RECORD OF PROCEEDINGS


      IN THE CASE OF:


      BOARD DATE:            16 September 2004
      DOCKET NUMBER:   AR2004101068


      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             |
|     |Mrs. Nancy L. Amos                |     |Analyst              |


      The following members, a quorum, were present:

|     |Mr. Luther L. Santiful            |     |Chairperson          |
|     |Mr. John T. Meixell               |     |Member               |
|     |Ms. Marla J. Troup                |     |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 that she be placed on active duty medical
evaluation (ADME) and that her military medical records be corrected to
reflect the injuries, illnesses, and diseases that were not diagnosed
during her active service.

2.  The applicant states that she was released from active duty with severe
injuries, illnesses, and diseases.  She should have been kept on active
duty until accurate documentation was entered in her medical records for an
active duty disability rating.  She was never informed about ADME until
July 2003.  ADME provisions allow a soldier to apply for ADME after release
from active duty but she was denied due to her application being submitted
after she had been released for almost a year.

3.  The applicant states that she has been diagnosed with severe
fibromyalgia that her doctors say probably occurred due to the increased
injury to her back when she fell from a 5-ton truck in March 2002.  The
symptoms were very mild after that accident; however, now the conditions
have come upon her at once, making simple tasks almost impossible.  The
results of the September 2002 echocardiogram were not disclosed to her
until recently.

4.  In a Soldier's Statement, the applicant states that she entered active
duty in August 1999 in an Active Guard Reserve (AGR) status.  In September
1999, during training, a bone scan found a stress fracture in her right
sacral wing.  She elected to continue training rather than go home.  In
December 1999, she fell while unloading her privately-owned vehicle.  In
January 2000, she was told she had compressed her spine and probably had a
compressed disc.  On 25 January 2000, an MRI found she had mild
degenerative disc disease.  The doctors told her she could go to work but
she was in constant pain.  She was sent to a Physical Evaluation Board
(PEB) in January 2002 and was returned to duty.

5.  In March 2002, she fell from a 5-ton truck and was sent to the nearest
hospital.  She was still awaiting her permanent P3 physical profile.  She
received no other medical treatment.  She was scared to go to the doctor
because her commander had complained so much about her seeking medical
treatment.  She received a permanent P3 physical profile in July 2002.

6.  The applicant further states that she went on sick call several times
complaining of chest pain and pressure.  She was told she had a heart
murmur and was sent to quarters.  Because of her profile, she could not
attend the Primary Leadership Development Course (PLDC) and was reduced in
rank and had to be released from the AGR program and active duty on 21
August 2002.

7.  The applicant provides her service medical records; an application for
ADME; a Department of Veterans Affairs (VA) Rating Decision; a VA magnetic
resonance imaging (MRI) report; line of duty investigation reports; her DD
Forms 214 (Certificate of Release or Discharge from Active Duty); an
evaluation from Doctor D___; letters of support; a retention physical dated
July 2003; official ADME guidance; a statement dated 27 December 2003; a
statement dated         9 April 2004; and a "Soldier's Statement."

CONSIDERATION OF EVIDENCE:

1.  After having had prior service in the U. S. Air Force, she enlisted in
the U. S. Army Reserve (USAR) on 24 October 1997 for 6 years.  On 22 August
1999, she was voluntarily ordered to active duty in an AGR status for 3
years for duty as a light wheel vehicle mechanic with the 968th
Quartermaster Company, Irvine, CA.

2.  A DA Form 2137 (Statement of Medical Examination and Duty Status) dated
20 October 1999 shows the applicant injured herself (pain in the tailbone
area) on or about 8 September 1999 while doing physical training.  The
injury was determined to have been incurred in the line of duty.

3.  A Radiological Examination Report dated 10 February 2000 shows that the
applicant had a bone scan in September 1999 that showed a focal uptake at
the right sacral wing consistent with a stress fracture.  The impression
was a congenital anomaly of the lumbosacral spine region with a sixth
lumbar-type vertebral body present with partial sacralization on the right
and also mild rotary scoliosis.

4.  A DA Form 2137 dated 12 July 2001 shows the applicant injured her back
on 2 November 1999 while doing situps for physical training.  The injury
was determined to have been incurred in the line of duty.

5.  A Staff Coordination/Approval/Routing Sheet dated 12 March 2001
indicates the applicant had been on profile since December 1999 but her
first notification to her chain of command about her profile was 12 June
2000.  On 12 May 2000, she had been conditionally promoted to Sergeant, E-5
and scheduled to attend PLDC.  Attached physical profile reports showed she
had lower back pain with muscle spasms with mild scoliosis and degenerative
disc disease.  The Staff Coordination/Approval/Routing Sheet noted the
applicant had been referred for medical boarding and requested her
deferment from PLDC.  The request was approved on 13 March 2001.

6.  A U. S. Army Physical Disability Agency (USAPDA) memorandum dated
23 January 2002 indicates the applicant appeared before a PEB and was
determined to be physically fit to perform the duties of her grade, rank
and military occupational specialty and was deployable within the
limitations of her profile.  The PEB proceedings are not available.

7.  A DA Form 2173 dated 9 March 2002 shows the applicant injured her back
on 8 March 2002 when she fell off a truck.  The injury was considered to
have been incurred in the line of duty.

8.  A DA Form 3349 (Physical Profile) dated 12 June 2002 shows the
applicant was given a permanent L3 profile due to chronic mechanical low
back pain.  She was given assignment limitations of "NO BENDING, STOOPING
OR CRAWLING.  NO MARCHING. NO LIFTING OVER TWENTY POUNDS.  MAY WEAR LCE."
The form noted that she had undergone Medical Evaluation Board (MEB)/PEB
proceedings and was returned to duty as fit per the USAPDA memorandum dated
23 January 2002.

9.  On 21 August 2002, the applicant was released from active duty upon the
completion of her required active service.

10.  An echocardiogram dated 26 September 2002 shows the applicant was
evaluated for a cardiac murmur.  The evaluation revealed no evidence of
aortic insufficiency.  The aortic valve flow was within normal limits.
Evaluation of the mitral valve revealed trace insufficiency.  There was no
evidence of mitral stenosis.  Evaluation of the tricuspid valve revealed
mild insufficiency.

11.  On 10 July 2003, the applicant underwent a retention physical
examination.  The DD Form 2808 (Report of Medical Examination) shows that
she was not qualified for service with the following significant or
disqualifying defects listed:  degenerative disc disease; muscle strain
lumbar spine without radiculopathy; patellar femoral syndrome; tendonititis
– shoulder – impingement; Achilles tendonitis; and asthma.  An attached
echocardiogram revealed no abnormalities other than a first-degree
atrioventricular (AV) block.

12.  A Radiology Report dated 1 August 2003 shows that an MRI of the
applicant's spine revealed a minor abnormality – minimal degenerative disc
at L5-S1 with minimal disc protrusion and minimal impingement on the thecal
sac but no compression on the nerve roots; minimal hypertrophy of the
ligamentum flavum was also noted at the same level; and partial
lumbarization of S1.  The alignment of the spine was normal with normal
height of the vertebral bodies.

13.  A second Radiology Report dated 1 August 2003 shows that an MRI of the
applicant's shoulder revealed a major abnormality – a partial tear in the
rotator cuff.  It also noted, "NO ATTN. NEEDED."
14.  A VA Rating Decision dated 5 August 2003 shows the applicant was
entitled to unemployability effective 22 August 2002.  She was awarded a
combined     90 percent disability rating (thoracolumbar spine condition,
40 percent; right shoulder strain, 30 percent; left ventricular hypertrophy
with mitral valve insufficiency, 30 percent; left shoulder strain, 20
percent; left elbow strain,          10 percent; tinnitus, 10 percent;
bilateral tinea pedis, 10 percent; asthma,          10 percent; left
Achilles tendonitis, 10 percent, left knee strain, 10 percent, and right
knee strain, 10 percent).

15.  On 8 August 2003, the applicant requested ADME status, which
apparently was disapproved by the Office of the Deputy Chief of Staff, G-1.

16.  Per information received from the U. S. Army Human Resources Command
in St. Louis on 7 September 2004, the applicant is still in the USAR, in a
troop program unit (TPU), with an expiration term of service of 23 October
2004 after having received two extensions.

17.  The letters of support provided by the applicant appear to have been
originally provided as support to a Noncommissioned Officer Evaluation
Report appeal.  At least two of the letters (one dated 30 April 2001 and
one dated 1 May 2001) attest to her working diligently to complete her
tasks with little or no assistance, i.e., working with tactical vehicles,
dismounting and replacing truck tires, and removing and replacing
generators.

18.  An Office of the Army Deputy Chief of Staff, G-1 memorandum dated
      16 September 2002 states that [previously issued] procedural guidance
for Reserve Component soldiers on ADME is extended until it can be included
in Army Regulation 135-XX.  Reserve Component soldiers may be retained on
active duty when the injury or illness was occurred in the line of duty and
prevents the soldier from performing his or her normal military duty.  The
request will consist of the member's consent to remain on active duty, the
physician's statement that medical treatment is required for more than 30
days, the line of duty determination, and a DA Form 4187 (Personnel Action)
signed by the commander.

19.  The Army Deputy Chief of Staff, G-1 Procedural Guidance for Reserve
Component Soldiers on ADME includes all Reserve Component soldiers who are
on active duty orders or on inactive duty training and require medical
treatment/evaluation for 30 days or more (inpatient or outpatient), and
fall under the rules, regulations, and specified entitlements for active
duty personnel.  This guidance applies to all Reserve Component soldiers
when it is determined that they are unable to perform normal military
duties in their military occupational specialty/area of concentration by a
military medical authority.  They shall be retained, subject to their
consent and Department of the Army approval, pending resolution of their
medical condition or completion by the Physical Disability Evaluation
System.  Soldiers eligible for ADME status are those requiring treatment or
evaluation for 30 days or more for an injury, illness, or disease incurred
or aggravated in the line of duty.

20.  The National Institutes of Health Internet site describes a heart
murmur as an extra or unusual sound heard during the heartbeat.  A heart
murmur is not a disease; it is a sound that the doctor hears with the
stethoscope.  It may be normal, or it could be a sign that something may be
wrong.  Most heart murmurs are harmless.  Some are a sign of a heart
problem, especially if other signs or symptoms of a heart problem are
present.

21.  The Internet site goes on to describe the types of heart murmurs.
There are innocent (harmless) murmurs, where a person has a normal heart
and usually has no other symptoms or signs of a heart problem; and abnormal
murmurs, where a person usually has other signs or symptoms of a heart
problem.  In adults, abnormal murmurs are most often due to heart valve
problems caused by infection, disease, or aging.

22.  The National Institutes of Health Internet site describes an AV block.
 It states that sometimes the signal from the upper (atria) to lower
(ventricles) chambers of the heart is impaired or does not transmit.  This
is "heart block" or "AV block."  This does not mean that blood flow or
blood vessels are blocked. There are several degrees of heart block:

      First-degree heart block occurs when the electrical impulse moves
through the AV node more slowly than normal.  Heart rate and rhythm are
normal, and there may be nothing wrong with the heart;


      Second-degree heart block occurs when some signals from the atria do
not reach the ventricles, resulting in "dropped beats;" and


      Third-degree or complete heart block means that the heart's electrical
impulse does not pass from the heart's upper to lower chambers.

23.  The National Institutes of Health Internet site describes injuries to
the rotator cuff.  It states that, most of the time, treatment for rotator
cuff injuries involves exercise therapy.  Depending on the severity of the
injury, physical therapy may take from three weeks to several months.
Other treatments may include steroid injections or, if there is a large
tear in the rotator cuff, surgery.
DISCUSSION AND CONCLUSIONS:

1.  Soldiers eligible for ADME status are those requiring treatment or
evaluation for 30 days or more for an injury, illness, or disease incurred
or aggravated in the line of duty and which prevents the soldier from
performing his or her normal military duty.

2.  On 22 August 1999, the applicant was voluntarily ordered to active duty
in an AGR status for 3 years.

3.  The evidence of record shows the applicant was injured several times
after entering active duty in 1999.  All her injuries were determined to be
in line of duty.  Her injuries were apparently severe enough for her to be
referred to a PEB sometime in 2001.  Her PEB packet is not available.
However, it is noted that several of the letters of support she provided
showed she was fully capable of performing her duties in April and May 2001
and, in January 2002, the PEB found her fit for duty.

4.  The evidence of record shows the applicant injured her back in March
2002 in an accident that was determined to be in line of duty.  She was
given a permanent profile for chronic mechanical low back pain in June
2002.  However, as she noted in her statement, her symptoms were very mild
after that accident.  Her contention that her now-diagnosed severe
fibromyalgia may have been the result of that accident has been carefully
considered.  However, as she also stated, the conditions that are now
making simple tasks almost impossible have come upon her at once.  There is
no evidence of record and she provides none that shows she was unable to
perform her military duties as a result of the March 2002 accident.

5.  It is acknowledged that the applicant was evaluated in September 2002,
about a month after her separation from active duty, for a heart murmur.
However, there is no evidence to show that it was anything other than a
"harmless" murmur.  It is noted that, when she underwent her retention
physical examination on 10 July 2003, an echocardiogram revealed no
abnormalities other than a  first-degree AV block.

6.  At this point in time, calling the applicant to ADME does not appear to
be an effective remedy.

7.  Regarding the applicant's request to correct her military medical
records to reflect the injuries, illnesses, and diseases that were not
diagnosed during her active service, the Army has an interest in promoting
the reliability of its medical records.  Alteration, or the addition, of a
diagnosis in those records after the fact may lead to fundamental questions
about the veracity of the records in this case and generally.  For these
reasons, the Board declines to add a condition that was not discovered
until after the applicant's separation in her medical records.

8.  The Secretary’s interest is in ensuring an orderly system in which a
physician makes certain observations and records them faithfully in the
medical records at the time.  It would take an extraordinary showing for
the Board to alter or add to such observations.  In this case, the
applicant’s military medical records reflect the conditions known at the
time and she has not presented sufficient reason to alter those records.

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF

________  ________  ________  GRANT PARTIAL RELIEF

________  ________  ________  GRANT FORMAL HEARING

__lls___  __jtm___  __mjt___  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.




            __Luther L. Santiful__
                    CHAIRPERSON




                                    INDEX

|CASE ID                 |AR2004101068                            |
|SUFFIX                  |                                        |
|RECON                   |                                        |
|DATE BOARDED            |20040914                                |
|TYPE OF DISCHARGE       |                                        |
|DATE OF DISCHARGE       |                                        |
|DISCHARGE AUTHORITY     |                                        |
|DISCHARGE REASON        |                                        |
|BOARD DECISION          |DENY                                    |
|REVIEW AUTHORITY        |Mr. Chun                                |
|ISSUES         1.       |110.00                                  |
|2.                      |124.00                                  |
|3.                      |                                        |
|4.                      |                                        |
|5.                      |                                        |
|6.                      |                                        |


-----------------------
[pic]