IN THE CASE OF:	  

		BOARD DATE:	  30 September 2014

		DOCKET NUMBER:  AR20130020375 


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 any reference to a delusional disorder, anxiety, or adjustment disorder or statements that she was not pregnant be removed from her records.  

2.  The applicant states she has never had any mental health issues and she still had not been hospitalized.  She has not been given the opportunity to receive medical treatment and she has not been properly examined.  She is still trying to get a physical examination.  She is seeking to have her medical records corrected because she believes the information in them to be incorrect.  She believes that she is pregnant and that the pregnancy is an abnormal pregnancy.

3.  The applicant provides documentation from:

* Dr. M____ R___, Womack Army Medical Center (WAMC), Fort Bragg, NC
* Dr. B_____ M____, WAMC
* Dr. J________ T_______, WAMC
* Cape Fear Valley Health
* Cumberland County Department of Public Health, Fayetteville, NC
* Northside OB/GYN, Atlanta, GA
* email, dated from 25 January 2013 to 29 April 2013 between the applicant and her counsel


CONSIDERATION OF EVIDENCE:

1.  She previously had 8 years of active service in the U.S. Navy.  On 18 August 2006, she enlisted in the Regular Army.  She was serving in military occupational specialty (MOS) 68W (Health Care Specialist).  She was promoted to sergeant/pay grade E-5 on 1 October 2011.

2.  On 18 April 2012, she was referred to the Integrated Disability Evaluation System (IDES) for "somatoform disorder."  

3.  She was evaluated by Dr. Pr____, MEB physician, Fort Bragg on 21 May 2012.  The Narrative Summary (NARSUM) provided the following information:

	a.  On 28 December 2011 and 20 March 2012, an ultrasound of the pelvis showed no evidence of intrauterine gestation.  On 30 March 2012, Dr. N_______ Psychiatry at WAMC, provided a diagnosis of "delusional disorder, Somatic type."

	b.  The applicant stated her last menstrual period was in February/March 2011.  She subsequently developed abdominal pain which has continued, and in March 2011 she started to "feel movement."  She stated that home pregnancy tests had been positive, although pregnancy tests done at medical clinics had been consistently negative as had pelvic ultrasounds.  She was convinced she was pregnant.

	c.  She has had investigations including medical visits, pregnancy tests, and ultrasounds to confirm or refute the diagnosis of pregnancy.  These were negative; however, she was not convinced because "she was not allowed to see her ultrasound when it was being performed."

	d.  The applicant remained convinced she was pregnant in spite of evidence to the contrary.  She could perform the activities of daily living to include driving a vehicle.  She could not perform certain basic Soldier functional activities and she was considered non-deployable and could not have access to weapons because of her psychiatric diagnosis.  A protective mask would have increased her level of anxiety.

	e.  The applicant remained convinced she was pregnant despite evidence to the contrary.  She was on no psychotropic medication but was taking prenatal vitamins.  It was uncertain whether there would be significant improvement in her condition during the next 5 years.  Improvement would likely require a willingness to use ongoing psychotropic medication.  Her condition was not compatible with the rigors of soldiering.
	f.  The examiner provided a disqualifying diagnosis of delusional disorder, somatic type (delusion that the person has some physical defect or general medical condition).

4.  On 5 June 2012, she received a Compensation and Pension (C&P) Examination for Mental Disorders (except Post-Traumatic Stress Disorder (PTSD) and Eating Disorders).  The examiner was Dr. Pu_____.  He indicated the applicant displayed medical and/or psychiatric symptoms (other than PTSD) during the past year.

	a.  The applicant displayed a persistent belief that she was pregnant despite multiple sources of medical evidence to the contrary.  She stated her conviction that she originally became pregnant in February of 2011 and that a second pregnancy may have begun in May of 2012.  She believed that she was experiencing two pregnancies simultaneously and that one or both of these were abnormal in some way (i.e., abnormal development of the fetus).  She stated that the repeated negative pregnancy results from tests indicate to her that medical professionals wanted to hide problems with the fetus from her and wanted to cover up the errors made by previous examiners.  When asked to explain how the two pregnancies could have lasted 13 and 16 months respectively, she stated that she believed the fetal development may have slowed.  She stated that she believed that labor would need to be induced in order for the babies to be born.

	b.  The examiner indicated the applicant experienced daily episodes of anxiety and sadness of moderate intensity, onset in 2011.  She described this emotional distress as a reaction to medical professionals and some friends not believing her about being pregnant and the likelihood of losing her military career.

	c.  She reported significantly reducing her contact with friends during the past year due to some negative feedback from people regarding the pregnancy issue and partially because she wished to spend more time in prayer and spiritual meditation.  She described having experienced a spiritual re-awakening in February of 2011.

	d.  The examiner indicated the applicant had a persistent fixed somatic delusion that she was pregnant.  He indicated she does not understand the outcome of her behavior and she does not understand that she has a problem.

	e.  The examiner stated some of her behavior as well as certain attitudes towards others were influenced by the delusional process.  She refused some assigned physical duties due to her belief that they could harm her unborn child.  As a result of her delusional system it was possible that she could make errors in judgment that would have adverse effects for co-workers, customers, or patients. Any future job role held while the disorder remains active should be closely supervised and should not include responsibilities which could impact significantly on the lives of others.

	f.  The examiner indicated she had a GAF score of 30 and diagnosed her with delusional disorder, somatic type.

5.  A DA Form 3947 (Medical Evaluation Board (MEB) Proceedings), dated 
15 June 2012, shows an MEB determined her delusional disorder did not meet retention standards in accordance with paragraph 3-31 of Army Regulation 40-501 (Standards of Medical Fitness) and referred her to a Physical Evaluation Board (PEB).  The following diagnoses were found not to be medically disqualifying:

* status post bunion removal with residual left foot pain
* bilateral pes planus
* bilateral patellofemoral syndrome

6.  On 18 June 2012, the approving authority approved the findings and recommendation of the MEB.

7.  On 26 June 2012, the applicant acknowledged she had been informed of the approved findings and recommendation of the MEB and she did not agree with the board's findings and recommendation.  She submitted a written appeal, dated 26 June 2012.

	a.  She stated she was a good Soldier and would like to be able to continue her military career.

	b.  She had an underlying medical condition that was preventing her from performing her soldierly duties.  If the proper care and treatment was provided she could be returned to duty and found fit for duty as well.   

8.  On 6 July 2012, after considering her appeal the approving authority confirmed the original findings and recommendation of the MEB.

9.  On 7 February 2013, a formal PEB found the applicant physically unfit for delusional disorder and recommended a disability rating of 100 percent and that she be placed on the Temporary Disability Retired List (TDRL) with a reexamination during February 2014.

	a.  The applicant appeared before the formal PEB on 6 February 2013.  She requested the board find her fit for duty for her delusional disorder.  She stated she could still perform the duties of her MOS and provided evidence she successfully completed an Army Physical Fitness Test on 13 December 2012.

	b.  She testified she believed she conceived in early 2011 and that she remained pregnant despite medical testing proving otherwise.  

10.  The DA Form 199-1 (Formal PEB Proceedings) in her Official Military Personnel File (OMPF) does not show her elections in Section X - Soldier's Election.  However, it appears she did not concur with the findings and recommendation of the formal proceedings in that the file contains her written statement concerning these proceedings.

	a.  The formal PEB stated that despite treatment efforts her condition persists. She stated treatment was not made available.  If she is not pregnant the proper diagnosis would pseudocyesis, false pregnancy, instead of delusional disorder.

	b.  She should have been allowed to continue on active duty and been sent to the warrior transition unit or battalion so she could have time to address her medical issues and receive a proper medical examination.  She felt they did not screen her for her medical issues.

	c.  She had an ultrasound done at Cape Fear on 22 October 2011.  She was shown the ultrasound that was done in 3D mode.  She had said the fetus didn't look right and the technician told her she would have to follow up with Dr. C_____ for the results.  She tried multiple times to follow up but she never received the results or the ultrasound pictures.  She stated that just because she was not being provided her medical documentation did not mean she was not pregnant.  They had not shown her she was not pregnant.  Her home pregnancy tests were all coming out positive.

	d.  On 5 June 2012, she saw Dr. Pu_____ at the Robeson Plaza Mental Health Facility.  He performed the Folstein exam on her and came up with a Global Assessment of Functions (GAF) score of 30.  She stated this is a really good score, a perfect score.  She stated Dr. Pu_____ told her she did not appear to have any mental health issues but she was confused when she got the notes and he sided with the other doctors and said she had a delusional disorder.

	e.  She was still having minor abdominal pain, “decidual” bleeding, tenderness returned to her breasts; however, no discharge.  She had been having vaginal pain.  She really needed a physical exam.  She had been checked multiple times for sexually transmitted diseases and told that she did not have any.  She was not sexually active and her last menses was 10 March 2011.  She did a lot of research and didn't find anything that could cause her menses to stop but pregnancy.  She requested her records be updated, removing the delusional disorder.  She requested that she be allowed to conduct her own ultrasound because she was having an extremely hard time trusting people after some of the episodes that she experienced.

11.  On 11 June 2013, her formal PEB was approved.  She was retired on 
19 August 2013 and placed on the TDRL on 20 August 2013 with a 100 percent disability rating.

12.  The applicant provided an undated Emergency Department Record from WAMC signed by Dr. M____ R___.  

	a.  Dr. Rose noted the applicant:

* complained of abdominal pain
* refused examination, wouldn't get undressed
* was uncooperative
* stated she was pregnant

	b.  Dr. R___ indicated the applicant tested negative on a pregnancy test and that she was delusional.  Dr. Rose discharged her to home.

13.  The applicant provided two undated Emergency Department Records from WAMC signed by Dr. B_____ M____.

	a.  Dr. M_____ noted the applicant:

* complained of abdominal pain 
* insisted she was pregnant despite evidence against it
* had a previous diagnosis of pseudocyesis (false pregnancy)

	b.  Dr. M____'s impression was pseudocyesis.  She discharged the applicant to home.

14.  The applicant provided two documents from Dr. J________ T_______.

	a.  On 17 May 2011, Dr. T_______ informed the applicant she needed to schedule a loop electrosurgical excision procedure (LEEP).

	b.  On 20 June 2011, Dr. T_______ notified her she needed a repeat colposcopy due to a moderate dysplasia being confirmed on the LEEP specimen.
15.  The documents she provided from Cape Fear Valley Health provided no evidence as to whether she was pregnant.

16.  She provided two billing statements from Cumberland County Department of Public Health, dated 9 September 2013, and Northside OB/GYN, dated 9 April 2012.  Both statements billed her for a urine pregnancy test; however, the results of those tests are not shown.

17.  The GAF Scale is contained in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV).  According to the GAF Scale a score of 30 - 21 indicates:

Behavior is considerably influenced by delusions or hallucinations
OR serious impairment in communication or judgment (e.g., sometimes
incoherent, acts grossly inappropriately, suicidal preoccupation)
OR inability to function in almost all areas (e.g., stays in bed all day; no job, home, or friends).

18.  Paragraph 3–31 (Disorders with psychotic features) of Army Regulation 
40-501 states the causes for referral to an MEB are as follows:

	a.  Diagnosed psychiatric conditions that fail to respond to treatment or restore the Soldier to full function within 1 year of onset of treatment.

	b.  Mental disorders not secondary to intoxication, infections, toxic, or other organic causes, with gross impairment in reality testing, resulting in interference with social adjustment or with duty performance.

DISCUSSION AND CONCLUSIONS:

1.  The onset of her medical condition was in 2011.  The medical documents she provided do not support her contention that she was then or that she is now pregnant.  Dr. R___ indicated she was delusional and Dr. M____'s impression was pseudocyesis.

2.  The MEB examination on 21 May 2012 and the C&P examination on 5 June 2012 diagnosed the applicant with a delusional disorder, somatic type.

	a.  During the MEB examination Dr. Pr____ stated she remained convinced she was pregnant despite evidence to the contrary.  

	b.  During the C&P examination Dr. Pu_____ indicated she had a persistent fixed somatic delusion that she was pregnant.  He indicated she does not understand the outcome of her behavior and she does not understand that she had a problem.

3.  Her GAF score shows her behavior is considerably influenced by delusions or hallucinations.

4.  On 7 February 2013, a formal PEB found her physically unfit for delusional disorder and recommended a disability rating of 100 percent and that she be placed on the TDRL.  The PEB was approved on 11 June 2013.

5.  On 20 August 2013, she was placed on the TDRL with a 100 percent disability rating.

6.  Without evidence to the contrary, diagnoses and observations made by medical personnel present at the time of medical examinations, treatment, or admission to medical facilities are accepted as representative of the facts.

7.  In view of the above, there is no basis for granting relief in this case.

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

____x___  ____x___  ____x___  DENY APPLICATION

BOARD DETERMINATION/RECOMMENDATION:

The evidence presented does not demonstrate the existence of a probable error or injustice.  Therefore, the Board determined that the overall merits of this case are insufficient as a basis for correction of the records of the individual concerned.



      _______ _   _x______   ___
               CHAIRPERSON
      
I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case.
ABCMR Record of Proceedings (cont)                                         AR20130020375



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ABCMR Record of Proceedings (cont)                                         AR20130020375



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