ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS IN THE CASE OF: BOARD DATE: 31 August 2022 DOCKET NUMBER: AR20210012575 APPLICANT REQUESTS: in effect, reconsideration of his previous case to show that he should have been medically retired. APPLICANT’S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of (Military Record) * Medical Evaluation Board (MEB) document, dated 29 December 2008 * Department of Veterans Affairs (VA) Disability Rating document, dated 20 Dec 2017 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 AR20190007780, dated 14 December 2021. 2. The applicant states, a. He should have gone to a MEB prior to the end of his Reserve contract and was unjustly bypassed, resulting in the loss of retirement benefits. Due to his deployment and transfer among Reserve units, as well as his ADOS tour, he was not afforded the opportunity to go before the MEB to ascertain the level of exacerbation of disabilities sustained during a previous active duty enlistment that resulted in an honorable discharge and placement of the temporary disability retired list (TDRL). b. He has served the U. S. Army, Military Police (MP) Corps faithfully, and honorably for a blended 16 years of active duty and Reserve time. He was injured while in the line of duty, which is verifiable through Army medical records. He also has a VA disability rating. c. As he understands it, the standards for Army and VA disability rating both use the same U.S. Code rating guidelines. Upon completion of his ADOS tour, he was rated at 40 percent (%) starting in 2013. He is currently rated at 90% and pending approval for 100% disability through the VA after the discovery of improper surgery he received and other disabilities which were incurred during his service. 3. The applicant provides: a. An MEB document, dated 29 December 2008, which states that the applicant was not deployment and requires a medical board. This document was a memorandum for the applicant’s commander, signed by a medical document. b. A VA Disability Rating document, dated 20 December 2017, which reflects his post-traumatic stress disorder was increased to 50%, his scar on his left ankle was increased to 20%, and his ligament sprain to his right ankle is continued at 10 percent. 4. The applicant’s service record shows the following documentation: a. Orders 157-0002, issued by Headquarters, 24th Infantry Division (Mechanic) and Fort Riley, dated 6 June 2003, reflects he was reassigned to the U.S. Army Transition Point, with a reporting date of 12 June 2003. b. DD Form 214 (Certificate of Release or Discharge from Active Duty), for the period ending on 12 June 2003, shows he was placed on the retired list due to a disability - temporary on 12 June 2003. He completed 4 years, 11 months, and 27 days of net active service this period. c. Report of Medical Examination, dated 26 September 2007, shows he completed a medical examination prior to his reentry into military service. ABCMR Medical Staff will review and discuss further in this discussion. d. DD Form 1966, shows he had an accession date of 11 December 2007 into the USAR, with an active duty service date of 14 January 2003. e. DD Form 4 (Enlistment/Reenlistment Document), shows he enlisted in the USAR on 11 December 2007. f. DA Form 3349 (Physical Profile), dated 11 September 2008, shows he had a PULHES permanent rating of "L2". g. Active Duty Report, shows his entry on active duty for the period of 13 December 2008 to 30 December 2008. h. Orders 365-2208, issued by Headquarters, U.S. Infantry Center, shows he was released from active duty on 30 December 2008, and assigned to the USAR Command, Augmentation Unit. i. Periodic Health Assessment, dated 26 August 2009, shows in: (1) Overall Health-2: he had bilateral ankle instability and had surgeries to try and correct it, but they did not work. The provider commented, "ongoing problem. Medical board pending. Left wrist contusion and hand contusion, in a splint/med and PT. 3/20/09". (2) Overall Health-4: he received VA disability for his ankles. The provider commented, current problem, hearing loss/ankle instability. (3) Overall Health-6: the provider commented, "temporary profile now for ankle instability 9/2008. No running. Walk is ok". (4) PULHES: "P1, U3, L3, H1, E1, S1. j. Medical documents will be reviewed and addressed by ABCMR Medical Staff. k. DA Form 3349, dated 4 September 2009, shows he had a PULHES permanent rating of "U3 and L3". I. Reserve Health Readiness Program (PHA) dated 1 September 2009, will be reviewed and address by the ABCMR Medical Staff. m. Orders A-09-313482, dated 20 September 2013, shows he was ordered to active duty on 1 October 2013, for operational support, for a period of active duty for 365 days, with an end date of 30 September 2014. n. Orders A-09-313482A01, dated 16 October 2013, amended his previous orders to show a period of active duty of 20 days vice 365 days. o. Orders 290-0159, issued by U.S. Army Installation Management Command, dated 17 October 2017, shows he was reattached for separation process, with a reporting date of 18 October 2013. p. DD Form 214, for the period ending on 20 October 2013, shows he was released from active duty due to the completion of his required service. He completed 1 year, 10 months, and 9 days of net active service this period, with 5 years, 3 months, and 15 days of total prior active service, and 3 years, 11 months, and 13 days of total prior inactive service. q. Orders C-10-414193, issued by U.S. Army Human Resources Command (HRC), shows he was released from USAR Control Group (Reinforcements) due to being temporarily medically disqualified, with an effective date of 11 October 2014. r. Orders C-10-414193R, issued by HRC, dated 16 October 2014, rescinded his previous orders. s. Orders C-10-415049, issued by HRC, dated 27 October 2014, shows he was voluntarily released from the USAR Control Group (Reinforcements) and assigned to the 391th Military Police Battalion, effective 22 October 2014. t. Orders 15-349-00047, issued by Headquarters, 88th Regional Support Command, shows he was honorably discharged from the USAR, with an effective date of 15 December 2015. 5. Army Review Boards Agency, Memorandum, subject: Department of Defense Physical Disability Board of Review Recommendation for [Applicant], AR20160011076, dated 27 July 2016, shows the applicant applied to the PDBR for a change or modification of his disability rating, which was previously assigned. The PDBR Board unanimously recommended no change in the PEB adjudication at both TDRL placement and TDRL removal. In the matter of the contended left and right ankle conditions, the Board unanimously recommended no change from the PEB determinations as not unfitting. There were no other conditions within the Board's scope of review for consideration. The Board, therefore, recommends that there be no re-characterization of the Cl's TDRL placement and removal disability and separation determinations. ARBA accepted the Board's recommendation and denied his application. 6. In a Prior ABCMR Docket Number AR20190007780, dated 14 December 2021, shows that the Board denied his request for a medical retirement. The Board reasoned that 10019034, dated 20 April 2012, the applicant requested, in effect, reinstatement on TDRL. His request was denied. The Board reasoned that based upon the available documentation and the findings and recommendation of the medical advisor, who recommended denying the applicant relief, the Board concluded there was insufficient evidence of an error or injustice which would warrant a change to the applicant’s relief. 7. MEDICAL REVIEW: The Army Review Boards Agency (ARBA) Medical Advisor was asked to review this case. Documentation reviewed included the applicant’s ABCMR application and accompanying documentation, the military electronic medical record (AHLTA), the VA electronic medical record (JLV), the electronic Physical Evaluation Board (ePEB), the Medical Electronic Data Care History and Readiness Tracking (MEDCHART) application, and the Interactive Personnel Electronic Records Management System (iPERMS). The ARBA Medical Advisor made the following findings and recommendations: a. The applicant is applying to the ABCMR requesting a referral to the Disability Evaluation System (DES). He states: “I was referred to the Disability Evaluation System and had been assigned a case manager to assist in gathering records and identifying disabling conditions. Prior to completion of the medical evaluation board process, I was notified I was transferred to the retired reserve. I was not able to complete the MEB process. I was denied a military disability retirement for my service connected unfitting conditions.” b. The Record of Proceedings details the applicant’s military service and the circumstances of the case. Orders published by the Headquarters of the 88th Regional Support Command (RSC) show the applicant was honorably discharged for the USAR on 15 December 2015. c. His most recent DD 214 shows the former USAR Officer entered active duty on 13 June 2009 and it shows he served in Iraq from 19 July 2009 thru 1 June 2010. d. This request was previously denied in full on 14 December 2021 (AR20190007780). Rather than repeat their findings here, the board is referred to the record of proceedings and medical advisory for that case. This review will concentrate on the new evidence submitted by the applicant. e. The applicant was placed on a permanent duty limiting permanent profile for Head Injury, Shoulder Pain, Right Leg Pain, and Post-Traumatic Stress Disorder with referral to a medical evaluation board on 25 January 2011. The applicant was noted to be unable to perform seven of the ten functional activities required of all Soldiers (Block 5 of the Physical Profile, DA Form 3349) including: Carry and fire individual assigned weapon Ride in a military vehicle for at least 12 hours per day Wear body armor for at least 12 hours per day Wear load bearing equipment (LBE) for at least 12 hours per day Move 40lbs (for example, duffle bag) while wearing usual protective gear (helmet, weapon, body armor and LBE) at least 100 yards Live in an austere environment without worsening the medical condition f. The approval of a permanent duty limiting profile is the first step in the DES, and the applicant’s DES processing should have started at this time. g. On 5 June 2012, fifteen months later and one month prior to his transfer to the Retired Reserve, the applicant’s permanent profile was downgraded to a non-duty limiting permanent profile. He was now noted to be able to perform all ten required functional activities. The reasoning behind this profile downgrade is highly suspect, and did not appear to be related to any medical evidence, but actually to an absence of evidence. Noted in the comment’s block of the profile (block 8): “There is insufficient information to support limitations in block 5. If the Soldier feels that this is too restrictive, if their condition worsens, or if the command feels that a more restrictive profile is required, additional documentation can be submitted to the profiling authority in the Soldier’s {sic} chain of command.” h. The permanent profiling of Army Soldiers is serious business, and it to be based on medical evidence at ALL times. Paragraph 7-3a of AR 40-501, Standards of Medical Fitness (4 August 2011) states in part: “Since the analysis of the individual’s medical, physical, and mental status plays an important role in assignment and welfare, not only must the functional grading be executed with great care, but clear and accurate descriptions of medical, physical, and mental deviations from normal are essential.” i. Paragraph 7-4b(4) of AR 40-501 illuminates the injustice in this case: “Permanent profiles may be amended (following the correct procedure) at any time if clinically indicated and will automatically be reviewed and verified by the privileged provider at the time of a Soldier’s periodic health assessment or other medical examination.” j. There is no evidence the applicant’s last minute profile change was clinically indicated or based on medical science. In fact, both his Periodic Health Assessment and the accompanying Functional Capacity Certificate completed 2 months earlier, on 18 April 2012, show the applicant had permanent duty limiting restrictions due to his PTSD and right leg sciatica. k. Review of the applicant’s records in JLV show the applicant has a 70% disability rating for PTSD, 30% for migraine headaches, 20% for his sciatica, and 10% for traumatic brain disease. l. It is unknown why the applicant was not processed through the DES for his PTSD and other medical conditions related to his military service to our country when multiple Army regulations mandate referral of such cases to the DES. m. Paragraph 7-1 of AR 40-400, Patient Administration, states in part: “If the Soldier does not meet retention standards, an MEB is mandatory and will be initiated by the physical evaluation board liaison officer (PEBLO).” Note there is no mention of component or duty status. Paragraph 7-5b(5) is more direct for this case, stating that one of the situations which requires MEB consideration is “an RC member not on AD who requires evaluation because of a condition that may render him or her unfit for further duty.” n. Paragraph 4-8 of AR 635–40, Physical Evaluation for Retention, Retirement, or Separation (20 March 2012) identifies the error made by his command: “When a commander believes that a Soldier of their command is unable to perform the duties of their office, grade, rank, or rating because of physical disability, the commander will refer the Soldier to the responsible MTF for evaluation.” o. It is the strong opinion of the ARBA Medical Advisor that a long overdue referral of his case to the Disability Evaluation System is clearly warranted. BOARD DISCUSSION: After review of the application and all evidence, the Board found partial relief is warranted. The applicant’s contentions, medical concerns, and the medical advisory opinion were carefully considered. The Board concurred with the advisory official finding it is unknown why the applicant was not processed through the DES for his PTSD and other medical conditions related to his military service to our country when multiple Army regulations mandate referral of such cases to the DES. Based upon the preponderance of the evidence, the Board agreed the applicant’s record should be referred to the Office of the Surgeon General for medical evaluation consideration, with all relief dependent upon a final medical determination. 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 AR20190007780 dated 14 October 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. REFERENCES: 1. DA Pamphlet 40-502 (Medical Readiness Procedures) describes the processes and procedures for assessing, documenting, reporting, and administering medical readiness. a. Paragraph 1-6 (MRC) states MRC 1 pertains to fully medically ready Soldiers who have a current status for a completed Periodic Health Assessment, dental readiness classification (DRC) 1 or DRC 2 assessment, immunization requirements, medical readiness and laboratory studies, individual medical equipment, and are without any deployment-limiting medical conditions or medications. b. Paragraph 4-3 (Physical Profile Serial System) states the basis for the physical profile serial system is the function of body systems and their relation to military duties. Profiling providers will use permanent profiles to describe and rate the function of the extremities, sensory organs, physical capacity, and mental health. The permanent physical profile has six functional areas "P-U-L-H-E-S" with four numerical designations used to reflect different levels of functional capacity. The determination of the numerical designation 1, 2, 3, or 4 evaluates the functional capacity of a particular organ or system of the body. The functional areas for consideration are: P - physical capacity or stamina, U - upper extremities, L- lower extremities, H - hearing and ears, E - eyes, S - psychiatric. An individual having a numerical designation of "1" on all the functions describes a high level of medical fitness, deployable. 2. Army Regulation 635-40, dated 19 January 2017, superseded Army Directive 2012- 18 (MOS Administrative Retention Review (MAR2), dated 23 August 2012. Chapter 3 (MAR2) implement and establishes policy for the MAR2. Soldiers must be of sufficient medical fitness to satisfactorily perform their primary MOS (PMOS) or area of concentration (AOC), as well as those functional activities listed on the DA Form 3349 (Physical Profile), which all Soldiers must perform regardless of PMOS or AOC. Of note, all functional activities listed on the DA Form 3349 must be marked "Yes" for the Soldier to be eligible for referral to a MAR2. The MAR2 is an administrative process for Soldiers who meet the medical retention standards of Army Regulation 40-501 (Standards of Medical Fitness), but who nonetheless may not be able to satisfactorily perform the duties of their PMOS or AOC in a worldwide field or austere environment because of medical limitations. The MAR2 process is used to determine whether a Soldier will be retained in their PMOS or AOC or reclassified into another PMOS or AOC. Soldier who do not meet PMOS or AOC standards and who do not qualify for reclassification will be referred into the DES. For referral to a MAR2, the Soldier must have been issued a DA Form 3349 with a permanent (P) 3 or 4 in at least one of the profile serial factors for a medical condition(s) that meet the medical retention standards of Army Regulation 40- 501. 3. Army Regulation 40-501 provides information on medical fitness standards for induction, enlistment, appointment, retention, and related policies and procedures. Chapter 3 gives the various medical conditions and physical defects which may render a Soldier unfit for further military service and which fall below the standards required. These medical conditions and physical defects, individually or in combination, are those that: a. Significantly limit or interfere with the Soldier's performance of their duties. b. May compromise or aggravate the Soldier's health or well-being if they were to remain in the military Service. This may involve dependence on certain medications, appliances, severe dietary restrictions, or frequent special treatments, or a requirement for frequent clinical monitoring. c. May compromise the health or well-being of other Soldiers. d. May prejudice the best interests of the Government if the individual were to remain in the military Service. 4. Army Regulation 40-501 also states in: a. Paragraph 9-10, normally, Reservists who do not meet the fitness standards set by chapter 3 will be transferred to the Retired Reserve or discharged from the USAR. They will be transferred to the Retired Reserve only if eligible and if they apply for it. Reservists 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. Reservists 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. b. Paragraph 9-12, Reserve Component Soldiers with non-duty 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 RC Soldiers with non-duty related medical conditions, MEBs are not required and cases are not sent through the PEB liaison officers at the medical 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 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. 5. Army Regulation 635-40 governs the evaluation for physical fitness of Soldiers who may be unfit to perform their military duties because of physical disability. The regulation in effect at the time, dated 15 September 1990, states in: a. Paragraph 3-9, the TDRL is used in the nature of a "pending list." It provides a safeguard for the Government against permanently retiring a Soldier who can later fully recover, or nearly recover, from the disability causing him or her to be unfit. Conversely, the TDRL safeguards the Soldier from being permanently retired with a condition that may reasonably be expected to develop into a more serious permanent disability. Requirements for placement on the TDRL are the same as for permanent retirement. The Soldier must be unfit to perform the duties of his or her office, grade, rank, or rating at the time of evaluation. The disability must be rated at a minimum of 30 percent or the soldier must have 20 years of service computed under section 1208, Title 10, United States Code. In addition, the condition must be determined to be temporary or unstable. A Soldier who is determined to be physically fit will not be placed on the TDRL regardless of the severity of the physical defects or the fact that they might become unfitting were the Soldier to remain on active duty for a period of time. b. Paragraph 3-13: (1) General officers and medical corps officers will not be found to be unfit by reason of physical disability if they can be expected to perform satisfactorily in an assignment appropriate to their grade, qualifications, and experience. (2) General officers and medical corps officers who are processing for retirement by reason of age or length of service may not be retired for physical disability unless the initial unfitness determination of the Secretary of the Army is approved by the Secretary of Defense on the recommendation of the Assistant Secretary of Defense (Health Affairs) (ASD (HA)). (3) General officers and medical corps officers not processing for retirement by reason of length of service at the time of their referral into the disability system, may not be retired or separated for physical disability until a recommendation therefore by the Secretary of the Army is approved by the ASD (HA). 6. DODI 1332.38, dated 14 November 1996, paragraph E3. P4.5.3 (Prior Service Impairments) states that any medical condition incurred or aggravated during one period of service or authorized training that recurs or is aggravated during later service, regardless of the time between, should normally be considered incurred in the line of duty (LOO) provided the condition or subsequent aggravation was not the result of the member's misconduct or willful negligence. In those cases, in which the service member reverts to a civilian status after the condition is incurred, the service member must prove by a preponderance of evidence that the medical condition was incurred or aggravated in the LOD. 7. 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 a medical evaluation board (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 Physical Evaluation Board (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. 8. 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%. 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. 9. Title 38, U.S. Code, section 1110 (General – Basic Entitlement) states for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service, during a period of war, the United States will pay to any veteran thus disabled and who was discharged or released under conditions other than dishonorable from the period of service in which said injury or disease was incurred, or preexisting injury or disease was aggravated, compensation as provided in this subchapter, but no compensation shall be paid if the disability is a result of the veteran's own willful misconduct or abuse of alcohol or drugs. 10. Title 38, U.S. Code, section 1131 (Peacetime Disability Compensation – Basic Entitlement) states for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service, during other than a period of war, the United States will pay to any veteran thus disabled and who was discharged or released under conditions other than dishonorable from the period of service in which said injury or disease was incurred, or preexisting injury or disease was aggravated, compensation as provided in this subchapter, but no compensation shall be paid if the disability is a result of the veteran's own willful misconduct or abuse of alcohol or drugs. 11. Title 38, U.S. Code, sections 1110 and 1131, permits the VA to award compensation for disabilities that were incurred in or aggravated by active military service. However, an award of a higher VA rating does not establish error or injustice on the part of the Army. The Army rates only conditions determined to be physically unfitting at the time of discharge which disqualify the Soldier from further military service. The VA does not have the authority or responsibility for determining physical fitness for military service. The VA awards disability ratings to veterans for service- connected conditions, including those conditions detected after discharge, to compensate the individual for loss of civilian employability. These two government agencies operate under different policies. Unlike the Army, the VA can evaluate a veteran throughout his or her lifetime, adjusting the percentage of disability based upon that agency's examinations and findings. //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20210012575 1 1