IN THE CASE OF:	  

		BOARD DATE:	  21 August 2012

		DOCKET NUMBER:  AR20120005026 


THE BOARD CONSIDERED THE FOLLOWING EVIDENCE:

1.  Application for correction of military records (with supporting documents provided, if any).

2.  Military Personnel Records and advisory opinions (if any).


THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE:

1.  The applicant requests, in effect, correction of his DD Form 214 (Certificate of Release or Discharge from Active Duty) to show he was medically discharged for disability instead of honorably discharged by reason of a "condition - not a disability."

2.  The applicant states:

* He received a chapter 5-17 on 29 June 2011 for cholinergic urticaria which also gave him stress-induced asthma
* He is allergic to sweat and when his body temperature rises, he breaks out in hives; if he does not remove himself from the situation or cool down, he goes into shock and his throat begins to close
* He believes this condition should have been considered by a medical evaluation board (MEB)
* His discharge was wrong because the shots he received for his condition threw his body in a loop
* He was a welder/mechanic until two weeks before basic combat training which he completed along with Airborne school
* If his condition was a pre-existing condition, he would not have made it or the condition would have been detected at the Military Entrance Processing Station (MEPS)
* He can no longer go outside in the sun and even a simple hot shower can now give him difficulty breathing
* He did not have this problem before and it is now affecting his quality of life
3.  The applicant provides:

* Letter to his Member of Congress
* Separation approval memorandum
* DD Form 2808 (Report of Medical Examination)
* DD Form 2807 (Report of Medical History)
* AE Form 40-6A (Unit Commander Request for Mental Health Evaluation)
* Hearing Conservation data
* Multiple chronological records of medical care
* DD Form 214
* Self-authored statement
* Letter from his employer
* Letter from a friend

CONSIDERATION OF EVIDENCE:

1.  The applicant enlisted in the Regular Army at the Lansing, MI, MEPS on 12 May 2010.  He completed basic combat and advanced individual training as well as the Basic Airborne Course at Fort Benning, GA, and he was awarded military occupational specialty 11B (Infantryman).  

2.  Subsequent to completion of training, he was reassigned to Company D, Task Force 3rd Battalion, 66th Armor Regiment, Germany, in or around October 2010.

3.  Between December 2010 and May 2011, the applicant was seen on multiple occasions at the local clinic for cholinergic urticaria, hearing problems, and other routine medical issues.  His issues mainly consisted of an increase in body temperature or mood changes.  The attending physicians prescribed medications, education, information, and recommendations for follow-ups.

4.  Two records of medical care, dated 10 December 2010 and 12 January 2011, show he complained of rashes and hives consistent with cholinergic urticaria.  He stated that his rashes began to occur in basic training and that his rashes would flare when his body heat increases.  

5.  Another record of medical care, dated 4 March 2011 shows:

* He complained of pinpoint rash and hives after working out, consistent with cholinergic urticaria; he tried antihistamine blockers with no success
* His evaluation revealed urticaria with any increase in body temperature or with mood changes (anger, anxiety, excitement) 
* Exercise was a common trigger but frequently occurs outside of exertion
* He reported evaluation off post in recent past for these same complaints, including skin testing for aeroallergy and food allergy with negative results

6.  On 7 April 2011, the applicant underwent a medical examination at the 172nd Brigade Aid Station.  The military doctor diagnosed him with:

* cholinergic urticaria and prescribed anti-histamines as required
* hyperlipitenia with a recommendation for lifestyle changes
* medically qualified for service

7.  His immediate commander referred him to a mental health evaluation and stated that:

* The applicant began noticing complications upon arrival in October 2010
* He was unable to perform physical labor
* He was on medication since December 2010 with no change to his condition
* He experienced difficulties performing physical activities due to his allergies

8.  On 13 May 2011, he underwent a mental status evaluation at the U.S. Army Health Center, Grafenwoehr.  The military clinical psychologist indicated that Axis 1 (psychiatric condition) revealed normal variations in stress and emotion level exacerbating urticaria.  The psychologist stated that:

* From a behavioral health standpoint, the applicant was fit for duty, including deployment
* He had no cognitive impairments but his pre-existing medical-dermatological condition was highly sensitive to normal variation in stress and emotional level
* In the clinical psychologist's opinion, the applicant was able to understand and participate in administrative proceedings
* The applicant's medical condition was highly reactive to normal and expected variations in day to day stress level
* The applicant's interaction of his medical condition with the normal changes in his psychological state such as stress, anger, frustration, and even strong positive feelings made him poorly suited to meet the demands of active duty service

9.  On 9 June 2011, the applicant's immediate commander notified the applicant of his intent to initiate separation action against him for other designated physical or mental conditions.  The specific reason for discharge was based on the recommendation by the psychiatrist due to normal variations in stress and emotion levels exacerbating his urticaria.  He recommended an honorable discharge.

10.  The applicant acknowledged receipt of the separation notification memorandum by reason of other designated physical or mental condition under chapter 5-17 of Army Regulation 635-200 and subsequently consulted with legal counsel.  He was advised of the basis for the contemplated separation action and its effects, the rights available to him, and the effect of a waiver of his rights.  He acknowledged he understood that he may expect to encounter substantial prejudice in civilian life if a general discharge under honorable conditions was issued to him.

11.  Subsequent to this acknowledgement, the applicant's immediate commander initiated separation action against him under the provisions of Army Regulation 635-200, paragraph 5-17.  He recommended the applicant receive an honorable discharge.

12.  On 9 June 2011, the intermediate commander recommended approval of the discharge with an honorable discharge.

13.  Consistent with the chain of command's recommendations, on 10 June 2011, the separation authority approved the applicant's discharge under the provisions of Army Regulation 635-200, paragraph 5-17 by reason of other designated physical or mental condition with an honorable discharge.

14.  He was accordingly discharged on 14 August 2011 under the provisions of Army Regulation 635-200, paragraph 5-17, based on a physical condition, not a disability, with an honorable discharge.  He was assigned a separation code of "JFV."  This form also shows he completed 1 year, 3 months, and 3 days of creditable active service.

15.  He submitted:

	a.  self-authored statement, dated 27 September 2011, wherein he states that he was an active person prior to joining the Army but his life changed after he joined.  Now, he has to spend the summer indoors because exposure to the sun would cause his hives to flare and he begins to experience anaphylactic shock, breathing difficulties, and wheezing.  Even in the winter, while on missions in Germany, he had to stop and cool himself down.  The military doctors tried anti-histamines with no success.  He worked as a welder prior to the military and despite the warm/hot working conditions, he did not experience these symptoms. His condition could not be pre-existing.  His condition should be classified as a disability.
	b.  letter, undated, from an employer who states the applicant never showed symptoms of his conditions at the time he worked there (between 2000 until he joined the military).   

	c.  letter, dated 24 August 2011, from a friend who states he witnessed the applicant's condition as his close friend.  He experienced wheezing, difficulty breathing, shortness of the breath, and red hives.  Within minutes of standing outside, his hives would flare.  He could not do physical fitness training and could only wear his uniform when tolerated. 

16.  Army Regulation 635-200, chapter 5, paragraph 5-17 states commanders who are special court-martial convening authorities may approve separation under this paragraph on the basis of other physical or mental conditions not amounting to disability that potentially interfere with assignment to or performance of duty.  A recommendation for separation must be supported by documentation confirming the existence of the physical or mental condition.  Members may be separated for physical or mental conditions not amounting to disability, sufficiently severe that the Soldier's ability to effectively perform military duties is significantly impaired.

17.  Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation) establishes the Army Physical Disability Evaluation System (PDES) 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 or her office, grade, rank, or rating.  It provides for MEBs 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 Army Regulation     40-501 (Standards of Medical Fitness).  

18.  Paragraph 3-1 of Army Regulation 635-40 provides that the mere presence of impairment does not, of itself, justify a finding of unfitness because of physical disability.  In each case, it is necessary to compare the nature and degree of physical disability present with the requirements of the duties the Soldier reasonably may be expected to perform because of their office, grade, rank, or rating.  To ensure all Soldiers are physically qualified to perform their duties in a reasonable manner, medical retention qualification standards have been established in Army Regulation 40-501, chapter 3.  These standards include guidelines for applying them to fitness decisions in individual cases.  These guidelines are used to refer Soldiers to an MEB.

19.  Army Regulation 635-40 also 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 congenital malformations and hereditary conditions or similar conditions in which medical authorities are in such consistent and universal agreement as to their cause and time of origin that no additional confirmation is needed to support the conclusion that they existed prior to military service.  Likewise, 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.  

20.  Army Regulation 40-501 governs medical fitness standards for enlistment; induction; appointment, including officer procurement programs; retention; and separation, including retirement.  

	a.  Chapter 2 provides for the physical standards for appointment, enlistment, and induction.  The purpose of the standards contained in this chapter is to ensure that individuals medically qualified.  Paragraph 2-28 lists all the skin and cellular tissues conditions that may not meet the standards.  Among them is history of photosensitivity (692.72), including, but not limited to any primary sun-sensitive condition, such as polymorphous light eruption or solar urticaria; any dermatosis aggravated by sunlight such as lupus erythematosus does not meet the standard.

	b.  Chapter 3 gives the various medical conditions and physical defects which may render a Soldier unfit for further military service and which fall below the standards required for the individuals in paragraph 3–2.  These medical conditions and physical defects, individually or in combination, are those that significantly limit or interfere with the Soldier’s performance of their duties; may compromise or aggravate the Soldier’s health or well-being if they were to remain in the military Service (this may involve dependence on certain medications, appliances, severe dietary restrictions, or frequent special treatments, or a requirement for frequent clinical monitoring); may compromise the health or well-being of other Soldiers; and/or may prejudice the best interests of the Government if the individual were to remain in the military service.  A Soldier will not be referred to an MEB because of impairments that were known to exist at the time of acceptance in the Army and that have remained essentially the same in degree of severity and have not interfered with successful performance of duty.  Paragraph 3-38 (skin and cellular tissues) lists the various skin conditions that may cause referral to an MEB.  One of these conditions is Urticaria/Angioedema, chronic, severe, and not responsive to treatment.

     c.  Army Regulation 40-501 states situational maladjustments due to acute or chronic situational stress do not render an individual  unfit because of physical disability, but may be the basis for administrative separation if recurrent and causing interference with duty.

21.  According to the National Institute of Health, U.S. Department of Health and Human Services, cholinergic urticaria is a subcategory of physical urticaria, also known as hives.  It is a skin rash brought on by a hypersensitive reaction to body heat.  Symptoms follow any stimulus to sweat such as exercise (also called exercise-induced urticaria), heat from the sun, hot showers, spicy foods which may cause an increase in body temperature or even stress due to blushing or anger.  Some people only have symptoms during the winter months where their body temperature rises when it is unacclimatized to heat.  Consistently exercising to break a sweat before the onset of cold weather, and through the winter months may reduce the symptoms greatly.  Stress and/or anxiety is often present in the pathogenesis of this condition.  Therapy can sometimes aid in treatment.  Cholinergic urticaria is a fairly common type of hives and is often comorbid with other forms of urticaria, especially chronic urticaria.  The prevalence of the disorder is also higher in people who have other atopic conditions such as eczema, allergic conjunctivitis, allergic rhinitis, or asthma.  These other atopic reactions can sometimes be triggered by the urticaria attack.  There is some evidence that in at least some individuals the condition is hereditary.  The age of onset is anywhere from 10-30 and the condition may occur spontaneously in people with no history of the condition.  People who are chronically affected by the condition will sometimes go through phases of no reactions and phases where their skin is hypersensitive.  These phases may relate to the season, diet changes, or other environmental factors, but often have no obvious cause.  Most people who are afflicted by this condition maintain a tendency for outbreaks for several years (anywhere from 3–30 years) before it finally disappears.

DISCUSSION AND CONCLUSIONS:

1.  The two important issues are whether the applicant had a medical condition that warranted his entry into the PDES and whether the applicant was appropriately discharged for a condition, not a disability.  

2.  The applicant enlisted in the Regular Army on 12 May 2010.  Prior to his enlistment, he reported that he worked as a welder between 2000 and 2010, working with heavy machines, welding, and fabricating.  According to the medical records he submitted, he stated that his rashes began to occur in basic training and that his rashes would flare when his body heat increases.  

3.  Upon arrival in Germany, he was seen on multiple occasions for the same issue.  The various military physicians who examined him diagnosed him with cholinergic urticaria which is consistent with the symptoms he had since entry on active duty or at least during basic combat training.  

4.  As he began noticing complications upon arrival in Germany and since he was experiencing difficulties performing physical activities due to his allergies, his commander referred him for a mental status evaluation.  The clinical psychologist indicated that his psychiatric condition revealed normal variations in stress and emotion level exacerbating urticaria.  

5.  The psychologist opined that from a behavioral health standpoint, the applicant was fit for duty, including deployment.  He had no cognitive impairments but his pre-existing medical-dermatological condition was highly sensitive to normal variation in stress and emotional level.  In the clinical psychologist's opinion, the applicant's medical condition was highly reactive to normal and expected variations in day to day stress level and his interaction of his medical condition with the normal changes in his psychological state such as stress, anger, frustration, and even strong positive feelings made him poorly suited to meet the demands of active duty service.  That is, relieve the day to day stress of being in the Army and the “disability” resolves itself.

6.  He underwent a medical examination in connection with his separation and he was found fully qualified for service.  In other words, his pre-existing medical condition did not render him unable to perform the duties required of his grade and/or military specialty.  In fact, the clinical psychologist stated that the applicant met retention standards of Army Regulation 40-501, including deployment.  The psychologist’s opinion that the interaction of the applicant’s medical condition with the normal changes in his psychological state indicate the psychologist believed the applicant’s inability to meet the demands of active duty service resulted from an adjustment disorder rather than a disability requiring medical processing.

7.  His chain of command initiated separation action against him under the provisions of Army Regulation 635-200, paragraph 5-17.  All requirements of law and regulation were met, and his rights were fully protected throughout the separation process.  His discharge under chapter 5-17 of Army Regulation      635-200 was not improper, and he provides insufficient evidence to show otherwise.    

8.  Therefore, he is not entitled to the requested relief.


BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

__X____  ___X____  ___X____  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.



      _______ _  X_______   ___
               CHAIRPERSON
      
I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case.


ABCMR Record of Proceedings (cont)                                         AR20120005026





3


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1

ABCMR Record of Proceedings (cont)                                         AR20120005026



2


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1