IN THE CASE OF: BOARD DATE: 12 January 2023 DOCKET NUMBER: AR20220006410 APPLICANT REQUESTS: his medical condition be deemed combat incurred. APPLICANT'S SUPPORTING DOCUMENT(S) CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * Orders CR-166-0026 dated 14 June 2016 * DD Form 214 (Certificate of Release or Discharge from Active Duty) * Department of Veterans Affairs (VA) Letter with Medical Records (244 pages) FACTS: 1. The applicant states he is requesting his medical condition be deemed combat related because it started at a hazardous duty station. He began to experience psychotic side effects in Qatar that led to his medical retirement from the Army. With the stress and constant anxiety, he has been affected permanently. He returned home and was plagued with both audio and visual hallucinations which led to him seeking medical attention. He was concerned he would hurt himself or his family being constantly told to do something by the audio hallucinations. 2. The applicant provides: a. The below listed documents to be referenced in the service record: * Orders CR-166-0026 dated 14 June 2016 * DD Form 214 effective 26 August 2019 b. A VA letter indicating the applicant’s medical records are provided as requested with 244 pages of medical records, for treatment received from approximately 3 August 2020 through 12 August 2022. 3. A review of the applicant’s service record shows: a. He enlisted in the Regular Army on 4 February 2013. b. The service record includes the applicant’s medical evaluations for the purposes of enlistment which indicated he was generally in good health. The applicant was marked qualified for service. * DD Form 2807-1 (Report of Medical History) dated 7 September 2012 * DD Form 2807-2 (Medical Prescreen of Medical History Report) dated 29 August 2012 * DD Form 2808 (Report of Medical Examination) dated 7 September 2012 c. His Enlisted Record Brief shows he served in Qatar from 29 July 2016 through 24 April 2017. d. Orders CR-166-0026, dated 14 June 2016, deployed the applicant in a Temporary Change of Station (TCS) in support of Operation Enduring Freedom (Spartan Shield) to Qatar for a period not to exceed 270 days and a report date of 28 July 2016. An amendment was published, Orders CR-166-0026 (A1), on 5 September 2016 to add the accounting code. e. A DA Form 199 (Information Physical Evaluation Board (PEB) Proceedings) shows on 5 June 2019 a PEB convened and found the applicant physically unfit. The PEB recommended a rating of 90% and that the applicant’s disposition be placement of the Temporary Disability Retirement List (TDRL) and reexamination during December 2020. The disabling conditions listed are partial complex seizures with secondary generalization at 80% (VASRD Code 8914) and persistent depressive disorder with anxious distress at 50% (VASRD Codes 9499-9434). The diagnosis of his conditions was in 2018 while assigned to Fort Carson, CO. On 12 June 2019, the applicant concurred with the findings, waived a formal hearing of his case, and did not request reconsideration of his VA findings. (1) Section IV (Medical Conditions Determined Not to be Unfitting) listed: * unspecified personality disorder * mild obstructive sleep apnea * primary hypertension * recurrent anal fissure, chronic * hemorrhoids, resolved * visual disturbances, photophobia, bilateral * chorioretinal scar, right eye * heterononymous nasal visual field defect, right * heterononymous nasal visual field defect, left * allergic rhinitis * tachycardia * acute sinusitis, resolved * acute gastroenteritis, resolved * abdominal incision scar, healed with keloid and scab * normal hearing bilaterally with subjective complaint of tinnitus bilaterally (2) Section V (Administrative Determinations) noted: * the disability disposition is not based on disease or injury incurred in the line of duty in combat with an enemy of the United States and as a direct result of armed conflict or caused by an instrumentality of war and incurred in the line of duty during a period of war (5 USC 8332, 3502, and 6303) * the disability did not result from a combat-related injury under the provisions of 26 USC 104 or 10 USC 10216 f. Orders 169-0039, dated 18 June 2019, released the applicant from assignment and duty because of physical disability incurred while entitled to basic pay and under conditions that permitted his placement on the TDRL with a 90% disability rating effective 26 August 2019. g. He was honorably retired from active duty on 26 August 2019. His DD Form 214 shows he completed 6 years, 6 months, and 23 days of active service. He was assigned separation code SEK and the narrative reason for separation listed as “Disability, Temporary (Enhanced).” h. A DA Form 199 shows on 6 December 2021 a PEB convened and found the applicant physically unfit. The PEB recommended a rating of 80% and that the applicant’s disposition be permanent disability retirement. The disabling conditions listed are partial complex seizures with secondary generalization at 60% (VASRD Code 8914) and persistent depressive disorder with anxious distress at 50% (VASRD Codes 9499- 9434). On 9 December 2021, the applicant concurred with the findings and waived a formal hearing of his case. Section V (Administrative Determinations) remained unchanged. i. Order D347-11, dated 13 December 2021, removed the applicant from the TDRL effective 13 December 2021 and on the day following day permanently retired him with an 80% disability rating. 4. The applicant’s Combat Related Special Compensation (CRSC) applications, supporting documents, and CRSC decision letters are contained within the applicant’s service record. Included are the following: a. An incomplete DD Form 2860 (Claim for Combat-Related Special Compensation (CRSC)). b. On 20 December 2021, the applicant was notified his application could not be processed as it did not include the required signature and date, nor did it specify which conditions he was requesting for consideration. c. On 22 December 2021, the applicant resubmitted his DD Form 2860 which indicated he was submitting a claim for schizoaffective disorder. The applicant stated with the stress forced on his while at a hazardous duty location, his military career ended. Following his deployment, a medical evaluation board (MEB) was initiated for mental disorders of continuous audio and visual hallucinations, in addition to seizures. Those were the two disabilities that led to the finding of unfit for duty. He submitted his DA Form 199 dated 5 June 2019 as supporting evidence. d. On 25 January 2022, the applicant was notified his claim for CRSC was approved only for tinnitus with a rating of 10% and allergic rhinitis with a rating of 0%. The schizoaffective disorder, for which he applied, could not be verified as a combat-related disability. A VA rating, dated 8 December 2020, shows his requested condition was listed as service connected, Gulf War incurred. e. On 14 March 2022, the applicant submitted a reconsideration request indicating he was providing a personal letter explaining how the disability was linked to hazardous duty. He stated at the time of his deployment to Qatar he began to experience audio and visual hallucinations from the increased security needs during multiple post lockdowns. As he would play with his children, he would hear a voice demanding that he hurt his children which caused him severe depression and anxiety. That was the substantial key that drove the change from major depressive disorder to schizoaffective diagnosis. He also included his updated DA Form 199 dated 6 December 2021, in addition to his DD Form 214. f. The applicant was subsequently notified by CRSC the rating remained the same. He was receiving a second disapproval for the schizoaffective disorder. 5. By regulation (AR 635-40), physical disability evaluation will include a decision and supporting documentation regarding whether the injury or disease that makes the Soldier unfit or that contributes to unfitness was incurred in combat with an enemy of the United States, was the result of armed conflict, or was caused by an instrumentality of war during a period of war. a. Armed Conflict. The fact that a Soldier may have incurred a medical impairment during a period of war, in an area of armed conflict, or while participating in combat operations is not sufficient to support a finding that the disability resulted from armed conflict. There must be a definite causal relationship between the armed conflict and the resulting unfitting disability. b. Combat related. Covers those injuries and diseases attributable to the special dangers associated with armed conflict or the preparation or training for armed conflict. A physical disability will be considered combat related if it causes the Soldier to be unfit or contributes to unfitness and was incurred under any of the following circumstances: * As a direct result following armed conflict. * While engaged in hazardous service. * Under conditions simulating war. * Caused by an instrumentality of war 6. By law (Title 26, USC, section 104), authorizes special rules for combat-related injuries for compensation for injuries or sickness. For purposes of this subsection, the term "combat-related injury" means personal injury or sickness (A) which is incurred (i) as a direct result of armed conflict, (ii) while engaged in extra-hazardous service, or (iii) under conditions simulating war; or (B) which is caused by an instrumentality of war. 7. The law (Title 10, USC, section 1413a) defines the term "combat-related disability" means a disability that is compensable under the laws administered by the Secretary of Veterans Affairs and that (1) is attributable to an injury for which the member was awarded the Purple Heart; or (2) was incurred (as determined under criteria prescribed by the Secretary of Defense) (A) as a direct result of armed conflict; (B) while engaged in hazardous service; (C) in the performance of duty under conditions simulating war; or (D) through an instrumentality of war. 8. MEDICAL REVIEW: a. The applicant is applying to the ABCMR requesting his medical condition be deemed combat incurred. b. The specific facts and circumstances of the case can be found in the ABCMR Record of Proceedings (ROP). Pertinent to this advisory are the following: 1) The applicant enlisted in the Regular Army on 04 February 2013; 2) He served in Qatar from 29 July 2016 through 24 April 2017; 3) On 5 June 2019, a PEB convened and found the applicant physically unfit, but his conditions were not found to be incurred in the line of duty in combat; 4) The applicant was honorably retired from active service on 26 August 2019. c. The Army Review Board Agency (ARBA) Medical Advisor reviewed the supporting documents and the applicant’s military service records. The Armed Forces Health Longitudinal Technology Application (AHLTA) and VA’s Joint Legacy Viewer (JLV) were also reviewed. d. The applicant has a long history of interpersonal, occupational, and behavioral health problems. He was found medically unfit for continued service for seizures and persistent depressive disorder with anxious distress. The applicant reports a history of depression, anxiety, self-mutilation, suicidal ideation, and auditory hallucinations prior to his military service. The applicant served in Qatar, but there is no evidence he experienced direct active combat exposure. The applicant stated there was an increase of psychiatric symptoms while serving in Qatar, but he was neither command nor self- referred to behavioral health. After returning, he did begin to attend behavioral health treatment, and he was diagnosed with depression, adjustment disorder, suicidal ideation, sleep problems, and unspecified personality disorder. A review of JLV provided evidence the applicant has been actively engaged in behavioral health treatment at the VA. He was diagnosed with schizoaffective disorder on 08 October 2020. The applicant was found to be 100% disabled with a rating of 100% for schizoaffective disorder. e. On 20 December 2021, the applicant was notified his application for Combat- Related Special Compensation (CRSC) could not be processed as it did not include the required signature and date, nor did it specify which conditions he was requesting for consideration. On 22 December 2021, the applicant resubmitted his application, which indicated he was submitting a claim for schizoaffective disorder. On 25 January 2022, the applicant was notified his claim for CRSC was not approved for schizoaffective disorder, because it could not be verified as a combat-related disability. On 14 March 2022, the applicant submitted a reconsideration request with a personal letter explaining how the disability was linked to hazardous duty. The applicant was subsequently notified by CRSC the rating remained the same. f. Based on the available information, it is the opinion of the Agency BH Advisor there is insufficient evidence to support the applicant’s condition of schizoaffective disorder meets the qualifications for a combat incurred injury. Specifically, the applicant had 1) a history of similar behavioral health symptoms prior to his enlistment; 2) the applicant was not assigned to an area of armed active conflict; 3) the applicant has been repeatedly found to not qualify for CRSC. Therefore, it is not recommended the applicant be referred again. Kurta Questions A. Did the applicant have a condition or experience that may excuse or mitigate the discharge? N/A, the applicant was honorably medically retired from active service. Also, there is insufficient evidence to support the applicant’s condition of schizoaffective disorder meets the qualifications for a combat incurred injury. B. Did the condition exist or experience occur during military service? N/A C. Does the condition experience actually excuse or mitigate the discharge? N/A BOARD DISCUSSION: After reviewing the application and all supporting documents, the Board determined relief was not warranted. The applicant’s contentions, the military record, and regulatory guidance were carefully considered. Based upon the available documentation and the findings of the medical advisor, the Board concluded there was insufficient evidence to show that the applicant’s medical conditions were combat related. 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 635-40 (Disability Evaluation for Retention, Retirement, or Separation) 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. Physical disability evaluation will include a decision and supporting documentation regarding whether the injury or disease that makes the Soldier unfit or that contributes to unfitness was incurred in combat with an enemy of the United States, was the result of armed conflict, or was caused by an instrumentality of war during a period of war. a. Armed Conflict. The fact that a Soldier may have incurred a medical impairment during a period of war, in an area of armed conflict, or while participating in combat operations is not sufficient to support a finding that the disability resulted from armed conflict. There must be a definite causal relationship between the armed conflict and the resulting unfitting disability. b. Combat related. Covers those injuries and diseases attributable to the special dangers associated with armed conflict or the preparation or training for armed conflict. A physical disability will be considered combat related if it causes the Soldier to be unfit or contributes to unfitness and was incurred under any of the following circumstances: * As a direct result following armed conflict. * While engaged in hazardous service. * Under conditions simulating war. * Caused by an instrumentality of war 2. Army Regulation 40-501 (Standards of Medical Fitness) governs medical fitness standards for enlistment, induction, appointment, retention, and separation (including retirement). Once a determination of physical unfitness is made, disabilities are rated using the VA schedule of disability rating. 3. Title 38, United States Code, Section 1110 (General - Basic Entitlement) sates 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. 4. Title 38, United States 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. 5. Title 10, U.S. Code, section 1413a, as amended, established CRSC. CRSC provides for the payment of the amount of money a military retiree would receive from the VA for combat-related disabilities if it were not for the statutory prohibition for a military retiree to receive a VA disability pension. Payment is made by the Military Department, not the VA, and is tax free. Eligible members are those retirees who have 20 years of service for retired pay computation (or 20 years of service creditable for Reserve retirement at age 60) and who have disabilities that are the direct result of armed conflict, especially hazardous military duty, training exercises that simulate war, or caused by an instrumentality of war. CRSC eligibility includes disabilities incurred as a direct result of: * armed conflict (gunshot wounds, Purple Heart, etc.) * training that simulates war (exercises, field training, etc.) * hazardous duty (flight, diving, parachute duty) * an instrumentality of war (combat vehicles, weapons, Agent Orange, etc.) 6. Section 1556 of Title 10, United States Code, 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. //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20220006410 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1