IN THE CASE OF: BOARD DATE: 16 June 2023 DOCKET NUMBER: AR20220010722 APPLICANT REQUESTS: physical disability retirement in lieu of separation with severance pay. APPLICANT'S SUPPORTING DOCUMENT(S) CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * DD Form 214 (Certificate of Release or Discharge from Active Duty) * Orders 279-0603, 5 October 2012 * Summary of benefits letter, 2 August 2022 * Disability ratings * DD Form 293 (Application for the Review of Discharge from the Armed Forces of the United States) FACTS: 1. The applicant did not file within the 3-year time frame provided in Title 10, U.S. Code, section 1552(b); however, the Army Board for Correction of Military Records (ABCMR) conducted a substantive review of this case and determined it is in the interest of justice to excuse the applicant's failure to timely file. 2. The applicant states he is seeking that his status be changed from honorably discharge to retired from service-related injuries. During his second tour in Afghanistan, he was injured overseas and was medically discharged upon return from his deployment. At that time, the Army medical board decided that while the VA rated him at 60% disability, the Army only gave him 10% and severance pay. He had been away from his spouse and kids for several months and decided he would rather be with them rather than take more time to fight the difference. He has recently been changed from 90% disabled to 100% permanent and total service connected and feel like this injustice should be corrected as he should have been retired from the Army. The only condition the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) looked at was his right knee injury at the time and did not consider other conditions and injuries for his overall rating. If the following conditions which were rated by the VA at the time of discharge were considered he would have been eligible for retirement. Sleep apnea VA rated 50% the MEB board would not send him for a sleep study but gave him narcotic sleep medication instead, Migraines was listed at the time of separation but was recently increased by the VA to 50% as the symptoms from military service were getting worse, left knee patellofemoral syndrome 10% and right knee patellofemoral syndrome, with painful extension 10% were both listed at discharge, but he only received 10% from the board. For those reasons he is asking the board to increase his percentage to above 30% and change his separation to retirement. 3. The applicant’s records contain DD Form 2807-1 (Report of Medical History), conducted on 6 December 2007, showing 4 stitches. DD Form 2808 (Report of Medical Examination), showing he was medically qualified for service. 4. The applicant enlisted in the Regular Army on 17 January 2008. He held military occupational specialty (MOS) 92F (Petroleum Supply Specialist). 5. He served in Afghanistan from 1 November 2008 – 29 January 2009 and again from 12 February 2010 – 14 February 2011. 6. A DA Form 199 (Informal Physical Evaluation Board (PEB) Proceedings) shows a PEB convened on 11 September 2012, which found the applicant physically unfit and recommended a rating of 10% and that his disposition be separation with severance pay. The unfitting condition was patellofemoral syndrome, right knee rated at 10%. a. The PEB noted, this condition began during his second deployment to Afghanistan. Despite multiple treatment modalities the Soldier's impairment persists. This was unfitting because it prevented the Soldier from lifting more than 40 pounds or climbing on an off vehicle rending him unable to conduct refueling operations required by MOS 92F. b. The PEB considered MEB Diagnoses 2-6 (left ankle Achilles enthesophyte; allergic rhinitis; insomnia; right ear hearing within normal limits, left ear sensorineural hearing loss; and bilateral tinnitus) both individually and in combination with other conditions. These conditions (individually and in combination) were not associated with profile limitations and did not impact the Soldier's ability to perform any one of the ten functional activities. The MEB has indicated these conditions meet medical retention standards. Therefore, these conditions were not unfitting. c. The applicant concurred and waived a formal hearing of his case. He did not request reconsideration of his VA ratings. 7. Orders 279-0603, issued by Headquarters 101st Airborne Division (Air Assault), Fort Campbell, KY, on 5 October 2012, shows the applicant was assigned to transition center with a report date of 28 December 2012. Additional Instructions shows: * 10% disability rating * disability is based on injury or disease received in the line of duty 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 as defined by law: No * disability resulted from a combat related injury as defined in 26 USC 104: No * disability was incurred in a combat zone or incurred during the performance of duty in combat-related operations as designated by the Secretary of Defense (NDAA 2008 Sec 1646): Yes 8. Orders 283-0616, issued by Headquarters 101st Airborne Division (Air Assault), Fort Campbell, KY, on 9 October 2012, reads Orders 279-0603 were amended to show: * rank: Sergeant * you are authorized disability severance pay in pay grade e05 based on 6 years of service… * service time is 4 years, 11 months, 12 days of service as computed 10 USC section 1208 9. On 28 December 2012, the applicant was honorably discharged for disability, severance pay, combat related (enhanced) in accordance with Army Regulation 635-40 (Physical Evaluation for Retention, Retirements, or Separation), chapter 4. His DD Form 214 shows he completed 4 years, 11 months, and 12 days of net active service this period. 10. The applicant provides: a. Summary of benefits letter, 2 August 2022, showing he was rated 100% service- connected disabilities by the VA effective 19 April 2022. b. Disability ratings showing: * migraine headaches, rated 50% * gastroesophageal reflux disease (GERD), rated 10% * posttraumatic stress disorder (PTSD) (previously rated as anxiety disorder not otherwise specified), rated 50% * obstructive sleep apnea, mild, rated 50% * penile condition, rated 0% * limited flexion, patellofemoral syndrome, s/p right knee sprain, rated 0% * left ankle Achilles enthesophyte with “F-AROM”, rated 10% * left knee patellofemoral syndrome, rated 10% * lumbar strain, rated 10% * hearing loss, left, rated 0% * allergic rhinitis; mild atelectatic scarring within the lingula (also claimed as respiratory condition), rated 0% * right knee patellofemoral syndrome, with painful extension, rated 10% * maxillary sinusitis (also claimed as respiratory condition), rated 10% * right ankle strain, rated 10% * hearing loss, right, rated 10% 11. The Army rates only conditions determined to be physically unfitting at the time of discharge, which disqualify the Soldier from further military service. The Army disability rating is to compensate the individual for the loss of a military career. The VA does not have authority or responsibility for determining physical fitness for military service. The VA may compensate the individual for loss of civilian employability. 12. Title 38, U.S. Code, Sections 1110 and 1131, permit the VA to award compensation for disabilities which were incurred in or aggravated by active military service. However, an award of a VA rating does not establish an error or injustice on the part of the Army. 13. Title 38, CFR, Part IV is the VA’s schedule for rating disabilities. The DVA awards disability ratings to veterans for service-connected conditions, including those conditions detected after discharge. As a result, the DVA, operating under different policies, may award a disability rating where the Army did not find the member to be unfit to perform his duties. Unlike the Army, the DVA can evaluate a veteran throughout his or her lifetime, adjusting the percentage of disability based upon that agency's examinations and findings. 14. MEDICAL REVIEW: a. 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/or the Interactive Personnel Electronic Records Management System (iPERMS). The ARBA Medical Advisor made the following findings and recommendations: b. The applicant has applied to the ABCMR requesting additional medical conditions be determined unfitting for continued military service with a subsequent increase in his military disability rating and change in his current disability separation disposition from separated with disability severance pay to permanent retirement for physical disability. The applicant states in part: “During my second tour in Afghanistan, I was injured overseas and was medically discharged upon return from my deployment. At that time, the Army Medical board had decided that while the VA rated me at 60% disability, the Army only gave me 10% and a severance package. I had been away from my spouse and kids for several months and decided I would rather be with them than take more time to fight the difference. I have recently been changed from 90% disabled to 100% permanent and total service connected and feel like this injustice should be corrected as I should have been retired from the Army. The only condition the MEB and PEB looked at was my right knee injury at the time and did not consider other conditions and injuries for my overall rating. If the following conditions which were rated by the VA at the time of discharge were considered I would have been eligible for retirement. Sleep apnea - VA rated 50% the MEB board wouldn't send me for a sleep study but gave me narcotic sleep medication instead; Migraines was listed at the time of separation but was recently increased by the VA to 50% as the symptoms from military service were getting worse; left knee patellofemoral syndrome 10% and right knee patellofemoral syndrome, with painful extension 10% were both listed at discharge but I only received 10% from the board. For these reasons I am asking the board to increase my percentage to above 30% and change my separation code to retirement c. The Record of Proceedings details the applicant’s service and the circumstances of the case. The DD 214 for the period of Service under consideration shows he entered the regular Army on 17 January 2008 and was separated with $29,851.20 of disability severance pay on 28 December 2012 under provisions provided in Chapter 4 of AR 635-40, Physical Evaluation for Retention, Retirement, or Separation (20 March 2012). d. A Soldier is referred to the IDES when they have one or more conditions which appear to fail medical retention standards as documented on a duty liming permanent physical profile. At the start of their IDES processing, a physician lists the Soldier’s referred medical conditions in section I the VA/DOD Joint Disability Evaluation Board Claim (VA Form 21-0819). The Soldier, with the assistance of the VA military service coordinator, lists all conditions they believe to be service-connected disabilities in block 8 of section II or a separate Statement in Support of Claim (VA form 21-4138). e. Soldiers then receive one set of VA C&P examinations covering all their referred and claimed conditions. These examinations, which are the examinations of record for the IDES, serve as the basis for both their military and VA disability processing. All conditions are then rated by the VA prior to the Soldier’s discharge. The physical evaluation board (PEB), after adjudicating the case sent them by the medical evaluation board (MEB), applies the applicable VA derived ratings to the Soldier’s unfitting condition(s), thereby determining their final combined rating and disposition. Upon discharge, the Veteran immediately begins receiving the full disability benefits to which they are entitled from both their Service and the VA. f. On 19 April 2012, the applicant was referred to the IDES for “Patellofemoral syndrome, right knee.” g. A medical evaluation board (MEB) determined his “Patellofemoral syndrome, right knee” was the only medical condition which failed the medical retention standards of AR 40-501, Standards of Medical Fitness. They determined five additional medical conditions met medical retention standards, to include left Achilles enthesophyte, allergic rhinitis, insomnia, right ear hearing within normal limits with left hear sensorineural hearing loss, and bilateral tinnitus. h. On 29 June 2012, the applicant concurred with the MEB’s findings and recommendation and his case was forwarded to a physical evaluation board (PEB) for adjudication. i. On 11 September 2012, the applicant’s informal PEB found his “Patellofemoral syndrome, right knee” to be the sole unfitting medical condition for continued service. They determined the remaining five medical conditions were not unfitting for continued military service. The PEB applied the VBA derived ratings of 10% and because the applicant’s combined military disability rating was less than 30%, the PEB recommended the applicant be separated with disability severance pay. On 25 September 2012, after being counseled on the informal PEB’s findings and recommendation by his PEB Liaison Officer (PEBLO), he concurred with the informal PEB’s findings, waived his right to a formal hearing, and declined to request a VA reconsideration of his disability rating. j. Review of his records in AHLTA show his insomnia was being effectively treated with medication (Lunesta); his only visits for low back pain were two encounters in February 2011; his only mental health related visit was for insomnia on 28 September 2011; and he was neither seen for or diagnosed with headaches or sleep apnea prior to his separation from the Army. k. The VA did service connect his migraines with a 0% rating prior to his separation. He was granted a service-connected disability rating for PTSD in December 2014 and for sleep apnea in May 2015. l. There is no significant probative evidence the applicant had any additional medical condition(s) which would have failed the medical retention standards of chapter 3 of AR 40-501, Standards of Medical Fitness, prior to his discharge; or which prevented the applicant from being able to reasonably perform the duties of his office, grade, rank, or rating prior to his discharge. m. Review of his records in JLV shows he has been awarded multiple VA service- connected disability ratings, including rating for sleep apnea, migraine headaches, and PTSD. However, the DES only compensates an individual for service incurred medical condition(s) which have been determined to disqualify him or her from further military service. The DES has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions which were incurred or permanently aggravated during their military service; or which did not cause or contribute to the termination of their military career. These roles and authorities are granted by Congress to the Department of Veterans Affairs and executed under a different set of laws. n. It is the opinion of the ARBA Medical Advisor that neither an increase in his military disability rating nor a referral of his case back to the DES is warranted. BOARD DISCUSSION: 1. After reviewing the application, all supporting documents, and the evidence found within the military record, the Board found that relief was not warranted. The applicant’s contentions, the military record, a medical advisory opinion, and regulatory guidance were carefully considered. The Board also considered the findings of the PEB. The Board concurred with the advisory official finding the DES only compensates an individual for service incurred medical condition(s) which have been determined to disqualify him or her from further military service. The Board further noted on 25 September 2012, after being counseled on the informal PEB’s findings and recommendation, the applicant concurred with the informal PEB’s findings, waived his right to a formal hearing, and declined to request a VA reconsideration of his disability rating. The applicant is advised the DD Form 214 shows circumstances as they were on the date prepared. Based upon a preponderance of the evidence, the Board determined there is insufficient evidence that shows a medical retirement was warranted during his period of active service. 2. The Board agreed that the VA provides post-service support and benefits for service connected medical conditions. The VA operates under different laws and regulations than the Department of Defense (DOD). In essence, the VA will compensate for all service connected disabilities. ? 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. Title 10, U.S. Code, Section 1552(b), provides that applications for correction of military records must be filed within 3 years after discovery of the alleged error or injustice. This provision of law also allows the ABCMR to excuse an applicant's failure to timely file within the 3-year statute of limitations if the ABCMR determines it would be in the interest of justice to do so. 2. 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. 3. Army Regulation 635-40 (Physical 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. 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. 4. Army Regulation 40-501 (Standards of Medical Fitness) governs medical fitness standards for enlistment, induction, appointment (including officer procurement programs), retention, and separation (including retirement). The Department of Veterans Affairs Schedule for Rating Disabilities (VASRD). VASRD is used by the Army and the VA as part of the process of adjudicating disability claims. It is a guide for evaluating the severity of disabilities resulting from all types of diseases and injuries encountered as a result of or incident to military service. This degree of severity is expressed as a percentage rating which determines the amount of monthly compensation. 5. Department of Defense (DoD) Directive-Type Memorandum (DTM) 11-015 (Disability Evaluation System) explains the Integrated Disability Evaluation System (IDES). The version in effect at the time defined the IDES process and procedures. The guidelines within the DTM were incorporated in the DoD Manual Number 1332.18 (DES Manual: General Information and Legacy DES Time Standards). a. The IDES is the joint DoD-VA process by which DoD determines whether wounded, ill, or injured Service members are fit for continued military service and by which the DOD and the VA determine appropriate benefits for Service members who are separated or retired for a Service-connected disability. The IDES features a single set of disability medical examinations appropriate for fitness determination by the Military Departments and a single set of disability ratings provided by the VA for appropriate use by both departments. Although the IDES includes medical examinations, IDES processes are administrative in nature and are independent of clinical care and treatment. b. Unless otherwise stated in this DTM, DOD will follow the existing policies and procedures promulgated in DOD Directive 1332.18 (Disability Evaluation System (DES)) and the Under Secretary of Defense for Personnel and Readiness Memoranda. All newly-initiated, duty-related physical disability cases from the Departments of the Army, Air Force, and Navy at operating IDES sites will be processed in accordance with this DTM and follow the process described in this DTM unless the Military Department concerned approves the exclusion of the Service member due to special circumstances. Service members whose cases were initiated under the legacy DES process will not enter the IDES. c. IDES medical examinations will include a general medical examination and any other applicable medical examinations performed to VA compensation and pension (C&P) standards. Collectively, the examinations will be sufficient to assess the member’s referred and claimed condition(s) and assist the VA in ratings determinations and assist military departments with unfit determinations. d. Within 15 days of receiving the proposed disability ratings from the Disability Rating Activity Site (D-RAS), the PEB will apply the rating using the diagnostic code(s) provided by the D-RAS to the Service Member’s unfitting conditions and publish the disposition recommendation. For example, if the PEB identifies a condition to the D-RAS as “schizophreniform disorder”, but the D-RAS rates the condition as “psychotic disorder NOS (VASRD 9210), the PEB will apply the rating as “schizophophreniform disorder rated as psychotic disorder NOS (VASRD 9210). e. Upon separation from military service for medical disability and consistent with Board for Corrections of Military Records (BCMR) procedures of the Military Department concerned, the former Service member (or his or her designated representative) may request correction of his or her military records through his or her respective Military Department BCMR if new information regarding his or her service or condition during service is made available that may result in a different disposition. For example, a veteran appeals the VA’s disability rating of an unfitting condition based on a portion of his or her service treatment record that was missing during the IDES process. If the VA changes the disability rating for the unfitting condition based on a portion of his or her service treatment record that was missing during the IDES process and the change to the disability rating may result in a different disposition, the Service member may request correction of his or her military records through his or her respective Military Department BCMR. 6. 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. 7. 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. 8. 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. 9. On 3 September 2014, the Secretary of Defense directed the Service Discharge Review Boards (DRBs) and Service Boards for Correction of Military/Naval Records (BCM/NRs) to carefully consider the revised PTSD criteria, detailed medical considerations, and mitigating factors, when taking action on applications from former service members administratively discharged under other than honorable conditions, and who have been diagnosed with PTSD by a competent mental health professional representing a civilian healthcare provider in order to determine if it would be appropriate to upgrade the characterization of the applicant's service. 10. On 25 August 2017, the Office of the Undersecretary of Defense for Personnel and Readiness issued clarifying guidance for the Secretary of Defense Directive to DRBs and BCM/NRs when considering requests by Veterans for modification of their discharges due in whole, or in part, to: mental health conditions, including PTSD; traumatic brain injury; sexual assault; sexual harassment. Boards were directed to give liberal consideration to Veterans petitioning for discharge relief when the application for relief is based in whole or in part on those conditions or experiences. The guidance further describes evidence sources and criteria and requires Boards to consider the conditions or experiences presented in evidence as potential mitigation for that misconduct which led to the discharge. 11. On 25 July 2018, the Under Secretary of Defense for Personnel and Readiness issued guidance to Military Discharge Review Boards and Boards for Correction of Military/Naval Records (BCM/NRs) regarding equity, injustice, or clemency determinations. Clemency generally refers to relief specifically granted from a criminal sentence. BCM/NRs may grant clemency regardless of the type of court-martial. However, the guidance applies to more than clemency from a sentencing in a court- martial; it also applies to other corrections, including changes in a discharge, which may be warranted based on equity or relief from injustice. This guidance does not mandate relief, but rather provides standards and principles to guide Boards in application of their equitable relief authority. In determining whether to grant relief based on equity, injustice, or clemency grounds, BCM/NRs shall consider the prospect for rehabilitation, external evidence, sworn testimony, policy changes, relative severity of misconduct, mental and behavioral health conditions, official governmental acknowledgement that a relevant error or injustice was committed, and uniformity of punishment. Changes to the narrative reason for discharge and/or an upgraded character of service granted solely on equity, injustice, or clemency grounds normally should not result in separation pay, retroactive promotions, and payment of past medical expenses or similar benefits that might have been received if the original discharge had been for the revised reason or had the upgraded service characterization. 12. 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. //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20220010722 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1