IN THE CASE OF: BOARD DATE: 5 November 2021 DOCKET NUMBER: AR20210011191 APPLICANT REQUESTS: correction of his DD Form 214 (Certificate of Release or Discharge from Active Duty) to show he was separated because of a disability. APPLICANT'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * DD Form 214 * Department of Veterans Affairs (VA) Disability Rating Decision FACTS: 1. The applicant states he was discharged for a medical condition that later became a service connected disability. He'd like his DD Form 214 to reflect service connected disability. He was discharged for his right hip. 3. The applicant provides his DD Form 214 and an extract from his VA Disability Rating Decision, which shows: a. The letter was a summary of benefits he was receiving fro the VA. b. He served in the Army from 23 January 2018 and was honorably discharged on 26 November 2019. His combined service connected evaluation was 60 percent effective 1 December 2020. c. The letter did not say what the service connected disability was. 4. On 29 December 2017, the applicant enlisted in the U.S. Army Reserve (USAR) delayed entry program (DEP) for a period of for 8 years. On 23 January 2018, the applicant was discharged from the USAR DEP and entered in active duty for a period of 4 years and 23 weeks. On completion of initial training, he was assigned to Fort Hood, Texas, and he arrived on 28 June 2018. 5. Along with his enlistment the applicant completed a Report of Medical Examination which did not show any medical issues and he was qualified for enlisted in the Armed Forces. His Report of Medical History and Accessions Medical Prescreen Report both show he was in good health and had no medical conditions. 6. The applicant's complete separation packet and any medical board proceedings were not present in his service record. His service record contains an undated memorandum which shows the separation authority ordered the applicant separated from the Army prior to the expiration of his term of service under the provisions of Army Regulation 635-200 (Active Duty Enlisted Administrative Separations), paragraph 5-17 (Other Designated Physical or Mental Conditions); directed an honorable characterization of service; stated the applicant would not be transferred to the Individual Ready Reserve (IRR); and rehabilitative transfer requirements were not required. 7. On 26 November 2019, the applicant was discharged accordingly. His DD Form 214 shows he completed 1 year, 8 months, and 29 days of service. The separation authority was paragraph 5-17, Army Regulation 635-200, and the narrative reason for separation was "Condition, Not a Disability." 8. Army Regulation 635-200, in effect at the time, required commanders to initiate separation action against Soldiers who had physical or mental conditions that did not amount to a disability, as defined in Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation), and which did not include conditions more appropriately handled under paragraphs 5-11 (Separation of Personnel who Did Not Meet Procurement Medical Fitness Standards) or 5-13 (Separation Because of Personality Disorder). Paragraph 5-17 included but was not limited to chronic airsickness, chronic seasickness, enuresis, sleepwalking, dyslexia, severe nightmares, claustrophobia, and other disorders, such as those manifested by disturbances of perception, thinking, emotional control, or for behavioral conditions that were severe enough to affect the Soldier's ability to perform military duties. 9. The VA and the Army operate under separate provisions of Federal law (Title 38 (Veterans' Benefits) and Title 10, respectively). As such, each makes independent determinations by applying the policies and mandates set forth within their respective parts of the law. Decisions made by the VA regarding a Soldier's service- connected disability are not binding on the Army, and do not reflect that determinations made by the Army were wrong. 10. MEDICAL REVIEW: The Army Review Boards Agency (ARBA) Medical Advisor reviewed the supporting documents and the applicant's records in the Interactive Personnel Electronic Records Management System (iPERMS), the Armed Forces Health Longitudinal Technology Application (AHLTA), the Health Artifacts Image Management Solutions (HAIMS) and the VA's Joint Legacy Viewer (JLV). a. The applicant’s 9 January 2017 Report of Medical Exam (for enlistment) revealed a normal physical exam. He was deemed qualified for service. He endorsed good health and did not disclose any medical conditions in his 9 January 2017 Report of Medical History. b. Medical and related pertinent records while in service: (1) 7 November 2018 – right hip view revealed a normal film—no evidence of acute abnormality was seen. The film was ordered to investigate hip pain that started 8 months ago. (2) On 23 January 2019, the applicant re-engaged with physical therapy services. He had left hip pain at one point but the symptoms were much less than the right hip. He did not injure the hip; he noticed the pain while he was running. He was on profile for the right hip for over 9 months. He had participated in five physical therapy visits in August 2018. (3) 25 February 2019 – His primary care physician reviewed physical therapy records and also noted his normal images, and concluded that he did not meet Medical Evaluation Board criteria. He was advised that they recommend medical separation via AR 635-200, paragraph 5-17. The temporary profile was extended by his request. (4) 5 March 2019 – Bennett Physical Therapy's assessment was “Right hip pain with excessively tight hamstrings, tight hip flexors and weak hip and core musculature as contributing factor; he did not continue previously prescribed physical therapy home exercises long enough to expect benefit and did not follow up as requested.” He began a second round of physical therapy. On the last day of physical therapy, he reported that he had pain when he rucked 3 miles recently. He was not running yet. (5) 16 April 2019 – During his administrative separation physical, he denied any pain or discomfort at the time. His physical exam was normal. He was not on a profile. He was deployable. (6) 21 June 2019 – He reported pain was 2/10—he noticed the pain, but it did not interfere with activities. He was in the process of administrative separation. He desired continued profiling to prevent recurrence of pain with strenuous activity. He was not taking anti-inflammatories. He was undergoing administrative separation for exertional hip pain desiring a second opinion. (7) 24 July 2019 – Right hip MRI revealed suspicions for a labral tear, iliopsoas tendinosis, insertional tendinitis and bursitis; tendinosis with minimal chronic partial tear of the distal gluteus medial tendon; tendinosis of the gluteus minimus; and a joint effusion with suspicion for a left para labral cyst. (8) 13 August 2019 – An embedded behavioral health note indicated he was married, without children, and reported depression, anxiety, and low motivation. He reported not having any enjoyment being around friends or family. He reported sleep disruption with difficulty falling and staying asleep. He reported difficulty staying focused and desired to be tested for attention deficit/hyperactivity disorder. His prognosis was good. He had no duty restrictions necessitating a behavioral health profile. He met the retention standards for continued service. He remained world-wide qualified and cleared for any temporary duty or deployments. No alterations to duty status or security clearance were recommended at the time. (9) 23 August 2019 – A right hip exam showed a positive FADIR (flexion, adduction, and internal rotation) for possible impingement. The FABER test was negative which was consistent with not having pathology or dysfunction at the hip joint, muscles around the hip joint, and at the sacroiliac joint. The specialist indicated that he independently reviewed all the patient's imaging. He indicated that the hip and pelvis film showed a slight CAM lesion (a developmental abnormality). And he also indicated that overall, the cartilage appeared to be well intact. Concerning the hip MRI, the specialist indicated that there was no evidence to suggest a definitive labral tear. The measured hip ranges of motion met retention standards. The assessment was: Psoas tendinitis versus mild FAI (femoro-acetabular impingement) with a possible associated labral injury. There was no clear cut indication for surgical intervention. The next step was to perform a diagnostic/therapeutic intra-articular steroid injection in the hip. (10) 27 August 2019 – In a telephone consult with primary care, the applicant was requesting a profile extension and was pending a hip injection. The profile was extended for 30 days. It was annotated that “he admits he still desires medical separation and informs me that 5-17 was initiated.” This was confirmed with command. (11) 7 October 2019 – He was scheduled to receive the hip injection on this date, with follow up in 3 weeks. There was no indication that he received the injection or that he returned. (12) Although during the 15 October 2019 Report of Medical Assessment, he reported that his health was better than the last exam (completed 3 August 2019); he did report that the right hip pain currently limited his ability to work in his primary military occupational specialty. (13) 10 October 2019 – An exam at the Baylor Scott & White Roney Bone and Joint Institute (a second opinion for the right hip condition) showed an antalgic gait favoring the right lower extremity; and FABER and FADIR tests were positive on the right. There was moderate tenderness to palpation over the right trochanteric area and ITB (iliotibial band) projection. Assessment: Right Hip Impingement Syndrome; Right Hip Pain; and Tendinopathy of right Gluteal Region. Plan: Trial of intra-articular steroid injection with diagnostic and treatment purposes. He was instructed to gradually increase his activities after the injection if he had significant improvement of his pain. An injection under fluoroscopy guidance was ordered for that day. He was supposed to follow up in 6 weeks. There was no available documentation that he received the hip injection that day or that he had returned for follow up. (14) 15 October 2019 – This final appointment in AHLTA was a walk-in visit for medical out-processing. (15) 27 November 2019 – His Enlisted Record Brief (ERB) showed the date of the last physical exam was 23 Juy l2019. The record also revealed that he failed the Army Physical Fitness Test in August 2019. His PULHES was 111111 (i.e., no limitations). c. Medical and related pertinent records after discharge: (1) 18 February 2020 – He had been referred to Physical Medicine & Rehab for hip steroid injection. The order was administratively closed on this date. The order had expired. (2) 5 April 2021 – Physical Medicine & Rehab asked to evaluate him for chronic low back pain and cervicalgia consistent with spondylosis. There was no mention of hip pain. (3) 5 April 2021 – To a primary care physician he reported left lower extremity hip pain, cervicalgia (neck pain), and chronic low back pain with radicular symptoms to right lower extremity calf pain. The exam showed normal gait and normal strength all extremities. (4) 29 July 2021 – He was referred to Community Care Physical Therapy for lumbar spondylosis d. A JLV search revealed that the applicant was total combined service connected by the VA at 80% for the following disabilities: Dysthymic Disorder (50%); Migraine Headaches (30%); Lumbosacral or Cervical Strain (10%); Tinnitus (10%); Limited Extension of the Thigh (10%; Limited Flexion of the Thigh (0%); Thigh Condition (0%); and Allergic or Vasomotor Rhinitis (0%). The applicant’s hip pain was not helped much by physical therapy. Although the applicant was scheduled to have injections on at least 2 dates (7 October 2019, and 10 October 2019) there was no indication he received the diagnostic hip injection on either date. During the JLV search, the ARBA Medical Advisor did not find follow up visits for the right hip condition after discharge from service. (The 5 April 2021 primary care physician note indicated he reported left hip pain during that visit.) e. The record did show that he had serial profiling for the hip condition for over 240 days. The record did not reveal a permanent level 3 physical profile for any condition at the time of discharge. The ERB showed PULHES 111111. He was separated prior to the expiration of his term under provisions of AR 635-200, paragraph 5-17, for other designated physical or mental condition. The applicant’s right hip condition was evaluated by orthopedics and did not fail medical retention standards in accordance with AR 40-501 (Standards of Medical Fitness), chapter 3. At the time of separation, the Soldier's medical (physical) condition did not constitute a disability under the provisions of AR 635-40 and therefore did not warrant entry into the Disability Evaluation System. BOARD DISCUSSION: 1. After reviewing the application and supporting documentation, the Board found relief is not warranted. 2. The Board concurred with the conclusion of the ARBA Medical Advisor that while he was on active duty, the applicant did not have any medical conditions that failed the medical retention standards of AR 40-501, and therefore there was no basis for referring him to the Disability Evaluation System to be considered for discharge with severance pay or retirement due to disability. Based on a preponderance of evidence, the Board determined the applicant's discharge for a condition, not a disability, was not in error or unjust. BOARD VOTE: Mbr 1 Mbr 2 Mbr 3 : : : GRANT FULL RELIEF : : : GRANT PARTIAL RELIEF : : : GRANT FORMAL HEARING :XX :XX :XX 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 635-200, in effect at the time, prescribed policies and procedures for enlisted administrative separations. Paragraph 5-17 (Other Designated Physical or Mental Conditions) stated commanders were authorized to separate Soldiers on the basis of other physical or mental conditions that, per Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation), did not amount to a disability, and which did not include conditions more appropriately handled under paragraphs 5-11 (Separation of Personnel Who Did Not Meet Procurement Medical Fitness Standards) or 5-13 (Separation Because of Personality Disorder). a. Included conditions were: * Chronic airsickness * Chronic seasickness * Sleepwalking * Dyslexia * Severe nightmares * Claustrophobia * Other disorders manifesting disturbances of perception, thinking, emotional control, or behavior that are sufficiently severe so as to affect the Soldier's ability to perform military duties b. When commanders determined the Soldier had a qualifying physical condition, the commander was to refer the Soldier for a medical examination; a separation recommendation had to be supported by documentation that confirmed the existence of the physical condition. c. Separation processing could not be initiated until the Soldier had been formally counseled as to his/her deficiencies, and had been afforded ample opportunity to overcome those deficiencies. 2. Army Regulation 635-8 prescribes policies and procedures for the completion of the DD Form 214. It cites Army Regulation 635-5-1 (Separation Program Designator (SPD) Codes) as the source for entries in item 28 of the DD Form 214. 3. Army Regulation 635-5-1, in effect at the time, stated Soldiers separated under the provisions of paragraph 5-17, AR 635-200 were assigned the SPD "JFV" on the DD Form 214; the required entry in item 28 of the DD Form 214 was "Condition, Not a Disability." //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20210011191 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1