IN THE CASE OF: BOARD DATE: 6 October 2021 DOCKET NUMBER: AR20200010221 APPLICANT REQUESTS: * correction of his DD Form 261 (Report of Investigation Line of Duty (LOD) and Misconduct Status) to show his illness was found to have occurred in line of duty-existed prior to service (EPTS)-service aggravated * personal appearance before the Board APPLICANT'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * DD Form 261 and allied documents * Memorandum from the National Guard Bureau (NGB), Personnel Division, dated 26 December 2019, subject: LOD Determination [applicant] * Memorandum from U.S. Army Human Resources Command (HRC), Casualty and Mortuary Affairs Operations Division, dated 2 November 2020, subject: LOD Investigation Appeal, [applicant] * excerpts of Department of Defense Instruction (DoDI) 1332.18 and Army Regulation 600-8-4 (LOD Policy, Procedures, and Investigations), dated 15 March 2019 FACTS: 1. The applicant states: a. DoDl 1332.18, dated 5 August 2014, Section 7, Appendix 3 to Enclosure 3 states that: The Secretary of the Military Department concerned must base a finding that the Service member's condition was not incurred in or aggravated by their current period of military service on objective evidence in the record, as distinguished from personal opinion, speculation, or conjecture. When the evidence is unclear concerning whether the condition existed prior to their current period of military service or if the evidence is equivocal, the presumption of sound condition at entry to the current period of military service has not been rebutted and the Secretary of the Military Department concerned will find the Service member's condition was incurred in or aggravated by military service. b. The Investigating Officer (IO) follow up memorandum conclusion was that the episode was aggravated by military service. c. Army Regulation 600-8-4, paragraph 2-5, states: Not in line of duty- Not Due to Own Misconduct. A determination supported by a preponderance of the evidence that the member's injury, illness, disease, or death happened while the member was absent without authority, and the injury, illness, disease, or death was not proximately caused by the member's own misconduct. If the Soldier was absent without leave at the time, only a behavioral health (BH) expert can determine mental soundness for that Soldier. EPTS conditions also fall under this finding unless negligence or misconduct is found. (No question there were two minor and brief undiagnosed episodes prior to hospital emergency presenting itself but, hindsight should not be 2020. He was given an exploratory reduced 50mg medication 3 weeks prior to the hospital episode. He was referred to BH at hospital discharge, and officially diagnosed after hospital by a future doctor appointment on 7 June 2019. Medication over monthly visits had increased up to 200mg and stable now.) d. Request changed to: In line of duty-existed prior to service-service aggravated (ILD-EPTS-SA). This finding is made when there is clear and unmistakable evidence the Soldier's injury, illness, or disease existed prior to service and the condition has been service aggravated. Aggravation will be determined by an appropriate provider in accordance with DoDI 1332.18. Mental soundness can only be determined by a BH expert. 2. The applicant was appointed a Reserve commissioned officer on 8 August 1992. He is currently a member of the Mississippi Army National Guard (MSARNG) serving in the rank of lieutenant colonel. 3. On 15 April 2020, an LOD IO appointed by the MSARNG provided a memorandum with the findings of an LOD investigation pertaining to the applicant. The IO stated: a. Background: The applicant attended annual training (AT) during the period 1-15 June 2019. On 2 June 2019, while returning from lunch, he experienced what he thought was a cardiac episode. The applicant stated that his chest started feeling cool and his hands and arms started sweating. He explains there was not any acute chest pain, but there was significant discomfort. He got light headed, his breathing became more labored, and he started to feel unusually weak. These symptoms of pain, discomfort, and difficulty breathing caused him to become very agitated and unable to sit still. The driver of the vehicle recognized the applicant's condition as a potential life threatening condition and drove immediately to the Troop Medical Clinic (TMC). b. An ambulance was dispatched to take the applicant to the Emergency Room (ER). After a battery of test to determine whether or not he was experiencing a cardiac event, the ER doctor admitted him for further evaluation. Following further testing, it was determined that he did not have a heart attack or suffer from a cardiac related episode. Instead, he received a diagnosis that what happened was actually an anxiety attack. There is no history in the applicant's records of having the diagnosis of anxiety from previous assessments. Therefore, it stands to reason that his anxiety attack could have been brought on by a combination of factors that include his current physical health status and prescribed medication, the added stress of this particular AT period, as well as the required continuous activity out in the heat most of the day. c. Follow up findings: At the time of this incident, the applicant was working three different jobs, each with significant duties and responsibilities. First, he was assigned as the battalion commander. Second, he was the acting Director of Logistics for Camp Shelby, MS, a role he filled for at least a year leading up to June 2019. Third, his civilian job is the Superintendent of the MATES at Camp Shelby. All three of these are clearly stressful in and of themselves let alone having responsibility for all three at the same time. d. This particular AT period was of great significance for Camp Shelby because of the mobilization exercise in support of Camp Shelby being stood up as a Mobilization Force Generating Installation as well as a validation exercise (VALEX) of new communications systems. Both of these exercises had strategic implications for the installation, and the applicant's expertise was essential to success. Resulting from this the applicant had been under tremendous stress for almost a year in managing the responsibilities of the three jobs he was covering. e. Findings. Based on the follow up interview with the applicant, the IO felt the stress the applicant was under and the responsibility he shouldered are the root cause of symptoms exhibited and most certainly the reason for the episode investigated. 4. The applicant provided a DD Form 261, dated 5 September 2019, that shows: a. The applicant was diagnosed with general anxiety with panic attacks based on an episode on 2 June 2019. b. The IO stated: The applicant was formally diagnosed with anxiety and panic attacks on 7June. There are some references in the doctors notes to symptoms prior to the event on 2 June. However, no formal diagnosis was established until after the attack he suffered on 2 June. c. The IO found the applicant's condition in LOD. The appointing authority approved the findings on 15 November 2019 and stated: The applicant was on official orders the day he had his attack and was hospitalized for a couple of days. He was diagnosed on 7 June 2019 with a definitive diagnose. IO has found service member was within LOD. d. The NGB, Chief, Personnel Division, as the final approval authority, determined the applicant's condition "not in line of duty-EPTS-not service aggravation (NSA) Anxiety Disorder and Panic Disorder." The NGB, Chief, Personnel Division, also stated: a. The applicant was on AT from 1-16 June 2019 at Camp Shelby Joint Forces Training Center. On 2 June 2019 while returning from lunch, he started experiencing chest pains and cold sensations in his chest area. He went to the ER and was diagnosed with chest pain due to anxiety/panic attacks. His behavioral health symptoms had been escalating for several months that increases rate of escalation for the past few weeks prior to the incident on the second day of his AT. The mere fact he had symptoms of a chronic condition while in an authorized status does not automatically make that condition duty related, in accordance with Army Regulation 600-8-4, paragraph 3-4b. 5. A memorandum from HRC, Casualty and Mortuary Affairs Operations Division, dated 2 November 2020, subject: LOD Investigation Appeal, [applicant], informed the applicant the following: a. Army Regulation 600-8-4, paragraph 4-8 (4)(a)(2) states if an EPTS condition was not aggravated by military service, the determination will be "Not in Line of Duty- EPTS-Not Service Aggravated." b. After reviewing provided documentation and medical records from the electronic medical record system used by medical providers of the U.S. Department of Defense (Armed Forces Health Longitudinal Technology Application (AHLTA)), it has been determined your diagnosis of anxiety disorder and panic disorder were not incurred or aggravated by military service. c. You were on AT from 1-16 June 2019. On 2 June 2019, the second day of training, you began having chest pains and cold sensations in your chest area while returning from lunch. You went to the ER and was diagnosed with chest pain due to anxiety/panic attacks. Your behavioral health symptoms had been escalating for the past few weeks prior to the incident on the second day of AT. At your follow-up visit on 7 June 2019, you stated that you had an increasing problem with generalized anxiety over the preceding couple of months before coming on orders. You indicated your anxiety acutely worsened over the previous several weeks with "several fairly severe panic attacks in the last couple of weeks" before the event while on orders. 6. The applicant was also advised to apply to this Board for consideration of his LOD determination appeal. 7. MEDICAL REVIEW: The Army Review Board Agency (ARBA) Medical Advisor reviewed the supporting documents and the applicant’s military service records. A review of the Armed Forces Health Longitudinal Technology Application (AHLTA) & Health Artifacts Image Solutions (HAIMS) contains medical treatment from June 2009 to March 2010. On 2 Jun 2019, he was seen in the clinic due to a panic attack. The applicant reported that he had anxiety and had recently started Zoloft to address anxiety symptoms. He was sent to the local emergency room for an EKG and additional screening. He was admitted for overnight observation. No further medical care was provided. The report of investigation document, DD Form 261, indicates the applicant’s symptoms had been escalating for several months prior to the incident on the second date of his annual training. The approving authority determined that the applicant’s symptoms of a chronic condition in authorized status does not automatically make that condition duty related. Memo from the investigating officer dated 15 Apr 2020 found that the investigating officer felt the applicant’s stress and responsibility are the root cause of his symptoms. It should be noted that the investigating officer is not a medical or behavioral health provider. A review of JLV indicates the applicant has a service connected disability rating of 90% for multiple medical conditions. He does not have a service connected disability rating for any behavioral health conditions. Per his treatment records, he works as a civilian at Camp Shelby. He reported taking Zoloft, trazadone and Ritalin until the Ritalin was discontinued by his civilian provider. His diagnosis was Anxiety Disorder unspecified. Primary care note from 28 Dec 2020 indicates a diagnosis of Major Depressive Disorder but provides not further information. On 26 Jul 2021, he was also diagnosed with Adjustment Disorder related to marital distress. After reviewing all available documentation, the applicant’s anxiety disorder (which includes panic attacks) existed prior to annual training and was not service aggravated. Not in Line of Duty- Existed Prior to Service-Not Service Aggravated determination is correct. No change is warranted. BOARD DISCUSSION: After reviewing the application, all supporting documents, medical review and the evidence found within the military record, the Board determined that relief was not warranted. The Board carefully considered applicant’s contentions, medical advisory, military record, and regulatory guidance. The Board concurred with the medical review finding that the applicant had a condition that existed prior to service and which was neither aggravated by his service nor determined to be in the line of duty. Based on the preponderance of evidence available for review, the Board determined evidence presented insufficient to warrant a recommendation for relief. 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. REFERENCES: 1. Army Regulation 600-8-4, in effect at the time, prescribes policies and procedures for investigating the circumstances of disease, injury, or death of a Soldier providing standards and considerations used in determining LOD status. a. A formal LOD investigation is a detailed investigation that normally begins with DA Form 2173 (Statement of Medical Examination and Duty Status) completed by the medical treatment facility and annotated by the unit commander as requiring a formal LOD investigation. The appointing authority, on receipt of the DA Form 2173, appoints an investigating officer who completes the DD Form 261 and appends appropriate statements and other documentation to support the determination, which is submitted to the General Court Martial Convening Authority for approval. The regulation in effect at the time states in: b. Paragraph 2-4, a Soldier’s injury, illness, disease, or death is presumed to have occurred in LOD unless rebutted by the evidence. Unless another regulation or directive, or an instruction of the appointing authority, establishes a different standard, the findings of investigations governed by this regulation must be supported by a greater weight of evidence than supports a contrary conclusion (such as, by a preponderance of the evidence). The weight of the evidence is not determined by the number of witnesses or volume of exhibits, but by considering all the evidence and evaluating factors, which as a whole shows that the fact sought to be proved is more probable than not. c. Paragraph 3-4, The mere fact that the Soldier was in an “authorized status” (duty, pass, leave, and so forth) does not necessarily support a determination of in LOD in and of itself. d. Paragraph 4-8, the term “EPTS” may be added to a medical diagnosis if there is a preponderance of evidence the injury, illness, or disease or underlying condition existed prior to the current period of military service or it happened between periods of active service. Included in this category are chronic diseases with an incubation period that clearly prevents a conclusion that the injury, illness, or disease started during short tours of authorized training or duty. e. Paragraph, 4-8, service aggravation is defined as a permanent worsening of a pre-service medical condition over and above the natural progression caused by trauma or the nature of military service. A permanent worsening of a condition, as a result of the performance of military duties, is required to find there is service aggravation. f. Paragraph 5-3, for ARNG, the State surgeon’s office is responsible for assisting commanders in understanding the diagnosis, prognosis, and treatment plan for the Soldier and whether the injury, illness, or disease was caused or aggravated through military service while in a duty status or was EPTS. This responsibility includes making a definitive diagnosis that has not been accomplished by the initial treating facility, initial civilian treatment facility or Department of Veterans Affairs treatment facility. 2. Army Regulation 600-8-4, currently in effect, states in paragraph 4-8 that if an EPTS condition was aggravated by military service, the determination will be in LOD. If an EPTS condition was not aggravated by military service, the determination will be "Not in Line of Duty-EPTS-Not Service Aggravated." 3. Army Regulation 15-185 (Army Board for Correction of Military Records), paragraph 2-11 states applicants do not have a right to a hearing before the ABCMR. The Director or the ABCMR may grant a formal hearing whenever justice requires. //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20200010221 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1