RECORD OF PROCEEDINGS


	IN THE CASE OF:	  


	BOARD DATE:	  4 December 2007
	DOCKET NUMBER:  AR20070002063 


	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.  


Ms. Catherine C. Mitrano

Director

Mrs. Nancy L. Amos

Analyst


The following members, a quorum, were present:


Ms. Linda D. Simmons

Chairperson

Ms. Eloise C. Prendergast

Member

Mr. James R. Hastie

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 her discharge for disability due to an EPTS (existed prior to service) condition be changed to a medical retirement.

2.  The applicant states that the Medical Evaluation Board (MEB) found that her condition, multiple sclerosis (MS), was not EPTS.  The Physical Evaluation Board (PEB) then ignored the finding of the MEB and stated that her condition was EPTS.  There is compelling evidence to show she had left optic neuritis prior to her active duty service.  However, optic neuritis and MS are two different and separate disorders.  She was diagnosed with left optic neuritis in September 2000 and was diagnosed with MS in November 2002.  At the time of her diagnosis of left optic neuritis, an MRI (magnetic resonance imaging) had ruled out MS.  No one knows what causes MS.  The progression of MS can be unpredictable.  She has extensively researched the disease, and her research proves that in MS there are no absolutes.  

3.  The applicant provides a letter, dated 13 November 2006, from her neurologist; her DD Form 214 (Certificate of Release or Discharge from Active Duty) for the period ending 16 June 2005; an Army National Guard (ARNG) Retirement Points History Statement; active duty for special work (ADSW) orders, dated 4 January 2002; ADSW orders, dated 14 March 2002; separation orders, dated 8 June 2005; discharge orders, dated 3 January 2006; her MEB packet; and a portion of her formal PEB packet.

CONSIDERATION OF EVIDENCE:

1.  The applicant enlisted in the ARNG on 17 May 1996.

2.  In September 2000, the applicant was diagnosed with optic neuritis.  At the time, an MRI revealed no abnormalities of the brain.

3.  The applicant entered active duty in an ADSW status on or about 15 January 2002 until on or about 5 April 2002.  She entered active duty in an Active Guard Reserve (AGR) status on 22 April 2002.  

4.  A neurological examination, dated on or about 27 February 2003, indicated that the applicant’s optic neuritis started in her left eye in April 2002.  It cleared, then occurred in her right eye in August 2002.

5.  A civilian eye examination, dated 31 October 2002, indicated that the applicant was recently seen for a complaint of blurred vision in both eyes, worse when exercising and when hot “over 5 months.”
6.  The applicant’s MEB Narrative Summary, in the History of Present Illness section, indicated that she developed optic neuritis in November 2002.  On       24 November 2004, the MEB referred the applicant to a PEB due to MS with Uthoff’s phenomenon.  On the DA Form 3947 (Medical Evaluation Board Proceedings), the MEB indicated that the condition was not EPTS.

7.  The advisory opinion obtained in this case noted that, on 8 December 2004, an informal PEB found that the applicant’s condition of MS actually began at the time of her first optic neuritis diagnosis in 2000 and that her condition of MS actually began or was incurred at, or prior to, that initial discovery.  The informal PEB recommended separation without benefits.  The applicant nonconcurred and requested a formal hearing.  

8.  On 11 February 2005, a formal PEB found the applicant to be unfit due to MS with optic neuritis.  The PEB also found the condition to have been EPTS, not permanently aggravated by her service beyond natural progression.  The DA Form 199 (Physical Evaluation Board (PEB) Proceedings) noted, “Despite the DA Form 3947 entry, a 31 Oct 02 Outpatient Note and 17 December 2004 Neurology Memo state that Soldier had left optic neuritis two years prior.  Brain lesions present on MRI at time of diagnosis in 2002 indicating MS well established.”  The formal PEB recommended the applicant be separated without disability benefits.

9.  The advisory opinion obtained in this case noted that, on 21 February 2005, the applicant nonconcurred with the findings of the formal PEB and requested further review.  The PEB did not change its findings.  On 4 March 2005, the U. S. Army Physical Disability Agency (USAPDA) reviewed the applicant’s case and found that the PEB’s findings were supported by a preponderance of the evidence.

10.  On 16 June 2005, the applicant was honorably discharged by reason of an EPTS disability.  

11.  The applicant provided a letter from her neurologist, dated 13 November 2006.  Her neurologist noted that having had one episode of optic neuritis in September 2000 was NOT (emphasis in the original) diagnostic of MS even 
when considered retrospectively.  He stated, “Hence, one cannot tell a patient 
who subsequently develops multiple sclerosis, that having had one episode of optic neuritis several years back meant she had the disease since then.  The criteria of having more than 2 symptoms spaced out in time and space are essential to establish the diagnosis.”

12.  In the processing of this case, an advisory opinion was obtained from the   USAPDA.  This Agency noted that the applicant and the MEB viewed “incurred” as the act of final diagnosis rather than when the disease process actually began.  The USAPDA acknowledged that the applicant’s MS was not officially diagnosed until she was on active duty in 2002.  However, the Agency also noted that her first diagnosis of optic neuritis in 2000 was the discoverable beginning of her MS.  The Agency cited long-term follow-up studies that have indicated that up to 75 percent of female patients initially presenting with optic neuritis ultimately develop MS, and the applicant’s diagnosis of MS within 2 years after the occurrence of optic neuritis supports the conclusion that the demyelinating inflammation/processes associated with her confirmed MS had its genesis prior to her being ordered to active duty.

13.  A copy of the advisory opinion was provided to the applicant for comment or rebuttal.  She did not respond within the given time frame.

14.  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 regulation defines “physically unfit” as unfitness due to physical disability.  In pertinent part, it states 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 the military service.  Examples are manifestation of lesions or symptoms of chronic disease from date of entry on active military service (or so close to that date of entry that the disease could not have started in so short a period) will be accepted as proof that the disease existed prior to entrance into active military service.  

15.  The National Institutes of Health internet website medlineplus.gov states that the cause of optic neuritis is unknown.  The inflammation of the optic nerve may occasionally be the result of a viral infection, or it may be caused by autoimmune diseases such as MS.  About 20 percent of patients with a first episode of optic neuritis will develop MS.

DISCUSSION AND CONCLUSIONS:

1.  It is acknowledged that optic neuritis and MS are two different and separate disorders.  However, there is a body of credible medical evidence that closely links the two diseases.  


2.  The applicant was first diagnosed with left optic neuritis in September 2000.  She entered active duty in January 2002.  There is evidence of record to show her optic neuritis in her left eye reoccurred in April 2002, only 3 months after she entered active duty.  It then occurred in her right eye in August 2002.  She was diagnosed with MS in November 2002.  

3.  The applicant’s MEB Narrative Summary indicated that she developed optic neuritis in November 2002.  It appears the MEB may not have been aware that she was initially diagnosed with optic neuritis in September 2000 and that it reoccurred in April and August of 2002.  Based on this apparent ignorance, it is then understandable why the MEB would have determined that her MS was not EPTS.

4.  It is acknowledged that the progression of MS can be unpredictable and “in MS there are no absolutes.”  Nevertheless, according to accepted medical principles manifestation of symptoms of chronic disease from date of entry on active military service (or so close to that date of entry that the disease could not have started in so short a period) will be accepted as proof that the disease existed prior to entrance into active military service.  

5.  It is very possible that the applicant did not have full-blown MS at the time the MRI was taken in September 2000.  However, according to those medical principles, and given the applicant’s occurrences of optic neuritis in September 2000 and April 2002, it is very likely she had MS prior to her entry on active duty in January 2002.  The fact that it was not formally diagnosed until November 2002 does not mean that she did not have MS at an earlier date.  It appears that her PEBs made a valid determination that her condition was EPTS based upon those accepted medical principles. 

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

__lds___  __ecp___  __jrh___  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.




__Linda D. Simmons____
          CHAIRPERSON




INDEX

CASE ID
AR20070002063
SUFFIX

RECON

DATE BOARDED
20071204
TYPE OF DISCHARGE

DATE OF DISCHARGE

DISCHARGE AUTHORITY

DISCHARGE REASON

BOARD DECISION
DENY
REVIEW AUTHORITY
Ms. Mitrano
ISSUES         1.
108.00
2.

3.

4.

5.

6.