RECORD OF PROCEEDINGS


      IN THE CASE OF:


      BOARD DATE:         26 OCTOBER 2004
      DOCKET NUMBER:  AR2004102423


      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             |
|     |Ms. Deborah L. Brantley           |     |Senior Analyst       |


      The following members, a quorum, were present:

|     |Mr. John Slone                    |     |Chairperson          |
|     |Mr. Curtis Greenway               |     |Member               |
|     |Ms. Eloise Prendergast            |     |Member               |

      The Board considered the following evidence:

      Exhibit A - Application for correction of military records.

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

THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE:

1.  The applicant requests, in effect, that her discharge be voided.

2.  The applicant states that she feels that she was “unjustly discharged.”
 She states that she went through “a Medical Board for approximately two
years” and that she has a diagnosis of “Somatoform Disorder” and, at the
time she submitted her application, was scheduled to be discharged without
benefits.

3.  She states that her medical records do not support the diagnosis and
that she had no “psych” records.

4.  The applicant maintains that her medical board was not based on her
medical conditions, but was “solely psychological.”  She states she had no
one to help her.

5.  The applicant notes that when she got off the plane in Alaska she had a
headache and when it did not go away she sought medical treatment.  She
states that she felt pain in her right hip after coming down “Birch Hill”
and sought medical treatment for that but x-rays proved nothing.  When she
arrived at Fort Meade, Maryland in November 2000 she began all over again
with pain in her hip.  She states that she saw her primary care physician
but by that time she was having other medical issues, including an
overactive bladder.  She states that when no relief was available and her
physician could not determine the source of her problems she was referred
to a psychiatrist.  Although different psychiatrists saw her, no records
are available and she was told they just took personal notes.

6.  The applicant states that she tried to give her chain of command the
respect they deserved but got no respect in return.

7.  The applicant provides copies of her service medical reports in support
of her request.

CONSIDERATION OF EVIDENCE:

1.  Records available to the Board indicate that the applicant underwent an
entrance physical examination on 21 August 1996 in which she noted that she
was in good health.  She did note that she had recently experienced weight
gain and that she had sustained a head injury, which required sutures, but
no other complications.  She also noted that she had a hysterectomy in 1991
after giving birth to three children (1983, 1985, 1987).  The examining
physician found her medically qualified for enlistment.
2.  On 17 October 1996, at the age of 31, she enlisted in the Army for a
period of 4 years.  She was not married at the time and her three children
were “in the custody of the other parent or another adult by court order”
according to her enlistment documents.  She successfully completed training
as a medical supply specialist and in March 1997 she was assigned to the
Medical Activity at Fort Wainwright, Alaska.

3.  Almost immediately, the applicant began seeking medical treatment.
While the medical documents from service medical records created at the
time the applicant was assigned to Alaska are difficult to read, they do
indicate that she had multiple visits to medical authorities for headaches,
in addition to complaints of neck pain, hip pain, blurred vision, face and
neck pain, insomnia, eczema, rashes, and stomach pain.  The records do
indicate that in 1997 she was treated twice for depression.

4.  A 1 July 1997 medical consultation sheet notes that she was seen by
mental health officials for depression, and that she complained of
insomnia, poor appetite and crying spells.  The analyst’s impression was
that the applicant was suffering from a major depressive disorder, single
episode, mild which was partially responsive after increasing her anti-
depressant dosage.  The physician also noted that a borderline personality
disorder was possible and that there were no chronic medical problems
reported.  The physician recommended continued medication, enrollment in
stress and anger management classes, and follow-up visits with mental
health.

5.  In March 2000 the applicant was evaluated for physical therapy because
of her bilateral hip pain complaints.  The evaluation noted that she had
complained of bilateral hip pain since May 1999, although her symptoms at
the time were intermittent and that at the time of the evaluation she was
only experiencing pain in her right hip.  Her range of motion included 115
degrees flexion for left hip and 110 degrees for right hip (90 degrees is
considered normal), 35 degrees external and internal rotation left hip, 30
degrees external rotation right hip, and 40 degrees internal (45 degrees is
considered normal), and 30 degrees abduction for both right and left hips
(45 degrees is considered normal).  Special tests were all negative.

6.  A 12 September 2000 evaluation of her right hip pain showed that her x-
rays were normal and any focal lesion in her right proximal “that looked to
be possible osteoid osteoma” over a year ago had resolved.  The evaluating
orthopedic surgeon noted that “at this point there is no objective basis
for the pain that she has in her hip.”  On 13 September 2000 the applicant
attempted to contacted the physician via telephone requesting that she be
seen as soon as possible for back and leg pain.  She related that she was
in pain and asked that the physician call her at work.  The physician noted
that he was not available to see her and that she could make an appointment
with another provider, but that orthopedics was unable to help her and
suggested that she get a second opinion at her next duty station.

7.  A 21 September 2000 evaluation by another orthopedic surgeon found that
the applicant walked with a normal gait, was able to squat and rise without
difficulty, has full range of motion, normal bone scan, normal MRI, and
normal
x-rays.  He indicated that he did not “feel that it is articular in nature”
and that it could be a soft tissue issue.  He recommended she follow up
with her primary care provider as needed.

8.  In November 2000 the applicant was reassigned to Fort Meade, Maryland.

9.  In December 2000 the applicant sought medical treatment three times for
headaches.  In 2001 and 2002 she was seen by medical officials up to three
times per month for a variety of complaints including headaches, hip pain,
gas, wrist pain, urinary urgency, flu like symptoms, constipation, and an
overactive bladder.

10.  A 27 March 2001 visit noted that her recent labs were within normal
limits, a 17 April 2001 colonoscopy was normal, and a 16 November 2001 MRI
was also normal.

11.  A 29 August 2001 medical treatment form noted that the applicant was
seen by neurology and psychiatry.  The treatment form reflected the
notation “multiple complaints” followed by question marks and the notation
“somatic pain.”  She was advised to follow up with neurology and
psychiatry.

12.  A 19 October 2001 evaluation noted that the applicant had been seen by
several providers over the past 3 years for hip pain, and complained that
nothing made it better and nothing made it worse, although at the time of
the 19 October 2001 visit she had no pain in either hip.  The evaluating
physician noted the applicant was not in any acute distress, that she had
good range of motion and equal strength and that her physical evaluation
was within normal limits.  The physician annotated the evaluation with the
notation “Somatization Disorder.”

13.  In 2003 the applicant continued to seek medical attention at least
once or twice per month.  Her complaints consisted of low back pain and
continued hip pain, weight loss, sleep problems, flu like symptoms, that
her ears hurt, swelling and pain in her arm following a flu shot, digestive
disorders, and that she felt tingling in her arm, numbness in her toes and
that her hands were cold.  She did complain of headaches on at least three
occasions, which in 2000 had been the predominant basis for her seeking
medical treatment.

14.  On 7 January 2003 the applicant was issued a permanent physical
profile for “undifferentiated somatoform disorder” which precluded her from
deploying or field exercises, use of firearms, and that she was required to
stay within 50 miles of a medical treatment facility.  The profile did not
preclude any physical activity and indicated that she could participate in
physical fitness training and take the physical fitness test.

15.  In February 2003 her physician recommended that she be scheduled for a
physical examination for a Medical Evaluation Board (MEB).

16.  On 4 February 2003 the applicant underwent a MEB.

      a.  The evaluation noted that the applicant “presents a long history
of physical complaints to which no clear and consistent physiological basis
can be determined.”


      b.  The applicant stated that her problems were medical and not
psychological and complained that she was not being given consistent,
appropriate care by her physicians.  She reported that her problems began 4
years ago in Alaska when she developed headaches which have persisted since
then.  She noted that at times the headaches were in the temporal area and
at times in the back of the neck.  She related that shortly after her
arrival in Alaska she developed hip pain and that orthopedics followed her
case for a year.  She stated that “when she played softball she could
forget about the head and hip pain, but they would come back as soon as she
stopped playing.”  She stated that since December 2000 she has also noted
an overactive bladder.  She believes that everything is medical and the
doctors just cannot find the cause.

      c.  The evaluating physician noted the applicant’s medical records
showed “visits to the medical doctors roughly one to two times per month,
with the complaint alternating often.”

      d.  Psychological testing, conducted in June and July 2001, reflected
an individual extremely preoccupied with physical fears and complaints that
are indicative of a somatoform disorder with hypochondriacal features.  The
diagnosis of somatization disorder is more appropriate than pain disorder
associated with a general medical condition.  Her personality style of
passivity, denial of anger and not expressing emotions is very consistent
with somatization. Her withdrawal and introversion probably serve to worsen
her symptoms.

      e.  The applicant was seen on three occasions by mental health.  In
1996 just a few months prior to enlisting in the Army, in July 2000 when
she was given a diagnosis of somatization disorder and pain disorder
associated with psychological factors, and once at Walter Reed.

17.  The evaluating physician concluded that the applicant suffered from
undifferentiated Somatoform Disorder manifested by a 4½ year pattern of
recurring, multiple, clinically significant somatic complaints.  He noted
that at times she describes headaches that seem to be migraines at other
times stress.  However, her description is very dramatic.  Her hip pain
cannot be fully explained by any known general medical condition.  She has
also had irritable bowl syndrome and presently complains of urinary
frequency.  Because of a lack of undocumented symptoms prior to age 30, she
does not meet the full criteria for somatoform disorder but meets all the
other criteria.

18.  He concluded that the applicant strongly believes she has a medically
based disorder and is very resistant to a predominately psychologically
based explanation of her symptoms.  This is a chronic but fluctuating
disorder with a poor prognosis.  Based on several sessions, the Soldier has
no insight into her condition and is consider a poor candidate for therapy.
 Her primary care manger reports that the applicant had continued frequent
use of medical resources and has a new set of medical complaints.  The
service member reported that the only reason she stayed in the Army was she
wanted the Army to take care of her medical conditions before she got out.
She is able to perform her military duties, but looses much time from work
because of medical complaints.  He recommended referral to a Physical
Evaluation Board (PEB).

19.  The applicant’s unit commander noted “there is no room in today’s MTF
[medical treatment facility] or the Army to retain a non-deployable
soldier.”

20.  The applicant non-concurred with the MEB on 6 March 2003 and submitted
a statement of rebuttal.  She stated that she had not seen the doctor since
sometime mid last year and that in order to make an appropriate summary,
the doctor should at least evaluate her to determine if the condition has
changed or not.  She requested an appointment with another physician on
staff “to ensure that the Medical Board that is submitted accurately
reflects my current medical condition.”  A notation on the statement listed
multiple medical visits in response to the applicant’s contention that she
had not seen the doctor since sometime mid last year.
21.  In response to her rebuttal, the evaluating physician noted that the
applicant’s medical board and outpatient medical records were reviewed and
that the applicant was “also given a clinical interview.”  He stated that
her medical records and her report both contain “an extensive medical
history covering at least several years of chronic physical complaints
without a known medical condition or conditions to explain them.”  He then
listed the common complaints and noted that various treatments and
medications have failed to resolve her complaints.  He noted that she likes
to keep to herself and not be bothered by others and that since her medical
board in February, she has continued to have many medical visits without
significant findings or improvement in her symptoms. He concurred with the
diagnoses and recommendations in her medical board.

22.  Prior to the applicant’s informal PEB, her case was returned for
further medical clarification of issues contained in her MEB.

23.  On 17 June 2003, after the issues had been clarified, the applicant
underwent an informal PEB.  The PEB concluded that the applicant’s
somatoform disorder, and her current profile prohibiting the use of
firearms, rendered her unfit.  It noted that other than being non-
deployable, the applicant is able to perform all requirements of her
primary specialty but that she has “a history of a psychiatric disorder
prior to entry on active duty.”  The PEB reviewed the medical evidence of
record and concluded there was “sufficient evidence to substantiate an EPTS
(existed prior to service) condition” which rendered her unfit for
continued service.  The PEB recommended she be discharged without benefits
based on the EPTS condition.  The applicant nonconcurred and demanded a
formal hearing.

24.  On 9 September 2003, the applicant underwent a formal PEB.  The formal
PEB also concluded that the applicant’s condition existed prior to entry on
active duty and recommended discharge without benefits.  The applicant did
not concur and submitted a statement of rebuttal.

25.  In her rebuttal she listed her medical conditions and the medication
she was taking for each condition.  She stated that she felt that even
though she did not “meet the full criteria for somatoform disorder because
of lack of undocumented symptoms prior to the age of 30…they didn’t have an
answer but just put me in that category to get rid of me.”  She argued that
her medical issues were not addressed or considered because they were not
listed.

26.  Her appeal was considered by the PEB, including a 30 September 2003
addendum to her formal PEB from an orthopedic doctor who concluded that
based on his assessment she was suffering from “low-grade chronic low back
and right hip pain” but that it was not disqualifying and no specific
orthopedic recommendations were made.  The president of the PEB noted that
although the applicant did not present any new clinical objective evidence,
her case was carefully reviewed and the PEB found no basis to change its
original determination and “reaffirmed its previous findings.”

27.  On 28 October 2003 the findings and recommendation of the formal PEB
were approved on behalf of the Secretary of the Army.

28.  Although a copy of the applicant’s separation document was not
available to the Board, orders contained in files which were available
indicate that the applicant was discharged on 29 January 2004.  Her
application to this Board was dated 23 January 2004.

29.  Documents available to the Board noted that the applicant married in
1999 and at some point regained custody of her three children and assumed
responsibility for a grandchild as well.  She reenlisted in July 2000 for 3
years and in September 2002 for 4 years.  She successfully completed the
Primary Leadership Development Course in December 2002 and was promoted to
pay grade E-5 in May 2003.  Her single performance evaluation report,
completed in January 2004 as part of her separation processing, noted that
she was a successful Soldier who received commendable ratings, and
maintained 100 percent accountability of medical supplies.  The evaluation
noted that the applicant passed a physical fitness test in October 2003,
that she inspired others by being energetic and physically fit, and
consistently achieved exceptional results in all assigned duties.  She was
awarded two awards of the Army Good Conduct Medal.

30.  The Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, states that the common feature of the Somatoform Disorders is the
presence of physical symptoms that suggest a general medical condition and
are not fully explained by a general medical condition, by the direct
effects of substance, or by another mental disorder.  The symptoms must
cause clinically significant distress or impairment in social, occupation,
or other areas of function.  In contrast to Factitious Disorders and
Malingering, the physical symptoms are not intentional.  There are multiple
versions of Somatoform Disorders including Somatization Disorder (a
polysymptomatic disorder that begins before age 30, extends over a period
of years, and is characterized by a combination of pain, gastrointestinal,
sexual, and pseudoneurological symptoms) and Undifferentiated Somatoform
Disorder (characterized by unexplained physical complaints, lasting at
least 6 months, that are below the threshold for a diagnosis of
Somatization Disorder).
31.  Army Regulation 635-40,  paragraph  3-3,  provides  that  according  to
accepted medical principles, certain abnormalities and  residual  conditions
exist that, when discovered, lead to the  conclusion  that  they  must  have
existed or have started before the individual entered military service.

32.  Army Regulation  635-40,  paragraph  B-10,  provides  that  hereditary,
congenital and other EPTS conditions  frequently  become  unfitting  through
natural progression and should not be assigned a  disability  rating  unless
service aggravated complications are clearly documented or unless a  soldier
has been permitted to continue on active duty after such a condition,  known
to be progressive, was diagnosed or should have been diagnosed.

DISCUSSION AND CONCLUSIONS:

1.  The applicant’s contention that her medical conditions were not
considered during her disability processing is without foundation.  Both
the MEB and PEB document that the applicant’s entire medical records and
her input were considered prior to rendering a final determination.  Both
the MEB and PEB noted that while the applicant was able to perform her
military duties, she was rendered unfit primarily because of the
restrictions placed on her military service by her physical profile which
was implemented because of her Undifferentiated Somatoform Disorder.  The
fact that her other unexplained physical complaints were not listed is not
evidence that they were not considered, nor does is serve as a basis to
invalidate the MEB or PEB.

2.  Contrary to the applicant’s contention, her disability processing did
not go on for over two years.  She was referred to the MEB in February 2003
and discharged in January 2004, less than 12 months later.  Delays in the
finalization of her disability processing could be attributed to her
rebuttal of the findings of the MEB, informal PEB, and formal PEB.  In each
instance the rebuttals resulted in further reviews of her complaints and
her medical records.

3.  The evidence which is available in the form of passed physical fitness
test, a complimentary performance evaluation report, successful completion
of the Primary Leadership Development Course, promotion, award of two Army
Good Conduct Medals, and her reenlistment on two separate occasion, is
evidence that in spite of her numerous medical complaints and doctor
visits, the applicant was a good Soldier.  Obviously members of her chain
of command continued to work with the applicant and believed that her
situation would and could be resolved.  It was not until her physical
profile became so limiting as to preclude deployment, handling of weapons,
and assignment restrictions, that disability processing became necessary.
The fact that she was allowed to remain in the military as long as she did,
and continued to move up through the ranks, is evidence that members of her
chain of command supported her, which is contrary to her contention that
she had no one to help her.

4.  The applicant has not provided any new medical evidence, which was not
available at the time of her disability processing, which shows that the
findings and recommendations of the PEB were incorrect.

5.  The applicant’s separation was accomplished in compliance with
applicable regulations with no indication of procedural errors which would
tend to jeopardize her rights.

6.  The contention of the applicant that she was unjustly discharged or
that her diagnosis was wrong is not supported by either evidence submitted
with the application or the evidence of record.

7.  In order to justify correction of a military record the applicant must
show, or it must otherwise satisfactorily appear, that the record is in
error or unjust.  The applicant has failed to submit evidence that would
satisfy the aforementioned requirement.

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF

________  ________  ________  GRANT PARTIAL RELIEF

________  ________  ________  GRANT FORMAL HEARING

__JS____  __CG ___  ___EP __  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 for correction of the
records of the individual concerned.



                                  ______John Slone________
                                            CHAIRPERSON

                                    INDEX

|CASE ID                 |AR2004102423                            |
|SUFFIX                  |                                        |
|RECON                   |YYYYMMDD                                |
|DATE BOARDED            |20041026                                |
|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.                      |                                        |


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