be a civil matter covered under tort law and not a medical issue. MRI’s are rarely performed in an emergency department setting for an acute injury. An MRI is frequently performed after the patient has failed a trial of Physical Therapy, the condition is not improving despite a trial of conservative treatment, or it is abundantly clear on physical exam that there is significant ligament, cartilage, muscular, or other soft tissue injury. Whether the applicant was in the military or not, it would still be his responsibility to seek medical care if he felt something more significant was present. The Agency Medical Advisor did not find any indication in the available records that suggest that any of the applicant’s injuries resulted from his own misconduct. Therefore, it is the opinion of the Agency Medical Advisor, based on the available documentation, that any change in the type of LOD investigation completed is immaterial to the case, and the outcome of the case would not be different regardless, provided the injuries were not a result of the applicant’s own misconduct. According to the available records, there is no indication that anyone has alleged that the applicant’s injuries, as stated, resulted from the applicant’s own misconduct. BOARD DISCUSSION: After reviewing the application and all supporting documents, the Board found the relief was warranted. The applicant’s contentions, his military record, and regulatory guidance were carefully considered. The Board concurred with the advisory opinion which found no indication in the available records that suggest that any of the applicant’s injuries resulted from his own misconduct, and any change in the type of LOD investigation completed is immaterial to the case. However, based upon a preponderance of the evidence, and notwithstanding the recommendation of the advisory official, the Board determined there is sufficient evidence to grant relief. BOARD VOTE: Mbr 1 Mbr 2 Mbr 3 : X :X :X GRANT FULL RELIEF : : : GRANT PARTIAL RELIEF : : : GRANT FORMAL HEARING : : : DENY APPLICATION 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 amending LODI 055-17- 00116 and LODI 055-17-00623 to reflect the injuries the applicant sustained in 2007 and 2013 were incurred in the line of duty (LOD). 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. AR 600-8-4 prescribes policies and procedures for investigating the circumstances of injury, illness, disease, or death of a Soldier. It provides standards and considerations used in making LOD determinations. a. The Army LOD Program is a commander’s program which essentially protects the interest of both the Soldier and the U.S. Government where service is interrupted by injury, illness, disease, or death. b. LOD investigations determine: duty status at the time of incident and whether misconduct was involved and, if so, to what degree. Additionally, LOD investigations may be required to determine an existed prior to service condition, and, if so, determine service aggravation. c. An LOD investigation will be conducted for all Soldiers, regardless of Component if the Soldier experiences a loss of duty time for a period of more than 24 hours and: (1) The injury, illness, or disease is of lasting significance (to be determined by a physician, physician assistant, or nurse practitioner). (2) There is a likelihood that the injury, illness, or disease will result in a permanent disability. (3) If an RC Soldier requires follow-on care for an injury, illness, or disease incurred during a period of active duty. d. Medical and Dental care for Soldiers on duty other than active duty: A Soldier of the RC is entitled to hospital benefits, pensions, and other compensation, similar to that for Soldiers of the Regular Army for injury, illness, or disease incurred in LOD while performing active duty for a period of 30 days or less. e. The unit commander may, if approved by the appointing authority, elect to conduct an informal investigation so long as misconduct or gross negligence is not suspected on the part of the Soldier and a formal investigation is not required. f. All informal LOD investigations must be initiated within 5 calendar days of the command’s discovery of the injury, illness, disease, or death. When an informal investigation is not completed within the given time, the reasons the report is late should be included in the remarks section of DA Form 2173 (Statement of Medical Examination and Duty Status). The timeline for completing an informal investigation is no more than 60 days. If evidence required to support an in LOD determination is not available within the prescribed time frame, the unit commander must provide the reason(s) in the 30-day investigative update to the appointing authority. g. Soldiers will have up to 180 days following the completion of their qualified duty to request consideration for an LOD, absent special circumstances. Special circumstances are those in which the covered condition pre-dates the 180 day period, for example, latent onset symptoms of post-traumatic stress and unreported sexual assault. h. LOD determinations for injury, illness, or disease that have no lasting effect, defined as not requiring follow on care ultimately affecting a Soldier’s overall health or career, will not be accepted. LODs where the diagnoses are listed as, abrasions, scratches, pain, headache (not associated with behavioral health), hernia, and pregnancy, are injuries or illness that leave no lasting effect on the Soldier or require hospitalization for further treatment. 2. DODI 1241.01, Reserve Component (RC) Line of Duty Determination for Medical and Dental Treatments and Incapacitation Pay Entitlements, enclosure 3, paragraph 2 (a)(2) sates in general, an RC Service member or the Military Service concerned has up to 180 days after completion of the qualified duty status to request consideration for an in-LOD determination absent special circumstances. Special circumstances are those in which the covered condition pre-dated the 180 day period, e.g., latent onset symptoms of post-traumatic stress disorder. //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20180016390 13 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1