IN THE CASE OF: 
BOARD DATE: 17 August 2023 
DOCKET NUMBER: AR20230001055 


APPLICANT REQUESTS: reconsideration of his prior request to correct his DA Form 199 (Informal Physical Evaluation Board (PEB) Proceedings) to show: 

•his traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) failedmedical retention standards and were unfitting

•disability rating as 100 percent



APPLICANT'S SUPPORTING DOCUMENT(S) CONSIDERED BY THE BOARD: 

•DD Form 149 (Application for Correction of Military Record)

•Counsel's Brief

•ABCMR Case AR20210005825, 12 January 2022

•Department of Veterans Affairs (VA) Decision Letter, 5 August 2020

•VA Decision Letter, 2 July 2015

•VA Decision Letter, 2 September 2014

•Orders 205-0250, 24 July 2018

•Memorandum: CRSC Claim letter (unknown author), 29 September 2015

•Memorandum: Line of Duty Verification for [applicant]'s Military Training Accident(undated)

•DA Form 286-AB (U.S. Army Abbreviated Ground Accident Report),


19 April 2012
•ABCMR Case AR20160006869, 19 June 2018

•Medical Evaluation Board Narrative Summary (MEB NARSUM),


9 July 2014
•DA Form 3947 (Medical Evaluation Board Proceedings), 10 July 2014

•DA Form 5893 (Soldier’s Medical Evaluation Board/Physical Evaluation BoardCounseling Checklist), 22 July 2014

•DA Form 7652 (Physical Disability Evaluation System (PDES) Commander’sPerformance and Functional Statement, 29 May 2014

•DA Form 199, 16 September 2014

•Medical Records (40 pages)




FACTS: 

1.Incorporated herein by reference are military records which were summarized in theprevious consideration of the applicant's case by the Army Board for Correction ofMilitary Records (ABCMR) in Docket Number AR20210005825 on 12 January 2022.

2.Counsel states:

a.The applicant submitted an application to the Board requesting his TBI and PTSDbe added as unfitting conditions to his Permanent Disability Retirement and his disability rating be increased from 30 percent to 100 percent. The applicant submitted his application via mail on or about August 2020. A decision was made on 27 February 2022, denying his requested relief. The Board agreed with an advisory opinion that there lacked sufficient evidence to refer to IDES. However, the board only focused on behavioral health aspects of the applicant's career and not the effect his mental health (PTSD) and TBI had on his physical health nor the collective or combined effect of PTSD, TBI and post traumatic migraines had on the applicant's career. The Board failed to recognize that the PEB failed to consider the applicant's primary condition in conjunction with his secondary unfitting condition when determining his overall fitness. 

b.The applicant enlisted in the U.S. Army on 4 February 2003. He was qualified inthe military occupational specialties of Civil Affairs Specialist, Shower/Laundry/Clothing Specialist, and Health Care Specialist. He deployed several times to Iraq and Afghanistan. He was assigned as a special operations civil affairs Non-Commissioned Officer (NCO).  

c.The applicant deployed to Iraq from June 2004 through May 2005 and September2006 through September 2007. He deployed to Afghanistan from April 2013 until October 2013. It was in preparation for his Afghanistan deployment that he suffered his career ending injuries. Prior to deploying to Afghanistan, his unit in preparation for the terrain and mission trained in the mountains in North Carolina. The training including riding motorcycles in the mountainous terrain of North Carolina. Unfortunately, during combat preparation, the applicant suffered career ending injuries in a motorcycle accident.  

d.He lost consciousness, suffered a concussion, memory loss, fractured tooth,bilateral wrist strains with bilateral tears, chronic lumbar strain, chronic left hip strain from left femur fracture, chronic left knee sprain from left femur fracture, chronic bilateral ankle inversion sprains from right fibula fracture, PTSD and chronic post traumatic migraines.  

e.The injuries led to a referral to a medical evaluation board (MEB) on 28 May2014. Based on his combat training injuries, he entered the Integrated Disability Evaluation System (IDES). As part of the IDES, all of the applicant' s service connected injuries and/or diseases were referred to the Veterans Affairs (VA) for a disability rating decision. The disability rating decisions on all his conditions would then be forwarded to the PEB. The PEB then considers each condition to determine if any one condition is unfitting. The PEB is then to consider if any of the conditions collectively are unfitting. Those conditions that are unfitting are then assigned the disability rating provided by the VA.  

f.The PEB found only the chronic post traumatic migraines as unfitting. Chronicpost traumatic migraines are often the result of mild TBI. Chronic post traumatic migraines are also linked to PTSD. According to one study, PTSD symptoms preceded migraine symptoms in almost 70 percent of those with migraine and PTSD.  

g.The MEB in the applicant’s case labeled his PTSD as other specified trauma orstressor-related disorder. The disability received a 50 percent disability rating by the VA. 

h.The non-medical assessment listed migraines and fatigue as limiting factorsobserved by the applicant' s command. [The applicant] suffers from chronic headaches and fatigue caused by a TBI. [The applicant] has to take frequent breaks throughout the day in order to minimize the effects. The Company Commander indicated he had moderate difficulties completing task/duties to standard and committed more than normal errors.  

i.Fatigue is a symptom of PTSD. Studies find a strong correlation between chronicfatigue syndrome and PTSD. The applicant's Company Commander observed the applicant suffered from both chronic headaches and fatigue. 

j.TBI symptoms and PTSD symptoms are hard to distinguish and may overlap.Complicating the issue of comorbidity is compounded by the fact that TBI, PTSD, and depression commonly occur in the context of chronic pain, which also results in symptoms that overlap with each of these conditions. 

k.The VA assigned a 50 percent disability rating for PTSD that was previouslydiagnosed as other specified trauma or stressor related disorder. According to the VA as 50 percent disability rating is warranted when there is: 

Difficulty adapting to work; difficulty in adapting to stressful circumstances; difficulty in adapting to a work like setting; disturbances of motivation and mood; forgetting directions; forgetting recent events; mid-memory loss; forgetting names; depressed mood; chronic sleep impairment; anxiety and occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 

l.The applicant described his duties as special operations civil affairs NCO asconducting combat readiness training to include target training, airborne operations, physical fitness training, and other special operations skill sustainment training. After his combat training accident, the applicant was unable to focus on detail oriented planning and training required of his position. His impairment led to his command placing him on limited duty. Despite his limitations at the time, he was deployed with his team with medication to treat his symptoms. Regardless, he continued to suffer headaches and an inability to concentrate. By the end of deployment, he would lose his thought in the middle of a conversation or while teaching.  

m.After his accident, he was under constant care of the TBI clinic at Womack.Upon return from deployment, he sought medical treatment for his TBI symptoms. The medical intervention only provided temporary relief. His job suffered as he began making many errors.  and 7. The non-medical assessment corroborates this fact.  

n.Other symptoms the applicant suffered were loss of memory, hard time recallingnames, and inability to complete routine activities. He was unable to recall names of places, friends, and family members. He was unable to remember names of family members and friends when he was with them.  

o.Immediately after the accident, the applicant was unable to recall being in themilitary or his combat training. The lack of memory persisted for four days after the accident. The memory problems continued afterwards despite the efforts of rehabilitation. The memory loss affected his ability to be effective at his job as an instructor and trainer.  

p.Memory loss is associate with both TBI and PTSD. Some of the core symptomsnoted across TBI and PTSD are also seen in depression, especially the more severe forms of TBI, including concentration problems, memory problems, irritability, reduced motivation, and fatigue. Although the applicant was not diagnosed with depression, he did have concentration problems, memory problems, and fatigue.  

q.The MEB in reviewing the applicant's PTSD, listed as other specified trauma orstressor related disorder, noted the VA physician wrote, the psychiatric symptoms cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. The applicant noted his inability to concentrate, making errors and losing his train of thought in mid-conversation.  

r.The VA rated the applicant's PTSD as 50 percent disabling. The VA re-examinedthe applicant's medical records in 2015 and again in 2020, reclassified his PTSD as posttraumatic stress disorder with dissociative symptoms and panic attacks (previously diagnosed as other specified trauma or stressor related disorder) and increased his PTSD rating to 70 percent. 

s.It is undeniable that the applicant received a TBI and as result was receivedPermanent Disability Retirement. However, neither his TBI nor his PTSD were found unfitting by the PEB. The applicant's physical ailment of post-traumatic migraines was the only condition to be found unfitting, despite the fact that the post traumatic migraines were the result of a TBI. There are ample medical studies to support that PTSD and TBI are intricately related and diagnosing one over the other is often complicated as the symptomology overlap. The PEB ignored all the symptoms as described by the NMA and the VA findings and as such erred in determining only the applicant's secondary condition to PTSD/TBI was unfitting. The PEB failed to consider the collective effect of the applicant 's injuries on his ability to perform his duties. 

t.The applicant's TBI and PTSD were result of his combat training accident andsignificantly impacted his ability to perform his duties. The applicant was involved in a combat training accident that led to loss of memory for at least four days. Afterwards, he reported memory loss, inability to complete sentences, committing errors in his task or duties. The applicant's Company Commander through his non-medical assessment indicated that the applicant was committing errors in his work. The applicant loss of memory negatively impacted his ability to perform his duties.  

u.The VA psychologist noted that the psychiatric symptoms cause occupationaland social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. It was noted that the applicant was still able to perform his duties to the satisfaction of his command. Despite this being noted by the NMA, the Company Commander still believed he should be discharged.  

v.The applicant was not just a trainer, he was part of the special operationscommunity. A lapse in judgment or memory lapse could cost people their lives. The applicant's position did not require him to be average but above average. It required him to be alert and aware 100 percent of the time. Unfortunately, his PTSD/TBI interfered with his readiness to train Soldiers. This flaw negatively impacted the course of study and presentation regardless of his effort and good intentions. The memory lapses effected his confidence that impacted his ability to be an effective leader and trainer.  

w.The Company Commander listed not only migraines as being problematic but theapplicant's fatigue as well. The NMA did not distinguish between which symptom interfered more with the applicant's work but only that both interfered and he was required to take frequent breaks to accommodate his migraines and fatigue. The applicant's fatigue is a symptom of both PTSD and TBI. The applicant's fatigue equally effected his ability to perform his duties as his migraines.  

x.Fatigue could have been a physical manifestation of his PTSD or it could havebeen a direct result of his TBI. Experts studying TBI and PTSD are unable to state for certain which diagnosis is causing the fatigue when a person suffers from both.  

y.In the applicant's case, the VA found while the applicant was enrolled in the IDESthat his PTSD was disabling and assigned a 50 percent disability rating. Fatigue was mentioned as interfering with the applicant's ability to perform his duties. Fatigue is a medically recognized symptom of PTSD. Therefore, PTSD interfered with the applicant's ability to perform his duties.  

z.Even if the Board believes that fatigue alone was insufficient to find theapplicant's PTSD unfitting, the condition considered in conjunction with his migraines is unfitting. The NMA did not distinguish between the two conditions and wrote about the negative effects both conditions had on the applicant's ability to perform his duties collectively. Hence, the PEB erred in not combining the PTSD and the secondary condition of post-traumatic migraines in determining the applicant's overall fitness. 

 aa.  The applicant's combined overall effect of disabilities were also unfitting. DoDI 1332.38 enclosure 3 part 3 (E3.P3) states, a member may be determined unfit as a result of the overall effect of two or more impairments even though each of them, standing alone, would not cause the member to be referred into the DES or be found unfit because of physical disability. 

 bb.  The applicant was diagnosed with many service-connected conditions. One condition is missing from the MEB/PEB findings. TBI was missing. Post traumatic migraines are linked to TBI. Post traumatic migraines are also linked to PTSD. Further, PTSD increases the frequency of post-traumatic migraines.   

cc.PTSD was listed as other specified trauma- or stressor-related disorder in hisMEB/PEB paperwork. It was subsequently reclassified as PTSD by the VA. PTSD is known to cause fatigue. The applicant's NMA indicated his work suffered because of migraines and fatigue. The NMA assessment did not recommend the applicant be retained in the service because of his migraines and fatigue. Further, the applicant's PTSD fatigue would limit his ability to wear heavy equipment or carry heavy loads reducing his effectiveness in the field or forward deployed. 

dd.The MEB/PEB failed to consider the combined overall effect of the applicant'sPTSD and secondary condition of post-traumatic migraines as both conditions negatively impacted his ability to perform his duties of his office, grade, rank or rating. Had the MEB/PEB properly examined all paperwork to include to observations of the applicant's Company Commander, they would have included PTSD as part of the unfitting finding when combined with the migraine.  

 ee.  TBI symptoms were necessarily included in the PTSD diagnosis and findings. There is no controversy that the applicant was in combat training when he was injured. The combat training incident resulted in mild TBI injury. TBI may be linked to the post-traumatic migraines. However, TBI was not listed as condition for consideration by the applicant 's MEB/PEB. However, it was listed as service connected injury by the VA.   

 ff.  Currently, the VA rates the applicant's PTSD at 70 percent and TBI at 0 percent. The applicant's original rating for PTSD was 50 percent and his TBI was 0 percent. The applicant's post traumatic migraines, normally associated with a TBI, has been consistently rated at 30 percent. The discrepancy for the TBI and PTSD is explainable. The TBI symptoms are categorized as PTSD.  

 gg.  Several medical research articles previously mentioned in this brief and cited herein, explain that the symptomology between TBI and PTSD are very similar. The similarities make it harder to attribute one symptom with TBI and one symptom with PTSD, especially when an individual suffers from both.  

 hh.  The applicant suffered a TBI while conducting combat training. The TBI has led to post-traumatic migraines and PTSD. Yet, the VA finds that the TBI is not significantly affecting the applicant. But the VA recognized the applicant's PTSD has worsened over time and increased his disability rating for PTSD from 50 percent to 70 percent.  

ii.Clearly, the VA is attributing all of the applicant's symptoms to PTSD and not TBI.However, that does not mean that TBI does not affect the applicant then or now. It simple demonstrates and reinforces the conclusions reached by other medical examiners who studied persons who suffered from both PTSD and TBI. In the applicant's case, the VA has chosen to lump all of his symptoms into one category rather than trying to determine which symptoms are attributable to TBI and which symptoms are attributable to PTSD.  

 jj.  The applicant suffered TBI while conducting combat training. His TBI led to post traumatic migraines and PTSD. The MEB/PEB failed to consider the combined effects that PTSD and migraines had on the applicant's ability to perform his duties. During the applicant's non-medical assessment, his Company Commander indicated that both migraines and PTSD symptoms negatively affected the applicant's ability to perform his duties. The NMA did not distinguish which condition affected him more. There was clear evidence that both conditions had a negative impact on the applicant's ability to perform his duties. It was an error and injustice for the MEB/PEB to only consider one condition when there is ample evidence for the PEB to find that the conditions collectively interfered with the applicant 's ability to perform his duties. 

3.The applicant underwent a medical examination for enlistment on 6 February 2002.He was found qualified for service and assigned a physical profile of 111111.

A physical profile, as reflected on a DA Form 3349 (Physical Profile) or DD Form 2808, is derived using six body systems: "P" = physical capacity or stamina; "U" = upper extremities; "L" = lower extremities; "H" = hearing; "E" = eyes; and "S" = psychiatric (abbreviated as PULHES). Each body system has a numerical designation: 1 meaning a high level of fitness; 2 indicates some activity limitations are warranted, 3 reflects significant limitations, and 4 reflects one or more medical conditions of such a severity that performance of military duties must be drastically limited. Physical profile ratings can be either permanent or temporary. 

4.The applicant enlisted in the United States Army Reserve on 19 February 2002 for 8years. He completed his initial active duty for training from 28 February 2002 to
15 June 2002 and was awarded the military occupational specialty (MOS) 71L(administrative specialist).

5.The applicant enlisted in the Regular Army on 4 February 2003 for 3 years. He wasdeployed to Iraq in support from 15 June 2004 to 15 May 2005.

6.The applicant reenlisted in the Regular Army for 4 years on 18 October 2005. Hewas deployed in support of Operation Iraqi Freedom from 1 September 2006 to
11 September 2007.

7.The applicant’s DA Form 2166-8 (NCO Evaluation Report) covering 1 August 2006to 31 July 2007 shows the applicant was on provide effective 5 July 2007 and did notcomplete his Army Physical Fitness Test (APFT). His profile did not interfere with hisoverall fitness and ability to perform as a leader in the unit. A copy of the referencedprofile was not resident in his official military personnel record (OMPF). His
DA Form 2166-8 covering 1 August 2007 to 18 April 2008 shows he passed his APFTon 14 January 2008. He displayed mental and physical toughness during technical andtactical training.

8.The applicant reenlisted in the Regular Army on 25 November 2008 for 6 years. HisDA Forms 2166-8 show the following:

•19 April 2008 - 18 April 2009: he passed his APFT on 31 March 2009 andmaintained the Army Physical Fitness Badge by scoring a 286

•19 April 2009 - 28 October 2009: he passed his APFT on 6 October 2009 andmaintained the Army Physical Fitness Badge by scoring a 292

•29 October 2009 - 31 January 2012: he passed his APFT on 24 September 2011and scored a 276



9.A U.S. Army Abbreviated Ground Accident Report, dated 19 April 2012, shows theapplicant was participating in ATV and motorcycle offroad driver’s training with his unit.While operating his assigned dirt bike for the off-road course, he entered a turn too fast and lost control of the bike. As he lost control of the bike, he went over the side of the curve, was thrown from his dirt bike and hit a tree. Hitting the tree resulted in the applicant breaking his teeth, falling unconscious, breaking his femur, and lacerating his face.  

10.The applicant’s DA Form 2166-8 covering 1 February 2012 to 31 January 2013show he passed his APFT and earned the Army Physical Fitness Badge by scoring a270.His DA Form 2166-8 covering 1 February 2013 - 31 January 2014 shows hepassed his APFT on 2 September 2013 and maintained the Army Physical FitnessBadge by scoring a 300.

9.A PDES Commander’s Performance and Functional Statement, dated 29 May 2014,shows his commander indicated the applicant’s medical conditions/limitations affect unitaccomplishing mission and did not recommend retaining him. The commander states:[the applicant] is a great Soldier with a strong work ethic. Unfortunately, [he] suffersfrom chronic headaches and fatigue caused by a TBI. [He] has to take frequent breaksthrough the day in order to minimize the effects. [He] currently works in the S3 sectionand is responsible for sending Soldiers to schools and coordinating for land and ammo.[He] … has difficulty looking at a computer screen for a length of time. This causes workto be delayed. He requires more time for each task, performs duties/tasks with errors orincompletely, and has intermittent period where he is unable to perform occupationaltasks. He has effective work relationships with both supervisors and co-workers. Thecommander did not observe symptoms related to social interactions and workplaceinteractions.

10.The MEB NARSUM, dated 9 July 2014, shows:

a.[The applicant] is a 33 year-old right hand dominant male, 38B/Civil Affairs,

referred to the IDES for post-traumatic headaches. The [applicant] was evaluated by Dr. , MEB Physician, Fort Bragg on 28 May 2014. b. Not Meeting Retention Standards: Chronic post-traumatic migraine Headaches; originating April 2012.  

c.Diagnoses Meeting Retention Standards:

•other specified trauma- or stressor-related disorder

•dry eye syndrome oculus uterque (OU), photophobia OU, vitreous floaters OUand visual aura associated with migraines

•tinnitus

•fractured tooth #8 secondary to trauma

•gastroesophageal reflux disease (GERD)


•chronic bilateral wrist strains with bilateral triangular fibrocartilage complex(TFCC) tears

•chronic lumbar strain with left L5 spondylolysis and right S1 radiculitis

•chronic left hip strain s/p intramedullary rod of left femur fracture (L2)

•chronic left knee strain s/p left femur shaft fracture intramedullary rod

•bilateral tibial parostitis s/p right distal 1/3 fibula shaft fracture

•chronic bilateral ankle inversion sprains s/p right fibula fracture

•bilateral pes planus with chronic bilateral plantar fasciitis and tinea pedis s/pleft great toe fracture



d.Medical Retention Determination Point (MRDP) Statement. (AR 40-501, 7-4b(2)):MRDP has been met for post-traumatic migraine headaches. The condition has been stable for more than 12 months. [The applicant] has had treatment as noted in 7c "Treatment Summary” but continues to have headaches. The condition interferes with the performance of MOS duties and the duties of a Soldier, further treatment is not likely to return [him] to full duty. 

e.DA 3349, Physical Profile: [the applicant] cannot perform certain basic Soldierfunctional activities (d,j), as documented in Block 5 of DA Form 3349:  he is unable to wear a helmet for 12 hours because it aggravates his headache pain; he is unable to live in an austere environment where significant environmental hazards would exacerbate existing medical conditions, and/or force protection levels mandate prolonged use of body armor; left hip/thigh intermittent pain s/p femur fracture surgery (L2) continuation of November 2013 permanent profile by Orthopaedics: low impact; APFT alternate event and physical training at own pace, distance and repetition. 

f.Diagnosis not Meeting Medical Retention Standards: Post-Traumatic MigraineHeadaches:  

(1)Medical Basis for Diagnosis:  on 23 May 2014, WAMC Neurology diagnosedpost-traumatic headaches and migraine headaches. 

(2)Onset: in April 2012, [the applicant] sustained multiple injuries in a dirt bikevs. tree accident during training, including concussion with LOC for a few hours  
(23 May 2014 Neurology note). Prior to the TBI, he had headaches that occurred only a few times per year. 

(3)Treatment Summary and Results:  he was initially hospitalized for acuteinjuries and received left femur ORIF/IM rod at Carolina Medical Center in Charlotte NC. He tried rest/profiles, Imitrex and oral/IM NSAIDs with limited relief. He is currently on Topamax and Metoprolol prophylaxis with Maxait abortive therapy with partial relief. He deployed to Afghanistan for 9 months in 2013 but was unable to go on missions due to headaches. 
(4)Present Condition: [the applicant] reported daily R temple/occipitalheadaches which last all day and wake out of sleep. They are aggravated by looking at a computer screen, emotional stress, prolonged reading or looking at something and certain Field activities. They are aggravated by activity or for no reason at all sometimes. On 26 March 2013, Neuropsychology stated that neurocognitive functions are intact, with no neurocognitive deficits. On 23 May 2014, Neurology confirmed there was no decrease in concentrating ability, and no memory lapses or loss. 

(5)Prognosis Statement: It is unlikely that there will be significant improvementof the condition during the next 5 years such that the condition will meet retention standards. The rigors of soldiering would likely worsen [the applicant]'s condition. 

(6)Impact on Duty Performance:

(a)Impact on MOS Physical Requirements per DA PAM 611-21: [theapplicant] cannot perform the following physical _requirement of MOS 388 because the activities aggravate his headache pain: Frequently hammers/pounds to drive masts and base assemblies, base plates and guy stakes into the ground. 

(b)Per DA Form 7652, the [applicant]'s Commander has determined that:

•Soldier performs duties in MOS - YES

•Soldier in appropriate TO&A or TDA position for grade and MOS - YES

•Soldier's medical conditions/limitations affect unit accomplishingmission - YES

•recommend retaining this Soldier - NO



(7)Selection of Applicable AR 40-501, Chapter 3 Provision with discussion:
post-traumatic migraine headache does not meet retention standards per AR 40-501, paragraph 3-30j. The [applicant]'s inability to comfortably and effectively perform certain physical requirements of his MOS duties and/or certain Soldier Functional Activities is unlikely to improve with continued Military Service. This condition significantly limits or interferes with [the applicant]'s performance of duties. 

g.Mental Competency Statement. when applicable: the [applicant] is deemedmentally competent for pay purposes, is capable of understanding the nature of, and cooperating in, PEB proceedings, and is not considered dangerous to self or others. 

h.Diagnoses Meeting Medical Retention Standards: none of the followingconditions, individually or in combination, significantly interfere with duty, or prevent the performance of functional activities listed in block 5 on DA Form 3349. They do not compromise or aggravate the [applicant]'s health or well-being, compromise the health or well-being of other Soldiers, or prejudice the Government's best interests. 
(1)Other specified trauma- or stressor-related disorder. The condition meetsretention standards IAW AR 40-501, para 3-33 because there is no evidence in AHLTA or profiles that the condition is duty limiting, interferes with effective military performance or has required hospitalization. VA Psychology stated that the psychiatric symptoms cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks although generally the Soldier is functioning satisfactorily with routine behavior, self-care and normal conversation. He does not appear to pose any threat of danger or injury to self or others. On 18 Jun 2014, WAMC Psychology stated that he meets behavioral health retention standards. On the day the DA Form 3947 was signed, WAMC Psychology reviewed the Army and VA Behavioral Health consultations and concurred that the condition meets retention standards. 

(2)Dry eye syndrome OU, photophobia OU, vitreous floaters OU and visual auraassociated with migraines. The corrected distance vision meets retention standards IAW AR 40-501, para 3-16e. The impact of the eye conditions on his ability to work is minor. On 29 November 2012 WAMC Optometry stated that he completed vision therapy with resolution of visual deficits. As above, post-traumatic migraine does not meet retention standards and the associated visual aura would not be considered a separate disqualifying condition.  

(3)Tinnitus. The condition meets retention standards IAW AR 40-501, para 3-41e because there is no evidence in AHLTA or profiles that the condition prevents the [applicant] from performing any of the functional activities listed in DA Form 3349.  

(4)Fractured tooth #8 secondary to trauma. The condition meets retentionstandards IAW AR 40-501, para 3-8 because there is no evidence in AHLTA or profiles that the condition prevents the [applicant] from performing any of the functional activities listed in DA Form 3349. VA Dental Surgery stated the dental condition does not impact his ability to work. 

(5)GERD. The condition meets retention standards IAW AR 40-501, para 3-41ebecause there is no evidence in AHLTA or profiles that the condition prevents the [applicant] from performing any of the functional activities listed in DA Form 3349. 

(6)Chronic bilateral wrist strains with bilateral TFCC Tears. The condition meetsretention standards IAW AR 40-501, para 3-41e because there is no evidence in AHLTA or profiles that the condition prevents the [applicant] from performing any of the functional activities listed in DA Form 3349. [The applicant] stated to [physician] that the condition has been stable since 2012. In May/June 2012, [the applicant] saw PCM and Occupational Therapy for hand/finger pain after a dirt bike training injury in April 2012 (resulting in left femur fracture) with continued use of crutches. [The physician] found no subsequent visits in AHLTA for any hand or wrist condition. Per C&P, there are no flare-ups that impact the function of the wrist. Repetitive wrist flexion and extension are within acceptable limits bilaterally with no objective evidence of painful motion. The bilateral wrist muscle strength is normal.  

(7)Chronic lumbar strain with left L5 spondylolysis and right S1 radiculitis. Thecondition meets retention standards IAW AR 40-501, para 3-39h because there is no evidence in AHLTA or profiles that the condition failed to respond to adequate conservative treatment and necessitates significant limitation of physical activity. He attributed the back condition to compensating after his April 2012 left femur fracture and the back condition has not had formal treatment. Despite reporting symptoms of intermittent, mild right sciatic symptoms, he stated to [the physician] that he has been able to continue to do physical training, including some running, and alternate event APFTs. Per C&P, straight leg raising is negative bilaterally. The sensory and motor exams are normal. There are no associated bowel, bladder or motor problems. There is no IVDS.  

(8)Chronic left hip strain s/p left femur fracture intramedullary rod (L2). Thecondition meets retention standards IAW AR 40-501, para 3-41e because there is no evidence in AHLTA or profiles that the condition prevents the [applicant] from performing any of the functional activities listed in DA Form 3349. In November 2013, Orthopaedics gave a permanent L2 profile for intermittent pain after clinical resolution of the left femur fracture. He stated to [the phycian] that he has been able to continue to do physical training and APFTs, which is appropriate for his L2 profile. The DA Form 7652 specifically states that his headaches limit his work, and there is no mention any lower extremity conditions. Per C&P, his hips are stable, ROM is within acceptable limits and muscle strength is normal.  

(9)Chronic left knee strain s/p left femur shaft fracture intramedullary rod andBilateral tibial parostitis s/p right distal 1/3 fibula shaft fracture. The conditions meet retention standards IAW AR 40-501, para 3-41e because there is no evidence in AHLTA or profiles that the conditions prevent the [applicant] from performing any of the functional activities listed in DA Form 3349. [The applicant] reported intermittent leg pain which do not limit his work. [The applicant] stated to [the physician] that he is still able to run but experiences some left leg pain (like it's getting hot') down to his left foot sometimes when running. The C&P states that his knees are stable, repetitive ROM is within acceptable limits, and muscle strength is normal bilaterally. There is no joint line or soft tissue tenderness of the knees.  

(10)Chronic bilateral ankle inversion sprains s/p right fibula fracture. Thecondition meets retention standards IAW AR 40-501, para 3-41e because there is no evidence in AHLTA or profiles that the condition prevents the [applicant] from performing any of the functional activities listed in DA Form 3349. The C&P states that the ankles are stable with normal muscle strength, and repetitive ROM is within normal limits. The right fibula fracture occurred in 2007 and is healed. [The applicant] reported multiple bilateral mild ankle injuries since then, which have not been formally treated. [The physician} found no visits in AHLTA for the ankle sprains.  

(11)Bilateral pes planus with chronic bilateral plantar fasciitis and tinea pedis s/pleft great toe fracture. Pes planus meets retention standards IAW AR 40-501, para 3-13b(2) because there is no evidence in AHLTA or profiles that the condition is more than moderately symptomatic, with pronation on weight bearing which prevents the wearing of military footwear or is associated with vascular changes. Plantar fasciitis meets retention standards IAW AR 40-501, para 3-13b(5) because there is no evidence in AHLTA or profiles that this condition is refractory to medical or surgical treatment, interferes with the satisfactory performance of military duties, or prevents the wearing of military footwear. Most cases of plantar fasciitis respond well to conservative treatment with complete resolution of pain over time. On 31 January 2006, flat foot was diagnosed on a routine physical exam. [The physician] found no subsequent visits in AHLTA for this condition and no visits for plantar fasciitis. 

i.Quality Assurance Check:

(1)Apparent Inconsistencies: None

(2)Timeliness of MEB Information: Supporting clinical information is from withinthe last 6 months. Where information is older than 6 months, the condition was not significantly changed and reevaluation would not change the MRDP status or whether the condition meets medical retention standards. There was no medical indication to update the evaluation. This has been explained to the [applicant]. 

11.The MEB proceedings, dated 10 July 2014, shows:

a.After consideration of clinical records, laboratory findings, and physicalexamination, the Board finds that the [applicant] has the following medical conditions/defects:   

•chronic post-traumatic migraine headaches; IAW AR 40-501, para 3-30j

•other specified trauma- or stressor-related disorder, non-disqualifying

•dry eye syndrome OU, photophobia OU, vitreous floaters OU and visual auraassociated with migraines, non-disqualifying

•tinnitus, non-disqualifying

•fractured tooth #8 secondary to trauma, non-disqualifying

•GERD, non-disqualifying

•chronic bilateral wrist strains with bilateral TFCC tears, non -disqualifying

•chronic lumbar strain with left L5 spondylolysis and right S1 radiculitis, non-disqualifying


•chronic left hip strain s/p intramedullary rod of left femur fracture (L2), non-disqualifying

•chronic left knee strain sip left femur shaft fracture intramedullary rod, non-disqualifying

•bilateral tibial parostitis s/p right distal 1/3 fibula shaft fracture, non-disqualifying

•chronic bilateral ankle inversion sprains sip right fibula fracture, non-disqualifying

•bilateral pes planus with chronic bilateral plantar fasciitis and tinea pedis sip leftgreat toe fracture, non-disqualifying



b.The findings were approved on 11 July 2014.

c.The applicant was informed of the approved findings and recommendation of theBoard on 22 July 2014. He agreed with the Board’s findings and recommendation. He indicated he reviewed the contents of the Medical Evaluation Board (MEB) packet and read the attached DA Form 3947 (Medical Board Proceedings), Narrative Summary (NARSUM), and the Physical Profile (DA Form 3349). He acknowledged he understood that the PEB will consider and review only those conditions listed on the DA Form 3947; the DA Form 3947 includes all his current medical conditions and whether or not they meet medical retention standards; the conditions which do not meet medical retention standards are properly listed on the following three documents: DA Form 3947; 
the Narrative Summary; and the Physical Profile (DA Form 3349); and agreed that this MEB accurately covers all his current medical conditions. 

12.A DA Form 199 shows:

a.An Informal PEB convened on 16 September 2014, found the applicant physicallyunfit and recommended a rating of 30 percent and that his disposition be permanent disability retirement.  

b.The applicant was found unfit for posttraumatic headache with photophobia andvisual aura associated with migraines PEB referred as chronic post-traumatic migraine headaches. Soldier reports onset occurred in April 2012, while in CONUS, when the [he] suffered injuries in a motorcycle accident. IAW DoDI 1332.38, E3.P3.2.1, [the applicant] is unfit because DA Form 3349, Physical profile limitations associated with this condition make [him] unable to reasonably perform in their PMOS/AOC. [His] condition prevents them from performing functional activity (d.) wearing a helmet for at least 12 hours per day. 

c.In full consideration of DoDI 1332.38, E3.P3, to included combined, overall effect,the following conditions were not unfitting because the [M]EB indicated these conditions met retention standards; did not indicate that any of these conditions caused profile limitations (functional activities a-h); and did not indicate that performance issues, if any, were due to these conditions:  

•other specified trauma- or stressor - related disorder

•dry eye syndrome OU, photophobia OU, vitreous floaters OU and visual auraassociated with migraines

•tinnitus

•fractured tooth #8 secondary to trauma

•GERD

•chronic bilateral wrist strains with bilateral TFCC tears

•chronic lumbar strain with Left L5 spondylolysisi and Right S1 radiculitis

•chronic Left hip strain s/p intramedullary rod of Left femur fracture

•chronic Left knee strain s/p left femur shaft fracture intramedullary rod

•bilateral tibial parostitis s/p Right distal 1/3 fibula shaft fracture

•chronic bilateral ankle inversion sprains s/p Right fibula fracture

•bilateral pes planus with chronic bilateral plantar fasciitis and tinea pedis s/p Leftgreat toe fracture



d.The PEB made the following administrative determinations:

(1)The disability disposition was not based on disease or injury incurred in theline 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 as defined by law.  

(2)Evidence of record reflects the individual was a member or obligated tobecome a member of an Armed Force or Reserve thereof, or the NOAA or the USPHS on 24 September 1975. 

(3)The disability did not result from a combat-related injury under in 26 USC 104or 10 USC 10216. 

e.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. The specific VASRD codes to describe the·[applicant]’s condition and the disability percentage was determined by the Department of Veterans Affairs (DVA) and is documented in DVA memorandum dated 2 September 2014. The disposition recommendation was determined by the PEB based on the DVA disability rating proposed and applicable statutes and regulations for the Physical Disability Evaluation System (PDES).  

f.The applicant concurred and waived a formal hearing of his case on30  September 2014. He did not request reconsideration of his VA ratings.  

g.The proceedings were finalized on 9 October 2014.

13.The applicant’s DA Form 2166-8 covering 1 February 2014 to 4 November 2014show he passed his APFT on 9 June 2014 and maintained the Army Physical FitnessBadge by scoring a 276.

14.The applicant was honorably retired on 1 January 2015 under the provisions of
AR 635-40, Chapter 4 for disability, permanent (enhanced).

15.On 16 March 2015, the applicant applied for and was subsequently awarded 90percent Combat-Related Special Compensation (CRSC) for the following conditions:

•8620 - lumbar radiculitis, right S-1

•5271 - bilateral, right ankle inversion sprain

•5271 - bilateral, left ankle inversion sprain

•5215 - bilateral, left wrist strain with triangular fibrocartilage complex,

•5215 - bilateral, right wrist strain with triangular fibrocartilage complex

•8100 - post-traumatic headache with photophobia and visual aura

•9411 - post-traumatic stress disorder with dissociative symptoms and panicattacks



16.The applicant applied to the ABCMR, requesting correction of his DA Form 199 toshow his disability was incurred in the line of duty as a result of a combat related injury.In the adjudication of that application, an advisory opinion was obtained from the U.S.Army Physical Disability Agency (USAPDA). The Board agreed with the USAPDA'sopinion that disabilities arising from military training, such as war games, tacticalexercises, negotiation of combat confidence, and obstacle courses are specificallydefined under conditions simulating war. On 19 June 2018, the Board granted theapplicant’s request.

17.On 24 July 2018, the applicant's retirement orders were amended to show:

•disability is based on injury or disease received in the line of duty as a directresult of armed conflict or caused by an instrumentality of war and incurred in theline of duty during a period of war as defined by law: Yes

•disability resulted from a combat related injury as defined in 26 USC 104: Yes



18.The applicant applied to the ABCMR again, requesting correction of his records toshow his TBI and PTSD failed medical retention standards and were found unfitting. Healso requested an increase of his disability rating from 30% to 100%.  In theadjudication of that application, a medical advisory opinion was provided by the ARBAmedical advisor, which has been provided in full to the current Board for review. TheARBA medical advisor opined, in pertinent part:

a.A review of the Armed Forces Health Longitudinal Technology Application(AHLTA) & Health Artifacts Image Management Solutions (HAIMS) was conducted.  

b.VA electronic medical record, Joint Legacy Viewer (JLV) was reviewed.

c.AHLTA contains an in-service Behavioral Health Diagnosis of Anxiety Disorder.His BH encounter dated 8 April 2014 notes: [the applicant] was involved in a training accident on 19 April 2012 in which the motorcycle he was riding hit a tree and he received a femur fracture and a TBI. [The applicant] endorses depressed mood for the past two years due to the accident and subsequent chronic headaches which impact his daily life. [The applicant] reports ongoing insomnia since the accident with multiple awakening during the night and headaches upon rising in the morning once every two weeks. [The applicant] reports daily intrusive memories of the accident leading to anxiety, hypervigilance and feeling that his future will be cut short. This encounter diagnosed the applicant with Anxiety Disorder NOS and specifically states the, [applicant] meets medical retention standards from a behavioral health perspective IAW AR 40-501, Paragraph 3-31 through 3-37. The applicant has 5 BH encounters in AHLTA with the last occurring on 18 June 2014 and all indicate that the applicant is fit for duty from a BH perspective. 

d.JLV contains additional post-service BH diagnoses of PTSD, and other specifiedmood disorders. The applicant is 100 percent service connected, 70 percent for PTSD. 

e.There is no indication from his military records that he was unfit for duty from aBH perspective before his discharge. The applicant was awarded the Meritorious Service Medal upon retirement for his years of service (29 November 2004 to  
30 November 2014). His most recent NCOER with a through date of 4 November 2014 all yeses on military values, Excellence on 3 Values/NCO Responsibilities, and Success on the others, with a Rater rating of 'Among the best' and a Senior rating of 1, 1 (superior, superior), promote ahead of peers. There is no evidence of a behavioral health temporary or permanent profile in his records.  

f.There is no evidence that the applicant failed medical retention standards from aBH perspective. 

g.With regards to military medical disability/retirement, the Army has a process thatbegins with entry into the disability evaluation system (DES). Referral to this system requires a designation of unfitness before an individual can be separated from the military because of an injury or medical condition. In the applicant's case, there is no indication that he had an unfitting behavioral health condition while on active duty as evidenced by the lack of: 1) a permanent physical profile for a psychological impairment; 2) a diagnosis of a behavioral health condition that failed medical retention standards; 3) a diagnosis of a behavioral health condition that rendered the applicant unable to perform the duties required of his MOS or military grade. 

h.It is important to realize that a diagnosis of a mental condition post-service andthe subsequent award of a VA rating does not establish entitlement to medical retirement or separation from the Army. Operating under its own policies and regulations, the VA, which has neither the authority nor the responsibility for determining medical unfitness for military duty, awards ratings because a medical condition is related to service and affects the individual's civilian employability. The VA evaluates a member throughout his lifetime, adjusting the percentage of disability based on that agency's examinations and findings. 

i.After considering all the available medical documentation, it is the opinion of theAgency psychologist that there is insufficient evidence to warrant a referral of the applicant's record to IDES (Integrated Disability Evaluation System) for consideration of an adjustment to his military medical disability/retirement. 

19.On 12 January 2022, the Board concurred with the medical advisory opinion anddenied the applicant’s request.

20.The Army rates only conditions determined to be physically unfitting at the time ofdischarge, which disqualify the Soldier from further military service. The Army disabilityrating is to compensate the individual for the loss of a military career. The VA does nothave authority or responsibility for determining physical fitness for military service. TheVA may compensate the individual for loss of civilian employability.

21.Title 38, U.S. Code, Sections 1110 and 1131, permit the VA to award compensationfor 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.

22.Title 38, CFR, Part IV is the VA’s schedule for rating disabilities. The VA awardsdisability ratings to veterans for service-connected conditions, including those conditionsdetected after discharge. As a result, the VA, operating under different policies, mayaward a disability rating where the Army did not find the member to be unfit to performhis duties. Unlike the Army, the VA can evaluate a veteran throughout his or herlifetime, adjusting the percentage of disability based upon that agency's examinationsand findings.

23.MEDICAL REVIEW:

a.The applicant is applying to the ABCMR requesting reconsideration of his priorrequest to show: 1) his traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) failed medical retention standards and were unfitting; 2) His disability rating increased from 30 to 100 percent. 
b.The specific facts and circumstances of the case can be found in the ABCMRRecord of Proceedings (ROP). Pertinent to this advisory are the following: 1) The applicant enlisted in the Regular Army on 4 February 2003; 2) The applicant deployed to Iraq from June 2004-May 2005 and September 2006-September 2007. He deployed to Afghanistan from April-October 2013; 3) On 19 April 2012, the applicant was involved in a training accident; 4) An Informal PEB convened on 16 September 2014, found the applicant physically unfit and recommended a rating of 30 percent for posttraumatic headache with photophobia and visual aura associated with migraines and that his disposition be permanent disability retirement. The applicant concurred and waived a formal hearing of his case on 30 September 2014; 5) The applicant was honorably retired on 1 January 2015, Chapter 4 for disability, permanent (enhanced); 6) The applicant applied to the ABCMR, requesting corrections of his DA Form 199. On 24 July 2018, the applicant's retirement orders were amended as requested; 7) The applicant applied to the ABCMR again, requesting correction of his records to show his TBI and PTSD failed medical retention standards, and he also requested an increase of his disability rating from 30% to 100%. On 12 January 2022, the Board denied the applicant’s request. 

c.The Army Review Board Agency (ARBA) Medical Advisor reviewed the supportingdocuments and the applicant’s military service and medical records. The VA’s Joint Legacy Viewer (JLV) and VA documentation provided by the applicant were also examined. 

d.The applicant requests his TBI and PTSD be added as unfitting conditions to hisPermanent Disability Retirement and his disability rating be increased from 30 percent to 100 percent. Through counsel, the applicant argues that the board only focused on behavioral health aspects of the applicant's career and not the effect his mental health had on his physical health nor the collective or combined effect of PTSD, TBI and post traumatic migraines had on the applicant's career. The applicant was involved in a training accident on 19 April 2012. The applicant was enrolled in the concussive care clinic after his accident, and he underwent a neuropsychological evaluations 31 July 2012 on 13 September 2012. During each evaluation, he completed a clinical interview and a battery of neuropsychological tests. During the time of his evaluations, he denied any psychological symptoms, but he reported problems with memory and headaches. The applicant did not demonstrate any cognitive deficits, and he was not diagnosed with a residual injury beyond his headaches related to his TBI. On 26 March 2013, he was reevaluated again from his suitability to deploy despite his history of TBI. He was evaluated again, and he was found to be performing within a normal range, and he was cleared to deploy.  
e.The applicant’s first behavioral health encounter occurred on 8 April 2014 with aLicensed Clinical Social Worker. He endorsed depressed mood and headaches since the accident. He also reported intrusive memories of accident with feelings of anxiety and hypervigilance. He also reported delayed onset of sleep with multiple awakenings.  He was diagnosed with Anxiety Disorder NOS, and he was found to meet medical retention standards from a behavioral health perspective IAW AR 40-501, Paragraph 3-31 through 3-37. The applicant had a total of five behavioral health appointments with the last occurring on 18 June 2014. The applicant was found to be improving with his level of anxiety and avoidance, and he was repeatedly found to be fit for duty from a behavioral health perspective. He was not placed on a temporary or permeant profile for a mental health condition, and he did not require inpatient behavioral health care while on active service. 
f.A review of JLV provided evidence the applicant has been diagnosed with service-connected PTSD (70%) and migraine headaches (30%). The applicant is 100 percent service connected. 
g.Based on the available information, it is the opinion of the Agency BH Advisor thatthe applicant was properly assessed by appropriate licensed behavioral health providers, neuropsychologists, and medical providers, while on active service. He was found to meet retention standards repeatedly from a behavioral health perspective, and he was found to be performing within normal standards in relation to his history of a TBI. He was previously evaluated by the PEB, who had all available active-duty information available at the time of his disability rating. Therefore, at this time, there is insufficient evidence to support an additional referral to IDES. 
Kurta Questions 
(1)Did the applicant have a condition or experience that may excuse or mitigate thedischarge? Yes, the applicant did experience a TBI while on active service, and he was diagnosed with service-connected PTSD by the VA. 
(2)Did the condition exist or experience occur during military service?  Yes, theapplicant did experience a TBI while on active service, and he was diagnosed with service-connected PTSD by the VA. 
(3)Does the condition experience actually excuse or mitigate the discharge? No, theapplicant was properly assessed by appropriate licensed behavioral health providers, neuropsychologists, and medical providers, while on active service. He was found to meet retention standards repeatedly from a behavioral health perspective, and he was found to be performing within normal standards in relation to his history of a TBI. He was previously evaluated by the PEB, who had all available active-duty information available at the time of his disability rating. Therefore, at this time, there is insufficient evidence to support an additional referral to IDES. 

BOARD DISCUSSION: 

1.The Board carefully considered the applicant's request, supporting documents,evidence in the records, and a medical review.

2.The Board concurred with the conclusion of the Army Review Boards AgencyBehavioral Health Advisor that the evidence does not indicate the applicant had anybehavioral health conditions that did not meet retention standards prior to his disabilityretirement.  Based on a preponderance of the evidence, the Board determined thedisability rating he received was 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 that the overall merits of this case are insufficient as a basis to amend the decision of the ABCMR set forth in Docket Number AR20210005825 on 12 January 2022. 

Microsoft Office Signature Line...
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 Departmentswith authority to retire or discharge a member if they find the member unfit to performmilitary duties because of physical disability. The U.S. Army Physical Disability Agencyis responsible for administering the Army physical disability evaluation system andexecutes Secretary of the Army decision-making authority as directed by Congress inchapter 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 medicalretention 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: theMEB 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 afinding 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 38 U.S. Code, Section 1110 (General - Basic Entitlement) states for disabilityresulting from personal injury suffered or disease contracted in line of duty, or foraggravation of a preexisting injury suffered or disease contracted in line of duty, in theactive military, naval, or air service, during a period of war, the United States will pay toany veteran thus disabled and who was discharged or released under conditions otherthan 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. 
 
3.  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. 
 
4.  Army Regulation (AR) 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. Once a determination of physical unfitness is made, all disabilities are rated using the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD). 
 
 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.  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. 
 
5.  AR 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. 
 
6.  Section 1556 of Title 10, U.S. Code, requires the Secretary of the Army to ensure that an applicant seeking corrective action by the Army Review Boards Agency (ARBA) be provided with a copy of any correspondence and communications (including summaries of verbal communications) to or from the Agency with anyone outside the Agency that directly pertains to or has material effect on the applicant's case, except as authorized by statute. ARBA medical advisory opinions and reviews are authored by ARBA civilian and military medical and behavioral health professionals and are therefore internal agency work product. Accordingly, ARBA does not routinely provide copies of ARBA Medical Office recommendations, opinions (including advisory opinions), and reviews to Army Board for Correction of Military Records applicants (and/or their counsel) prior to adjudication. 
 
7.  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, or sexual harassment. 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. 
 
8.  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. 
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