IN THE CASE OF: BOARD DATE: 27 July 2022 DOCKET NUMBER: AR20210015512 APPLICANT REQUESTS: reconsideration of his prior request for physical disability retirement. APPLICANT'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * self-authored statement FACTS: 1. Incorporated herein by reference are military records which were summarized in the previous consideration of the applicant's case by the Army Board for Correction of Military Records (ABCMR) in Docket Number AR20190015225 on 20 May 2021. 2. The applicant states: a. He is writing in hopes of reconsideration of his prior request. He submitted an application in an attempt to have his retirement changed from a normal 20-year retirement to a medical retirement. b. At the time of his separation from the military, he was not given any type of separation guidance or counseling and he was placed in a detachment with no full-time staff. Their command was located a couple of hundred miles away from the detachment and not once did anyone in his chain of command reach out to him and advise him on any options he had. Any paperwork he received was through the mail or email. c. He is not looking for anything other than a status change in his retirement so he can afford Tricare. If you take a second to look at the paperwork he previously submitted, you will see that the National Guard Bureau (NGB) Form 22 (Report of Separation and Record of Service) is not signed by him. It states that he was not available for signature. He was not available because all paperwork that was done for his separation was completed at a different location, where the command was located, while he was in a detachment with no full-time administrative support. Please reconsider the status chance to his retirement so he can provide Tricare for his family. 3. After over 3 years’ prior honorable service in the U.S. Army Reserve (USAR), the applicant enlisted in the Army National Guard (ARNG) on 1 July 1992. 4. State of Texas Adjutant General’s Department Orders 031-922, dated 31 January 2003, ordered the applicant to active duty in support of Operation Enduring Freedom, with reporting to Fort Hood, TX effective 6 February 2003. 5. A DD Form 2807-1 (Report of Medical History), dated 1 February 2003, shows the applicant underwent a medical examination on the date of the form for the purpose of a flight physical, due to his duty position as a flight engineer. As part of his medical history, the applicant indicated he underwent lower back surgery, lumbar discectomy. 6. A DD Form 2808 (Report of Medical Examination), dated 1 February 2003, shows the applicant underwent medical examination on the date of the form. The examiner’s recommendations indicate the applicant underwent a discectomy in August 2002 and the functional evaluation indicates he can do heavy physical work. The applicant was found qualified for service with a physical profile rating of “1” in all categories, except for E (Eyes), wherein he received a rating of “2.” 7. The applicant’s service records contain a DA Form 638 (Recommendation for Award), which shows he was recommended for award of the Army Commendation Medal on 23 July 2003, for his outstanding service as a CH-47 Helicopter Flight Engineer during Operation Iraqi Freedom for the period from 3 February 2003 through 31 August 2003. On 31 July 2003, the Army Commendation Medal was approved with Permanent Order Number 212-03. 8. A DD Form 2796 (Post-Deployment Health Assessment (PDHA)), dated 5 August 2003, shows the following: a. The applicant was deployed to Iraq and Kuwait from 16 April 2003 through 7 September 2003 in support of Operation Iraqi Freedom. b. He indicated his health stayed about the same or got better and that he was seen on sick call one time during his deployment. He indicated he did not have any medical or dental problems that developed during his deployment. c. The reviewing health professional determined referral was not indicated for any conditions. 9. The applicant’s service records contain an Air Medal Certificate with Permanent Orders Number 217-055, showing he was awarded the Air Medal on 11 August 2003 for exceptionally meritorious achievement and professionalism while performing aerial flight duties in support of Operations Enduring Freedom and Iraqi Freedom from 10 February 2003 through 31 August 2003. 10. A DA Form 2173 (Statement of Medical Examination and Duty Status) shows the following: a. The applicant was seen as an outpatient at the Troop Medical Clinic (TMC), Camp Arifjan, Kuwait on 15 August 2003 for vasovagal syncopy (Department of Veterans Affairs (VA) findings post-demobilization). b. The details of the incident show on or about 15 August 2003, after working out at the gym at Camp Arifjan, the applicant passed out while walking back to his tent in the company area. He was brought to the TMC via ambulance, however no tests were performed due to equipment failure. c. The applicant’s immediate commander signed the form on an unspecified date, indicating she was not present at the time this accident occurred and there were no medical documents covering the event, nor was a medical diagnosis made at the time of the event and that a formal line of duty (LOD) investigation was required. 11. The applicant’s DD Form 214 (Certificate of Release or Discharge from Active Duty), reflects he was ordered to active duty in support of Operation Enduring Freedom from 3 February 2003 through 21 September 2003, when he was honorably released from active duty due to the completion of required active service and transferred back to his ARNG unit. It does not reflect his location or dates of deployment nor does it reflect award of the Air Medal, the Army Commendation Medal, or the Iraq Campaign Medal. 12. A DA Form 4186 (Medical Recommendation for Flying Duty), dated 5 December 2003, shows the applicant was a self-referral to the flight surgeon and was given a temporary medical suspension from flight duty effective 19 November 2003, for an unknown estimated duration. 13. A DA Form 3349 (Physical Profile), dated 2 May 2004, shows the applicant was given a permanent physical profile rating of “3” in the category P (Physical stamina or capacity) due to cardiac arrhythmia status post pacemaker. The applicant was deemed not deployable, not to participate in the Army Physical Fitness Test (APFT), and needed a Military Occupational Specialty (MOS) Medical Retention Board (MMRB) as soon as possible. 14. A memorandum for record, signed by the applicant’s former unit commander on 11 March 2005, shows the following: a. He was the applicant’s commander during their deployment for Operation Iraqi Freedom. They were mobilized on 3 February 2003 and returned back to the U.S. on 26 August 2003. Shortly before their unit redeployed, the applicant lost consciousness while conducting physical training at Camp Arifjan, Kuwait. He was transported to the TMC where he was treated and released. He did not inform anyone in the Headquarter section of this and he did not receive a sick call slip because he was transported by ambulance. Aircrew members are reluctant to report loss of consciousness because this is an immediate grounding condition and most likely a career ending event. b. At the end of September 2003, the applicant was released from active duty. Shortly afterward, in October 2003, he again lost consciousness while running at Ellington Field in Houston. Because of his prior events, his wife made an appointment with the Naval Medical Facility at the Joint Reserve Base for treatment. He (the commander) was called by a nurse from the facility and informed he had an aircrew member who had lost consciousness. He immediately removed the applicant from flight duties and referred him to an Army Flight Surgeon for evaluation. This is when he became aware of the applicant’s prior events. 15. A DD Form 261 (Report of Investigation (ROI), LOD, and Misconduct Status), dated 16 March 2005, shows the following: a. The investigating officer’s remarks show there is no evidence (sick slip, record of medical treatment, etc.) to support the statements made by the applicant documenting the events of 15 August 2003. [The applicant’s statements are not in his available records for review by the Board.] The facts show he underwent physical evaluation on 1 February 2003, at the time of his unit’s mobilization, wherein he was found fully qualified. The finding was not in the LOD – not due to own misconduct. b. The appointing authority and reviewing authority both approved the finding of not in the LOD – not due to own misconduct in July 2005. c. On 15 August 2005, the Chief, NGB, the final approval authority, disapproved the finding and changed it to in the LOD, for neurocardiogenic syncope and subclinical hypothyroidism. 16. A second DA Form 3349 shows on 27 January 2008, the applicant was given a permanent physical profile rating of “3” in the category P for history of vasovagal syncope status pacemaker placement, limiting him in all functional activities, APFT, no exposure to high temperatures and humidity, and recommending him to a Physical Evaluation Board (PEB) to determine fitness for duty. 17. A Texas Military Forces, Joint Force Headquarters, Adjutant General’s Department memorandum dated 16 December 2008, notified the applicant of his eligibility for retired pay at age 60 (20 Year Letter) upon application. 18. A Texas Military Forces, Joint Force Headquarters, Adjutant General’s Department memorandum dated 1 June 2010, notified the applicant that an Enlisted Qualitative Retention Board (EQRB) was convened in April 2010 and the EQRB recommended the applicant as among the best qualified for continued retention for 2 years in the Texas ARNG. 19. The applicant’s available service records do not contain documentation reflecting his notification of medical unfitness for continued service in the ARNG after the EQRB recommended his 2-year retention, nor do they contain documentation reflecting his election of either consideration by a Physical Evaluation Board (PEB), discharge, or transfer to the Retired Reserve. 20. The applicant’s NGB Form 22 shows his honorably transfer to the Retired Reserve effective 31 October 2010, under the provisions of National Guard Regulation 600-200 (Enlisted Personnel Management), due to medical unfitness for retention per Army Regulation 40-501 (Standards of Medical Fitness). He was credited with 21 years, 10 months, and 22 days of total service for retired pay. Item 22 shows the applicant was not available for signature. 21. Texas Military Forces, ARNG, Adjutant General’s Department Orders 348-1037, dated 14 December 2010, honorably discharged the applicant from the ARNG and transferred him to the Retired Reserve effective 31 October 2010, due to medical unfitness for retention. The orders reflect his entitlement to “Gray Area Retiree Benefits.” 22. The applicant previously applied to the ABCMR on 3 September 2019, requesting a Medical Evaluation Board (MEB) and subsequent retirement due to physical disability incurred while deployed on active duty in 2003. 23. In the adjudication of his prior application, a medical advisory opinion was obtained from the Army Review Boards Agency (ARBA) medical advisor, which shows the following: a. A 23 March 2010 memorandum from the applicant’s medical provider shows the applicant is a patient under the care of the Electrophysiology Service at the Dallas VA. He has a history of vasovagal syncope with a strong bradycardic component documented in 2004. The vasovagal syncope was refractory to medical management and a pacemaker was implanted. He has not experienced recurrent syncope post pacemaker implant. He has not experienced pre-syncope since 2005. He has performed his current duties without difficulty. He should be able to continue these duties overseas. b. The applicant received a duty-limiting permanent physical profile for history of vasovagal syncope status post pacemaker placement on 2 February 2008 with a recommendation for PEB to determine fitness for duty. This equates to a non-duty related PEB. The applicant’s notification of disqualification memorandum is not available for review. The applicant was presented the following five options in his notification: (1) Transfer to the Retired Reserve if over 20 years’ qualifying service (2) 15-year notice of eligibility for non-regular retired pay and transfer to the Retired Reserve if 15 years’ service but less than 20 years’ qualifying service (3) Honorable discharge if under 15 years’ qualifying service (4) Non-duty related PEB (5) Duty-related Disability Evaluation System (DES) processing, if approved LOD and/or medical documentation provided proving medical condition is duty-related c. On 24 September 2010, the applicant signed his options memorandum indicating he received his 20-Year Letter and requested retirement due to medical unfitness. d. The applicant was given the opportunity to be processed for his disqualifying medical condition, but he elected to forgo Disability Evaluation System (DES) processing and elected transfer to the Retired Reserve, therefore referral of his case to the DES is unwarranted. 24. On 20 May 2021, the Board concluded there was insufficient evidence of error or injustice and determined relief was not warranted, denying his request. 25. MEDICAL REVIEW: The Army Review Board Agency (ARBA) Medical Advisor reviewed the supporting documents, the Record of Proceedings (ROP), and the applicant's records in the Interactive Personnel Electronic Records Management System (iPERMS), the Armed Forces Health Longitudinal Technology Application (AHLTA), and the VA's Joint Legacy Viewer (JLV). There were no records in the Health Artifacts Image Management Solutions (HAIMS). The applicant requested for his 20 year retirement to be changed to medical retirement. His previous request to ABCMR was denied. He is requesting reconsideration of the ABCMR’s decision. No new evidence was provided. A de novo review of the medical evidence as well as related documents, was completed. a. Pertinent medical records and related. (1) 01Feb2003 Report of Medical History and Examination, the applicant endorsed good health and he was not taking any medication. He was status post a discectomy August 2002 after which he had a full release from his private physician. His PULHES was 111121. He was deemed qualified for service. (2) 15Aug2003 Post Deployment Health Assessment (the same day as the reported syncopal event). He endorsed having developed headaches, weakness, back pain, muscle aches, skin problems, diarrhea, frequent indigestion, and vomiting during the deployment. He was not on profile or light duty. He endorsed good health. (3) The Statement of Medical Exam and Duty Status indicated that on or about 15Aug2003, after working out at the gym, he passed out while walking back to his tent (Camp Arifjan, Kuwait). There were no medical documents covering the event, nor was a medical diagnosis made at the time of the event. He had been seen at TMC, but no testing was performed due to equipment failure. The period of training covered 03Feb2003 to 21Sep2003. (4) On 05Dec2003, the applicant self-referred and was given a temporary medical suspension from flight duties effective 19Nov2003. It was signed by Command. (5) The first available medical documentation for the syncopal condition, took place on 12Jan2004 during a primary care visit at the VA, when the applicant reported 4 episodes of fainting in the prior 5 months. He stated the most recent event was Saturday (3 days prior) and resulted in a car accident, the timing of the first episode was not specified. (6) 13Jan2004 Cardiology Attending Note. The applicant was seen for 4 episodes of syncope over the previous 5 months. He mentioned that one episode occurred while he was in Kuwait. There were no preceding symptoms, seizure activity, or loss of bowel/bladder control. (7) In January 2004 the applicant underwent evaluation to determine the cause of his symptoms. The work up included an exercise tolerance test during which he achieved 15 METs (excellent exercise capacity). However, 38 seconds into recovery, his heart rate dropped to 40’s and 50’s in a junctional rhythm (not a normal sinus rhythm) and he fainted. The working diagnosis was Vasovagal Syncope. He was restricted from driving for 6 months; and ultimately failed conservative treatment which included medication, and tilt training. On 22Mar2022, he underwent successful permanent pacemaker placement for Neurogenic Syncope. (8) A 02May2004 physical profile for Cardiac Arrythmia/Status Post Pacemaker was contradictory in that the P3 was marked ‘temporary’ however, the physical profile was marked ‘permanent’. Deployment, and participation in PFT and APFT, were prohibited. It was recommended that he undergo a MDRB. The profile did NOT have a second approving signature, necessary for a valid permanent profile. (9) 11Mar2005 memorandum for record indicating when the Commander first learned of the applicant’s fainting episodes (sometime after October 2003). (10) On 12May2005, he underwent an exercise stress test without complication. At the time his NY Heart Association Classification was 2 (slight limit on physical activity). Then, from 14Oct2005 through 23Mar2010, he followed up every 6 months in the VA Cardiac Electrophysiology Clinic during which normal pacemaker function was documented and he continued without further recurrence of symptoms. He expressed a desire to have the pacemaker removed in order to remain in the military. To prepare, his pacemaker ‘lower rate limit’, was decreased to 40 bpm and he undertook a vigorous exercise program for 3 months without symptoms of syncope or presyncope. He wasn’t on any cardiac meds and his baseline ECG was normal. His NY Heart Association Classification at the time was 1 (no limit on physical activity). He had a normal exercise stress test. The pacemaker was removed on 09Jun2010. Later, he remained asymptomatic at follow up 12Jul2010 (Electrophysiology Note). b. 15Aug2005, the initial Not In Line of Duty investigation result, was overturned and changed to In Line of Duty for Neurocardiogenic Syncope and Subclinical Hypothyroidism by the Chief, National Guard Bureau under authority of the Secretary of the Army. c. Regulation in place at the time of discharge was 14Dec2007 AR 40-501, chapter 3-24b, which provides that implantation of permanent pacemaker was cause for referral for a MEB. d. The record showed a 27Jan2008 permanent P3 physical profile for History of Vasovagal Syncope Status Post Pacemaker Placement, with deployment being the sole functional activity limitation. It was recommended that he undergo a PEB for fitness for duty determination and for any restrictions on duty and training. PEB proceedings were not found in the record. e. NCO Evaluation Report covering the period between 01Nov2008 to 31Oct2009 showed that he passed the 04May2009 APFT. He had also passed the previous 01Oct2006 APFT. f. 01Jun2010 he was selected by the Enlisted Qualitative Retention Board as qualified for continued retention in the Texas Army National Guard for 2 years. He would be considered again in 2012. g. He was discharged from the Army National Guard effective 31Oct2010 due to being medically unfit for retention. The exact circumstance surrounding his discharge was not detailed in the available documentation. However, it was observed that the applicant’s training was in MOS Helicopter Repairer and Flight Engineer. And although the applicant’s pacemaker had been removed, it is likely that he was found to be medically disqualified for retention for flight duties under NGR 600-200 35l(8) per AR 40-501, chapter 4-15l due to his history of cardiac surgical procedure—the pacemaker insertion. h. Because the applicant was seeking medical retirement, the C&P exams were also reviewed. JLV search today revealed that the applicant was total combined service connected at 100% by the VA for the following disabilities: PTSD 100%; Chronic Fatigue Syndrome 60%; Fibromyalgia 40%; Neuralgia of Sciatic Nerve 20%; Degenerative Arthritis of the Spine 20%; Cardiac Pacemaker 10%; Tinnitus 10%; 2nd Degree Burns 0%; and Scars 0%. Some highlights from the C&P exams are below. (1) 30May2012 Back Conditions DBQ. He had forward flexion to 90 degrees (normal); extension to 20 degrees (normal is 30 degrees). He had a history of a herniated disc and discectomy in 2002, and a 2nd disc surgery in ~2008. He was not receiving treatment for his back condition at the time of the note. (2) 09May2015 Initial PTSD DBQ. The examiner opined that the applicant’s Generalized Anxiety Disorder and Obsessive-Compulsive Personality Disorder Traits diagnoses, resulted in occupational and social impairment due to mild or transient symptoms (the 10% level). The sole symptom listed for VA rating purposes was anxiety. He deployed to Kuwait/Iraq from 16Apr2003 to 07Sep2003 He did report a stressor, but his symptoms did not meet complete DSM-5 criteria for PTSD diagnosis. Stressor: A Chinook helicopter crew crashed during a deployment in Iraq and the applicant knew all but one of the crew members killed. He took Ambien for sleep for 3 months in 2010. There was no other history of meds for BH symptoms. There was no history of psychiatric hospitalizations. (3) 09May2015 Heart Conditions DBQ. The applicant had been released and was no longer followed by cardiology. His last visit was 12Jul2012. He was not taking any medication for a heart condition. He did divulge that on occasion, he still became lightheaded, but this usually resolved in 2-3 minutes. i. By regulation, the History of Vasovagal Syncope Status Post Pacemaker Placement condition, did not meet medical retention standards. There was also a permanent P3 physical profile which prohibited deployment. Based on records available for review, there was insufficient evidence to support that the applicant had other conditions at the time of discharge, which failed medical retention standards of AR 40-501. The applicant had a condition that was determined to be duty related, for which there was a permanent P3 profile; therefore, he was eligible for MEB/PEB processing at the time. In the “Twenty Year Letter” dated 16Dec2008, the applicant was notified that he was eligible to receive retired pay at age 60. The applicant’s options at the time as well as related consequences were previously analyzed in the ABCMR ROP dated 20May2021; and remain unchanged. The Board will determine if a change from 20 year retirement to medical retirement is warranted. The ARBA Medical Reviewer observes, that if the PEB were to find the History of Vasovagal Syncope Status Post Pacemaker Placement condition unfitting for continued service, he would receive the VA’s 10% rating under DC 7015. The disposition would be separation with severance pay. BOARD DISCUSSION: 1. After reviewing the application, all supporting documents, and the evidence found within the military record, the Board found that partial relief was warranted. The applicant’s contentions, the military record, a medical advisory opinion, and regulatory guidance were carefully considered. The Board agreed that the applicant should be afforded he opportunity for consideration by the Physical Disability Board. The Board further recognized the potential financial impact that could cause the applicant. Nevertheless, the Board determined that the applicant should be afforded the opportunity and a referral to the PEB is warranted. 2. Prior to closing the case, the Board did note the analyst of record administrative notes below, and recommended the correction is completed to more accurately depict the military service of the applicant. 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 amendment of the ABCMR's decision in Docket Number AR20190015225 dated 20 May 2021. 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 he should have been discharged or retired by reason of physical disability under the Integrated Disability Evaluation System (IDES). a. In the event that a formal physical evaluation board (PEB) becomes necessary, the individual concerned will 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. b. Should a determination be made that the applicant should have been separated under the IDES, these proceedings will serve as the authority to void his administrative separation and to issue him the appropriate separation retroactive to his original separation date, with entitlement to all back pay and allowances and/or retired pay, less any entitlements already received. 2. The Board further determined that 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 changing his type of discharge without evaluation under the IDES. 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): A review of the applicant’s records shows his DD Form 214 covering the period ending 21 September 2003, should be amended as follows: a. Correct item 13 (Decorations, Medals, Badges, Commendations, Citations, and Campaign Ribbons Awarded or Authorized) by adding the following: * Air Medal * Army Commendation Medal * Iraq Campaign Medal b. Correct item 18 (Remarks) by adding “Service in Iraq from 20030416 – 20030907” REFERENCES: 1. 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. 2. 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. 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. 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. c. Chapter 8 (Reserve Components), in effect at the time, provides guidance for Reserve component members eligible for physical disability processing in accordance with this regulation. (1) When a commander or other appropriate authority believes a Reserve component member is unable to perform the duties of his office, grade, rank, or rating because of physical disability resulting from an injury determined to be the proximate result of performing active duty (30 days or less), inactive duty training, or active duty under the authority of Title 10 U.S. Code, he will refer the member for medical evaluation. (2) If the result of the medical evaluation indicate the member is not qualified to perform his military duties he will be referred to an MEB. (3) If the MEB finds the member’s physical disability is the result of a disease not directly caused by an injury, he will be processed in accordance with the provisions of paragraph 6-8, where he might request continuance in the service in lieu of separation. (4) If the MEB finds the member’s physical disability is the result of an injury or disease directly caused by an injury the case will be referred to a PEB. 3. Army Regulation 40-501 provides information on medical fitness standards for induction, enlistment, appointment, retention, and related policies and procedures. Soldiers with conditions listed in chapter 3 who do not meet the required medical standards will be evaluated by an MEB and will be referred to a PEB as defined in Army Regulation 635–40 with the following caveats: a. U.S. Army Reserve (USAR) or Army National Guard (ARNG) Soldiers not on active duty, whose medical condition was not incurred or aggravated during an active duty period, will be processed in accordance with chapter 9 and chapter 10 of this regulation. b. Normally, Reserve Component Soldiers who do not meet the fitness standards set by chapter 3 will be transferred to the Retired Reserve per Army Regulation 140–10 (USAR Assignments, Attachments, Details, and Transfers) or discharged from the Reserve Component per Army Regulation 135–175 (Separation of Officers), Army Regulation 135–178 (ARNG and Reserve Enlisted Administrative Separations), or other applicable Reserve Component regulation to include National Guard Regulation 600- 200 (Enlisted Personnel Management). They will be transferred to the Retired Reserve only if eligible and if they apply for it. c. Reserve Component Soldiers who do not meet medical retention standards may request continuance in active USAR status. In such cases, a medical impairment incurred in either military or civilian status will be acceptable; it need not have been incurred only in the line of duty. Reserve Component Soldiers with non-duty related medical conditions who are pending separation for not meeting the medical retention standards of chapter 3 may request referral to a PEB for a determination of fitness in accordance with paragraph 9–12. d. Paragraph 9-12 states Reserve Component Soldiers with nonduty related medical conditions who are pending separation for failing to meet the medical retention standards of chapter 3 of this regulation are eligible to request referral to a PEB for a determination of fitness. Because these are cases of Reserve Component Soldiers with non–duty related medical conditions, MEBs are not required and cases are not sent through the PEBLOs (Physical Evaluation Board Liaison Officers) at the military treatment facilities. Once a Soldier requests in writing that his or her case be reviewed by a PEB for a fitness determination, the case will be forwarded to the PEB by the USARC Regional Support Command or the U.S. Army Human Resources Command Surgeon’s office and will include the results of a medical evaluation that provides a clear description of the medical condition(s) that cause the Soldier not to meet medical retention standards. 4. 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. 5. Title 10, U.S. Code, section 1556 requires the Secretary of the Army to ensure that an applicant seeking corrective action by the Army Review Boards Agency (ARBA) be provided with a copy of any correspondence and communications (including summaries of verbal communications) to or from the Agency with anyone outside the Agency that directly pertains to or has material effect on the applicant's case, except as authorized by statute. ARBA medical advisory opinions and reviews are authored by ARBA civilian and military medical and behavioral health professionals and are therefore internal agency work product. Accordingly, ARBA does not routinely provide copies of ARBA Medical Office recommendations, opinions (including advisory opinions), and reviews to Army Board for Correction of Military Records applicants (and/or their counsel) prior to adjudication. 6. Army Regulation 600-8-22 (Military Awards) prescribes Army policy, criteria, and administrative instructions concerning individual and unit military awards. a. The Air Medal is awarded in time of war for heroism and for meritorious achievement or service while participating in aerial flight. This award is primarily intended for personnel on flying status, but may also be awarded to those personnel whose combat duties require them to fly; for example, personnel in the attack elements of units involved in air-land assaults against an armed enemy. As with all personal decorations, formal recommendations, approval through the chain of command, and announcement in orders are required. b. The Army Commendation Medal may be awarded to any member of the Armed Forces of the United States who, while serving in any capacity with the Army after 6 December 1941, distinguishes himself or herself by heroism, meritorious achievement, or meritorious service. As with all personal decorations, formal recommendations, approval through the chain of command, and announcement in orders are required. c. The Iraq Campaign Medal is awarded to members who have served in direct support of Operation Iraqi Freedom (OIF). The area of eligibility encompasses all the land area of the country of Iraq, the contiguous water area out to 12 nautical miles, and all air spaces above the land area of Iraq and above the contiguous water area out to 12 nautical miles. The Iraq Campaign Medal period of eligibility is on or after 19 March 2003 to a future date to be determined by the Secretary of Defense or the cessation of OIF. 7. Army Regulation 635-5 (Separation Documents), in effect at the time, prescribed the separation documents that must be prepared for Soldiers upon retirement, discharge, or release from active duty service or control of the Active Army, to include the DD Form 214 (Certificate of Release or Discharge from Active Duty). The instructions for preparation of item 18 (Remarks) of the DD Form 214 state to use this block for entries required by Headquarters, Department of the Army for which a separate block is not available and for completing entries that are too long for their blocks. In a more current version of the regulation, among the mandatory entries includes if deployed on active duty to a foreign country to list “Service in (Name of Country Deployed) from YYYMMDD – YYYMMDD). //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20210015512 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1