IN THE CASE OF:	  

		BOARD DATE:	  11 December 2014

		DOCKET NUMBER:  AR20140006055 


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 his Medical Evaluation Board (MEB) proceedings diagnosis.

2.  The applicant states he has mycosis fungoides as per a letter from 
Dr. A Burshell, Oschner Medical Center, dated 9 May 2012.  His military record shows he had a pre-existing skin condition, which is simply untrue.  He entered the military without any skin condition.  It started after the second week of basic training.  The biopsy shows he had early signs of cancer.  The incorrect diagnosis has prevented him from qualifying for disability benefits.  He states that laboratory findings of the original biopsy interpreted it as parapsoriasis.  The subsequent biopsy of those lesions suggested early mycosis fungoides as interpreted by Dr. E. Helwig of the Armed Forces Institute of Pathology.  He states he was never told that he had cancer, rather he was told he had parapsoriasis.  However, letters from physicians indicate he has had cancer for some 40 years at this point.

3.  The applicant provides:

* DD Form 4 (Enlistment Record - Armed Forces of the United States)
* Standard Form 88 (Report of Medical Examination), dated 11 February 1968
* multiple Standard Forms 600 (Health Record - Chronological Record of Medical Care)
* Standard Form 88, dated 12 May 1969
* Standard Form 88, 18 June 1971
* Standard Form 502 (Clinical Record), dated 16 August 1971
* DA Form 8-118 (MEB Proceedings)
* internet article titled "Elson B. Helwig"
* Headquarters, Fifth U.S. Army Letter Orders Number 09-1433
* Anderson Cancer Center Preliminary Document
* Ochsner Medical Center letter
* Dermatology Clinic letter to the Department of Veterans Affairs (VA)
* L. Wilbourn's (Clinical Psychologist) letter
* Louisiana State University (LSU) Health Sciences Center letter

COUNSEL'S REQUEST, STATEMENT, AND EVIDENCE:

1.  His counsel states the applicant is entitled to have his discharge documents corrected due to a serious error committed by the military.

2.  Counsel states in a "Summary of Facts" that the applicant's enlistment documents contain no objective evidence to show that he had a pre-existing skin condition.  Records show he suffered from a skin condition while at Fort Polk during basic training where he sought medical attention several times due to extensive pain.  Records show complaint of a rash was first noted on 4 February 1969.  A biopsy was performed in July 1971 revealing mycosis fungoides of his buttocks.  The clinical record, dated 21 March 1968, stated, "The veteran is a twenty-one year-old white man who has never had a skin problem before."  The summary of facts further lists multiple medical examinations, proceedings, and letters related to the applicant's medical condition indicated above.

CONSIDERATION OF EVIDENCE:

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

2.  His enlistment Report of Medical Examination, dated 11 February 1968, does not mention a skin condition in item 40 (Skin Lymphatics).

3.  On 21 March 1968, the applicant enlisted in the U.S. Army Reserve (USAR). 

4.  On 19 December 1968, Headquarters, Fourth U.S. Army, issued Letter Orders Number 12-1610 ordering him to active duty for training (ACDUTRA).  His report date for basic training at Fort Polk, LA was 24 January 1969.  

5.  His records show he served on ACDUTRA from 24 January 1969 to 7 June 1969.  Upon completion of training he was awarded military occupational specialty 91A (Medical Corpsman).

6.  Multiple clinical records completed on and after 5 February 1969 indicate he complained of a rash about his trunk, hip, and buttocks.  He was referred to a dermatology clinic and he received a variety of treatments with mixed results.

7.  A Report of Medical Examination, dated 12 May 1969, shows "eczema (L) buttock" in item 40.

8.  A Report of Medical Examination, dated 18 June 1971, shows "parapsoriasis, plaque-type." 

9.  On 6 July 1971, an assistant adjutant, 4010th U.S. Army Hospital Augmentation, requested that the applicant be evaluated for physical qualification for retention in the USAR based on a consultation indicating he could not wear military clothing and only certain types of civilian clothes, which prevented him from performing his military duties.

10.  On 30 July 1971, an assistant adjutant, Headquarters, 807th Hospital Center, requested further evaluation and consultation due to there being no evidence shown in the consultation records that the applicant could not wear military clothing or perform military duties.

11.  On 16 August 1971, an MEB convened to consider the applicant's medical condition.  The board found he was medically unfit for further military service in accordance with current medical fitness standards.  The applicant was determined to have "parapsoriasis en plaque."  Item 20 of the MEB proceedings shows his condition was not incurred in the line of duty and that it existed prior to service (EPTS) with an approximate date of origin of 1967.  It states the condition was not aggravated by active duty.  It further states that the medical condition consisted of plaque-type parapsoriasis on both buttocks. 

12.  A Standard Form 502 (Clinical Record - Narrative Summary) dated 16 August 1971, states, in pertinent part, that the applicant's chief medical complaint was "rash on buttocks for three years."  The medical doctor recommended the applicant's separation under the provisions of Army Regulation 40-501 (Standards of Medical Fitness), chapter 3-33, section XVI, item "u."  He stated the applicant was unsuited for retention on active duty.  He had a chronic skin condition which precluded the wearing of standard military gear, would require continued medical care, and could be expected to interfere with the satisfactory performance of military duty.  For that reason, it was recommended that the applicant be separated from service for his EPTS condition.  It further shows:

	a.  Laboratory findings:  "Original biopsy interpreted as parapsoriasis.  Subsequent biopsy of these lesions suggested early mycosis fungoides as interpreted by Dr. Elson B. Helwig of the Armed Forces Institute of Pathology."

	b.  Diagnosis:  "parapsoriasis en plaque." 

13.  On 15 September 1971, Headquarters, Fifth U.S. Army, Letter Orders Number, 09-1433, honorably discharged the applicant from the USAR for the reason of being "medically disqualified."

14.  The applicant submits:

	a.  An Anderson Cancer Center Preliminary Document, dated 2 May 2011, which provides details of his present illness, based on his chief complaint of mycosis fungoides.

	b.  A Dermatology Clinic letter addressed to the Department of Veterans Affairs, dated 15 February 2012.  Dr. Poche stated in this letter that he first saw the applicant that morning, reviewed his medical records, and examined his skin lesions.  He stated the applicant carried a diagnosis of mycosis fungoides, which is a type of cutaneous T-cell lymphoma.  He stated that mycosis fungoides may begin as a rash that simulates other common conditions.  He further stated that the applicant had nonspecific lesions which were compatible with mycosis fungoides that had been verified by various skin biopsies.  Dr. Poche stated that the cause of mycosis fungoides is unkown.

	c.  An LSU Health Sciences Center letter from Dr. EIB, dated 16 April 2012, states that the applicant was being followed by her for Stage 1A T-cell lymphoma.  The applicant had advised her that he needed verification that he was being treated for cancer.  She stated that cutaneous T-cell lymphoma is certainly a cancer.

	d.  An Ochsner Medical Center letter, dated 9 May 2012, states the applicant has now been diagnosed with mycosis fungoides and that the best Dr. Burshell could tell, the applicant had developed the mycosis in the military and it had continued to be a problem for him to the present time.

15.  A review of multiple internet sites, including the National Center for Biotechnology Information, was conducted with respect to the medical conditions of parapsoriasis and mycosis fungoides.  This review revealed that making a differential diagnosis between early mycosis fungoides and parapsoriasis is often difficult at the clinical and histological level.  One article further indicated that parapsoriasis may evolve into mycosis fungoides.  Another article stated that the skin changes develop slowly, often over many years and, unfortunately it often takes up to several years before a reliable diagnosis of mycosis fungoides can be made.  A skin biopsy is usually required to confirm the diagnosis, but this may have to be repeated before the diagnosis can be made firmly.

DISCUSSION AND CONCLUSIONS:

1.  The applicant was seen multiple times during ACDUTRA for complaints of a rash beginning in February 1969.  Clinical records indicate it was first thought to be eczema.

2.  On 16 August 1971, an MEB found he was medically unfit for further military service in accordance with current medical fitness standards.  His medical condition was determined to be not in the line of duty and that it was EPTS with an approximate date of origin of 1967.  The MEB stated the condition was not aggravated by active duty.
  
3.  A Narrative Summary completed in connection with the MEB proceedings stated the applicant's original biopsy was interpreted as parapsoriasis.  A subsequent biopsy of the lesions suggested early mycosis fungoides.  The diagnosis listed on the MEB proceedings was "parapsoriasis en plaque."

4.  It is understandable that the applicant would now like to have the then suggested diagnosis of early mycosis fungoides shown as incurred during basic training.  Notwithstanding that various letters he submitted indicated mycosis fungoides is a cancer and that it may have begun in basic training, there is no evidence he incurred or aggravated this condition after entry on active duty.  In fact, current medical articles state that it may be hard to make a diagnosis of mycosis fungoides at an early stage, as early mycosis fungoides can look like common skin conditions such as eczema or psoriasis and that skin changes develop slowly, often over many years.  Furthermore, based on the entry on the MEB proceedings, it is reasonable to presume that the medical personnel had some form of information indicating the applicant already had this condition in 1967.  As such, there does not appear to be an error in the diagnosis made by the medical personnel at the time.

5.  In view of the foregoing, there appears to be no basis for granting the applicant's request.

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)                                         AR20140006055



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ABCMR Record of Proceedings (cont)                                         AR20140006055



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