IN THE CASE OF:	  

		BOARD DATE:	  12 March 2015

		DOCKET NUMBER:  AR20140008865 


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 reconsideration of her prior request for a medical retirement.

2.  The applicant states, in effect, her pituitary gland tumor was discovered after returning from Iraq.  In January 2005, after receiving numerous immunizations, she fainted, fell, and hit her head.  The tumor was hemorrhaging internally and rendered her unfit to continue as a commander.  Her medical condition was sustained in the line of duty (ILOD) while serving in Iraq.  She requested medical retirement in 2012.  She served faithfully over 26 years and it was the choice of the military to find her unfit to continue to serve based on circumstances beyond her control.  She did not have anything to do with it.  She believes it is unfair that she was not medically retired and forced into an early retirement against her will.

3.  The applicant provides copies –

* Active Duty (AD) orders, dated 22 November 2003, with an amendment
* Orders releasing her from AD, dated 6 January 2005
* DA Form 2173 (Statement of Medical Examination and Duty Status), dated 21 January 2005, with 3 administrative processing pages
* Medical Eligibility Verification report
* Periodic Health Assessment, 8 pages
* DA Forms 3349 (Physical Profile), dated 29 November 2011 and 
15 February 2012
* Functional Capacity Certificate Form 507, dated 30 January 2012

* Notification of Medical Unfitness For Retention, dated 1 March 2012
* Election Form, dated 7 March 2012
* Department of Veterans Affairs (VA) medical statement, dated 30 October 2013
* Private medical statement, dated 22 February 2014
* VA Medical Records, 27 pages

CONSIDERATION OF EVIDENCE:

1.  Incorporated herein by reference are military records which were summarized in the previous consideration of the applicant's case by the Army Board for Correction of Military Records (ABCMR) in Docket Number AR20130013039, on 1 May 2014.

2.  The prior review determined that the applicant failed to show that her tumor and related conditions were duty related and that she had properly transferred to the Retired Reserve. 

3.  The VA medical records and private medical statements do not appear to have been a part of the prior review and as such constitute new evidence.  Additionally, the applicant provides a second (earlier dated) response to the medical disqualification notice. 

4.  The applicant was commissioned as a U.S. Army Reserve (USAR) second lieutenant on 25 June 1985.  

5.  On 15 December 2003, she was called to active duty and deployed to Iraq from 24 January through 29 December 2004.

6.  An LOD, dated 21 January 2004, reports that the applicant fainted after receiving typhoid and smallpox vaccinations on 31 December 2003.  The form does not indicate the applicant hit her head when she fainted.  It was determined that the incident was in-LOD and no formal LOD investigation was warranted. 

7.  The applicant was released from active duty on 22 January 2005 and returned to her USAR unit.

8.  On 7 April 2005, the applicant was afforded a Retention Physical Examination.  She had reported problems with her gums, unexplained weight gain, a left breast cyst, and trouble sleeping.  With the exception of a diagnosis of galactorrhea (too much prolactin, the hormone produced in the pituitary gland responsible for milk production (lactation)), high cholesterol, and a history of a positive mammogram showing a left breast cyst, the examination was considered within normal limits.  

9.  Although the VA medical records report she was diagnosed with a pituitary gland tumor in 2005, the earliest available medical record showing treatment for this condition is February 2009.

10.  A Memorandum for Record, dated 7 March 2010, states the LOD dated 
21 January 2004 was not properly processed due to the unit's deployment.  It appears to have been included in her official records at that time.  She received her 20-Year letter in 2006, and was promoted to the rank of colonel on 29 May 2008.

11.  On 29 November 2011, the applicant received a temporary physical profile due to the diagnosis of a pituitary gland tumor.  On 15 February 2012, the profile was made permanent. 

12.  On 1 March 2012, the 88th Regional Support Command (RSC) memorandum notified the applicant that she had a medically disqualifying condition and she was informed of her options:

   a.  Request reassignment to Retired Reserve with 20 qualifying years of service for retired pay at age 60.
   
   b.  Request reassignment to Retired Reserve with 15 qualifying years of service but less than 20 qualifying years for retired pay at age 60.
   
   c.  Request an honorable discharge from the USAR.
   
   d.  Request a review of her medical disqualification by the appropriate medical board.

13.  The memorandum also advised the applicant that she had 30 days in which to make her election or she would be discharged.

14.  The applicant's election, provided in her prior review, is dated 25 June 2012 and has items "a" and "d" marked.  It is not signed by the commander.  However, the election provided with the current application is dated 7 March 2012 and has only item "d" marked.  This election contains the applicant's signature and the commander's signature.  There is no evidence that the election that was provided with the current request was completed and/or properly returned in March 2012.  

15.  On 3 July 2012, 88th RSC orders assigned the applicant to the Retired Reserve due to being medically disqualified – not as a result of her own misconduct, effective 26 September 2012.  The available records do not contain copies of the documentation related to this determination.

16.  The applicant's VA medical records indicate the applicant was diagnosed with prolactinoma (a benign tumor of the pituitary gland) in 2005 but do not give a specific date of the initial diagnosis or provide any evidence predating 2009.  The 2012 VA medical records show the tumor was responding to treatment at that time.  She was also diagnosed with low back pain, post-traumatic stress disorder (PTSD), galactorrhea, and headaches.  It is reported but not confirmed she is in receipt of a total disability evaluation from the VA.  

17.  A VA physician statement, dated 30 October 2013, notes he has been following the applicant since December 2011.  She has a history of prolactinoma, back pain, PTSD, decreased vision, sinusitis, high cholesterol, constipation, headaches, and an implanted tooth.  The applicant reported receiving a total disability evaluation for a "malignant endocrine neoplasm."  Her vision was improving and the size of her prolactinoma was decreasing.  Due to the symptoms of prolactinoma, back pain, and PTSD, her ability to work as an air traffic controller was affected and she was no longer able to work as an air traffic controller.

18.  In his 2014 medical statement, the applicant's private physician opined that the applicant's months of constant alertness and stress her body was put through activated sustained high levels of cortisol (stress hormone).  This in turn resulted in her weight gain, blotting, lack of vitamin D absorption, inability to sleep, and decreased bile production.  The physician stated that high levels of cortisol can also induce the development of pituitary tumors as a result of sustained stress.  He cited the reference to Encyclopedia of Endocrinology, Volume 4, page 101, by Frank Metter, MD, that states "Adrenal dysfunction does not become clinically manifest until nine tenths of the cortisol tissue had been rendered unresponsive."  Based on this he believes this is why cortisol had not been identified (in the applicant) as it is many times a subclinical problem which is difficult to detect on blood tests. 

19.  The Mayo Clinic on line website provides the following:

   a.  The cause of most pituitary gland tumors remains unknown.
   
   b.  A noncancerous (benign) tumor of the pituitary gland, located at the base of the brain, secretes an excess amount of adrenocorticotropic hormone (ACTH), which in turn stimulates the adrenal glands to make more cortisol. 
   c.  Long-term activation of the stress-response system, and the subsequent overexposure to cortisol and other stress hormones, can disrupt almost all of the body's processes. 
   
   d.  Hormone levels in the urine and blood will show whether the body is producing excessive cortisol.  Treatment for a tumor may include radiation therapy, surgical removal of the pituitary gland, medication control of the production of cortisol, and/or life style changes.

20.  Army Regulation 135-175 (Separation of Officers) serves as the authority for the separation of Reserve Component officers.  It provides, in pertinent part, members of the USAR will be removed from an active status when found to be medically unfit to perform active duty except when the officer has incurred a disability in the LOD and is eligible for processing under the provisions of pertinent medical regulations.

21.  Army Regulation 600-8-4 (LOD Policy, Procedures, and Investigations), prescribes policies, procedures, and mandated tasks governing LOD determinations of Soldiers who die or sustain certain injuries, diseases, or illnesses.  The LOD determination is presumed to be "LOD YES" without an investigation in the case of disease unless it is related to an accident, misconduct, or under suspicious conditions.

DISCUSSION AND CONCLUSIONS:

1.  The applicant was called to duty on 15 December 2003.  She is shown to have fainted after receiving typhoid and smallpox vaccinations on 31 December 2003.  The LOD conducted at this time does not indicate she hit her head.  She deployed to Iraq from 24 January through 29 December 2004.  She was released from active duty on 22 January 2005.

2.  The applicant's 7 April 2005 retention medical examination does not show elevated ACTH or cortisol levels in her blood tests.  Additionally, it does not show that she hit her head in December 2003 or that she had any complaints as a result of the vaccinations received at that time.  Further, there is no evidence that she had been diagnosed with a pituitary gland tumor or complaints or findings related to a hormonal imbalance.  

3.  The applicant's private physician stated that, in his opinion, the cause of her tumor and elevated cortisol was months of constant alertness and stress.  He does not indicate if this alleged prolonged stress was due to her period of active duty service or the result of her reported job as an air traffic controller or a combination of the two.  He also stated the applicant's cortisol level was perhaps not found because it is a subclinical problem which is difficult to detect on blood tests.

4.  While the applicant's VA medical records state that her pituitary gland tumor was diagnosed in 2005, the applicant has not provided and the records do not contain any actual record of this diagnosis to validate the date of onset of her tumor.

5.  The submission of two different election forms documents, both provided by the applicant, have different dates and different elections, which raises a question as to the validity of one or both forms.  

6.  An LOD would not have been required in the case of a disease unrelated to an accident, injury, misconduct, or under suspicious conditions.  Therefore, no LOD was warranted to determine her pituitary gland tumor.  

7.  Further, the applicant has not provided any medical evidence to show there is a correlation between her December 2003 fainting spell and her subsequent development of a pituitary gland tumor.

8.  As noted in the prior decision document, there is no evidence the applicant completed the necessary actions to affect a duty-related medical evaluation board within 30 days of notification.  

9.  Additionally, she has failed to provide evidence that shows her pituitary gland tumor and the complication thereof were related to her period of active duty service.  

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 to amend the decision of the ABCMR set forth in Docket Number AR20130013039, dated 1 May 2014.



      ___________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)                                         AR20140008865



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ABCMR Record of Proceedings (cont)                                         AR20140008865



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