RECORD OF PROCEEDINGS


      IN THE CASE OF:


      BOARD DATE:        26 October 2005
      DOCKET NUMBER:  AR20050000712


      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. James E. Vick                 |     |Chairperson          |
|     |Mr. Conrad V. Meyer               |     |Member               |
|     |Ms. Linda M. Barker               |     |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 disability separation with
severance pay be changed to a medical retirement.

2.  The applicant makes no additional statement other than what she
outlined in her rebuttals to the informal and formal Physical Evaluation
Boards (PEBs).

3.  The applicant provides the 10 enclosures listed in the "Outline of
Paperwork" attached to her application.

CONSIDERATION OF EVIDENCE:

1.  The applicant enlisted in the Army National Guard on 16 March 1990.
She was awarded primary military occupational specialty (MOS) 71M
(Chaplain's Assistant) and secondary MOS 71L (Administrative Specialist) on
9 January 1999.  She was honorably separated from the Army National Guard
on 15 March 2000.  She enlisted in the U. S. Army Reserve on 25 September
2000.   She was ordered to active duty around March 2001.

2.  The applicant's Narrative Summary shows she was evaluated for chief
complaints of chronic fatigue syndrome (CFS), neurocardiogenic syncope,
migraines, depression, and low grade fevers.  Her symptoms all dated to
March 2001 after receiving her immunizations preparatory to deployment to
Kosovo.  In April 2001, she began having lightheadedness described as a pre-
syncopal sensation.  A cardiac work-up was negative.  After a second
episode, she was sent to Germany and then to Walter Reed Army Medical
Center to rule out multiple sclerosis.  Work-up in May 2001 was significant
for a positive tilt test (a test used to determine the cause of syncope)
with her symptoms, although the tilt positive resolved after a one-liter
bolus.

3.  The Narrative Summary indicated the applicant had previously been
diagnosed with CFS, but on 27 February 2004 a doctor stated he believed the
applicant had myofascial pain syndrome.  The applicant gets very fatigued
if she stands for more than 35 – 45 minutes, if she is too active, if she
is too warm, or if she goes more than 3 – 6 hours without lying down.  If
she tries to push herself more than that, she gets so fatigued she may
experience a syncopal episode.  She will have 4 – 6 "decent" days per
month.  She will have 5 - 6 days per month that are "bad" and she can
barely get out of bed.  Her generalized aches on those days can reach an
8/10, and it reaches an 8/10 about 2 days per month.  On the days her pain
is an 8/10 she will take an extra amitriptyline.  She feels the
amitriptyline lessens the pain somewhat.  On the bad days she forces
herself to get up, eat, bathe, and do some reading or other activities that
do not expend much energy.  She had had a total of 10 episodes of syncope
since 2000 with the last episode in October 2003.  They had become less
frequent because she could tell when they were going to happen and could
prevent them.

4.  The Narrative Summary indicated the applicant had a headache every day
for about half of the day.  Most of the time the headaches were dull and
throbbing and about a 2 – 3/10.  She would have a migraine about 4 – 6
times a month.  She had never gone to the emergency room or to the doctor's
office on an urgent basis for her headaches because "we weren't brought up
that way."  Her low-grade fevers started when the above symptoms started.
She stated she "couldn't handle fevers as a child," although she had only
one febrile seizure her mother could relate to her.  Most of the time
doctors had no explanation or stated "it must be a virus."  She described
her depression as mild.

5.  On 23 June 2003, a Medical Evaluation Board (MEB) referred the
applicant to a PEB for diagnoses of (1) neurocardiogenic syncope; (2)
myofascial pain syndrome; (3) migraine headaches; (4) low grade fevers of
uncertain etiology (existed prior to service); and (5) depressive disorder.
 The MEB also noted Axis III:  CFS, non-progressive neurologic dysfunction.
 On 6 August 2003, the applicant agreed with the MEB's findings and
recommendation.

6.  On 19 September 2004, an informal PEB found the applicant unfit for
duty for a diagnosis of CFS associated with a myofascial pain syndrome.
Activity limited by pain and fatigue 3 – 6 hours a day.  Pain is described
as a dull achiness increasing to a level of 8/10 with the pain relieved
with Elavil (20 percent); neurocardiogenic syncopic syndrome beginning in
2001 manifested by lightheadedness.  Extensive workup with MRI (magnetic
resonance imaging), holter monitor, EEG (electro-encephalogram), ECHO
(echocardiogram), CT (computed tomography) of head all interpreted as
normal.  Last episode in 2003 (zero percent); and migraine headaches
occurring 4 – 6 times a month.          Pain described as dull, throbbing
of a 2-3/10 intensity and incapacitating for         3 – 8 hours.  Pain is
relieved by resting in a dark room and taking Elavil.  Soldier has not
sought medical attention while having a migraine attack (zero percent).
Diagnoses 4 and 5 were found to be medically acceptable.

7.  On 21 September 2004, the applicant did not concur in the findings of
the informal PEB and demanded a formal hearing without personal appearance.
 On 23 September 2004, she rebutted that most of the time she was required
to lie down and rest every 3 – 5 hours per day, if her condition would even
allow her to get out of bed on any particular day.  If she ignored her
symptoms and continued to do as she wished, she lost consciousness.  The
bottom line was she had not been physically able to return to either her
civilian or military obligations in almost three years.  She could not
understand how the Army could justify the rating of 20 percent when the
Department of Veteran Affairs (DVA) had already granted her a rating of 80
percent with an increase to 100 percent due to unemployabilty and the
Social Security Administration awarded her a rating of 100 percent totally
disabled.

8.  On 19 November 2004, a formal PEB found the applicant to be unfit for
duty under the Veterans Administration Schedule for Rating Disabilities
(VASRD) code 6354 for CFS associated with a myofascial syndrome,
neurocardigenic syncopic syndrome, and migraine headaches.  Daily routine
activities limited by pain and fatigue.  Pain is described as a dull
achiness increasing to a level of      8 - 10 with the pain relieved with
Elavil.  Extensive workup with MRI, holter monitor, EEG, ECHO, CT scan all
interpreted as normal (20 percent).  Diagnoses 4 and 5 were found to be
medially acceptable.  The PEB recommended the applicant be separated for
disability with a 20 percent disability rating.

9.  On 28 November 2004, the applicant nonconcurred with the findings of
the formal PEB.  She rebutted, in addition to her rebuttal of 23 September
2004, that some things needed to be addressed.  The first important detail
overlooked was her place of residence.  At the time of her hearing, she was
not living in Maryland as the PEB assumed.  She lived and continued to live
in Massachusetts.  Her residence and medical condition at the time were the
main factors why she was not able to personally attend the formal PEB.
Also, documentation presented to the PEB proved a high toxoplasmosis and
high titer level as a result of an immunizations overdose and exposure to
untreated Lyme Disease.  Doctor C___'s medical paperwork not only included
vast blood work but symptomology in detail.  Doctor C___ stated the
applicant was deemed totally disabled based on the test results and it was
her impression she would be indefinitely disabled.  One PEB member tried to
ask about the causal relationship of the immunization to her medical
condition but the president of the PEB cut him off.

10.  The applicant stated her CFS limited her more than 60 percent of the
time.  She had to lie down on average every 3 – 5 hours for 1 – 3 hours per
day due to the fatigue and other symptoms.  She was able to drive but not
for more than    30 minutes at a time.  She had been issued a handicapped
placard from the State of Massachusetts.  Her social life suffered greatly
as well.

11.  On 15 December 2004, the U. S. Army Physical Disability Agency noted
the applicant's disagreement with the findings of the PEB and reviewed her
entire case.  The Agency concluded her case was properly adjudicated by the
PEB.

12.  On 28 December 2004, the applicant was discharged from the USAR with
disability severance pay in the grade of Sergeant, E-5 based on 3 years and
     11 days of service with a 20 percent disability rating.
13.  Army Regulation 635-40 governs the evaluation of physical fitness of
Soldiers who may be unfit to perform their military duties because of
physical disability.  The unfitness is of such a degree that a Soldier is
unable to perform the duties of his office, grade, rank or rating in such a
way as to reasonably fulfill the purposes of his employment on active duty.
 Appendix B prohibits pyramiding.  Pyramiding is the term used to describe
the application of more than one rating on any area or system of the body
when the total functional impairment of that area or system can be
reflected under a single code.  All diagnoses that contribute to total
functional impairment of any area or system of the body will be merged with
the principal diagnosis for rating purposes.

14.  The VASRD is the standard under which percentage rating decisions are
to be made for disabled military personnel.  The VASRD is primarily used as
a guide for evaluating disabilities resulting from all types of diseases
and injuries encountered as a result of, or incident to, military service.
Unlike the DVA, the Army must first determine whether or not a Soldier is
fit to reasonably perform the duties of his office, grade, rank or rating.
Once a Soldier is determined to be physically unfit for further military
service, percentage ratings are applied to the unfitting conditions from
the VASRD.  These percentages are applied based on the severity of the
condition.

15.  The VASRD gives code 6354, (Chronic Fatigue Syndrome), a 60 percent
rating when the related debilitating fatigue and cognitive impairments, or
a combination of other signs and symptoms, are nearly constant and restrict
routine daily activities to less than 50 percent of the pre-illness level;
a 40 percent rating when the impairments or a combination of other signs
and symptoms are nearly constant and restrict routine daily activities to
50 to 75 percent of the pre-illness level; and a 20 percent rating when the
impairments or a combination of other signs and symptoms are nearly
constant and restrict routine daily activities by less than 25 percent of
the pre-illness level.  (It appears the VASRD has reversed the 60 and 40
percent ratings.)

16.  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.

17.  Title 38, U. S. Code, sections 1110 and 1131, permits the DVA to award
compensation for a medical condition which was incurred in or aggravated by
active military service.

DISCUSSION AND CONCLUSIONS:

1.  The applicant's contentions, in her current application and in her
rebuttals to the informal and formal PEBs, have been carefully considered.

2.  In her rebuttal to the formal PEB's findings, the applicant stated her
chronic fatigue syndrome limited her more than 60 percent of the time.
(This appears to contradict Doctor C___'s statement that she was deemed
totally disabled.)  She then stated she has to lie down on average every 3
– 5 hours for 1 – 3 hours per day due to the fatigue and other symptoms.
The Narrative Summary indicated she had stated she would have 5 - 6 days
per month (out of about 30 days per month, about 8 of which are weekend
days) that were "bad" and she could barely get out of bed.

3.  VASRD code 6354 gives a 20 percent rating when the impairments or a
combination of other signs and symptoms are nearly constant and restrict
routine daily activities by less than 25 percent of the pre-illness level.
The applicant provides insufficient evidence to show that at the time of
her PEB her routine daily activities were restricted by more than 25
percent of her pre-illness level.

4.  The applicant contended in her rebuttal to the formal PEB that one PEB
member tried to ask about the causal relationship of the immunization to
her medical condition but the president of the PEB cut him off.  It does
not appear to have been improper for the president of the PEB to have done
so as the cause of a disability is irrelevant to the PEB's consideration
and determination of how unfit the disability rendered her.

5.  The rating action by the DVA does not necessarily demonstrate an error
or injustice in the Army rating.  The DVA (and the Social Security
Administration) operates under its own policies and regulations and assigns
disability ratings as it sees fit.  The DVA is not required by law to
determine medical unfitness for further military service in awarding a
disability rating, only that a medical condition reduces or impairs the
social or industrial adaptability of the individual concerned.
Consequently, due to the two concepts involved (i.e., the more stringent
standard by which a Soldier is determined not to be medically fit for duty
versus the standard by which a civilian would be determined to be socially
or industrially impaired), an individual’s medical condition may be rated
by the Army at one level and by the VA at another level.

6.  Based on the available evidence, it appears the PEB made a proper
determination that the applicant's medical condition warranted a 20 percent
disability rating and separation with severance pay.

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF

________  ________  ________  GRANT PARTIAL RELIEF

________  ________  ________  GRANT FORMAL HEARING

__jev___  __cvm___  __lmb___  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.




                                  __James E. Vick_______
                                            CHAIRPERSON



                                    INDEX

|CASE ID                 |AR20050000712                           |
|SUFFIX                  |                                        |
|RECON                   |                                        |
|DATE BOARDED            |20051026                                |
|TYPE OF DISCHARGE       |                                        |
|DATE OF DISCHARGE       |                                        |
|DISCHARGE AUTHORITY     |                                        |
|DISCHARGE REASON        |                                        |
|BOARD DECISION          |DENY                                    |
|REVIEW AUTHORITY        |Mr. Chun                                |
|ISSUES         1.       |108.02                                  |
|2.                      |                                        |
|3.                      |                                        |
|4.                      |                                        |
|5.                      |                                        |
|6.                      |                                        |


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