IN THE CASE OF: BOARD DATE: 20 September 2023 DOCKET NUMBER: AR20230001481 APPLICANT REQUESTS: in effect, physical disability retirement in lieu of separation with severance pay. APPLICANT'S SUPPORTING DOCUMENT(S) CONSIDERED BY THE BOARD: * DD Form 293 (Application for Discharge Review (Online)) * Dr. letter, 14 February 2022 * My HealtheVet Record (35 pages) * VA Records FACTS: 1. The applicant states he feels the rating exams for his knees from the Veterans Affairs (VA) were not done correctly thus leaving the board with inaccurate information to decide on his disability rating. The exams did not state that he suffers from instability and osteoarthritis in both of his knees. With this information he believes that his rating would have been higher that the 20 percent rating he was given. A letter from his doctor states that he has been diagnosed with the two knee problems stated above. 2. The applicant enlisted in the Regular Army on 5 March 2002. He held military occupational specialty (MOS) 74D (Chemical Operations Specialist). 3. He was honorably released from active duty on 18 June 2005 and transferred to U.S. Army Reserve (USAR) Control Group (Reinforcements). His DD Form 214 shows he completed 3 years, 3 months, and 14 days net active service this period. 4. He enlisted in the Louisiana Army National Guard (LAARNG) on 18 September 2006. He had several periods of reenlistment and extensions during his career. 5. He was ordered to active duty on 1 March 2009 until 4 January 2010. His DD Form 214 shows he completed 10 months and 4 days net active service this period. He was honorably released from active duty on 4 January 2010, for completion of required active service. 6. He was ordered to active duty on 5 January 2010, in support of Operation Iraqi Freedom. He was honorably released from active duty on 11 February 2011, for completion of required active service. His DD Form 214 shows he completed 1 year, 1 month, and 7 days net active service this period. 7. A DA Form 199-1 (Formal Physical Evaluation Board (PEB) Proceedings) show a Formal PEB convened on 1 February 2022. The Board found the applicant physically unfit and recommended a rating of 20% and that his disposition be separation with severance pay. a. The conditions determined to be unfitting were: (1) Left knee chondromalacia rated at 10%. FORMAL RECONSIDERATION: The clear and unmistakable evidence that indicates this condition existed prior to service is, the Soldier's left knee pain began while a drilling member, not on a period of active duty of 30 days or more. The presumption of service aggravation is not overcome. The Soldier first sought in-service treatment for left knee pain in August 2018 at the Veterans Administration Hospital in. This condition was caused due to overcompensation from his right knee condition. In accordance with (IAW) AR 635-40, this Soldier is unfit because the DA Form 3349, Physical Profile Record, Section 4, functional activity limitations associated with this condition interferes with the Soldier's ability to reasonably perform required duties. (2) Right knee chondromalacia status post-surgery rated at 10%. The Soldier first sought treatment in March of 2002 while in Basic Combat Training at Fort Leonard Wood, Missouri. He reinjured his knee during physical fitness training while deployed to Iraq in 2009. His treatment included NSAIDS, knee brace and physical therapy. He subsequently underwent right knee surgery 20 June 2014. His response to treatment has been fair; however, he continues with persistent right knee pain limiting activities. IAW AR 635-40, this Soldier is unfit because the DA Form 3349, Physical Profile Record, Section 4, functional activity limitations associated with this condition make this Soldier unable to reasonably perform required duties. (3) Right knee chondromalacia status post-surgery-flexion rated at 0%. The Soldier first sought treatment in March of 2002 while in Basic Combat Training at Fort Leonard Wood, Missouri. He reinjured his knee during physical fitness training while deployed to Iraq in 2009. His treatment included NSAIDS, knee brace and physical therapy. He subsequently underwent right knee surgery 20 June 2014. His response to treatment has been fair; however, he continues with persistent right knee pain limiting activities. IAW AR 635-40, this Soldier is unfit because the DA Form 3349, Physical Profile Record, Section 4, functional activity limitations associated with this condition make this Soldier. unable to reasonably perform required duties. b. IAW with DoDI 1332.18, Enc. 3, App. 6, the Selected Reserve Soldier with at least 15 and less than 20 years of qualifying service who would otherwise be qualified for nonregular retirement may waive separation with or without severance pay to request early qualification for retired pay under the provisions of 10 USC 12731b. When the Soldier is eligible for and elects acceptance of disability severance pay, the Soldier forfeits all rights to a nonregular retired status based on their current qualifying service. There are no provisions under Title 10 USC to repay disability severance pay to then receive nonregular retired pay. c. This case was adjudicated as part of the Integrated Disability Evaluation System (IDES). As documented in the Department of Veterans Affairs (DVA) memorandum dated 26 January 2022, DVA determined the specific VASRD code(s) to describe the Soldier’s condition(s). The PEB determined the disposition recommendation based on the proposed DVA disability rating(s) and in accordance with applicable statutes and regulations. d. The applicant concurred and requested VA reconsider his disability ratings. e. He elected transfer to the Retired Reserve in lieu of being separated for disability with entitlement to disability severance pay or in lieu of being separated without entitlement to disability benefits, as applicable. 8. The applicant was transferred to USAR Control Group effective 10 October 2022. 9. An ARNG Current Annual Statement, dated 25 June 2023, shows he had 20 years of creditable service for retired pay. 10. The applicant provides: a. Doctor’s letter, dated 14 February 2022, stating he has been seeing the applicant for many years related to ongoing issues with both of his knees. His right knee has a more significant history with a multi-ligamentous knee injury while in active military service that required surgical reconstruction of his ACL, PCL, and MCL in 2014. While this improved his knee, he has continued to have functional limitations due to his knees related to some instability and secondary osteoarthritic issues. He continues to have some low-grade structural instability in the right knee that requires use of a brace for support. His left knee has developed osteoarthritic changes as well related to the amount of impact on his knees during his service as well as compensating for the right knee. While the left knee has not had structural instability requiring ligament repair, he does have functional instability due to the chronic inflammation from the osteoarthritis that he has. Both knees have been treated with physical therapy trying to address this instability and he undergoes regular hyaluronic acid injections to keep his osteoarthritis symptoms under control. The instability and pain associated from his knees limits his function both with daily activities as well as physical activity. b. My HealtheVet record (35 pages) in support of his claim. c. The following VA Records: * General Medical Disability Benefits Questionnaire (DBQ), 17 November 2020 * Knee and Lower Leg Conditions DBQ, 17 November 2020 * Audiological Evaluation, 11 November 2020 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 the Interactive Personnel Electronic Records Management System (iPERMS). The ARBA Medical Advisor made the following findings and recommendations: b. The applicant is applying to the ABCMR requesting an increase in his military disability rating with a subsequent change of his disability discharge disposition from separate with severance pay to permanent retirement for physical disability. He states: “I feel that the rating exams for my knees from the VA were not done correctly thus leaving the board with inaccurate information to make a decision on my disability rating. The exams did not state that I suffer from instability and osteoarthritis in both of my knees. With this information, I believe that my rating would have been higher than the 20 percent rating I was given. I have attached a letter from my doctor stating that I have been diagnosed with the two knee problems stated above. It is for this reason I am looking to have my record changed.” c. The Record of Proceedings details the applicant’s service and the circumstances of the case. Orders published by the Louisiana National Guard Joint Forces Headquarters show the former drilling Army National Guard Soldier was transferred to the Retired Reserve and retired for length of service effective 9 October 2022. His Army National Guard Current Points Statement prepared on 25 June 2023 the drilling Army National Guard Soldier had 20 years, 0 months, and 0 days of total service for retired pay as of 20 September 2022. d. A Soldier is referred to the Integrated Disability Evaluation System (IDES) when they have one or more conditions which appear to fail medical retention standards reflected on a duty liming permanent physical profile. At the start of their IDES processing, a physician lists the Soldiers 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 other conditions they believe to be service-connected disabilities in block 8 of section II of this form, or on a separate Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ). 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. The medical evaluation board (MEB) uses these exams along with AHLTA encounters and other information to evaluate all conditions which could potentially fail retention standards and/or be unfitting for continued military service. Their findings are then sent to the physical evaluation board for adjudication. f. All conditions, both claimed and referred, are rated by the VA using the VA Schedule for Rating Disabilities (VASRD). The physical evaluation board (PEB), after adjudicating the case, applies the applicable ratings to the Soldier’s unfitting condition(s), thereby determining his or her 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. g. On 5 October 2020, the applicant was referred to the IDES for “Right Knee Chondromalacia.” As Reserve Component Soldiers who currently have VA service- connected disability(s) are counseled on and are authorized to elect, the applicant declined to claim any additional conditions on a Statement is Support of Claim (VA Form 21-4138), stating “I do not wish to file for VA compensation with the MSC [military service coordinator] / IDES. I am currently SC [service connected] 100%.” h. A medical evaluation board (MEB) determined his “Right knee chondromalacia s/p surgery” failed the medical retention standards of AR 40-501, Standards of Medical Fitness. They determined two unclaimed medical conditions for which he was profiled – pseudofolliculitis barbae and sleep apnea - met medical retention standards. On 11 November 2020, the applicant concurred with the MEB’s decision and his case was subsequently forwarded to a physical evaluation board (PEB) for adjudication. i. On 19 February 2021, the applicant’s informal PEB found his “Right knee chondromalacia status post-surgery” to be the sole unfitting for continued military service. They found the two unclaimed profiled medical conditions not unfitting for continued service. The PEB applied the Veterans Benefits Administration (VBA) derived rating of 10% and recommended the applicant be separated with disability severance pay. j. An 18 March 2021 memorandum from the applicant’s Soldiers’ MEB Counsel to the PEB shows he appealed the findings and requested a formal PEB with regularly appointed counsel: “SGT [applicant] appeals the finding that his PTSD is fit/does not exist. The MEB left this condition off his DA 3947 in error. We ask the PEB to find this condition unfit or send his packet back to the MEB for a proper evaluation.” k. The PEB confirmed their informal findings as seen in their 23 April 2021 response to Soldiers’ MEB Counsel: “No evidence was included with the appeal memo. Your request was carefully considered, and your casefile reviewed. In your appeal, you request the PEB find you unfit for Post-Traumatic Stress Disorder (PTSD). The preponderance of evidence indicates your behavioral health condition is not unfitting. The Medical Evaluation Board (MEB) also reviewed your appeal and provided a response dated 20 April 2021 (Enclosure 1). Also noted, is the VA Form 21-4138 in your casefile dated 8 October 2020. It indicates you opted to not file a claim for the Integrated Disability Evaluation System (IDES) process.” l. Contrary to his counsel’s assertion, this was not an MEB or even a PEB error: The applicant had declined to claim the condition when he entered the IDES and his permanent physical profile has a serial of S1 (fully capable) and does not lists a mental health diagnoses. m. On 8 July 2021, applicant’s Soldiers’ PEB counsel requested his left knee be found an additional unfitting condition. n. Upon reconsideration, the PEB determined his left knee was an additional unfitting condition. Because he had not previously claimed this condition, the PEB had to reach out the VA’s Disability Ratings Activity Site (DRAS) to obtain a rating for the left knee condition. The DRAS provided their rating in a decision review dated 22 March 2022: “For Disability Evaluation System (DES) purposes only a 10 percent evaluation is assigned for left knee strain. The request for a separate 10 percent evaluation for instability is denied ... The rating schedule as it pertains to instability was received in February 2021. Instability now requires (1) recurrent subluxation or persistent instability and (2) ligament tear (sprain) and (3) requirement of a prescription (by a medical provider) of a can, walker, crutches or braces for ambulation. All three parts must be met for an evaluation under diagnostic code 5257 to be assigned. Or an evaluation may be assigned if there exists (1) recurrent patellar instability and (2) A diagnosed condition involving the patellofemoral complex (the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon); and (3) requirement of a prescription (by a medical provider) of a can, walker, crutches or braces for ambulation. In regard to the left knee which is under reconsideration, there exists "instability" as noted by Dr. . and your lay testimony and "the requirement of a brace" as evidence by the prescription in VAMC [VA Medical Center] records. However, the medical evidence does not confirm a "ligament tear (sprain)" or patellar instability affecting the patellofemoral complex (quadriceps tendon, the patella, and the patellar tendon) ... We have assigned a 10 percent evaluation for your left knee strain based on: • Painful motion of the knee (38 CFR §4.59 allows consideration of functional loss due to painful motion to be rated to at least the minimum compensable rating for a particular joint. Since you demonstrate painful motion of the knee, the minimum compensable evaluation of 10 percent is assigned)” o. The Formal Physical Evaluation (PEB) Proceedings (DA Form 199-1) show both his left and right knee chondromalacia as unfitting conditions, each assigned a 10% disability rating for a combined disability rating of 20%, and a recommendation the applicant be separated with disability severance pay. p. On 17 February 2022, after being counseled by his PEB Liaison Officer (PEBLO) on the PEB’s findings and recommendations, the applicant concurred with the PEB’s finding and elected to transfer to the Retired Reserve in lieu of being separated for disability with entitlement to disability severance pay under 10 USC 12731b for Soldiers of the Selected Reserve with at least 15, and less than 20, years of creditable service. q. There is no evidence the applicant had any additional service incurred medical condition which would have failed the medical retention standards of chapter 3, AR 40- 501 prior to his discharge. Thus, there was no cause for referral to the Disability Evaluation System. Furthermore, there is no evidence that any additional medical condition prevented the applicant from being able to reasonably perform the duties of his office, grade, rank, or rating prior to his discharge. r. Review of his PEB case file in ePEB along with his encounters in AHLTA revealed no substantial inaccuracies in or discrepancies. s. His records in JLV show he has been awarded multiple service-connected disability ratings. However, the DES compensates an individual only for service incurred 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 during or permanently aggravated by their military service. These roles and authority are granted by Congress to the Department of Veterans Affairs and executed under a different set of laws. t. It is the opinion of the ARBA Medical Advisor that neither an increase in his military disability rating, a change of his disability discharge disposition, 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 Board carefully considered the applicant's record of service, documents submitted in support of the petition and executed a comprehensive and standard review based on law, policy and regulation. Upon review of the applicant’s petition, available military records and the medical review the Board concurred with the advising official finding that neither an increase in his military disability rating, a change of his disability discharge disposition, nor a referral of his case back to the DES is warranted. Additionally, the opine found no evidence that any additional medical condition prevented the applicant from being able to reasonably perform the duties of his office, grade, rank, or rating prior to his discharge. 2. The Board found the applicant had declined to claim the condition when he entered the IDES and his permanent physical profile has a serial of S1 (fully capable) and does not lists a mental health diagnoses. The Board determined there is insufficient evidence in the record to support the applicant’s contentions for a physical disability retirement in lieu of separation with severance pay. Based on the preponderance of evidence, the Board denied relief. 3.. The Board agreed the VA applies its own polices and regulations to make service connection and rating determinations. It is not bound by determinations made by the Army. With that, unlike the VA, the Army’s determination of fitness and its mandatory application of VA ratings is a snapshot in time whereas the VA can make service connection and rating determinations throughout the veteran’s life. 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, chapter 61, provides the Secretaries of the Military Departments with authority to retire or discharge a member if they find the member unfit to perform military duties because of physical disability. The U.S. Army Physical Disability Agency is responsible for administering the Army physical disability evaluation system and executes Secretary of the Army decision-making authority as directed by Congress in chapter 61 and in accordance with DOD Directive 1332.18 and Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation). a. Soldiers are referred to the disability system when they no longer meet medical retention standards in accordance with Army Regulation 40-501 (Standards of Medical Fitness), chapter 3, as evidenced in an MEB; when they receive a permanent medical profile rating of 3 or 4 in any factor and are referred by an MOS Medical Retention Board; and/or they are command-referred for a fitness-for-duty medical examination. b. The disability evaluation assessment process involves two distinct stages: the MEB and PEB. The purpose of the MEB is to determine whether the service member's injury or illness is severe enough to compromise his/her ability to return to full duty based on the job specialty designation of the branch of service. A PEB is an administrative body possessing the authority to determine whether or not a service member is fit for duty. A designation of "unfit for duty" is required before an individual can be separated from the military because of an injury or medical condition. Service members who are determined to be unfit for duty due to disability either are separated from the military or are permanently retired, depending on the severity of the disability and length of military service. Individuals who are "separated" receive a one-time severance payment, while veterans who retire based upon disability receive monthly military retired pay and have access to all other benefits afforded to military retirees. c. The mere presence of a medical impairment does not in and of itself justify a finding of unfitness. In each case, it is necessary to compare the nature and degree of physical disability present with the requirements of the duties the Soldier may reasonably be expected to perform because of his or her office, grade, rank, or rating. Reasonable performance of the preponderance of duties will invariably result in a finding of fitness for continued duty. A Soldier is physically unfit when a medical impairment prevents reasonable performance of the duties required of the Soldier's office, grade, rank, or rating. 2. 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. 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. a. Disability compensation is not an entitlement acquired by reason of service- incurred illness or injury; rather, it is provided to Soldiers whose service is interrupted and who can no longer continue to reasonably perform because of a physical disability incurred or aggravated in military service. b. The percentage assigned to a medical defect or condition is the disability rating. A rating is not assigned until the PEB determines the Soldier is physically unfit for duty. These ratings are assigned from the Department of Veterans Affairs (VA) Schedule for Rating Disabilities (VASRD). (1) The fact that a Soldier has a condition listed in the VASRD does not equate to a finding of physical unfitness. An unfitting, or ratable condition, is one which renders the Soldier unable to perform the duties of their office, grade, rank, or rating in such a way as to reasonably fulfill the purpose of their employment on active duty. (2) There is no legal requirement in arriving at the rated degree of incapacity to rate a physical condition which is not in itself considered disqualifying for military service when a Soldier is found unfit because of another condition that is disqualifying. c. Soldiers who sustain or aggravate physically-unfitting disabilities must meet the following line-of-duty criteria to be eligible to receive retirement and severance pay benefits: (1) The disability must have been incurred or aggravated while the Soldier was entitled to basic pay or as the proximate cause of performing active duty or inactive duty training. (2) The disability must not have resulted from the Soldier's intentional misconduct or willful neglect and must not have been incurred during a period of unauthorized absence. 4. Army Regulation 40-501 governs medical fitness standards for enlistment, induction, appointment (including officer procurement programs), retention, and separation (including retirement). The 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. 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. 6. 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. 7. 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) AR20230001481 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1