RECORD OF PROCEEDINGS


         IN THE CASE OF:


         BOARD DATE: 01 JULY 2004
         DOCKET NUMBER: AR2003099080


         I certify that hereinafter is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in the case of the above-named individual.

Mr. Carl W. S. Chun		Director
Mr. Kenneth H. Aucock		Analyst

The following members, a quorum, were present:

Ms. Lana McGlynn		Chairperson
Ms. Linda Simmons		Member
Mr. John Meixell		Member

         The applicant and counsel if any, did not appear before the Board.

         The Board considered the following evidence:

         Exhibit A - Application for correction of military records.

         Exhibit B - Military Personnel Records (including advisory opinion, if any).


1. In effect, the applicant requests physical disability retirement.

2. The applicant states that the Department of Psychiatry at Tripler Army Medical Center in Hawaii intentionally failed to diagnose his condition as depression in order for him to be rated as such by a medical board. He requests that his case (medical board proceedings) be reopened and that his condition be rated as major depression, PTSD (posttraumatic stress disorder), and GAD? His condition has worsened as shown by Department of Veterans Affairs (VA) records.

3. He states that he was physically and mentally abused to include the sabotage of his medical board [proceedings] because he reported chemical leak agent detector alarm failures to his chain of command, thereby embarrassing them by exposing their inadequacies. He states that their political influences extended to pressuring doctors from diagnosing his condition as depression.

4. In a 22 May 2003 letter to the President and the Vice President, the applicant expounds on the theme that the Army deliberately neglected to diagnose his condition as depression, resulting in his current state of intense economic hardship. He states that he contacted a Member of Congress for assistance; however, he believes that the President should resolve the issue. The applicant provides a summary of events, stating that the psychiatrist (Doctor "C") at Johnston Atoll diagnosed his condition as depression; however, that doctor's diagnosis was questioned to the extent that another psychiatrist, who would outrank Doctor "C," would evaluate him. He was sent to Tripler, evaluated by a doctor who informed him that he [the doctor] was working for the chain of command, who wanted him discharged for a personality disorder. They failed to diagnose his condition as depression; however, the family practice clinic provided a diagnosis of depression. He was referred back to the Psychiatry Department as an emergency patient, and his condition has diagnosed as undifferentiated somatoform disorder. He returned to Johnston Island for a follow on appointment with Doctor "C," who informed him that the entire chain of command to include hospital personnel was questioning his (Doctor "C") professional expertise in an effort to remove the depression diagnosis from his medical records. He states that the actions clearly illustrate the conflict of interest that exists in the Psychiatry Department with regard to their role as career officers versus their duty as medical doctors.

5. In a supplemental paper he requested that documents reflecting his knee conditions be reviewed, stating in effect, that he should have received a 20 percent disability rating instead of a 0 percent rating for his conditions.

6. The applicant provides the documents depicted herein.
CONSIDERATION OF EVIDENCE:

1. The applicant was awarded the Army Achievement Medal for meritorious achievement for the period 23 January 1998 to 3 February 1998 while assigned to the Army Chemical Activity, Pacific while a member of the military police security force. He was awarded the Army Commendation Medal for meritorious service for the period 4 November 1997 to 10 December 1999 while assigned to that same activity. He has received two awards of the Army Good Conduct Medal, the last for the three-year period ending on 28 February 2002.

2. Other than as noted above, the evidence in this case is that submitted by the applicant. His 2 March 2002 DD Form 214 (Certificate of Release or Discharge from Active Duty) shows that the applicant enlisted in the Regular Army on 1 March 1996, and that he was trained as a military policeman. He had over 4 years of overseas duty.

3. The evidence shows that he submitted on 16 April 2002 a document in which he stated that he was exposed to hazardous duty while stationed at Johnston Atoll, and that he had irrefutable physical manifestations which could only be explained as Gulf War-like syndromes. He provided a list of his signs and symptoms, his illnesses, diseases, allergies, the dates that he was so diagnosed, and the treating physicians, clinics, or hospitals.

4. A 23 July 1999 Physical Profile (DA Form 3349) shows that the applicant had a physical profile serial of 1 1 3 1 1 1 for left knee retropatellar pain syndrome.

5. On 16 September 1999, Doctor "C," the Chief Medical Officer at the Johnston Atoll Health Clinic diagnosed the applicant's condition as depression, prescribing medication, to include Prozac, which could affect his ability to function in the chemical surety program. On 4 October 1999 that same doctor diagnosed his condition as depression/adjustment disorder, with the note that the applicant stated that he felt that the chain of command was hostile and non supportive, and that he was now working in administration.

6. A 5 October 2000 medical record from the Family Practice Clinic at Tripler Army Medical Center contains the notes, "… History of PTSD, depression, prev on prozac, seen today by [unreadable] self medication … worthlessness … overeating, no suicidal/homicidal ideation, history of ? chemical gas exposure [unreadable]." Also, "Major depression [unreadable], PTSD – prob GAD." The record listed eleven types of medications that he had been or was then taking.

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7. On 26 June 2001 a Medical Evaluation Board diagnosed the applicant's condition as chronic retropatellar knee pain syndrome; hypertensive vascular disease; hypercholesterolemia; arthritis; prurigo nodularis; lichen simplex chronicus; bee sting anaphylaxis; allergic rhinitis, chronic; bilateral elbow epicondylitis; bursitis, right hip; adjustment disorder; and fatty liver. The MEB recommended that he be referred to a Physical Evaluation Board (PEB). The applicant did not agree with the board's findings and recommendation, and indicated that he attached an appeal. The appeal is not available to this Board. The MEB noted that it had considered his appeal and had forwarded his case and appeal to a doctor in the PGWI [Persian Gulf War ?] clinic to address PGWI type syndromes.

8. On 13 December 2001 a formal PEB determined that the applicant had the following disabilities: Undifferentiated somatoform disorder, manifested by high concern for physical symptoms, development of variable physical symptoms when anxious or under stress, with the statement that his condition had been aggravated by excess alcohol consumption under the guise of self medication and was apportioned down for that reason – rated mild, with a recommended 10 percent disability rating; prurigo nodularis/lichen simplex chronicus, manifested by pruritic skin lesions, pigmentary changes, with a recommended 10 percent disability rating; and retropatellar pain syndrome, left, chronic, with intact ligaments, full range of motion, with a recommended 0 percent disability rating. The PEB indicated that a narrative summary was considered for each disability and that in addition a psychiatric addendum was obtained and considered for the diagnosis of undifferentiated somatoform disorder. The PEB determined that the other conditions listed by the MEB were considered and found to be not unfitting and therefore not ratable. The PEB determined that he was unfit for duty and that he should be discharged from the Army with a 20 percent disability rating.

         a. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) defines somatization disorder as a polysymptomatic disorder that begins before age 30 years, extends over a period of years, and is characterized by a combination of pain, gastrointestinal, sexual, and pseudoneurological symptoms. Undifferentiated somatoform disorder is characterized by unexplained physical complaints, lasting at least 6 months, that are below the threshold for a diagnosis of somatization disorder.

         b. Dorland's Illustrated Medical Dictionary, 27th Edition, defines prurigo as a name applied to several itchy skin eruptions of unknown cause, in which the characteristic lesion is dome-shaped with a small transient vesicle on top, followed by crusting or lichenification. Prurigo nodular is a chronic, intensely pruritic form of neurodermatitis, located chiefly on the extremities.

         c. Lichen simplex chronicus is defined as an eczematous dermatitis due to repeated itching and rubbing or scratching of the skin, arising spontaneously or initiated by or coexisting with other dermatoses.

9. On 3 January 2002 the applicant received a permanent physical profile serial of 3 3 3 1 1 1 for bilateral patella-femoral pain syndrome; bilateral elbow tendonitis; right greater trochanteric bursitis; bee sting anaphylaxis; multiple allergies; and left olecranon bone spur.

10. A 12 February 2002 medical record from that same clinic indicated a problem list, to include adjustment disorder with mixed disturbance of emotions and conduct, examination of eyes and vision, blepharospasm, adult physical abuse, pain in joint involving hand, other general medical examination for administrative purposes, major depression, recurrent [which the applicant highlighted), hypertension, hyperlipidemia, edema, localized, depression [which the applicant highlighted], other unspecified counseling, arthritis, peripheral nerve disease, myopia, other and unspecified injury to elbow, forearm, and wrist, undifferentiated somatoform disorder, and other and unspecified alcohol dependence, continuous drinking behavior.

11. The applicant was discharged because of his physical disability on 2 March 2002. His DD Form 214 shows that he was retained in the Army for 814 days for the convenience of government and that he was awarded disability severance pay of $21,027.60.

12. On 5 June 2002 the applicant was seen for one hour by a staff psychiatrist at a VA Medical Center. She assessed his condition as depressive disorder not otherwise specified, rule out PTSD, and alcohol abuse in remission for over six months. She stated that she was extremely concerned about his former chemical exposures and possible toxicities from the same (particularly with him telling her that the MRI (magnetic resonance imaging) of his head was abnormal and the neuropsychological testing notable for memory problems in someone who was once an honor's student with a BA).

13. Pages from VA medical records show that the applicant was evaluated by VA medical personnel on 16 December 2002 and 20 December 2002. Pages from a 7 May 2002 VA medical record show that he was evaluated by a clinical psychologist. An 11 July 2003 medical record indicates that the applicant had been admitted to a VA medical clinic and that he was discharged on 11 July 2003 with a discharge diagnosis of major depressive disorder, severe, with psychotic

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features, obsessive compulsive disorder, and PTSD (Axis I), dependent traits (Axis II, hypertension, edema, dermatitis, hyperlipidemia, knee problems, tendonitis, seizure disorder, hypertension, tinea pedis this admissison (Axis III), poor social support, multiple health problems, unemployed (Axis IV), and that his global assessment of functioning was 30-35 on admission and 45 on discharge (Axis V).

14. The term “Axis” refers to the use of the multiaxial system of evaluation outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Axis I refers to clinical disorders (conditions not attributable to a mental disorder that are a focus of attention or treatment). Axis II refers to personality disorders and mental retardation. Axis III refers to general medical conditions. Axis IV refers to psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders (Axes I and II). Axis V refers to the global (overall) assessment of functioning (GAF). Axis V is for reporting the clinician’s judgment of the individuals’ overall level of functioning.

15. The GAF scale may be particularly useful in tracking the clinical progress of individuals in global terms, using a single measure. The GAF scale is to be rated with respect only to psychological, social, and occupational functioning. Scale is reported on Axis V as follows: “GAF= “ followed by the GAF rating from 1 to 100, followed by the time period reflected in the ratings in parentheses, for example “(current),” and “(highest level in past year).”

16. GAF scale 100-91 describes a person with “superior functioning in a wide range of activities … No symptoms.” GAF 90-81, a person with “absent or minimal symptoms, good functioning in all areas … socially effective, generally satisfied with life, no more than everyday problems or concerns.” GAF 80-71, a person, “if symptoms are present, they are transient and expectable reactions to psychosocial stressors; no more than slight impairment in social, occupational, or school functioning.” GAF 70-61, a person with “some mild symptoms or some difficulty in social, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships.” GAF 60-51, a person with “moderate symptoms or moderate difficulty in social, occupational, or school functioning.” GAF 50-41, a person with "serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job)."

17. The examining psychiatrist stated that the applicant was a 40 year old domiciliary resident since February 2003 who went to the emergency room asking for help with his worsening depression and anger problems associated with suicidal ideation. The psychiatrist stated that the applicant was ruminating about his persecution while in the Army, and relating to his discharge which caused him to become enraged to the point of being unable to control his emotions, and that he felt that his condition had deteriorated since being discharged from the Army. He indicated that the applicant endorsed suicidal ideations with a plan to kill himself with carbon monoxide poisoning.

18. The doctor stated that the applicant was admitted to the locked acute psychiatric care unit as he was still endorsing suicidal/homicidal ideations toward his ex-commanding officers; however, upon exploration, he did not know where they were, had no plan to find out, and had never tried to contact them. He stated that the applicant had no history of violent behavior. He stated that the applicant was moved to the open unit, where he seemed to improved and that his mood did improve although he still reported feeling of sadness even on the day of his discharge; however, currently denied any suicidal/homicidal ideations and felt more in control of himself, his emotions, and his impulses. The doctor stated that he would be discharged with prescriptions for certain medications.

19. On 17 April 2003 the applicant completed a disability report for the Social Security Administration. On 1 September 2003 the Social Security Administration informed the applicant and his mother that the applicant was entitled to monthly disability benefits beginning in August 2002 and that his mother was the applicant's representative payee.

20. Army Regulation 635-40 establishes the Army physical 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. It provides for medical evaluation boards, which are convened to document a Soldier’s medical status and duty limitations insofar as duty is affected by the Soldier’s status. A decision is made as to the Soldier’s medical qualifications for retention based on the criteria in AR 40-501, chapter 3. If the MEB determines the Soldier does not meet retention standards, the board will recommend referral of the Soldier to a PEB.

21. Physical evaluation boards are established to evaluate all cases of physical disability equitability for the Soldier and the Army. It is a fact finding board to investigate the nature, cause, degree of severity, and probable permanency of the disability of Soldiers who are referred to the board; to evaluate the physical condition of the Soldier against the physical requirements of the Soldier’s particular office, grade, rank or rating; to provide a full and fair hearing for the Soldier; and to make findings and recommendation to establish eligibility of a Soldier to be separated or retired because of physical disability.

22. Title 10, United States Code, section 1203, provides for the physical disability separation of a member who has less than 20 years service and a disability rated at less than 30 percent.
23. Title 38, United States Code, sections 1110 and 1131, permit the Department of Veterans Affairs (VA) to award compensation for disabilities which were incurred in or aggravated by active military service. However, an award of a higher VA rating does not establish error or injustice in the Army rating. An Army disability rating is intended to compensate an individual for interruption of a military career after it has been determined that the individual suffers from an impairment that disqualifies him or her from further military service. The VA, which has neither the authority, nor the responsibility for determining physical fitness for military service, awards disability ratings to veterans for conditions that it determines were incurred during military service and subsequently affect the individual’s civilian employability. Accordingly, it is not unusual for the two agencies of the Government, operating under different policies, to arrive at a different disability rating based on the same impairment. Furthermore, unlike the Army, the VA can evaluate a veteran throughout his or her lifetime, adjusting the percentage of disability based upon that agency’s examinations and findings. The Army rates only conditions determined to be physically unfitting at the time of discharge, thus compensating the individual for loss of a career; while the VA may rate any service connected impairment, including those that are detected after discharge, in order to compensate the individual for loss of civilian employability. A common misconception is that veterans can receive both a military retirement for physical unfitness and a VA disability pension. By law, a veteran can normally be compensated only once for a disability. If a veteran is receiving a VA disability pension and the ABCMR corrects the records to show that a veteran was retired for physical unfitness, the veteran would have to choose between the VA pension and military retirement.

DISCUSSION AND CONCLUSIONS:

1. The applicant's medical records are sparse considering the numerous medical conditions for which he was evaluated. Obvious from the documents which he submits, is the fact that his conditions were evaluated extensively as shown by the conditions listed on his June 2001 MEB proceedings. The applicant himself lists over 20 conditions, names numerous doctors who treated him for his various conditions over a period of four years, and the clinics or hospitals where he was treated. His enlistment documents are unavailable to the Board; however, his DD Form 214 shows that he was retained in the Army, presumably beyond his separation date (ETS) for over two years, and again presumably because he was undergoing medical evaluations.

2. There is no narrative summary of his medical conditions noted on the MEB proceedings, nor are there any records of any MEB addendums, as most assuredly there would be, considering the fact that the MEB had referred their report and the applicant's appeal for additional consultation. There is no record of the informal PEB proceedings, which necessarily would have taken place before the convening of a formal board, nor has the applicant submitted copies of any appeals to any of the board proceedings.

3. That the applicant was treated for depression is noted as is the diagnoses provide by a VA clinical psychologist subsequent to his discharge; however; the MEB did not include a diagnose of depression in its findings and there is no evidence that this condition was unfitting. The applicant's contention that medical personnel intentionally failed to diagnosis his condition as depression is not borne out by the available evidence. His contention that he was physically and mentally abused is not supported by any evidence.

4. The applicant had medical problems while assigned to Johnston Atoll; however, apparently not affecting his performance of duty, at least not until the latter part of 1999, as evidenced by his award of the Army Achievement Medal and the Army Commendation Medal.

5. Whether or not the applicant has received a service-connected disability rating from the VA is not known. He is receiving disability benefits from the Social Security Administration. Nonetheless, any rating action by the VA or any disability benefits awarded by another agency does not necessarily demonstrate any error or injustice in the Army rating. The VA and the Social Security Administration operate under their own policies and regulations and assign disability ratings or benefits as they see fit. Actions by those agencies do not compel the Army to modify its rating.

6. Notwithstanding the documents that the applicant has submitted with his request, there is insufficient evidence to indicate that the applicant's discharge from the Army with severance pay was unjust or erroneous.

7. The applicant has submitted neither probative evidence nor a convincing argument in support of his request.

BOARD VOTE:

________ ________ ________ GRANT RELIEF

________ ________ ________ GRANT FORMAL HEARING

___LM __ ___LS___ ___JM___ DENY APPLICATION

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 for correction of the records of the individual concerned.





                  _____Lana McGlynn_______
                  CHAIRPERSON

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INDEX

CASE ID	AR2003099080
SUFFIX
RECON	YYYYMMDD
DATE BOARDED	20040701
TYPE OF DISCHARGE	(HD, GD, UOTHC, UD, BCD, DD, UNCHAR)
DATE OF DISCHARGE	YYYYMMDD
DISCHARGE AUTHORITY	AR . . . . .
DISCHARGE REASON
BOARD DECISION	DENY
REVIEW AUTHORITY
ISSUES 1.	108.00
2.
3.
4.
5.
6.