IN THE CASE OF BOARD DATE: 20 October 2022 DOCKET NUMBER: AR20220000448 APPLICANT REQUESTS: Correction of his DD Form 214 (Certificate of Release or Discharge from Active Duty) for the period ending 14 June 2013 to show he was retired by reason of medical disability with a 60% disability rating in lieu of disability severance pay non-combat (enhanced). APPLICANT'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * Applicant’s Statement * Two Wee Care Pediatric Documents * Methacholine Challenge Test * E-mail Request for Medical Waiver * Body Fat Content Worksheet * Two Pictures of Body Tattoos * Response to Congressional Correspondence * Fifty-Eight Chronological Records of Medical Care * Two Medical Prescreen/Medical History Reports * Two Clinical Records * Character Reference for Enlistment * Applicant's Statement for Enlistment * Report of Medical Examination * Medical History * VA Form 21-0819 * Physical Disability Evaluation System (PDES) Commanders Performance and Functional Statement * Statement in Support of Department of Veterans Affairs (VA) Claim * Leave and Earnings Statement (LES) * Examination for Temporomandibular Joint (TMJ) * History of TMJ Disorders * Two Compensation and Pension (C&P) Examinations * Medical History * Memorandum for Record (MFR), subject: Behavioral Health Review of Narrative Summary (NARSUM) * Medical Evaluation Board (MEB) Narrative Summary * MEB Proceedings * PEB Referral Transit Document * Physical Profile * MFR Addendum to NARSUM * PEB Determination * DES Proposed Rating * Informal PEB * DD Form 214 (Certificate of Release or Discharge from Active Duty) * Enlisted Record Brief FACTS: 1. The applicant did not file within the three-year time frame provided in Title 10, United States 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 the Army decided his preexisting psoriasis was not aggravated by military service, even though the VA rated it 60% disabling. 3. The applicant provides the following documents in support of his request: a. A personal statement indicating he was discharged under the Integrated Disability Evaluation System (IDES) in April 2013. His initial unfitting conditions were listed as chronic pain and instability due to chronic left ankle sprain with peroneus brevis tendon tear and psoriasis. He received a medical waiver for enlistment and did not have symptoms of psoriasis well over a year prior to enlistment. After suffering an ankle injury, the psoriasis resurfaced on his entire body making it impossible to perform his military duties. The IDES Board found the ankle condition as unfitting but not the psoriasis. (1) A VA Compensation and Pension (C&P) examination showing although the condition existed prior to service (EPTS), it was aggravated by military service. The VA found his psoriasis was 60% service connected, which is the highest rating possible for the condition. (2) The Army decided the psoriasis was not service connected and did not consider it an unfitting condition for IDES purposes. There is no evidence in his service treatment records nor the VA file to support this decision. In fact, it is in direct contradiction to the VA 's findings. In Section II of the DD Form 199 (Informal PEB Proceedings), dated 29 March 2013 under “Disability 2” the board decided the condition was not aggravated by military service but in the following sentence it references the DOD publication governing the IDES process, specifically stating the following “The medical condition imposes unreasonable requirements on the military to maintain or protect the member.” It also states the PEB found him unfit for military service because of the condition. b. Two Wee Care Pediatrics documents dated 9 and 26 September 2007, showing the applicant was age 18 and he had been seen for mild psoriasis during the past year. In clarification, the treating official stated his psoriasis was very mild. He had not been prescribed nor received any medication or treatment for his condition in over 1 year. It would not flare up during physical exercise. His uniform would not irritate the condition or cause it to flare up. In short, the condition should be considered dormant and would not interfere with his ability to serve in any way. c. A negative methacholine challenge test dated 19 September 2007. d. An email from the United States Army Recruiting Command (USAREC), dated 9 October 2007, showing the applicant requested considered for a medical waiver. e. A Body Fat Content Worksheet showing, on 11 October 2007, he was in compliance with Army Standards. f. Letter from Headquarters, USAREC, dated 20 December 2007, responding to the applicants Congressional Representative through the Chief, Congressional and Special Actions Branch indicating the Surgeon stated the applicant’s psoriasis was [not] waiverable at the present time, usually a normal Methacholine Challenge Test would result in an approved medical waiver; however, based on the applicant’s medical history and his use of steroids with flares associated with infections in 2005 and 2006, the applicant could not be considered for enlistment at this time. The Surgeon further stated the applicant was eligible to reapply for enlistment consideration in May 2009. Please understand there was no guarantee the applicant would be found medically or otherwise qualified for future enlistment in the US Army. The USAREC Surgeon's professional medical decisions are final and not subject to appeal. g. Fifty-eight Chronological Records of Medical Care, dated between 2010 through 2012, showing he was evaluated/treated, for the following conditions: Psoriasis, sleep management, allergies, ankle joint pain, a brace, ankle sprain, physical therapy for ankle sprain, peroneus tear of left foot, foot sprain left, airborne physical, and a sore throat and tightness in the chest. h. Two Clinical Records, dated 30 August 2010, showing his request for a medical waiver had been reviewed and approved. i. A character reference from a football coach, dated 22 July 2010, stating as a member of the coaching staff, he never saw asthma or any other medical condition affect the applicant, on or off the field. In any practice, scrimmage, game, or drill, he never saw the applicant fatigued or tired. Even in their most physically demanding exercises, the applicant never needed an inhaler or showed any trouble breathing during physical activity. j. The applicant’s statement, dated 3 August 2010, indicating he was age 21, and he was diagnosed with psoriasis as a child. Throughout his puberty and growth stages, his skin had gone through numerous outbreaks. After his 19th birthday, towards the end of puberty, his skin cleared up from outbreaks. His psoriasis was now in a dormant stage, requiring no medication or special treatment. It had been more than 4 years since he last saw a doctor or was prescribed a treatment for psoriasis. His skin had been free of itching, cracking, bleeding, or flaking for over 2 years, and the only signs of psoriasis were a few patches on his arms and legs, but mostly scarring from the healed skin. Psoriasis had not affected his daily life in the last 2 years. He required no medicines or lotions, and his [condition] had not stopped him from doing any physical activities. k. Report of Medical Examination, dated 19 August 2010, showing USAREC granted him a waiver for enlistment. l. Report of Medical History showing he checked “Yes,” when asked: * Do you have asthma, or any breathing problems related to exercise weather, pollen, etc. * Have you been subscribed or used an inhaler * Do you have a skin diseases, acne, eczema, or psoriasis, etc. * Are you currently in good health * Have you ever been rejected from military service for any reason m. VA Form 0819, 10 October 2012, showing he was referred to an MEB on this date for chronic left ankle sprain with instability. n. A PDES Commanders Performance and Functional Statement, dated 16 October 2012, showing “Yes,” in “Soldiers medical condition/limitation affect unit accomplishing mission.” (If yes fully explain) The explanation indicates, “He was currently undergoing the MEB process. “He had no issues maintaining all of his appointments, formations, and required training.” o. The applicant’s statement in support of VA Claim, dated 16 October 2012, stating “I wish to file service connection for the following conditions: TMJ [temporomandibular joint], porosis, right ankle condition, bilateral knee condition, insomnia, allergies, low back condition, and left foot condition. p. LES, dated 31 October 2012. q. An examination for TMJ and a history of TMJ disorders, both dated 7 November 2012, showing his condition was due to airborne school trauma that occurred on in August 2011. He sustained an injury to the jaw. The applicant reported the condition began as a helmet to head injury. r. A C&P Examination dated 16 November 2012, showing he was referred to the Military Evaluation Board (MEB) for chronic left ankle sprain with instability on 2 October 2012. The chronic left ankle sprain impaired his ability to perform all military duties. The impact on civilian employment had yet to be determined. He denied any hospitalization or surgeries in the past 12 months. (1) He had no impairment of performing his activities of daily living; he was fully capable of cooking, eating, bathing, dressing/undressing, personal hygiene, toileting, writing, and driving without assistance. His exercise limitations were primarily determined by his chronic left ankle sprain with instability and are as follows walking limited to 500 feet, standing limited to 15-20 minutes, and sitting limited to 30 minutes. He reported an altered gait, and slight limp. He reported the use of an assistive device, lace up ankle brace for left ankle, and custom orthotics. He reported incapacitating episodes of pain related to the lower back condition requiring physician-ordered bed rest in the past 12 months. Of note, the condition of insomnia will be evaluated by IDES mental health and TMJ will be evaluated by dental. (2) The general medical conditions claimed to be examined and reviewed in this report are: chronic left ankle sprain with instability, psoriasis, right ankle condition, bilateral knee condition, allergies, low back condition, and a left foot condition. (3) Overall this assessment was considered to be an accurate reflection of his current psychosocial and occupational functioning. (4) Diagnosis: * Axis I: Sleep Disorder Due to A General Medical Condition (ankle pain) Insomnia Type * Axis II: No diagnosis * Axis Ill: Ankle and back pain * Axis IV: Career transition * Axis V: Global Assessment of functioning is currently “68” (5) Discussion of mental health claims – “Insomnia -The Soldier meets criteria for sleep disorder due to: General medical condition (ankle pain). Insomnia type. This diagnosis is warranted because his sleep problems were directly related to his ankle pain and started at the same time as his ankle pain. This diagnosis is also warranted because the sleep problem is directly related to his ankle pain but is severe enough to warrant independent clinical attention. While his sleep problems are significant and are not well controlled by medication at this time, he reported adequate energy during the day and minimal impairment in his daily activities related to his sleep problem. Other than the diagnoses listed no other mental conditions were apparent. He was able to maintain activities of daily living including personal hygiene from a mental health perspective. There was no inappropriate behavior. Thought processes and communication were not impaired. Social functioning and employment were impacted. (6) Symptoms are continuous and require continuous medication. There has been no remission in the past year. He does not have problems with drugs or alcohol use. He was competent to handle VA funds. The prognosis for improvement is estimated to be good with treatment of the general medical condition. s. C &P Exam Report- Final, dated 5 December 2012: Effects on Social and Occupational Functioning Due to Insomnia: Occupational and social impairment due to mild or transient symptoms, which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. Shows he was currently assigned to the Warrior Transition Unit and was not performing duties other than attending appointments. He reported that he was not performing his regular duties due to ankle problems. t. An MEB Narrative Summary, completed on 14 December 2012, states his condition of chronic pain, and reported instability due to chronic left ankle sprain with peroneus brevis tendon tear did not meet medical retention standards. The prognosis was his condition may worsen due to the strenuous nature of warrior functional tasks and performing his military occupational specialty (MOS). Surgery may help the condition in some capacity but would unlikely improve the condition so that he could tolerate prolonged walking on uneven ground in his MOS. u. He also provided other documents that are in his service record; these documents will be address as a part of the separation process. 4. A review of the applicant’s service record shows on 15 February 2011 he enlisted in the Regular Army for 3 years. He held military occupational specialty 19D Cavalry Scout. 5. On 9 January 2013, he underwent a MEB. After consideration of clinical records, laboratory findings, and physical examination. The board found that he had the following medical conditions/defects. a. Chronic pain and reported instability due to chronic left ankle sprain with peroneus brevis tendon tear. Medically unacceptable per Army Regulation (AR) 40-50 I, chapter 3-14c. The condition was incurred while entitled to basic pay and it was not a preexisting condition. b. Psoriasis was medically unacceptable per AR 40-50 I, chapter 3-4v. The condition was not incurred while entitled to basic pay, it was a preexisting condition, and it was not permanently aggravated by military service. On 9 January2013 he was referred to a PEB. 6. On 11 January 2013, he was issued a permeant physical profile for psoriasis treated with Humira (rash): chronic left ankle pain and reported instability due to chronic left ankle sprain with peroneus. His P U L H E S are listed as: 3 1 3 1 1 1 7. An MFR, subject: Addendum to Narrative Summary (NARSUM for the Applicant), dated 11 January 2013, showing the narrative summary should also include the following condition that was also thought to fail retention standards: a. History of psoriasis as a child, dermatology evaluation shows he received a waiver for this condition to enter the military. The MEB will use the date of onset as the first time he was seen for this condition while on active duty, 21 May 2012. Treatment summary: He first presented with this condition during his WTU intake exam. He was referred to dermatology where he was seen in November 2012. He was noted to have guttate psoriatic patches covering 10% of the body surface area (BSA). He was started on Humira. At his VA C&P exam, he was noted to have 30-40% of BSA with plaques. This exam was done at the same time as his dermatologic evaluation, prior to starting Humira. He had no follow-up since starting Humira, without improvement. He reported he was treating the condition with emollient cream and oatmeal baths the first year he was in the Army, but he reported that the rash worsened after he injured his left ankle. He reported that he had [previously] been treated with steroids with improvement. b. This condition has not directly impacted his past duty performance; however, the restriction of live virus vaccines and increased risk of infection limited his deplorability. This condition failed retention standards per AR 40-501 3-40v, as the use of Humira precluded the use of live virus vaccines, which limits the geographic areas to which he could be deployed. His profile and duty restrictions were modified to reflect the diagnosis restriction that he should not receive live virus vaccines, which affected his global deplorability. This was determined to be an EPTS condition. 8. Memorandum for US Department of Veterans Affairs, Auburn Processing Center (DES), Auburn, WA, dated 7 February 2013, showing the PEB found the applicant physically unfit to continue military service for the following PEB referred conditions: * Chronic pain and reported instability due to chronic left ankle sprain with peroneus brevis tendon tear (MEB Dx I) (VI-No; V3-No; V4-No). * Psoriasis (MEB Dx 2) (VI- o; V3-No; V4-No) * The VA was requested to provide a VA rating 9. On 16 March 2013, the DES provided him the following proposed ratings: * 60% for psoriasis * 10 % for chronic left ankle sprain with split tear of peroneus brevis tendon (also claimed as left foot condition) * 20% for bilateral TMJ disorder with nocturnal bruxism as directly related to military service * 10% for chronic thoracolumbar strain (claimed as low back condition) as directly related to military service * 10% for chronic right knee strain (claimed as right knee condition) as directly related to military service * 10% for chronic right ankle strain (claimed as right ankle condition) as directly related to military service * 10% for sleep disorder due to a general medical condition, insomnia type (claimed as insomnia) as directly related to military service 10. Informal PEB Proceedings, dated 29 March 2013, show the board found the applicant physically unfit and recommended a rating of 10% and that his disposition be separation with severance pay. (1) Section II - Recommended Disposition - The board found him physically unfit and recommended a rating of 10% and that his disposition be separated with severance pay. (2) Section III - Medical conditions determined to be unfitting. * a - Incurred or aggravated in the line of duty in a duty status authorized by 10 USC 1201(c) or USC 1204 * b - Due to intentional misconduct, willful neglect, or unauthorized absence * c - For pre-existing findings without aggravation: The condition was noted at time of entrance on active duty (AD); or clear and unmistakable evidence demonstrates that disability existed prior to entrance on AD and was not aggravated by active military service * d - (Not applicable to RC adjudications under 10 USC 1204 - 10 USC 1206) (3) Disability 1 - Chronic pain and reported instability due to chronic left ankle sprain with peroneus brevis tendon tear (MEB Dx l). Onset of condition is 2011 when he sprained his left ankle with tendon tear during pre-deployment training while running in full gear and stepped in a hole. Despite conservative treatment, he experienced daily swelling, chronic pain and instability of his left ankle which limits time standing or walking which is something a calvary scout would need to do IAW DODI 1332.38, E3. P3.4. 1. 1, the PEB found his MOS 19D, Cavalry Scout, unfit for military service due to inability to wear LBE at least 12 hours a day and other functional activities. (4) Disability 2 - There is clear and unmistakable evidence that the onset of condition is childhood (EPTS) and he received a waiver for this condition. He had an acute outbreak of psoriasis after his ankle injury and start of the MEB process, which was evaluated by dermatology. Although the VA rates the condition at 60% the Soldier does require frequent medical treatment, which prevent performing MOS duties, this condition is not service aggravated and therefore not compensable. IAW DODI 1332.38, E3.P3.2.2.2. The PEB found the applicant’s, MOS 19D, Cavalry Scout, unfit for military service as the medical condition imposed: unreasonable requirements on the military to maintain or protect the member. (5) Section IV - Medical Conditions Determined not to be Unfitting: The following was determined by the MTF to meet retention standards. The case file contains no evidence the condition(s) independently or in combination render the applicant unfit for assigned duties. Accordingly, the PEB found the condition(s) not to be unfitting and therefore not ratable: MEB Dx: 3-sleep disorder, (Chronic right ankle strain, 5-Allergic rhinitis, 6-Allergic conjunctivitis, currently asymptomatic, 7-Thoracolumbar strain, 8-Right knee strain, and 9-Bilateral temporomandibular joint disorder and nocturnal bruxism. (6) Section V - Administrative Determinations: The PEB made the following findings: The disability disposition is not based on a 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). This determination is made for all compensable cases but pertains to potential benefits for disability retirees employed under Federal Civil Service. Evidence of record reflects the applicant was not a member or obligated to become a member of an armed force or Reserve thereof, or the NOAA or the USPHS on 24 September 1975. The disability did not result from a combat-related injury under the provisions of 26 USC 104 or 10 USC 10216. The disability severance pay was not awarded for disability incurred in a combat zone or incurred while performing combat-related operations as designated by the Secretary of Defense (10 USC 1212). (7) Section VI - Instructions and Advisory Statements: It is noted that the Soldier's disability rating is less than 30%. Soldiers with a disability rating of less than 30%, and with less than 20 _years of service as computed under 10 USC 1208 (active plus RC equivalent service), requires separation from service with disability severance pay. Disability severance pay, as changed by the National Defense Authorization Act of FY08, is computed by multiplying monthly basic pay for 2 months by the number of combined years (but not over 19) of active service and inactive duty points (to include membership points). The number of years for purposes of the calculation is not less than 6 years if the disability was determined to have been incurred in the line of duty in a combat zone or incurred during the performance of duty in combat-related operations, and no less than 3 years for all other Soldiers. The specific VASRD codes to describe the Soldier's condition and the disability percentage was determined by the VA and is documented in a VA Memorandum, dated 16 Mach 2013. The disposition recommendation was determined by the PEB based on the VA disability rating proposed and applicable statutes and regulations for the PDES. This case was adjudicated as part of the Integrated Disability Evaluation System (IDES) under the 19 December 2011 Policy and Procedure Directive-type Memorandum (DTM) 11-015. (8) Section VII – Presiding officer’s electronic signature. (9) Section V111 - PEBLO/Soldiers Counsel Statement: shows “I have informed the Soldier of the findings and recommendations of the PEB and explained to the Soldier the result of the findings and recommendations.” (10) On 5 April 2013, the applicant concurred with the findings and recommendations and waived a formal hearing. He did not request reconsideration of his VA rating. 11. On 13 June 2013, the applicant was honorably discharged under the provisions of Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation). He was credited with completing 2 years and 4 months of net active service this period. His DD Form 214 (Certificate of Release or Discharge from Active Duty) shows his narrative reason for separation was disability with severance pay, non-combat related. Item 18 (Remarks) shows he received disability severance pay in the amount of $12,486.60. 12. 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. 13. Title 38, Code of Federal Regulations (CFR), Part IV establishes the VA Schedule for Rating Disabilities (VASRD). The VA awards disability ratings to veterans for service-connected conditions, including those conditions detected after discharge. As a result, the VA, 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 VA can evaluate a veteran throughout his or her lifetime, adjusting the percentage of disability based upon that agency's examinations and findings. 14. Title 38, USC, 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. 15. 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/or the Interactive Personnel Electronic Records Management System (iPERMS). The ARBA Medical Advisor made the following findings and recommendations: a. The applicant has applied to the ABCMR requesting his unfitting psoriasis be determined compensable 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. He states: “My medical separation changed to a medical retirement with a 60% disability rating from the U.S. Army. The Army decided my preexisting psoriasis was not aggravated by military service even though the VA rated it at 60% based upon service aggravation.” b. 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 15 February 2011 and was separated with $12,486.60 of disability severance pay on 14 June 2013 under provisions provided in Chapter 4 of AR 635-40, Physical Evaluation for Retention, Retirement, or Separation (20 March 2012). c. The applicant was placed on a duty limiting permanent physical profile on 11 January 2013 for “Psoriasis treated with Humira (rash): Chronic left ankle pain and reported instability due to chronic left ankle sprain with peroneus brevis tendon tear.” His medical evaluation board determined that both conditions failed medical retention standards. They determined this left ankle injury was incurred in service and had not existed prior to service; and that his psoriasis was not incurred during service, had existed prior to service, and had not been permanently aggravated by his military service. d. From his 16 November 2012 VA Compensation and Pension Examination shows it started in childhood and he received a medical waiver for the condition: (1) CIRCUMSTANCES AND INTIIAL MANIFESTATIONS: Onset: preservice, diagnosed as a child. Entrance exam of August 2010 notes history of psoriasis; no active disease; scars noted on left arm, both calves. (2) SM {Service Member} states he had to get waiver prior to entering active duty service for this condition. (3) He states prior to entering Army this condition was stable with only a few mild areas noted on his body. He states the condition remained fairly dormant until his injury in August 2011. SM states when he was initially injured and then began MEB process he had full blown outbreak; he states once he got back home to Colorado his symptoms resolved. (4) The STR {service treatment record} shows an entry in May 2012 WTU { Warrior Transition Unit} intake visit: notes history of lifelong psoriasis with 1 year remission after entering Army; now with return of symptoms: complaining of itchy patches of raised, red blotchy skin over his entire torso and extremities (sparing hands and feet); does use oatmeal baths and Eucerin cream which helps with itching; notes has never seen dermatologist while on active duty; referred to dermatology.” e. His psoriasis as documented in his medical evaluation board narrative summary on 11 January 2013 also (1) “A. Medical basis for diagnosis: History of psoriasis as a child, Dermatology evaluation (2) B. Onset: Childhood, the SM received a waiver for this condition to enter the military. MEB will use the date of onset as the first time the SM was seen for this condition while on AD, 21 MAY 2012. (3) C. Treatment summary: The SM first presented with this condition during his WTU {Warrior Transition Unit – he was there for his left ankle injury} intake exam. He noted that he had been seen by a Dermatologist and diagnosed with psoriasis as a child. He reported that he had been treated with steroids. (4) He noted improvement in his symptoms during the first year he was in the Army but he reported that the rash worsened after he injured his left ankle. The SM reported he was treating the condition with emollient cream and oatmeal baths without improvement. He was referred to dermatology where he was seen in NOV 2012. (5) He was noted to have guttate psoriatic patches covering > 10% of body surface area (BSA). He was started on Humira. At his VA C&P exam, he was noted to have 30-40% of BSA with plaques. This exam was done at the same time as his Dermatologic evaluation, prior to starting Humira. (6) He has had no follow-up since starting Humira. (7) Impact on duty performance: This condition has not directly impacted the SM's past duty performance however the restriction of live virus vaccines and increased risk of infection limit the SM's deployability. (8) Applicable AR: Fails retention standards per AR 40-501, 3-40v, as the use of Humira precludes the use of live virus vaccines, which limits the geographic areas to which the SM can be deployed. f. On 4 February 2013, the applicant agreed with the MEB’s findings and recommendation and his case was forwarded to a physical evaluation board (PEB) for adjudication. g. On 29 March 2013, the applicant’s informal PEB found his left ankle condition and psoriasis to be unfitting medical conditions for continued service. They determined the psoriasis was non-compensable: “There is clear and unmistakable evidence that the onset of condition is childhood (EPTS) and Soldier received a waiver for this condition. Soldier had an acute outbreak of psoriasis after his ankle injury and start of MEB process which was evaluated by Dermatology. Although the VA rates the condition at 60%, the Soldier does require frequent medical treatment, which prevent performing MOS duties, this condition is not service aggravated and therefore not compensable. IAW DODI 1332.38, E3.P3.2.2.2., the PEB finds the Soldier, MOS 19D, Cavalry Scout, unfit for military service as the medical condition imposes unreasonable requirements on the military to maintain or protect the member h. The PEB applied the VBA derived rating of 10% to his ankle condition and recommended the applicant be separated with disability severance pay. On 5 April 2013, after being counseled on the informal PEB’s findings by her PEB Liaison Officer (PEBLO), 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. i. Form the Mayo Clinic website (https://www.mayoclinic.org/diseases- conditions/psoriasis/symptoms-causes/syc-20355840) : “Psoriasis is a skin disease that causes a rash with itchy, scaly patches, most commonly on the knees, elbows, trunk and scalp. Psoriasis is a common, long- term (chronic) disease with no cure. It can be painful, interfere with sleep and make it hard to concentrate. The condition tends to go through cycles, flaring for a few weeks or months, then subsiding for a while. Common triggers in people with a genetic predisposition to psoriasis include infections, cuts or burns, and certain medications. j. While his ankle injury may have led to a flaring of his psoriasis, it appears not to have caused a permanent service aggravation of this chronic condition which existed prior to service. k. AHLTA shows the applicant received his first dose on Humira on 15 November 2012. At the time of 16 November 2012 VA examination the next day, it was noted that 30-40% of his BSA was affected by “rashes or other lesions”; when examined for his MEB narrative summary on 11 January 2013 it was estimated the >10% of his BSA was affected by plaques; and from his dermatology follow-up encounter on 24 January 2013, “He notes 90% improvement with the Humira and is quite pleased. He has had some mild weight gain, but otherwise feels well.” l. Permanent service aggravation as defined in the glossary of AR 600-8-4, Line of Duty Policy, Procedures, and Investigations (15 April 2004): “Service aggravation refers to a medical condition that existed prior to service and which worsened or was aggravated as a result of military service more than it would have been worsened or aggravated in the absence of military service.” m. Paragraph 4-8e(3) of AR 600-8-4: “Specific findings of natural progress of the pre-existing injury or disease based upon well-established medical principles alone are enough to overcome the presumption of Service aggravation.” n. Without evidence of permanent service aggravation, the applicant’s medical waiver also made the condition non-compensable. Paragraph E3.P4.5.5 in enclosure 3 to part 4 of Depart of Defense Instruction 1332.38 SUBJECT: Physical Disability Evaluation, 14 November 1996: E3.P4.5.5. Medical waivers. Members who entered the Service with a medical waiver for a pre-existing condition and who are subsequently determined unfit for the condition shall not be entitled to disability separation or retired pay unless Military Service permanently aggravated the condition or hastened the condition's rate of natural progression. o. Given no evidence of error or injustice, 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 relief is not warranted. 2. The Board concurred with the conclusion of the ARBA Medical Advisor that the evidence does not support an increase in the applicant’s military disability rating. Based on a preponderance of the evidence, the Board determined the applicant’s discharge for disability with severance pay is not in error or unjust. 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, United States 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. Army Regulation 15-185 (ABCMR) prescribes the policies and procedures for correction of military records by the Secretary of the Army, acting through the ABCMR. The regulation provides that the ABCMR begins its consideration of each case with the presumption of administrative regularity. The applicant has the burden of proving an error or injustice by a preponderance of the evidence. It is not an investigative body. The ABCMR may, in its discretion, hold a hearing. Applicants do not have a right to a hearing before the ABCMR. The Director or the ABCMR may grant a formal hearing whenever justice requires. 3. 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). Once a determination of physical unfitness is made, the PEB rates all disabilities using the VASRD. 4. Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation) establishes the Army DES 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. It states, in part: a. Only the unfitting conditions or defects and those that contribute to unfitness will be considered in arriving at the rated degree of incapacity warranting retirement or separation for disability. The mere presence of impairment does not, in and of itself, justify a finding of unfitness because of physical disability. b. The PEB-appointed counsel advises the Soldier of the IPEB findings and recommendations and ensures the Soldier knows and understands his or her rights. The Soldier records his or her election to the IPEB on the DA Form 199 and has 10 calendar days from the date of receiving the PEB determination to make the election, submit a rebuttal, or request an extension. 5. Directive-Type Memorandum (DTM) 11-015 explains the Integrated Disability Evaluation System (IDES). It states, the IDES is the joint Department of Defense (DOD)/VA process by which the DOD determines whether wounded, ill, or injured service members are fit for continued military service and by which DOD and 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 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. 6. 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. 7. Title 38, USC, 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. 8. Title 38, Code of Federal Regulations (CFR), Part IV establishes the VA Schedule for Rating Disabilities (VASRD). The VA awards disability ratings to veterans for service-connected conditions, including those conditions detected after discharge. As a result, the VA, 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 VA can evaluate a veteran throughout his or her lifetime, adjusting the percentage of disability based upon that agency's examinations and findings. 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 UOTHC 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 (TBI); sexual assault; or sexual harassment. Standards for review should rightly consider the unique nature of these cases and afford each veteran a reasonable opportunity for relief even if the sexual assault or sexual harassment was unreported, or the mental health condition was not diagnosed until years later. Boards are 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 misconduct that 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. a. 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 on the basis of 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. b. 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. //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20220000448 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1