BOARD DATE:	 19 March 2014 

		DOCKET NUMBER:  AR20130004766 


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 records to show he was medically retired after receiving an evaluation from the Army Physical Disability Evaluation System (PDES) that resulted in a disability rating of at least 50 percent for the first 6 months from 6 December 2010 and, thereafter, 70 percent with applicable back pay.

2.  The applicant states he suffered from severe post-traumatic stress disorder (PTSD) while on active duty post-deployment.  He did not receive a medical evaluation board (MEB) or physical evaluation board (PEB) in violation of applicable Department of Defense Instructions (DODI) and regulations.

3.  The applicant provides what appears to be a complete copy of his service and post-service medical records, Department of Veterans Affairs (VA) rating decisions, and miscellaneous records and correspondence.

COUNSEL'S REQUEST, STATEMENT AND EVIDENCE:

1.  Counsel requests, in effect, correction of the applicant's records to show he was medically retired after receiving an evaluation from the Army PDES.

2.  Counsel states:

	a.  The applicant was trained as an indirect fire infantryman and served with the 10th Mountain Division for two tours in Afghanistan during the periods February 2007 through May 2008 and January through December 2009.

	b.  During his first deployment to Afghanistan, he was engaged in some short and intense firefights and ambushes; however, he claims his second deployment was much more intense as he was frequently shot at and 40 percent of his company was either wounded or killed during his time there.

	c.  The Army committed errors or injustices by not referring the applicant to the PDES, by not awarding him a medical disability retirement of at least 70 percent, and by not applying the VA Schedule for Rating Disabilities (VASRD) standards.

	d.  While it is understood that the military is not necessarily bound by VA ratings, the applicant urges the Board to consider the VA ratings because it was made within 1 year of his separation, similar to the requirement in DODI 6040.44 regarding Physical Disability Boards of Review (PDBR).  Although this is not a PDBR appeal, the same "fair and equitable recommendation pertaining to the assignment of disability ratings" should apply.

3.  Counsel provides an 11-page brief in support of the applicant's request to change his honorable discharge to a medical disability discharge pursuant to Title 10, U.S. Code, chapter 61, and receipt of retroactive disability retirement in the amount of at least 50 percent for the first 6 months and 70 percent thereafter, with applicable back pay.  He further provides what appears to be a complete copy of the applicant's service and post-service medical records, VA rating decisions, and miscellaneous records and correspondence.

CONSIDERATION OF EVIDENCE:

1.  The applicant enlisted in the Regular Army on 10 August 2006.  He completed training and was awarded military occupational specialty 11C (indirect fire infantryman).

2.  The evidence shows the applicant served in Afghanistan from 23 March through 30 December 2009.

3.  On 7 January 2010, the applicant was referred to the Behavioral Health Department (BHD) by his family life counselor and he was subsequently diagnosed with an Axis I adjustment disorder with disturbance of conduct and relational problems.  Dr. D____ referred the applicant to receive/participate in interpersonal group therapy.

4.  On 8 January 2010, the applicant attended an interpersonal group overview with six other patients.  His mood was okay and his thought process was appropriate.  He was released without limitations and instructed to follow up with Dr. D____.  He had an Army Substance Abuse Program (ASAP) evaluation pending and he was scheduled to continue with his interpersonal group therapy on 22 January 2010.

5.  On 20 January 2010, the applicant was seen at the battalion aid station because he was having trouble falling asleep.  He stated he had been having difficulty sleeping during the past 18 months and was having thoughts of his civilian experiences as well as incidents which took place while he was deployed to Afghanistan.  He further stated he was fed up with his unit and was trying to get into the Warrior Transition Unit (WTU) to "get away from 2-87 [2d Battalion, 87th Infantry Regiment]."  He was prescribed Ambien (zolpidem, a sedative) and counseled about the ties between exercise and sleep.

6.  In March 2010, he attended cognitive processing therapy (CPT) for PTSD group therapy sessions.  He was given a homework assignment which he did not complete due to his anxiety.  However, he agreed to document his thoughts,  feelings, and behaviors until the next session.

7.  On 6 April 2010, the applicant arrived 15 minutes late to his CPT for PTSD group therapy.  He completed the documents to track his thoughts, feelings, and behaviors and he received additional homework.  The applicant was making progress and understood the process.

8.  On 13 April 2010, the applicant did not complete his written homework assignment relating to a detailed account of his most traumatic event and daily monitoring of his thoughts; however, he was able to verbalize them to the group.  The applicant claimed his group was fired upon while on a mission and he returned fire with the M-60 machine gun.  They received mortar and small arms fire.  Three of the six members of his group were hit.  He retained anger about the mission he felt was only to make the command look good.  He received the Army Commendation Medal (ARCOM) with "V" Device, but he was recommended for award of the Bronze Star Medal.  He felt the award was downgraded due to his rank.

9.  On 19 April 2010, the applicant's treatment at the BHD was terminated by Dr. Z____ due to the applicant's noncompliance with medical treatment.  The doctor noted the applicant was a "no show" for his psychiatric medication initial evaluation.  A review of his chart indicated he was stable when last assessed with no medications prescribed by the BHD and multiple resources within the community to address his medication concerns and refills.  His noncompliance with attending treatment indicated disinterest and a lack of motivation and personal responsibility for treatment.  The applicant could re-initiate services with the BHD at any time if he remained interested in the services of the BHD.  His last assessed diagnosis by a BHD provider was on 13 April 2010 for an anxiety disorder (not otherwise specified (NOS)).

10.  On 20 April 2010, the applicant attended his fifth session of CPT for PTSD.  He had completed his homework and it was noted he was finding benefit from the group experience.  A licensed clinical social worker diagnosed him with PTSD and noted the applicant should continue with the weekly group sessions.

11.  His records contain a Standard Form 600 (Chronological Record of Medical Care), dated 5 May 2010, which shows the applicant was discharged from the Samaritan Medical Center after taking Ambien and alcohol.  The applicant still harbored much stress and had concerns about his tendency to have aggressive ideation toward others.  He was assessed as still showing signs of inner emotional distress affecting his mood, concentration, thought processes, and behavior related to PTSD symptomology.  He was instructed to follow up with his primary care manager and he was referred to the WTU.

12.  On 13 May 2010, the applicant was assessed for intake at the WTU.  The applicant stated to his provider that he suffered from low back and left knee pain and that he was deployed to Afghanistan from February 2007 through May 2008 and from January through December 2009.  In January 2010, he was arrested for assault against a civilian woman he claims was trying to take his phone.  The charges were dropped and he married the woman involved in the altercation.  He acknowledged active thoughts of hurting others and was placed on unit watch.  He stated he has control to stop the thoughts and was getting help from the BH Clinic.  He further stated his parents are divorced and that he resided with his mother and five siblings.  He described a juvenile criminal history from age 13, including two locked programs and three foster homes.  He continued to get into trouble after age 17 and was on his "third strike" when he was given the opportunity to join the military.

13.  The intake form further states the applicant was diagnosed with PTSD by the psychology clinic and he was attending group therapy but stopped at the end of April 2010 because he felt it wasn't helping him.  The applicant stated he remembered taking two Ambien and started drinking.  He subsequently remembered the police coming and taking him to the hospital.  He denied any altercation with his spouse or the command and he denied the need for ASAP, but admitted to drinking and having adverse effects with his medication and alcohol.  He further stated he did not miss appointments, but he was documented as missing them because the appointment line didn't cancel them as he requested.

14.  On 20 May 2010, the applicant attended a follow-up appointment with the WTU.  On 26 May 2010, he was seen again at the WTU for lower back pain and what was diagnosed as an adjustment disorder with anxiety.  The physician recommended his follow up with the BH Clinic and noted the applicant would reach his expiration of term of service (ETS) in December 2010; however, he did not feel the applicant would benefit from an MEB.

15.  On 3 June 2010, the applicant was seen by a psychologist at the Fort Drum Samaritan BH Clinic for what he described as "depression, anxiety, and PTSD."

	a.  In his initial assessment paperwork, he described the history of his present illness as being depressed daily since his first deployment in 2007, frequent problems with motivation, loss of interest in activities he usually enjoys, low appetite most days, varying weight, poor sleep, restlessness, difficulty making everyday decisions, anger, racing thoughts, worry, guilt, and combat-related nightmares.

	b.  He described his psychiatric history (personal and family) beginning with his hospitalization approximately a month ago after an altercation with police; he was drinking and taking Ambien at the time of the incident.  He also implied his father suffered from PTSD which was treated.

	c.  He described his early developmental history as being raised in poverty by his mother, being in a detention center at age 14, multiple foster care placements during adolescence, and residential treatment from ages 15 through 17.

	d.  He stated in his family history that he lived with his four brothers and a sister.  His father has a military background but was not consistently involved in his life.  He did not get along with his mother but got along well with his siblings.  He was currently married; however, he was in conflict with his wife and would divorce.  They had no children.

	e.  Although placed in foster care and residential treatment due to behavioral issues, the applicant claimed no history of abuse or neglect.  He claimed to have witnessed "a lot" of violence when younger but said that he was not impacted by the events.

	f.  He stated he had a general education diploma and was suspended multiple times for fighting.  He claimed he joined the military for the challenge of basic training, although he does not get along with his superiors and does not talk to most of his peers.  He also claimed to have received an administrative reduction for not showing up to work one day.  He further stated he was deployed to Afghanistan from 2006 to 2007 and again from 2008 to 2009.  He claimed combat exposure (fired mortars, shot others, exposure to improvised explosive devices and mortars, was shot at, captured high-target enemies) and perceived himself to be in mortal danger daily.  He further claimed to have witnessed 12 Soldiers killed in action and 26 Soldiers injured.

	g.  He claimed no known history of concussion, although he claimed to have blacked out a few times from mortars.  He blacked out briefly and was dazed upon awakening, he had no seizures, and he experienced ringing in the ears since his first deployment due to firing mortars.  He claimed no light sensitivity and no loss of balance, although he has problems with concentration.  He further stated he used to play a game with his brother in which they would "pass each other out" for 15 seconds.  A traumatic brain injury (TBI) screening was warranted and he was referred to a psychologist.

	h.  In his legal/financial history he claimed detention during adolescence (retail fraud and violation of probation), an assault conviction against his wife (girlfriend at the time), and domestic violence against his brother (arrested but not convicted).

	i.  He claimed in his substance use and treatment history that he drank alcohol once a week to the point of intoxication, although it had not caused any problems for him.  He also stated he had a history of cannabis and Ecstasy (methylenedioxy-methamphetamine, a synthetic psychoactive drug) use as recent as last year with no history of substance abuse treatment.  He further stated the BH Clinic staff tried to get him to enroll in ASAP and that his father apparently used cocaine, alcohol, and cannabis.

16.  The psychologist opined initial Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Text Revision) (DSM-IV-TR) diagnoses of:

* Axis I – major depressive disorder (MDD), single episode, severe without psychotic features – rule out PTSD
* Axis II – deferred
* Axis III – back pain, knee problems, hearing loss, possible TBI
* Axis IV – psychosocial stressors – combat and post-deployment – marital, occupational, and financial stress – legal history – multiple residential placements during adolescence
* Axis V – current Global Assessment of Functioning (GAF) score of 50

17.  The psychologist further recommended/stated the applicant was provided education about treatment options to address his symptoms; however, the applicant was not interested in psychotherapy.  He was only interested in taking medication to address his symptoms.  He was scheduled for a follow up with his provider in a week when his treatment plan would be completed and he would receive supportive psychotherapy every 4-6 weeks.  He was scheduled for a psychiatric evaluation and noted he should receive a cognitive screening assessment to rule out TBI.  The psychologist further noted that treatment providers should regularly assess the applicant for homicidal ideation due to his history of violent behavior.  He would also need regular assessment for substance abuse and a referral for substance abuse treatment might be warranted.

18.  On 10 June 2010, the applicant was seen for an individual psychotherapy session with a psychologist.  The applicant reported recent depressed mood and anxiety.  He anticipated that "bad" things would happen to him or that he would make poor decisions.  His motivation and energy were low and he reported seeing shadows at home.  He said he had strange beliefs in general but did not elaborate.  He also reported problems with sleeping and difficulty concentrating.  He and his wife continued to argue and plan to divorce.  He reported knee and back pain and he denied problems with substance abuse.  The psychologist observed that the applicant thinks about shooting select co-workers and he could access guns; however, he had no intent to harm others at this time.  He was provided education about treatment options; however, he was interested in medication management only and a treatment plan was developed.  He was scheduled to meet with the psychologist in a month for supportive psychotherapy and he was scheduled for a cognitive screening assessment in August 2010.

19.  On 18 June 2010, the applicant met with a psychiatrist who stated the applicant presented with symptoms of comorbid depression and PTSD.  The depression seemed to be pretty serious.  PTSD seemed to be of the complex type.  He had significant lack of trust and an indignant rage toward the military.  He was very sensitive to disrespect, not only toward him, but toward his peers as well.  The psychiatrist noted the applicant was a Soldier to be followed because of the severity of his symptoms.  Fortunately, the orders to transfer him to the WTU were signed.  The applicant felt the WTU would be a less stressful environment where he would not have to encounter the faces that usually aggravated him.

	a.  The psychiatrist recommended weekly supportive psychotherapy and a very gentle approach.  Relation rapport building was essential to his case, as the applicant had significant trust issues.  More conventional PTSD treatment, such as exposure or other modalities to recover memory or process them, were not indicated at the time.

	b.  The psychiatrist recommended a number of medications, including antidepressants, sleep medications, and mood stabilizers plus/minus Prazosin (an antihypertensive medication) for nightmares.  The applicant was informed of the risks of associating any medication with alcohol and he agreed to avoid the combination.  The applicant was informed about the side effects of the medications and instructed to stop the medication if he noticed any significant unbearable side effect.  A follow-up appointment was scheduled for 2 weeks later.

20.  A medical treatment record, dated 23 July 2010, shows the applicant was seen by his psychiatrist.

	a.  The psychiatrist had evaluated the applicant on 18 June 2010 and diagnosed him with PTSD with major depression.  At that time he was prescribed Effexor XR (venlafaxine hydrochloride – extended release, an antidepressant medication) for PTSD, trazodone (an antidepressant medication) and Prazosin for sleep and nightmares.  The applicant did not show up for his 2-week follow-up appointment and returned about 5 weeks later.  The applicant reported side effects from the Effexor XR so he discontinued the medication after a few doses.  The applicant stated the trazodone helped him with sleep, but he only took it 
2-3 times because he did not want to sleep and "miss out."  He did not try the Prazosin.

	b.  The applicant seemed depressed, morose, with flat affect and a minimal wish to interact.  He had gotten into trouble after he was stopped by police and found to have a suspended driver's license.  He claimed he has to show up in court but told the psychiatrist he would not.  The psychiatrist confronted the applicant about his self-sabotaging attitude and he indicated he was willing to try another medication.

21.  The psychiatrist rendered provisional DSM-IV-TR diagnoses of:

* Axis I – PTSD; depression (NOS) – rule out MDD – alcohol abuse
* Axis II – personality disorder (NOS) – rule out antisocial personality disorder (ASPD)
* Axis III – knee and back problem
* Axis IV – divorce and legal problems
* Axis V – GAF score of 52

22.  The psychiatrist further recommended/stated the applicant had no improvement with minimal collaboration and low level of treatment alliance.  The psychiatrist would try a different medication for depression and PTSD.  However, the applicant's prognosis seemed poor given the difficulty in forming a treatment alliance given his likely comorbid antisocial personality disorder.

23.  After the meeting with his psychiatrist, the applicant met with his psychologist.  The applicant stated he was feeling "bad, down."  He was sleeping 2 hours a night, his appetite had increased, and his memory was poor.  He stated he recently began to drink alcohol nightly and typically consumed 12 beers per day.  He further stated he stopped taking his psychotropic medication because he felt "weird" and unlike his normal self.  The psychologist's DSM-IV-TR diagnoses were:

* Axis I – PTSD, MDD, alcohol abuse
* Axis II – probable personality disorder (NOS), antisocial traits
* Axis III – knee, shoulder, and back pain – possible TBI
* Axis IV – occupational, combat, post-deployment, and financial stress – legal issues, marital uncertainty, multiple residential placements during adolescence
* Axis V – GAF score of 50

24.  The psychologist discussed the risk factors for PTSD, including excessive alcohol use.  The applicant discussed how he was attempting to transfer to the WTU and tell his chain of command "how it is."  He engaged in disrespectful acts toward select members of his chain of command and his first sergeant (1SG) (i.e., telling them, "fuck you," and not following orders).  He admittedly had no concern about the negative consequences of his behavior.  When asked about hobbies he reported he had few "legal" hobbies.  They discussed his future goals; he was vague and smiled.  He indicated he would like to be involved in the production of pornographic material.  The applicant was scheduled to meet with his psychologist in 1-2 weeks.

25.  On 27 August 2010, the applicant was seen jointly by his psychiatrist and psychologist who stated the applicant had not shown up for his appointments for about a month and a half and they were close to discharging him, yet he returned at the last moment.  The applicant expressed homicidal thoughts toward his 1SG and appeared paranoid.  The applicant finally agreed to act responsibly and continue treatment.  The applicant reported that Zoloft (sertraline, an antidepressant medication) helped him because he would take 
2-3 tablets to "numb him out."  Options were discussed with him only after he agreed to commit for safety.  The applicant said he had no thoughts of killing himself and he was once again assessed as having made no improvement with a poor prognosis given his difficulty in forming a treatment alliance and likely comorbid antisocial personality disorder.

26.  On 31 August 2010, the applicant was seen as a walk-in patient at the psychology clinic.

	a.  He threatened to kill his 1SG with his bare hands because his 1SG threatened to give him an Article 15 for being absent without leave when he was not.

	b.  He missed his appointment the previous day with his psychiatrist because he forgot due to his short-term memory problems.  He also stated he had not been screened for a TBI.

	c.  His unit was in the field and he could not go because he still wanted to kill his 1SG and didn't want to be in the Army anymore.  He claimed he would like to go overseas to "off" somebody and get away with it; he would "off somebody here, but [he] may not get away with it."  He stated he drinks alcohol daily to relax and he remains unable to sleep.

	d.  He was referred to ASAP and the unit gave him the paperwork to turn in, but he never returned it.  He denied suicidal thoughts but stated active homicidal thoughts toward his 1SG and his mother's boyfriend.  He remained very frustrated with the process to be assigned to the WTU.

27.  On 31 August 2010, the applicant's treatment was terminated due to his non-attendance/noncompliance.  It was recommended that the applicant continue psychiatric services and individual psychotherapy at Fort Drum Samaritan BH Clinic and he was informed how to access crisis management service there.

28.  On 7 September 2010, the applicant was seen as a walk-in patient after his discharge from the Samaritan Medical Center where he had been admitted on 31 August 2010 for overt threats to kill someone with his bare hands.  The applicant refused to complete paperwork, stating, "I didn't feel like filling out the form."  There was no discharge summary from the hospital.  The applicant stated his command met with his doctors that morning and decided it was time for him to get out.

	a.  He was to start leave on 22 September 2010 with plans to drive to Michigan to see his friends and pregnant girlfriend.

	b.  He stated, "They better move me to [the] WTU quickly," not wanting to remain in his unit any longer due to his strained and tense relationship with his 1SG.

	c.  He was instructed to follow up in the psychiatric clinic.  He declined individual counseling.  He had a history of not reporting for scheduled treatment at the "Coleman Clinic [Coleman Avenue location]."  He expected to be moved to the WTU upon return from leave.

29.  On 27 October 2010, the applicant was seen as an urgent walk-in patient at the psychology clinic of the Fort Drum BHD.  He was at the clinic because he was going to be "ETS'ing" in December and he did not want to.  He wanted to be assigned to the WTU to "concentrate on myself."  He admitted to having recent suicidal and homicidal thoughts but denied being at risk at the moment.  His Outcome Questionnaire-45 (OQ-45) yielded a score of 161 consistent with a self-report of extreme distress; however, he was opposed to the possibility of re-hospitalization.

	a.  He was somewhat hostile in the interview and described himself as angry.  His affect was congruent and, although calm on the surface, gave the impression of controlled hostility.  He was alert, fully oriented, and had no problems with concentration.  His long and short term memory appeared grossly intact.  His insight and judgment were poor and the applicant denied suicidal and homicidal thoughts, plans, or intent.

	b.  He was assessed as a high risk to self or others.  His case was discussed with Captain H____ who agreed to speak to the applicant regarding his administrative concerns about going to the WTU and noted his fitness for duty needed to be further assessed.

30.  On 1 November 2010, the applicant was seen for a medication evaluation, supportive therapy, and psychiatric treatment planning.

	a.  The applicant was assessed with a lack of personal accountability with a strong sense of entitlement, anger, and irritability; resistance to change and oppositional defiance, denial, and untruthfulness; threats to obtain secondary gain; as "defiant, intimidating, obstinate…threatening staff and patients" while at Samaritan with verbalization by the chain of command that the applicant belongs in jail; and all present and pervasive traits that meet full criteria for ASPD, other than youth, unknown, rather than symptoms of PTSD.

	b.  Though the applicant may have PTSD and this may be worsening his Axis II traits, his brief report of trauma presents as that of ego rather than empathy.  In addition, there is the suspicion of secondary gain as the applicant continually adamantly refused any treatment as offered from the VA, including inpatient and partial inpatient programs, because he does not want to be a civilian.

	c.  There is no reason to believe that any extension of time in the military will garner compliance as he has a history of significant noncompliance at two clinics as well as inpatient hospitalizations, and as he expressed refusal of offered treatments this day and stated he wanted to leave the appointment.  It was nearly impossible to perform an initial assessment on the applicant due to his minimal cooperation.

	d.  No imminent safety issues were noted; however, collaboration to manage the potential of overmedication and acting out to get his way to remain in the Army were issues.  The applicant, due to his antisocial behavior, could not be relied on to contract.

31.  On 3 November 2010, the applicant presented at the psychology clinic stating he could not get out (of the Army) because he was not ready and he threatened to kill someone.  He stated he had not attended the briefings necessary to clear the unit and the Army.  He was encouraged to speak to the various representatives for information about his options.  He denied current suicidal or homicidal ideation, intent, or plan, and he was diagnosed with an adjustment disorder with anxiety.  The applicant was instructed to follow up with his appointment later in the week for a command-directed mental status evaluation.

32.  On 8 November 2010, the applicant underwent a command-directed mental health evaluation.

	a.  Based on his current presentation, report of substance abuse, and invalid responses to testing, it was difficult to obtain a clear picture of the applicant's symptoms.  While it was likely that some symptoms consistent with trauma reactions were present, what was not clear was if the symptoms met the criteria for a diagnosis of PTSD.  The applicant had, however, reported misuse of anxiolytic (anti-panic or antianxiety) drugs and misuse of alcohol.  He had a history of noncompliance with individual treatment, group treatment, medication management, and ASAP.

	b.  Most likely, the applicant's Axis I difficulties were exacerbated by maladaptive personality characteristics.  The applicant repeatedly showed a failure to conform to social norms, deceitfulness, impulsivity, irritability and aggressiveness, reckless disregard for the safety of himself and others, consistent irresponsibility, and lack of remorse for having harmed or mistreated others.  Because these traits appear to be ingrained and longstanding, his prognosis for treatment was poor as he was unlikely to be able to comply with therapy on a consistent basis or engage in a positive therapeutic relationship.

	c.  Despite the applicant's considerable legal difficulties and frequent interaction with the BH Clinic, neither the applicant nor his command noted a significant deterioration in his ability to perform his duties or significant disciplinary problems within the military system.  It was likely that his history of hospitalization was related more to Axis II pathology than combat-related symptoms.

33.  The command-directed mental health evaluation rendered the following recommendations:

	a.  Due to the applicant's maladaptive personality traits, substance abuse, noncompliance with treatment, and invalidation of test results, a clear assessment of his true psychological symptoms was difficult.  At this time, it did not appear that he had a disorder that was disqualifying in accordance with Army Regulation 40-501 (Standards of Medical Fitness) that would require disposition through medical channels.  While substance abuse and personality traits have resulted in multiple hospitalizations, these conditions would render an individual administratively unfit, rather than unfit due to mental disability in accordance with Army Regulation 40-501.

	b.  As the applicant was due to reach his ETS in the next 30 days and he had not been compliant with treatment in that clinic or at the Coleman Avenue clinic, further scheduled treatment in the military system was not recommended at that time.  The applicant has been offered continued acute care in emergency situations.

	c.  The applicant should be command referred to ASAP for a substance abuse evaluation.

	d.  The command should counsel the applicant to make contact with the VA Medical Center, as well as the veterans' center in Watertown, NY, to arrange for continued behavioral health care following discharge.

	e.  Due to the applicant's history of violent behavior and threats to the same, the command should not hesitate to contact the military police to have the applicant escorted to the Samaritan Medical Center emergency room in the event his behavior resulted in danger to himself or others.

	f.  The applicant was mentally responsible for his behavior, could distinguish right from wrong, and possessed sufficient mental capacity to participate in administrative or judicial proceedings as deemed appropriate by the command.

34.  On 6 December 2010, the applicant was honorably released from active duty in accordance Army Regulation 635-200 (Active Duty Enlisted Administrative Separations), with chapter 4, for completion of required active service.  He was transferred to the 431st Quartermaster Company, U.S. Army Reserve.  His DD Form 214 (Certificate of Release or Discharge from Active Duty) shows he completed 4 years, 3 months, and 27 days of net active service with 9 months and 8 days of foreign service.  This form also shows he served in Afghanistan during the period 23 March through 30 December 2009.

35.  On 24 May 2011, the applicant received a VA rating decision which granted him 100-percent service-connected disability for PTSD with alcohol abuse and a 10-percent service-connected disability rating for bilateral tinnitus effective 7 December 2010.  Service connection for bilateral sensorineural hearing loss was granted with a rating of 0 percent.

36.  On 1 November 2011, the applicant received a general discharge under honorable conditions from the 431st Quartermaster Company due to unsatisfactory participation.

37.  Counsel contended:

	a.  In July 2009, the applicant's up-armored High Mobility Multipurpose Wheeled Vehicle (commonly known as HMMWV) was hit within 15 feet by an improvised explosive device which shook him up and left him with headaches and fearful of hostile military activity.  He remembered a lot of ambushes and he lost a lot of his buddies.  On 21 July 2009, he received the ARCOM with "V" Device for "valorous and meritorious service while under intense small arms fire in support of Operation Enduring Freedom."

	b.  In January 2010, the applicant was diagnosed with PTSD and subsequently referred to the BHD by a family life counselor.  He denied suicidal ideation.  He reported low frustration tolerance, guilt, poor memory, interpersonal conflicts, and transient homicidal thoughts, although he denied intent or plans to harm others or himself.  He was easily startled by loud noise, dreams of combat experience, irritability, poor sleep, and concentration.  He reported trauma from exposure to combat and re-experiencing dreams of combat with insomnia.  He reported disciplinary problems of fights and suspension and indicated thoughts of harming persons in his unit with no plans to do so.  He was diagnosed with an adjustment disorder with disturbance of conduct and relational problems.

	c.  In January 2010, he began interpersonal therapy and in March 2010 he started a 12-week PTSD therapy group.  On 19 April 2010, he was a "no show" for a psychiatric medication evaluation and psychopharmacotherapy (psychoactive drug treatment) services were terminated.  On 20 April 2010, he attended a PTSD therapy session where a licensed clinical social worker stated he had PTSD and follow-on diagnoses clearly showed the applicant had Axis I PTSD and MDD.

	d.  On 5 May 2010, the applicant was intoxicated and had taken an overdose of medication.  He was arrested for assault against a civilian woman whom he claimed tried to take his phone.  The charges were dropped and he later married the woman involved in the altercation.  His health records noted that he had just been released from the hospital after an overdose of sleeping pills and that he still harbored stresses and had concerns about his tendency to have aggressive ideation toward others.  The assessment stated he still showed signs of inner emotional distress affecting his mood, concentration, thought processes, and behavior as related to PTSD symptomology.  According to the applicant, he had been feeling gradually worse since returning from deployment.

	e.  On a 13 May 2010 intake history, the applicant stated he admitted to active thoughts of hurting others and was placed on unit watch.  He described his juvenile criminal history from age 13, which included two locked programs and three foster homes.  He continued to get into trouble and was given the option to join the military.  The applicant stopped going to group PTSD therapy at the end of April 2010 because he felt it was not helping him.  He was admitted to inpatient mental health after his arrest and subsequent hospitalization for an overdose of sleeping pills.

	f.  On 26 May 2010, the applicant was evaluated for the WTU.  A healthcare provider concluded the applicant suffered from lower back pain and adjustment disorder with anxiety.  He recommended continued follow-up care with the BH Clinic and he did not feel the applicant would benefit from an MEB.  However, the applicant's chain of command was well aware of his pending ETS in December 2010 and took the easier approach of letting him reach his ETS rather than initiating an evaluation through the PDES.

	g.  A 2 June 2010 assessment showed the applicant still showed signs of inner emotional distress affecting his mood, concentration, thought processes, and behavior as related to PTSD symptomology.  The applicant's initial assessment at the Fort Drum Samaritan BH Clinic on 3 June 2010 stated the applicant's chief complaint was for depression, anxiety, and PTSD.  He claimed to get along with his superiors and to talk to most of his peers.  Although there was no evidence of record, he further claimed he was administratively reduced for not showing up for work one day and admitted to having a history of cannabis and Ecstacy use within the past year.

	h.  On 18 June 2010, Dr. G____ M____ completed a psychiatric evaluation on the applicant and assessed him as presenting with "symptoms of Comorbid Depression and PTSD.  The depression seems to be pretty serious.  PTSD seems to be of the complex type…The symptoms of depression are remarkable as well, especially the rather flattened affect….However, the symptoms are not that old and seem to be more related to combat, which was actually pretty serious in his case.  He is reluctant to engage in treatment, at least in certain modalities.  He cannot open up and he has trust issues, yet he agrees to take medications and to try different combinations of them until he finds the right mix.  He is a soldier to be followed because of the severity of his symptoms."

	i.  On 23 July 2010, Dr. J____ W____ noted the applicant missed a 2-week follow-up appointment return about 5 weeks later, reporting side effects from Effexor.  He felt "more depressed."  The applicant was apparently stopped by police with a suspended license.  Dr. J____ W____ noted there was "no improvement…will try a different medication for depression and PTSD."  Dr. G____ M____ noted "no improvement.  Collaboration elicited with difficulty.  Prognosis seems poor given the difficulty of forming a treatment alliance and the likely comorbid antisocial personality disorder.  Today we noted a heightened level of paranoia."

	j.  The applicant received three sessions of individual psychotherapy with the last occurring on 27 August 2010.  He indicated that he had homicidal thoughts against his 1SG and "appeared paranoid."  On 31 August 2010, he was seen by D____ M____ O____, a licensed clinical social worker, after being directed to go to the BH Clinic as a walk-in patient.  He claimed to have forgotten about his previous appointment due to short-term memory problems.  He stated his sleep was poor and his medication was not helping.  He was hospitalized for 8 days and discharged on 7 September 2010.

	k.  On 27 October 2010, he was a walk-in patient at the Guthrie Army Health Clinic Psychology Clinic.  He admitted to having recent suicidal and homicidal thoughts.  His OQ-45 score yielded a total score of 161 "consistent with a self-report of extreme distress."  He presented risk factors of "suicidal and homicidal ideation, prior attempts, multiple hospitalizations, limited support system, alcohol use, and interpersonal problems."

	l.  On 1 November 2010, the applicant went to the psychiatry clinic stating he wanted to go to the WTU and extend his enlistment for 1 year because he was not ready to be a civilian.  "He is angry that he saw his friends get killed, has nightmares, and drinks to forget."  His medications were changed and L____ Z____, a psychiatric mental health nurse practitioner, terminated him from her care due to his pending ETS.  On 4 November 2010, the applicant showed up for an appointment with D____ M____ O____, again claiming that "he wasn't ready to get out" and that he "may kill someone."

	m.  On 8 November 2010, the applicant underwent a command-directed examination.  The examining psychologist stated that based on the applicant's current presentation, report of substance abuse, and invalid response to testing, it was difficult to obtain a clear picture of the applicant's symptoms.  While it was likely that some symptoms consistent with trauma reactions were present, what was not clear was if these symptoms met criteria for a diagnosis of PTSD.  He had, however, reported misuse of anxiolytic drugs and misuse of alcohol.  He had a history of noncompliance with individual treatment, group treatment, medication management, and ASAP.  Most likely, the applicant's Axis I difficulties were exacerbated by maladaptive personality characteristics.  The applicant had a history of conduct problems dating back to age 13.  Furthermore, he had repeatedly shown a failure to conform to social norms, deceitfulness, impulsivity, irritability and aggressiveness, reckless disregard for the safety of others, consistent irresponsibility, and lack of remorse for having harmed or mistreated others.  Because these traits appeared to be ingrained and longstanding, his prognosis for treatment was poor as he was unlikely to be able to comply with therapy on a consistent basis or engage in a positive therapeutic relationship.  Despite his considerable legal difficulties and frequent interaction with the BH Clinic, neither the applicant nor his command noted a significant deterioration in his ability to perform his duties or significant disciplinary problems within the military system.  It was likely that his history of hospitalization was more related to Axis II pathology than combat-related symptoms.

* Axis I – anxiolytic abuse, alcohol abuse, rule out alcohol dependence, noncompliance with treatment, anxiety disorder (NOS)
* Axis II – ASPD
* Axis III – None
* Axis IV – Occupational Problem, Insufficient Social Support
* Axis V – GAF score of 55

	n.  The psychologist provided a recommendation which stated that due to the applicant's maladaptive personality traits, substance abuse, noncompliance with treatment, and invalidation of test results, a clear assessment of his true psychological symptoms was difficult.  At that time, it did not appear that he had a disorder that was disqualifying in accordance with Army Regulation 40-501 that would require disposition through medical channels.  While his substance abuse and personality traits have resulted in multiple hospitalizations, these conditions would render an individual administratively unfit, rather than unfit due to mental disability in accordance with Army Regulation 40-501, paragraph 3-35.  As the applicant was due to ETS in the next 30 days and had not been compliant with treatment in this clinic or the Coleman Avenue clinic, further scheduled treatment in the military system was not recommended at that time.  The applicant was offered continued acute care in emergency situations.

	o.  On 24 November 2010, the applicant received separation counseling and he did not waive any of his rights.  On 6 December 2010, he was honorably discharged and transferred to the 431st Quartermaster Company, 88th Regional Support Command, in Lansing, MI.

	p.  On 2 May 2011, the applicant underwent a VA Compensation and Pension psychiatric examination.  The examiner noted the applicant complained of hypervigilance, intrusive thoughts, flashbacks, perimeter checking, anger problems, anxiety, some depression, paranoia, and sleep disturbance.  He also noted the applicant had a significant amount of social dysfunction from his PTSD.  The examiner concluded the applicant had PTSD under Axis I secondary to his Afghanistan war experiences with alcohol abuse secondary to PTSD.  He also suffered from moderate to severe social dysfunction secondary to PTSD.  On 24 May 2011, the VA awarded the applicant service connection for PTSD with alcohol abuse with a rating of 100 percent effective 7 December 2010.  As the decision stated, the examiner assigned a current GAF score of 48, meaning serious symptoms or any serious impairment in social, occupational, or school functioning.

38.  Counsel further contended that if a service member appeared to be unfit to physically perform his or her military duties, the military must start the MEB process.  He maintains the military will argue that the applicant was fit to perform his duties; therefore, an MEB was not necessary.

	a.  The Army will cite the 8 November 2010 report which states, in part, that "despite the Soldier's considerable legal difficulties and frequent interaction with BH, neither the Soldier nor his command noted significant deterioration in his ability to perform his duties or significant disciplinary problems within the military system."

	b.  The latter statement is incorrect because the applicant had "significant disciplinary problems" and significant deterioration in his ability to perform his duties.  He was administratively reduced, with his grade eventually restored, and was threatened with an Article 15 in August 2010.  He had fights and a suspension.  He missed a huge amount of duty due to the mental health treatments he received and for his 12 days of hospitalizations, in one case for an intentional overdose.  He was chronically drunk, at one time stating he drank 6-12 beers a day during the week and a fifth of liquor on weekends mixed with the use of prescription and possibly illegal drugs.

	c.  The records are replete with references to him being chronically tired, sleeping only several hours a night.  He had nightmares and flashbacks.  He was taking Ambien to sleep and was difficult to awake.  Despite the statements in his records, there is nothing from his command regarding his work performance other than that he was placed on unit watch.  The applicant stated he had "negative feelings about his inability to perform basic soldiering duties due to his inability to concentrate, anger, and impatience."  This was available to the writer of the November 2010 report, but dutifully ignored.

	d.  Under no circumstance was the applicant's duty performance not affected by his PTSD symptomology.  Importantly, he was placed on unit watch with the unit simply marking time until his ETS rather than starting the PDES process by convening an MEB.  The 8 November 2010 report places heavy emphasis on the applicant's maladaptive traits and criminal behavior as a juvenile.  Importantly, the applicant's "criminal behavior" as a juvenile was for retail fraud for stealing paintballs.  He had a dysfunctional home life, was locked in juvenile detention several times, and placed in three foster homes.  That conviction was waived by the Army for his enlistment.  Prior to and during his second deployment to Afghanistan, there is no record of any disciplinary or behavioral issues.  To the contrary, he performed admirably, receiving an ARCOM for valor.  His problems essentially began after his second deployment.

	e.  The Army will also argue the applicant's medical conditions, PTSD in particular, did not rise to the level requiring the first step of the PDES, being an MEB.  It will cite the 26 May 2010 WTU evaluation which stated the applicant could end his term of service in December 2010 and would not benefit from an MEB.  Several things should be noted.  First, the evaluation was for whether the applicant should be reassigned to the WTU.  It was not an evaluation for the purposes of the PDES.  Second, the phrase, "do not feel he would benefit from a MEB" does not comply with PDES requirements and clearly misunderstands the purpose of an MEB which is not to "benefit" the Soldier but to determine fitness for duty.  Third, it is evident that D____ M____ W____ was simply trying to evaluate the applicant for the WTU and to manage him so he could ETS later in the year.

	f.  The Army will also cite the applicant's 8 November 2010, evaluation by K____ C____ which states, in part, "At this time, it does not appear that he has a disorder that is disqualifying in accordance with Army Regulation 40-501 that would require disposition through medical channels.  While substance abuse and personality traits have resulted in multiple hospitalizations, these conditions would render an individual administratively unfit, rather than unfit due to mental disability in accordance with Army Regulation 40-501, paragraph 3-35."  The report stated the applicant reported high levels of depression, trauma-related anxiety, antisocial personality characteristics and behavior, and substance abuse, but cautioned that these should only be viewed as the Soldier's description of his difficulties rather than his actual experience of symptoms.  Also, what is not clear is if these symptoms met the criteria for a diagnosis of PTSD.  The report emphasized the applicant's substance abuse and invalid responses to testing; and said that he was exaggerating his symptoms, that his prognosis for treatment was poor, and "that it is likely that his history of hospitalization was related more to Axis II pathology than combat-related symptoms."

	g.  The latter report is flawed for several reasons.  First, it questions whether the applicant even had PTSD.  This contradicts the original January 2010 PTSD diagnosis and, later, the thorough evaluation and diagnosis of Dr. G____ M____, a psychiatrist, on 18 June 2010, that stated the applicant had "symptoms of Comorbid Depression and PTSD…the depression seems to be pretty serious, with symptoms of depression "remarkable," and PTSD "seems to be of the serious type."  Second, the 8 November 2010 report refers to "failure to conform to social norms, deceitfulness, impulsivity, irritability and aggressiveness, reckless disregard," which are precisely the indications of PTSD symptomology.  As stated previously, the applicant's behavior and self-medicating behavior, including drinking alcohol and use of prescription and illegal drugs, was a result of his PTSD symptomology.  The 8 November 2010 report discounts this entirely.  Third, the 8 November 2010 report does not list PTSD under Axis I, directly contradicting Dr. G____ M____'s Axis I PTSD diagnosis as well as the Axis I PTSD diagnosis of others.  Fourth, the report failed to take into account the applicant's attempted suicide in May 2010, although the report's risk assessment clearly states this.  Even though the report questions the applicant's test results, there is no allegation that his original PTSD diagnosis in January 2010 and subsequent evaluations prior to November 2010 were faked or exaggerated.

	h.  At no point was the applicant evaluated for fitness for duty in accordance with Army Regulation 40-501.  His GAF score was 50 and 51 as noted by Dr. G____ M____ in the 8 November 2010 report.  The VASRD 70-percent disability rating criteria for mental disorders states:  "Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as:  suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships."  The administrative record and GAF scores clearly show the applicant met the 70-percent criteria while in service which was known to his military health care providers and command.  It was in error for the military not to follow the VA General Medical Examination and the applicable Compensation and Pension Automated Medical Information Package worksheets as mandated.  It was also in error in that the applicant was not referred to the PDES and awarded a 70-percent disability rating.

39.  Army Regulation 635-200, paragraph 5-17, states that 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, which includes those members suffering from a disorder manifesting disturbances of perception, thinking, emotional control, or behavior sufficiently severe that the Soldier's ability to effectively perform military duties is significantly impaired.

40.  Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation) establishes the 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 MEB's 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 chapter 3 of Army Regulation 40-501.  Disability compensation is not an entitlement acquired by reason of a service-incurred illness or injury; rather, it is provided to Soldiers whose service is interrupted and who can no longer continue to reasonably perform because of a physical disability incurred or aggravated in service.

	a.  Paragraph 3-1 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 member reasonably may be expected to perform because of his or her office, rank, grade, or rating.  The Army must find that a service member is physically unfit to reasonably perform his or her duties and assign an appropriate disability rating before he or she can be medically retired or separated.

	b.  Paragraph 3-2b(2) states that when a member is being processed for separation for reasons other than physical disability (e.g., retirement, resignation, reduction in force, relief from active duty, administrative separation, discharge, etc.), his or her continued performance of duty creates a presumption that the member is fit for duty.  Except for a member who was previously found unfit and retained in a limited assignment duty status in accordance with chapter 6 of this regulation, such a member should not be referred to the PDES unless his or her physical defects raise substantial doubt that he or she is fit to continue to perform the duties of his or her office, grade, rank, or rating.

	c.  Paragraphs 3-2b(2)(a) and 3-2b(2)(b) state that when a member is being processed for separation for reasons other than physical disability, the presumption of fitness may be overcome if the evidence establishes that the member, in fact, was physically unable to adequately perform the duties of his or her office, grade, rank, or rating even though he or she was improperly retained in that office, grade, rank, or rating for a period of time and/or acute, grave illness or injury or other deterioration of physical condition that occurred immediately prior to or coincidentally with the member's separation for reasons other than physical disability rendered him or her unfit for further duty.

	d.  Paragraph 3-5 states the percentage assigned to a medical defect or condition is the disability rating.  A rating is not assigned until the PEB determines the Soldier is physically unfit for duty.  Ratings are assigned from the VASRD.  The fact that a Soldier has a condition listed in the VASRD does not equate to a finding of physical unfitness.  An unfitting or ratable condition is one which renders the Soldier unable to perform the duties of his or her office, grade, rank, or rating in such a way as to reasonably fulfill the purpose of his or her employment on active duty.  There is no legal requirement in arriving at the rated degree of incapacity to rate a physical condition which is not in itself considered disqualifying for military service when a Soldier is found unfit because of another condition that is disqualifying.  Only the unfitting conditions or defects and those which contribute to unfitness will be considered in arriving at the rated degree of incapacity warranting retirement or separation for disability.

41.  Army Regulation 40-501 governs medical fitness standards for enlistment, induction, appointment (including officer procurement programs), retention, and separation (including retirement).  Chapter 3 provides 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 individual in paragraph 3-2, below.  These medical conditions and physical defects, individually or in combination:

* significantly limit or interfere with the Soldier's performance of duties
* may compromise or aggravate the Soldier's health or well-being if the Soldier remains in the military – this may involve dependence on certain medications, appliances, severe dietary restrictions, frequent special treatments, or a requirement for frequent clinical monitoring
* may compromise the health or well-being of other Soldiers
* may prejudice the best interests of the government if the individuals were to remain in the military service

42.  Army Regulation 40-501, paragraph 3-36 (Adjustment Disorders), provides that 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 military duty.

43.  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 of less than 30 percent.

44.  Title 38, U.S. Code, sections 1110 and 1131, permit the VA to award compensation for disabilities which were incurred in or aggravated by active military service.  However, an award of a higher VA rating does not establish an error or injustice on the part of the Army.  The Army rates only conditions determined to be physically unfitting at the time of discharge which disqualify the Soldier from further military service.  The Army disability rating is to compensate the individual for the loss of a military career.  The VA does not have authority or responsibility for determining physical fitness for military service.  The VA awards disability ratings to veterans for service-connected conditions, including those conditions detected after discharge, to compensate the individual for loss of civilian employability.  As a result, the VA, operating under different policies, may award a disability rating where the Army did not find the member to be unfit to perform his duties.  Unlike the Army, the VA can evaluate a veteran throughout his or her lifetime, adjusting the percentage of disability based upon that agency's examinations and findings.

DISCUSSION AND CONCLUSIONS:

1.  The applicant and counsel's request to correct the applicant's records to show he was medically retired after receiving an evaluation from the Army PDES which resulted in a disability rating of at least 50 percent for the first 6 months from 6 December 2010 and 70 percent with applicable back pay thereafter has been carefully considered.

2.  The purpose of the PDES is to maintain an effective and fit military organization with the maximum use of available manpower, provide benefits for eligible Soldiers whose military service is terminated because of a service-connected disability and provide prompt disability processing while ensuring the rights and interests of the Army and the Soldier are protected.

3.  As such, a Soldier who suffers an injury or an illness while serving on active duty is retained in the service until he or she has attained maximum hospital benefits and completion of a disability evaluation if otherwise eligible for referral into the disability system.  Medical officials are responsible for counseling Soldiers concerning their rights and privileges at each step in the disability evaluation process, beginning with the decision of the treating physician to refer the Soldier to an MEB and until final disposition is accomplished.

4.  There is insufficient evidence in the available records and the applicant did not provide sufficient evidence to show he was ever determined to have a medical condition which was of such severity that it would have warranted his entry into the PDES.

5.  The evidence shows he was diagnosed by healthcare professionals with either an adjustment disorder or PTSD.  Regardless of the malady, adjustment disorder, PTSD, nightmares, anxiety, etc., they can be and are routinely treated.  More important is the multiple references in the applicant's records regarding his noncompliance with treatment.  The evidence shows he was noncompliant with the recommendations of several different providers, sometimes resulting in a termination of the patient-physician relationship.  He did not go to counseling, he did not take his medications as prescribed, and he did not show up for required evaluations.  Under these circumstances, it is not relevant whether he had PTSD.  Soldiers are referred to the PDES if they have a malady that cannot be treated or cannot be brought to standard with treatment.  When a Soldier is not compliant with treatment, he or she can be discharged for a "condition, not a disability" in accordance with Army Regulation 635-200, paragraph 5-17, even though his malady would otherwise be compensable.

6.  The applicant and counsel believe he should have received a medical retirement for his various medical conditions due to being granted a VA disability rating for his service-connected conditions.  However, an award of a rating by another agency, such as the VA, does not establish error on the part of the Army.  Operating under different laws and its own policies, the VA does not have the authority or the responsibility for determining medical fitness for military service.  The VA may award ratings because of a medical condition related to service (service connected) that affects the individual's civilian employability.

7.  The PDES provides that 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 a physical disability present with the requirements of the duties the Soldier may be reasonably expected to perform based on the Soldier's office, grade, rank, or rating.

8.  A disability rating assigned by the Army is based on the level of disability at the time of the Soldier's separation and can only be accomplished through the PDES.  The applicant appears to have been physically or medically fit at the time of his discharge from active duty in December 2010.  In view of the foregoing, there is insufficient evidence to grant the requested relief.  The applicant has not shown error, injustice, or inequity for the relief he requests.

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 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.
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