IN THE CASE OF:	  

		BOARD DATE:	    29 October 2014

		DOCKET NUMBER:  AR20140001761 


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 line-of-duty (LOD) determination to show her illness was incurred in the LOD, not due to her own misconduct.

2.  The applicant states she was serving on active duty (as a member of the Alabama Army National Guard (ALARNG)) at the time she was administered an influenza vaccine.  Proper and thorough research shows there is a small possibility that the influenza vaccine could be associated with Guillain-Barré Syndrome (GBS) – no more than one or two cases per million people.  However small the chance, it should not be ruled out as the cause.

3.  The applicant provides:

* self-authored letter to the Army Review Boards Agency
* memorandum from the U.S. Army Human Resources Command (HRC)
* GBS and influenza vaccine information from the Centers for Disease Control and Prevention (CDC) Internet web site

CONSIDERATION OF EVIDENCE:

1.  The applicant enlisted in the ALARNG on 25 January 1991.

2.  A DA Form 3349 (Physical Profile), dated 6 June 2009, shows she was issued a permanent physical profile rating of 3 for the physical capacity or stamina factor, a permanent physical profile rating of 2 for the lower extremities factor, and a permanent physical profile rating of 2 for the psychiatric factor.  The issuing officer determined the applicant was not able to carry and fire her individually- assigned weapon, she was not able to move with a fighting load at least 2 miles, she was not able to construct an individual fighting position, she was not healthy without any medical condition that prevented deployment, and she was not able to perform any standard or alternate APFT events.  She was able to run, walk, bicycle, or swim at her own pace and distance.  The issuing officer noted the applicant was diagnosed with GBS and had multiple functional limitations.  The issuing officer did not note whether the applicant met retention standards in accordance with Army Regulation 40-501 (Standards of Medical Fitness) and did not indicate the applicant needed a review by a medical evaluation board (MEB) or physical evaluation board (PEB).

3.  On 1 February 2012, she was issued a notification of eligibility for retired pay at age 60 (20-year letter).

4.  A memorandum for record from the Commander, 778th Maintenance Company, ALARNG, dated 7 June 2012, states the applicant hasn't taken an APFT with the unit since 2007 and has a physical profile preventing her from taking it.  It also states she has a possible duty-related injury and an LOD investigation pending a determination.

5.  A memorandum from Detachment 1, 778th Support Maintenance Company, dated 16 May 2013, subject:  APFT Scores for (Applicant), states she took her last APFT in November 2007.  She was placed on a temporary "no APFT" physical profile in 2008 and a permanent "no APFT" physical profile in 2009 for undisclosed medical issues.  Her case was currently pending determination by the National Guard Bureau.

6.  A memorandum from HRC, dated 18 November 2013, subject:  LOD Investigation Appeal, (Applicant), states that after a thorough administrative review of the applicant's LOD investigation, HRC determined the finding of not in the LOD-not due to own misconduct would stand.  The HRC Surgeon General's office rendered an opinion supporting the LOD determination final approving authority.  Although the applicant provided ample documentation establishing a diagnosis of GBS approximately 2 weeks after receiving an influenza vaccine in October 2008 while performing active duty service, no convincing evidence linked the vaccine to the development of the symptoms to the exclusion of other potential causes.  According to the CDC from a 2013 study, the influenza vaccine is not associated with GBS and the CDC's policy remains that the current influenza vaccine has no association with GBS.  Army Regulation 600-8-4 (Line of Duty Policy, Procedures, and Investigations), paragraph 2-6, states an injury, disease, or death is presumed to be in the LOD unless refuted by substantial evidence contained in the investigation.  An LOD determination must be supported by substantial evidence and by a greater weight of evidence than supports any different conclusion.

7.  On 23 January 2014, she executed an oath of extension of her current enlistment or reenlistment for a period of 1 year.  Her new expiration of term of service was established as 24 January 2015.

8.  ALARNG Orders 107-567, dated 17 April 2014, discharged her from the ALARNG effective 2 April 2014 and transferred her to the Retired Reserve effective 3 April 2014.  The additional instructions show "medical, physical, or mental condition retention" as the assignment/loss code.

9.  ALARNG Orders 114-556, dated 24 April 2014, amended ALARNG Orders 107-567 by changing her discharge effective date to 5 April 2014.

10.  Her National Guard Bureau Form 22 (Report of Separation and Record of Service) shows she was discharged from the ALARNG effective 2 April 2014 and transferred to the Retired Reserve under the authority of ALARNG 
Orders 107-567; ALARNG Orders 114-556; Army Regulation 40-501; and National Guard Regulation 600-200 (Enlisted Personnel Management), paragraph 6-36o; by reason of being medically unfit for retention.  She completed 23 years, 2 months, and 8 days of service for retired pay.

11.  The applicant's available records do not specifically indicate when she was diagnosed with GBS.

12.  The applicant's available records do not contain a copy of her LOD determination.

13.  The applicant's available records do not contain copies of any MEB or PEB proceedings.  Her available records also do not contain documentation indicating why she was found medically unfit for retention.

14.  The applicant provided a fact sheet about GBS from the CDC, dated 15 December 2009.  The fact sheet states people can get GBS after having the flu or other infections such as Epstein Barr virus.  Except for the swine flu vaccine used in 1976, no other flu vaccines have been clearly linked to GBS.  Since 1976, many studies have been done to see if other flu vaccines may cause GBS.  In most studies, no link was found between the flu vaccine and GBS.  However, two studies did suggest that about 1 more person out of 1 million people vaccinated with seasonal flu vaccine may develop GBS.  This continues to be studied.

15.  The applicant provided an Inactivated Influenza Vaccine Information Statement from the CDC, dated 26 July 2013.  The information statement indicates some people should not get the flu vaccine.  It advises individuals to tell the person administering the vaccine if they ever had GBS, as some people with a history of GBS should not get the vaccine.  Among the risks of a vaccine reaction, the applicant highlighted the severe problems following an inactivated flu vaccine as:

* a severe allergic reaction could occur after any vaccine (estimated less than 1 in a million doses)
* there is a small possibility that inactivated flu vaccine could be associated with GBS, no more than 1 or 2 cases per million people vaccinated – this is much lower than the risk of severe complications from the flu which can be prevented by the flu vaccine

16.  The CDC describes GBS as a rare disorder in which a person's own immune system damages their nerve cells, causing muscle weakness and sometimes paralysis.  GBS can cause symptoms that last for a few weeks.  Most people fully recover from GBS, but some people have permanent nerve damage.  Many things can cause GBS; about two-thirds of people who develop GBS symptoms do so several days or weeks after they have been sick with diarrhea or a respiratory illness.  People can also develop GBS after having the flu or other infections.  On very rare occasions, they may develop GBS in the days or weeks after getting a vaccination.

17.  Army Regulation 600-8-4, paragraph 2-6, states an injury, disease, or death is presumed to be in the LOD unless refuted by substantial evidence contained in the investigation.  An LOD determination must be supported by substantial evidence and by a greater weight of evidence than supports any different conclusion.

18.  Army Regulation 40-501 provides information on medical fitness standards for induction, enlistment, appointment, retention, and related policies and procedures.  Current or a history of disorders involving the immune mechanism, including immunodeficiencies, do not meet the physical standard for appointment, enlistment, and induction into military service, but are not listed in chapter 3 as unfitting for further military service.  Chapter 3 provides the various medical conditions and physical defects which may render a Soldier unfit for further military service.  These medical conditions and physical defects, individually or in combination, are those that significantly limit or interfere with the Soldier's performance of his or her duties.  Reserve Component Soldiers with non-duty related medical conditions who are pending separation for failing to meet the medical retention standards of this regulation are eligible to request referral to a PEB for a determination of fitness.  Because these are cases of Reserve Component Soldiers with non-duty related medical conditions, MEB's are not required and cases are not sent through the PEB liaison officers at the medical treatment facilities.

19.  National Guard Regulation 600-200, paragraph 6-36o, provides for discharge and transfer to the Retired Reserve.

DISCUSSION AND CONCLUSIONS:

1.  The applicant requests correction of her LOD determination to show her illness was incurred in the LOD, not due to her own misconduct.

2.  Her available records do not specifically indicate when she was diagnosed with GBS.  The physical profile she was issued on 6 June 2009 shows the issuing officer determined the applicant was not able to perform any standard or alternate APFT events.  The issuing officer noted the applicant was diagnosed with GBS and had multiple functional limitations.

3.  Her available records do not contain a copy of her LOD determination.  However, after a thorough administrative review of the applicant's LOD investigation, HRC determined the finding of not in the LOD-not due to own misconduct would stand.  Although the applicant provided ample documentation establishing a diagnosis of GBS approximately 2 weeks after receiving an influenza vaccine in October 2008 while performing active duty service, no convincing evidence linked the seasonal influenza vaccine to the development of the symptoms to the exclusion of other potential causes.  According to the CDC, the influenza vaccine is not associated with GBS and the CDC's policy remains that the current influenza vaccine has no association with GBS.

4.  Army Regulation 600-8-4, paragraph 2-6, states an injury, disease, or death is presumed to be in the LOD unless refuted by substantial evidence contained in the investigation.  An LOD determination must be supported by substantial evidence and by a greater weight of evidence than supports any different conclusion.

5.  Based on the foregoing evidence, there is no basis for granting the requested relief.



BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

____X____  ___X_____  ___X_____  DENY APPLICATION

BOARD DETERMINATION/RECOMMENDATION:

The evidence presented does not demonstrate the existence of a probable error or injustice.  Therefore, the Board determined 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)                                         AR20140001761



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ABCMR Record of Proceedings (cont)                                         AR20140001761



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