IN THE CASE OF:	  

		BOARD DATE:	  30 January 2014

		DOCKET NUMBER:  AR20130003880 


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 correction of her DD Form 214 (Certificate of Release or Discharge from Active Duty) to show she was medically retired.

2.  The applicant states, in effect, she had numerous health issues and a severe medical condition that the Army was not able to diagnose.  Her medical condition contributed to her weight gain.  Instead of being sent before a Medical Evaluation Board (MEB)/Physical Evaluation Board (PEB) she was separated from the Army in 1999 for being overweight.  She feels she was entitled to a medical retirement in accordance with Title 10, U.S. Code, chapter 61.

3.  The applicant provides:

* Standard Forms (SF) 600 (Chronological Record of Medical Care), dated 
1 October 1997, 24 November 1997, 1 July 1998, and 13 August 1998
* Memoranda, dated 1 December 1997, 29 December 1997, and 6 May 1998
* DD Form 1610 (Request and Authorization for Travel), dated 18 May 1998
* 6 DA Forms 4856 (General Counseling Form), dated between 29 May 1998 and 4 February 1999
* 8 DD Forms 689 (Individual Sick Slip), dated between 28 March 1998 and 6 January 1999
* 7 DA Forms 3349 (Physical Profile), dated between 28 August 1998 and 22 February 1999
* Personal journal entries (health related), dated between 19 September 1998 and 27 September 1998
* Memorandum with 5 endorsements, dated 23 September 1998
* Memorandum, undated
* Letter of financial hardship to the Department of Veterans Affairs (VA), dated, 20 August 2002
* VA rating decisions, dated 13 November 2002 and 25 April 2005
* Self-authored statement, dated 19 February 2013

CONSIDERATION OF EVIDENCE:

1.  Title 10, U.S. Code, section 1552(b), provides that applications for correction of military records must be filed within 3 years after discovery of the alleged error or injustice.  This provision of law also allows the Army Board for Correction of Military Records (ABCMR) to excuse an applicant's failure to timely file within the 3-year statute of limitations if the ABCMR determines it would be in the interest of justice to do so.  While it appears the applicant did not file within the time frame provided in the statute of limitations, the ABCMR has elected to conduct a substantive review of this case and, only to the extent relief, if any, is granted, has determined it is in the interest of justice to excuse the applicant's failure to timely file.  In all other respects, there are insufficient bases to waive the statute of limitations for timely filing.

2.  The applicant enlisted in the Regular Army on 28 April 1994 and she held military occupational specialty 92Y (Unit Supply Specialist).  She served through one reenlistment and an extension and attained the rank/grade of specialist 
(SPC)/E-4.

3.  Her record contains several SFs 600 that show she was referred to and treated in the internal medicine department by a rheumatologist (Army lieutenant colonel (LTC)) on 24 November 1997.  The rheumatologist thought she had Sjogren's syndrome.  He saw her in follow-up on 7 January 1998 and remarked that she had severe weight gain presumably secondary to steroid treatment for eczema.  Her diagnosis of Sjogren's was not confirmed by biopsy.  He changed her steroid dose from previous treatment of eczema but kept her on steroids.  He also opined that "should the patient's symptoms persist and require more aggressive treatment other than chloroquine or prednisone, she will most likely require an MEB at her primary station."

4.  Her record shows she required multiple additional medications in an attempt to control her multiple joint pain.

5.  Her record contains an SF 600, dated 13 August 1998, that shows she was referred to and treated in the internal medicine department.  Her physician (Air 

Force LTC) indicated she had previously been evaluated by rheumatology, endocrinology, dermatology, obstetrics and gynecology (OB/GYN), internal medicine, and optometry.  She was seen several times by rheumatology at Brooke Army Medical Center (BAMC) at Fort Sam Houston, TX and by rheumatology at Madigan Army Medical Center (MAMC) at Fort Lewis, WA.  Her prior evaluations were summarized and the conclusion was that there was still no diagnosis for her symptoms.  The physician stated that "If she cannot meet army standards then she should undergo an MEB."

6.  Her record contains a DA Form 4856, dated 23 September 1998, that shows she was enrolled in the Army weight control program because she exceeded the maximum allowable weight for her height by 60 pounds and her body fat content by 6.46 percent.  She was informed she would be flagged immediately upon her enrollment and would require enhanced physical training until her removal from the program.  Additionally, she was informed that if she was unable to make satisfactory progress and removal from the program within 6 months she could be separated from military service.

7.  Her record contains seven DA Forms 5501-R (Body Fat Worksheet (Female)), dated between 23 September 1998 and 23 March 1999.  At the time these forms were completed she was 33 years old, her height was 63.25, her maximum allowable weight was 137 pounds, and her maximum allowable body fat was 34 percent.  These forms show the following:

			DATE						WEIGHT				PERCENT BF
23 September 1998
197
40.46
20 October 1998
190
36.83
16 November 1998
191
39.16
22 December 1998
191
40.39
20 January 1999
194
39.1
22 February 1999
196
40.46
23 March 1999
190
39.04
8.  Her record contains several memoranda and endorsements.  The start date of this correspondence was 23 September 1998.  It appears the chain of command used a template with pre-entered dates and neglected to adjust the dates on each endorsement as the correspondence progressed through each appropriate level.

	a.  on 23 September 1998 (1st endorsement), her immediate commander informed her she exceeded the body fat standard and a goal of 3-8 pounds of 

weight loss per month was considered satisfactory progress.  Failure to make satisfactory progress or achieve the body fat standard could result in separation from service.  She would be flagged and entered into a weight control program.  She signed this document indicating she understood it was her responsibility to achieve the body fat standard and to have her weight recorded periodically during unit training assemblies.

	b.  on 23 September 1998 (2nd endorsement), her immediate commander informed the commander of U.S. Army Medical Department Activity (USAMEDDAC) that the applicant exceeded her maximum allowable weight by 60 pounds and her maximum allowable body fat by 6.46 percent.  He requested a medical evaluation be conducted for initiation of a separation packet.

	c.  on 16 April 1999 (3rd endorsement), a Physicians Assistant, USAMEDDAC informed her immediate commander that in accordance with Army Regulation 600-9 (Army Weight Control Program) the applicant had been examined and found to be fit for participation in a weight control/physical exercise program.  The cause of the overweight conditions was not due to a medical condition.  The commander, USAMEDDAC recommended initiation or continuation in a weight reduction program.  

	d.  on 23 September 1998 (4th endorsement), her immediate commander informed the commander, USAMEDDAC that the applicant exceeded her maximum allowable weight by 60 pounds and her maximum allowable body fat by 6.46 percent.  He requested she receive education and weight reduction counseling in accordance with Army Regulation 600-9.

	e.  on 23 September 1998 (5th endorsement), the commander, USAMEDDAC informed her immediate commander that the applicant had been provided with education and weight reduction counseling in accordance with Army Regulation 600-9.

9.  Her record contains a notification of completed medical examination, dated 
12 March 1999, that shows she weighed 187 pounds, had a temporary level 3
(T-3) profile under the "Physical capacity or stamina – P" factor.  She was not permitted to participate in the run event of the Army Physical Fitness Test (APFT). 

10.  Her record contains a Physical Exams Checklist, dated 26 March 1999, that shows she received a physical examination for overweight/separation.

11.  Her record contains a DA Form 4700-E (Supplemental Medical Data), dated 12 April 1999, that shows she weighed 180 pounds.

12.  Her record contains an SF 93 (Report of Medical History), dated 16 April 1999, that shows she weighed 183 pounds and wherein she indicated she:

* was in poor health
* was taking medication
* had a drug reaction to chloroquine
* had a lack of vision due to recurrent corneal erosions
* had swollen or painful joints due to migratory polyarthralgias and myalgias
* had frequent or severe migraines
* had episodic vertigo
* had episodic leg cramps
* had hemorrhoids following the birth of her first child
* had recent weight loss over the past 12 months due to physical training and trying to lose weight
* had frequent trouble sleeping and only slept soundly for 4 hours a night
* had easy fatigability since 1996 and had a crack tip displacement (CTD) test but no diagnosis was made 
* used tobacco (cigarettes) for 22 years
* had an inability to perform certain motions and to assume certain positions for which she had been on a recurrent temporary profile for the past year

13.  Her record contains an SF 88 (Report of Medical Examination), dated 
16 April 1999, that shows the clinical evaluation revealed she weighed 187 pounds and had a body mass index of 33 percent.  The examining physician noted she had visceral abdominal obesity and body habitus, migratory polyarthralgias, myalgias, fatigue, and recurrent corneal erosions.  She was diagnosed with early undifferentiated connective tissue disease.  The examining physician further indicated that she was qualified for separation due to a chapter of expiration term of service.

14.  On 11 May 1999, the applicant’s immediate commander notified the applicant of his intent to initiate separation action against her in accordance with Army Regulation 635-200 (Personnel Separations - Enlisted Personnel),
chapter 18 (Weight Control Failure) for failing to meet the Army composition/
weight control standards in accordance with Army Regulation 600-9.  Her commander was recommending she receive an honorable characterization of service.  Her commander also advised her of her rights.  She acknowledged receipt of the notification that same day.

15.  On 12 May 1999, she consulted counsel concerning the basis for the contemplated action to separate her for failing to meet the Army composition/
weight control standards and its effects, and of the rights available to her and the effect of any action taken by her in waiving any of her rights.  She elected not to submit a statement in her own behalf.

16.  On an unknown date, the Judge Advocate reviewed her separation packet and found it to be legally sufficient.

17.  On 17 May 1999, the separation authority directed the applicant be separated under the provisions of Army Regulation 635-200, chapter 18 and directed the applicant receive an Honorable Discharge Certificate.  Accordingly, on 6 June 1999, she was honorably released from active duty and transferred to the U.S. Army Reserve (USAR) Control Group (Reinforcement) to complete her remaining service obligation.

18.  Her DD Form 214 shows she was honorably released from active duty in accordance with Army Regulation 635-200, chapter 18, by reason of weight control failure.  She completed 5 years, 1 month, and 9 days of creditable active service. 

19.  She provided an SF 600, dated 1 October 1997 that shows:

* she had a goiter (abnormal enlargement of the thyroid gland)
* she had 1 anterior cervical node
* she was losing hair
* she was hot or cold at various times
* she was gaining weight
* she was fatigued
* her physician felt she had hypothyroidism but the laboratory finding did not support that diagnosis
* her physician had not ruled out Graves' Disease as a possible diagnosis

20.  She provided an Optional Form (OF) 275, dictated on 8 January 1998, that shows she was seen by a rheumatologist.  The physician stated:

* her anti-nuclear antibodies (ANA) were positive
* her sulfosalicylic acid (SSA) was positive
* she had corneal erosions with dry eyes and mouth consistent with Sjögren's syndrome
* her minor salivary biopsy was negative
* 
she had a history of questionable euthyroid sick syndrome
* she had a T4 level of 1.4
* she had a TSH level of 0.04
* she had a history of dyshidrotic eczema with severe weight gain secondary to corticosteroids

21.  She provided a memorandum from the Physician Assistant, USAMEDDAC that informed her immediate commander that in accordance with Army Regulation 600-9, she had been examined and found to be fit for participation in a weight control/physical exercise program.  The cause of the overweight condition was not due to a medical condition.  The commander, USAMEDDAC recommended initiation or continuation in a weight reduction program.

22.  She provided an undated memorandum, subject:  Weight Control Program that was issued by "Health Care Professional."  It is unclear who completed this memorandum and there is no signature block.  However, the preparing official indicated the cause of her overweight was due to a medical condition.  The preparing official recommended medical treatment for pathological medical disorders and stated "patient has Sjögren's syndrome with euthyroid sick 
syndrome."  Since June 1997 she had gone from weighing 173 pounds to 216 pounds.  The weight gain can be explained by this condition.

23.  She provided 8 DA Forms 689 that show on:

	a.  23 March 1998, she was treated for excess knee and leg pain and blurred vision in her right eye.  The medical official directed physical training (PT) at her own pace and distance for 14 days

	b.  1 April 1998, she was treated for pain, tiredness, and swelling.  The medical official directed pool PT for 1 month.

	c.  3 April 1998, she was treated for swelling/eye pain.  The medical official directed the applicant be placed on quarters for 24 hours.

	d.  17 July 1998, she was treated for an illness.  The medical official directed no running, jumping, road marching, or ruck marching, and that she continue PT in the pool or gym for 1 month.

	e.  18 August 1998, she was treated for an injury.  The medical official directed the use of sunglasses for 2 days in bright conditions.

	f.  23 November 1998, she was treated by a medical official who directed the applicant be placed on quarters for 2 days.

	g.  6 January 1999, she was treated for an illness/injury and the medical official directed the applicant be placed on quarters for 24 hours.

24.  She provided 7 DA Forms 3349, dated between 28 August 1998 and 
20 May 1999.  These physical profiles show on:

* 28 August 1998, she received a temporary profile for polyarthralgia in multiple joints (issued by a physician) 
* 28 September 1998, she received a temporary profile for arthralgias and fatigue (issued by a Physician Assistant)
* 3 November 1998, she received a temporary profile for polyarthralgia (issued by a Physician Assistant)
* 1 December 1998, she received a temporary profile for polyarthralgia (issued by a Physician Assistant)
* 30 December 1998, she received a temporary profile for polyarthralgia (issued by a Physician Assistant)
* 10 February 1999, she received a temporary profile for polyarthralgia (issued by a Physician Assistant)
* 22 February 1999, she received a temporary profile for polyarthralgia (issued by a Physician Assistant)

25.  The record shows that a Physician Assistant extended a 30-day T3 profile multiple times without the co-signature of a physician and that he issued a
90-day profile without a co-signature.

26.  Research shows that:

	a.  The term undifferentiated connective tissue disease (UCTD) is used to describe people who have symptoms and certain laboratory test results that look like a systemic autoimmune disorder or connective tissue disease.  But they do not have enough of such characteristics to meet the diagnosis for a well-defined connective tissue disease, such as rheumatoid arthritis, lupus, or scleroderma.  Thus, they seem to have another, similar disorder that doctors call undifferentiated connective tissue disease.  A systemic autoimmune disorder means that it affects your whole body (systemic) and that your immune system, which normally protects you from outside invaders such as bacteria, turns on parts of your own body and attacks them as if they were invaders.  Connective tissue is the "glue" that supports and connects various parts of the body; it 

includes skin, cartilage, and other tissue in the joints and surrounding the heart and lungs and within the kidney and other organs.  The term was first used in 1980's to identify people who were recognized as being in the early stages of a connective tissue disease (CTD) but who did not yet meet the standard criteria for a well-defined CTD.

	b.  Graves' Disease is an autoimmune disease.  It most commonly affects the thyroid, frequently causing it to enlarge to twice its size or more (goiter), become overactive, with related hyperthyroid symptoms such as increased heartbeat, muscle weakness, disturbed sleep, and irritability.  It can also affect the eyes, causing bulging eyes.  It affects other systems of the body, including the skin, heart, circulation and nervous system.

	c.  Sjögren's syndrome is an inflammatory disease that can affect many different parts of the body, but most often affects the tear and saliva glands.  Patients with this condition may notice irritation, a gritty feeling, or painful burning in the eyes.  Dry mouth (or difficulty eating dry foods) and swelling of the glands around the face and neck are also common.  Some patients experience dryness in the nasal passages, throat, vagina and skin.  Swallowing difficulty and symptoms of acid reflux are also common.  Primary Sjögren's syndrome occurs in people with no other rheumatologic disease.  “Secondary” Sjögren's occurs in people who have another rheumatologic disease, most often systemic lupus erythematosus and rheumatoid arthritis.  Most of the complications of Sjögren's syndrome occur because of decreased tears and saliva.  Patients with dry eyes are at increased risk for infections around the eye and may have damage to the cornea.  Dry mouth may cause an increase in dental decay, gingivitis (gum inflammation), and oral yeast infections (thrush) that may cause pain and burning.  Some patients have episodes of painful swelling in the saliva glands around the face.  Complications in other parts of the body can occur.  Pain and stiffness in the joints with mild swelling may occur in some patients, even in those without rheumatoid arthritis or lupus.  Rashes on the arms and legs related to inflammation in small blood vessels (vasculitis) and inflammation in the lungs, liver, and kidney may occur rarely and be difficult to diagnose.  Numbness, tingling, and weakness also have been described in some patients.

	d.  Polyarthralgia is defined as aches in the joints, joint pains, arthralgia of multiple joints, and multiple joint pain.  Polyarthritis is the word usually used to describe pain affecting five or more joints.  The initial symptoms that usually appear in the third to fifth decade of life include painless swelling or thickening of the skin of the hands and fingers, pain and stiffness of the joints (polyarthralgia), 

often mistaken for rheumatoid arthritis, and paroxysmal blanching and cyanosis (becoming blue) of the fingers induced by exposure to cold (Raynaud syndrome).

27.  Army Regulation 40-501 (Standards of Medical Fitness), in effect in at the time, states that Physician Assistants are limited to awarding temporary numerical designators "1," "2," and "3" for a period not to exceed 30 days.  Any extension of a temporary profile beyond 30 days must be confirmed by a physician, except when the provisions of paragraph 7-9 apply (7-9 applies to postpartum profiles).  This regulation does not allow a Physician Assistant to extend a 30-day profile without the concurrence of a physician.  It also does not allow a Physician Assistant to give a 90-day profile.  

28.  Army Regulation 635-200 provides the basic authority for the separation of enlisted personnel.  Chapter 18 of this regulation covers separation for failure to meet body fat standards.  It states that Soldiers who fail to meet the body fat standards set forth in Army Regulation 600–9 are subject to involuntary separation when such condition is the sole basis for separation.  Separation proceedings may not be initiated under this chapter until the Soldier has been given a reasonable opportunity to meet the body fat standards, as reflected in counseling or personnel records.  Soldiers who have been diagnosed by health care personnel as having a medical condition that precludes them from participating in the Army body fat reduction program will not be separated under this chapter.  If there is no underlying medical condition and a Soldier enrolled in the Army Wright Control Program fails to make satisfactory progress in accordance with Army Regulation 600–9, separation proceedings will be considered.  

29.  Army Regulation 600-9 (dated 10 June 1987 and in effect at the time) established policies and procedures for the implementation of the Army Weight Control Program.  It stated that each Soldier (commissioned officer, warrant officer, and enlisted) is responsible for meeting the standards prescribed in this regulation.  To assist Soldiers in meeting these responsibilities, screening tables were prescribed for use.  This regulation also states/shows:

	a.  Routine weigh-ins will be accomplished at the unit level.  Percent body fat measurements will be accomplished by company or similar level commanders (or their designee) in accordance with standards.  A medical evaluation will be accomplished by health care personnel when the Soldier has a medical limitation, or is pregnant, or when requested by the unit commander.  One is also required for Soldiers being considered for separation due to failure to make satisfactory progress in a weight control program.

	b.  Army Screening Table Weight, in effect at the time, states that for females ages 28-39 and of a height of 63 inches the maximum allowable weight was
137 pounds.

	c.  The maximum allowable percent body fat standards for females ages 
28 - 39 was 34 percent.

30.  Title 10, U.S. Code, chapter 61, provides the Secretaries of the Military Departments with authority to retire or discharge a member if they find the member unfit to perform military duties because of physical disability.  The U.S. Army Physical Disability Agency, under the operational control of the Commander, U.S. Army Human Resources Command (HRC), is responsible for administering the Physical Disability Evaluation System (PDES).

	a.  The objectives of the system are to:

* maintain an effective and fit military organization with maximum use of available manpower
* provide benefits for eligible Soldiers whose military service is terminated because of service-connected disability
* provide prompt disability processing while ensuring that the rights and interests of the government and the Soldier are protected

	b.  Soldiers are referred to the PDES:

* when they no longer meet medical retention standards in accordance with Army Regulation 40-501, chapter 3, as evidenced in a medical evaluation board
* receive a permanent medical profile, P3 or P4, and are referred by an MOS Medical Retention Board
* are command-referred for a fitness-for-duty medical examination
* are referred by the Commander, HRC

	c.  The PDES assessment process involves two distinct stages: the MEB and the PEB.  The purpose of the MEB is to determine whether the service member’s injury or illness is severe enough to compromise his/her ability to return to full duty based on the job specialty designation of the branch of service.  A PEB is an administrative body possessing the authority to determine whether or not a service member is fit for duty.  A designation of “unfit for duty” is required before 
an individual can be separated from the military because of an injury or medical condition.  Service members who are determined to be unfit for duty due to disability are either separated from the military or are permanently retired, depending on the severity of the disability and length of military service.  Individuals who are “separated” receive a one-time severance payment, while veterans who retire based upon disability receive monthly military retirement payments and have access to all other benefits afforded to military retirees.

	d.  The mere presence of a medical impairment does not in and of itself justify a finding of unfitness.  In each case, it is necessary to compare the nature and degree of physical disability present with the requirements of the duties the Soldier may reasonably be expected to perform because of his or her office, grade, rank, or rating.  Reasonable performance of the preponderance of duties will invariably result in a finding of fitness for continued duty.  A Soldier is physically unfit when a medical impairment prevents reasonable performance of the duties required of the Soldier's office, grade, rank, or rating.

31.  Army Regulation 40-501 governs medical fitness standards for enlistment; induction; appointment, including officer procurement programs; retention; and separation, including retirement.  Once a determination of physical unfitness is made, the PEB rates all disabilities using the VASRD.  Ratings can range from 0% to 100%, rising in increments of 10%.  Paragraph 3–40 (Systemic diseases) states the causes for referral to an MEB are as follows:

		(1)  Rheumatoid arthritis that interferes with successful performance of duty or requires geographic assignment limitations or requires medication for control that requires frequent monitoring by a physician due to debilitating or serious side effects.

		(2)  Sjogren’s syndrome, when chronic, more than mildly symptomatic and resistant to treatment after a reasonable period of time.

		(3)  Mixed connective tissue disease and other overlap syndromes that interfere with successful performance of duty or require geographic assignment limitations or require medication for control that requires frequent monitoring by a physician due to debilitating or serious side effects.

		(4)  Any chronic or recurrent systemic inflammatory disease or arthritis not listed above that interferes with successful performance of duty or requires geographic assignment limitations, or requires medication for control that requires frequent monitoring by a physician due to debilitating or serious side effects.

32.  Title 10, U.S. Code, section 1201, provides for the physical disability retirement of a member who has at least 20 years of service or a disability rating of at least 30 percent.  Title 10, U.S. Code, section 1203, provides for the physical disability separation of a member who has less than 20 years of service and a disability rating at less than 30 percent.

33.  The VASRD is used by the Army and the VA as part of the process of adjudicating disability claims. It is a guide for evaluating the severity of disabilities resulting from all types of diseases and injuries encountered as a result of, or incident to, military service.  This degree of severity is expressed as a percentage rating which determines the amount of monthly compensation. 

DISCUSSION AND CONCLUSIONS:

1.  The issue of weight control is difficult to resolve.  Her record shows a Physician Assistant certified for the commander that there was no medical reason for her weight gain.  She gained in excess of 80 pounds at one point, which is a lot of weight to blame on steroids.  Nevertheless, two physicians, at least one of whom was a specialist, opined that the steroids caused her weight problem.

2.  Two physicians, both field grade specialists, stated that the applicant needed an MEB if she could not be controlled on her current medications and/or could 
not meet the Army medical standard.  Her record shows she required multiple additional medications in an attempt to control her multiple joint pain.  These statements were made in January 1998 and August 1998.

3.  On 27 August 1998, she was placed on a T3 profile for polyarthralgia.  It is unlikely that this is the first profile she received because she had already been under the care of physicians for the profiled condition for about one year.  On
27 August 1998, the profiling officer was a physician.  The next 6 profiles were given by a Physician Assistant (the same PA who cleared her for the weight control program).  The profiles were all for polyarthralgia and the last one was for a 3-month period ending 20 May 1999.  As such, she was essentially on a profile for arthralgia the entire time she was on the weight control program until she was discharged on 6 June 1999.

4.  The record shows a Physician Assistant extended a 30-day T3 profile multiple times without the co-signature of a physician and that he issued a 90-day profile without a co-signature.  Although it is clear that Army Regulation 40-501 was not followed by the Physician Assistant in profiling the Soldier, it is less clear as to whether or not an injustice occurred.  Work appraisals uniformly show that the applicant was able to perform the duties of her MOS as a supply clerk during the entire period under discussion.  Her profiles significantly limited her lifting and walking capacity, forbade taking the APFT, and consistently graded her severity as a "3" for polyarthralgias.
5.  Her contention that she should have had an MEB appears to have merit.  The conditions postulated by two physicians stating she should be referred to an MEB appeared to have been met.  The use of multiple temporary profiles issued by a Physician Assistant appears to have been used instead of what should have been a permanent "3" profile and an MEB referral.  The end result was that the applicant was administratively discharged without appropriately assessing her fitness for duty.  The possibility that her reason for discharge (weight) may have been secondary to her medical condition is an additional consideration but need not be established in order to conclude that the applicant was inappropriately profiled, and was not referred to an MEB as recommended.

6.  The Office of the Surgeon General (OTSG) needs to look at the complete medical record that is not available to the ABCMR.  It is possible that appropriate medical opinion was obtained regarding an MEB but the ABCMR only has six pages of clinical record and two of those pages represent partial documents.  It would be easier to presume government regularity if there were not significant breaches of the profiling regulation and if the Physician Assistant's assessment 
of the Soldier's medical condition as it pertained to weight gain were in line with the opinion of the physicians providing her care.  

7.  However, it is impossible to accomplish an MEB 15 years after the fact.  Therefore, OTSG should facilitate an interview and possible assessment of the applicant and evaluate the complete record.  Should it be determined the applicant should have had an MEB, an attempt will have to be made to reconstruct the putative findings of a 1999 MEB.  

8.  If a reconstructive MEB is accomplished, the MEB may, upon completion of her military medical examination/examination of her medical records recommend her medical records go before a PEB.  If this is the case, she should be afforded the opportunity.

BOARD VOTE:

___x____  ___x____  ____x___  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

________  ________  ________  DENY APPLICATION



BOARD DETERMINATION/RECOMMENDATION:

The Board determined that the evidence presented was sufficient to warrant a recommendation for relief.  As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by:

* having the Office of the Surgeon General (OTSG) contact the applicant and arrange an interview or physical evaluation via appropriate medical facilities and, if appropriate, referral to an MEB
* directing OTSG to issue appropriate invitational travel orders to the applicant to accomplish the physical evaluation and, if appropriate the MEB
* directing OTSG to issue appropriate invitational travel orders to the applicant to prepare for and participate in consideration of her case by a formal PEB in the event that a PEB becomes necessary




      ___________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)                                         AR20130003880



3


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1

ABCMR Record of Proceedings (cont)                                         AR20130003880



2


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1