BOARD DATE:	  28 October 2014

		DOCKET NUMBER:  AR20140017076 


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 earlier request for a review of her disability evaluation pertaining to mental health (MH).  

2.  The applicant states

	a.  She disagrees with the Special Review Panel (SRP) decision about her behavioral health condition.  Her condition resulted from her deployment to Iraq in 2008 not from problems in her relationship.  For the entire 15 months in Iraq, she worked the night shift covering G4.  This included battle loss and battle damage reports and mortuary affairs.  After four months of reading non-sanitized reports of Soldiers' death and tracking dead bodies, she started having nightmares, trouble sleeping, and increased anger.  These reports gave a detailed description of these Soldiers’ deaths and the events that led up to them. One report she read was a radio transcript of a Soldier begging for someone to help his buddy.  His buddy was trapped in a HMWWV that was on fire and that also contained live ammunition.  One week after reading this report our weekly tribute was dedicated to this Soldier.  She told her chain of command about how this job was affecting her and she asked them to be moved to another section.  Yet, her request was ignored.  

	b.  Approximately 6 months into her deployment the number of sexual assaults started rapidly increasing.  The majority of assaults took place during the day (the hours she slept) in public and private places.  She no longer felt safe in her room because a few of the assailants gained access to these females' rooms under the false pretense of being KBR workers.  She became very paranoid.  She could not stop checking doors.  Her nightmares, trouble sleeping, increased anger, paranoia, and obsessive behavior continued when she returned home.  She no longer felt safe in her home.  She started sleeping on her couch because she was too afraid to sleep in her bedroom.  She checked her doors and windows constantly throughout the day and night.  Several mornings she was late for work because she felt the persistent need to turn around and check her windows and doors.  Shortly after she stopped using her curler and iron because she felt the persistent need to ensure these items where unplugged.  

	c.  These are the main reasons why she sought behavioral/mental health counseling when she arrived at Fort Stewart.  This is the story she told her social worker and the medical evaluation board (MEB) and providers.  When she was presented with her behavioral health narrative summary, she told her physical evaluation board liaison officer (PEBLO) that it was not correct.  He told her her narrative summary could not be changed so she signed her DA Form 3947 (MEB Proceedings).  Throughout her medical board he did not offer her any advice or explained the process to her.  He just told her to sign the documents.  She informed her chain of command and Fort Stewart's MEB supervisor about how her PEBLO was handling her case.  After several complaints from other Soldiers within her brigade, her PEBLO was removed from the clinic.  Unfortunately for her, this problem was not corrected until after she signed her DA Form 199 (PEB Proceedings).

3.  The applicant provides a statement from her husband. 

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 AR20140011793, on 6 August 2014.

2.  The applicant provides a statement from her husband.  This is considered new evidence and warrants consideration by the Board. 

3.  The applicant enlisted in the Regular Army on 22 June 2000.  She held military occupational specialty 89B (Ammunition Specialist).  She served through multiple extensions or reenlistments in a variety of assignments.  

4.  Her records show she served in the Philippines, from 1 May to 30 September 2003; Afghanistan, from 25 April 2004 to 30 March 2005; and Iraq, from 28 January 2008 to 28 April 2009. 

5.  She entered the Integrated Disability Evaluation System (IDES) and agreed to a Department of Veterans Affairs/Department of defense (VA/DOD) joint evaluation of her unfitting and/or service-connected disabilities. 

6.  On 6 May 2010, an MEB convened and, after consideration of clinical records, laboratory findings, and physical examinations, found the applicant was diagnosed with the conditions below.  The MEB recommended referral to a PEB. She was counseled and agreed.

Diagnosis
Met Retention Standards
Did Not Meet Retention Standards
1.  Acute Intermittent Porphyria

X
2.  Adjustment disorder
X

3.  Pes planus
X

4.  Migraine headaches 
X

5.  Aryrosis 
X

7.  The VA conducted a Compensation and Pension (C&P) evaluation and rendered a proposed rating for her unfitting conditions as well as her service-connected disabilities.  As for the unfitting conditions, the VA proposed a 30 percent rating for her acute intermittent porphyria, rated as irritable bowel syndrome, and a 10 percent rating for anxiety disorder, not otherwise specified. 

8.  On 26 May 2010, an informal PEB (IPEB) convened and found the applicant's condition(s) prevented her from performing the duties required of her grade and military specialty and determined she was physically unfit. 

	a.  The PEB rated her medically-unacceptable condition under VA Schedule for Rating Disabilities (VASRD) Code 7319, Acute Intermittent Porphyria manifested by acute abdominal cramping with nausea and vomiting, and rated this condition at 30 percent.

	b.  The PEB also considered her other conditions.  The PEB determined the adjustment disorder does not constitute a physical disability.  The PEB also determined her other conditions of pes planus, migraine headaches, and argyrosis met retention standards and since those conditions did not fail retention standards and/or were not unfitting, they were not ratable.  

	c.  The PEB recommended a combined rating of "30 percent" and that her disposition be "Permanent disability retirement."  The applicant was counseled by a PEBLO, concurred with the PEB's findings and recommendation, and waived her right to a formal hearing of her case.

9.  On 24 August 2010, she retired from active duty under the provisions of Army Regulation 635-40 (Physical Evaluation for Retention, Separation, and Retirement), chapter 4, by reason of permanent disability.  She was placed on the Retired List in her retired rank/grade of sergeant first class/E-7. 

10.  On 30 May 2013, she petitioned the Board for a review of her MH diagnosis. She agreed to have the SRP of the DOD Physical Disability Board of Review (PDRB) review her case. 

11.  On 30 June 2014, after a thorough review of her service medical records, VA medical records, and the evidence she provided, the SRP determined there was insufficient cause to recommend a change in the PEB fitness determination for the MH condition and therefore no disability rating could be recommended.  The SRP stated: 

	a.  The SRP considered whether an MH condition, regardless of specific diagnosis, was unfitting for continued military service.  The SRP’s charge with respect to MH conditions referred for review that were determined to be not unfitting by the PEB is an assessment of the appropriateness of the PEB’s fitness adjudication.  The SRP’s threshold for countering PEB not-unfit determinations requires a preponderance of evidence.  SRP members noted that the commander’s statement had not indicated any impairment of function due to an MH condition and, in fact, recommended retention.  There is no profile in the available record other than S1 and the available noncommissioned officer evaluation reports which indicate very fine performance.  

	b.  Although the C&P psychologist had noted a decrease in symptoms associated with treatment and described only "mild or transient impairment with decrease in work efficiency and occupational tasks only during periods of significant stress," the narrative summary psychiatrist had stated:  "the member has continued to work at Fort Stewart and to participate in her occupational, personal, and social life.  There is no level of disability associated with service member's psychiatric condition/symptoms."  SRP members concluded that the preponderance of the evidence supported that no MH condition, regardless of diagnosis, rose to the level of being unfitting at the time of separation.  Furthermore, the SRP determined that adjustment disorder had been appropriately considered by the PEB to not constitute a physical disability in accordance with DOD Instruction 1332.38.

	c.  After due deliberation in consideration of the preponderance of the evidence, the SRP concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the MH condition, and, therefore, no disability ratings can be recommended.  
12.  The applicant was provided with a copy of this advisory opinion but she did not respond.  

13.  On 6 August 2014, the Board accepted the SRP's recommendation.  Accordingly, the Board denied her request. 

14.  She provides a statement from her spouse.  He states he can attest to her condition when she came back from Iraq and while she was going through her medical board.  It is true that they had issues within their relationship; however, that was not the main source of her problems.  He believes her tour to Iraq is what changed her.  When she came back she was withdrawn, irritable, and paranoid.  She stopped interacting with her family and friends.  She no longer answered their phone calls and instant messages.  Despite how close they lived to her family, she refused to go visit them.  It seem like she was angry with the world.  She would constantly check their doors 24 hours a day.  They couldn't make it 5 miles from their house without her having the urge to go back home to ensure the doors were locked and the iron was unplugged.  Whenever he had Staff Duty she would sleep in the living room on the couch because she was too afraid to sleep in the bedroom.  She also had trouble falling asleep, and when she did she woke up in a state of panic covered in sweat.

15.  Army Regulation 635-40 establishes the Physical Disability Evaluation System (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.  

	a.  The PDES assessment process involves two distinct evaluations, the MEB and the PEB.  The purpose of the MEB is to determine whether the service member's injury or illness is severe enough to compromise his or her ability to return to full duty based on the job specialty designation of the branch of service. A PEB is an administrative body possessing the authority to determine whether a service member is fit for duty.  A designation of "unfit for duty" is required before an individual can be separated from the military because of an injury or medical condition.  Service members who are determined to be unfit for duty due to disability are either separated from the military or permanently retired, depending on the severity of the disability and length of military service.  

	b.  Paragraph 3-2b (Processing for Separation or Retirement from Active Duty) states 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.  

16.  Directive-type Memorandum (DTM) 11-015 explains the IDES.  It states: 

	a.  The IDES is the joint DOD-VA process by which DOD determines whether wounded, ill, or injured Service members are fit for continued military service and by which DOD and the VA determine appropriate benefits for Service members who are separated or retired for a Service-connected disability.  The IDES features a single set of disability medical examinations appropriate for fitness determination by the Military Departments and a single set of disability ratings provided by the VA for appropriate use by both departments.  Although the IDES includes medical examinations, IDES processes are administrative in nature and are independent of clinical care and treatment.

	b.  Unless otherwise stated in this DTM, DOD will follow the existing policies and procedures promulgated in DOD Directive 1332.18 and the Under Secretary of Defense for Personnel and Readiness Memoranda.  All newly-initiated, duty-related physical disability cases from the Departments of the Army, Air Force, and Navy at operating IDES sites will be processed in accordance with this DTM and follow the process described in this DTM unless the Military Department concerned approves the exclusion of the Service member due to special circumstances.  Service members whose cases were initiated under the legacy DES process will not enter the IDES.

	c.  IDES medical examinations will include a general medical examination and any other applicable medical examinations performed to VA C&P standards.  Collectively, the examinations will be sufficient to assess the member’s referred and claimed condition(s) and assist the VA in ratings determinations and assist military departments with unfit determinations. 

	d.  Upon separation from military service for medical disability and consistent with Board for Corrections of Military Records (BCMR) procedures of the Military Department concerned, the former Service member (or his or her designated representative) may request correction of his or her military records through his or her respective Military Department BCMR if new information regarding his or her service or condition during service is made available that may result in a different disposition.  For example, a veteran appeals the VA’s disability rating of an unfitting condition based on a portion of his or her service treatment record that was missing during the IDES process.  If the VA changes the disability rating for the unfitting condition based on a portion of his or her service treatment record that was missing during the IDES process and the change to the disability rating may result in a different disposition, the Service member may request correction of his or her military records through his or her respective Military Department BCMR.

	e.  If, after separation from service and attaining veteran status, the former Service member (or his or her designated representative) desires to appeal a determination from the rating decision, the veteran (or his or her designated representative) has 1 year from the date of mailing of notice of the VA decision to submit a written notice of disagreement with the decision to the VA regional office of jurisdiction.

DISCUSSION AND CONCLUSIONS:

1.  The applicant's case was processed under the IDES.  This means she underwent an examination by the VA and upon completion the VA proposed a disability rating for the unfitting condition(s) to the military department and a proposed disability rating for other service-connected disabling conditions to the member, if applicable.  

2.  The VA proposed a combined rating of 30 percent for her unfitting condition. The IPEB accepted and adopted this rating.  She was counseled, concurred, and waived her right to a formal hearing.  She also elected not to request reconsideration of his VA rating.  Any change to the applicant's VA rating is not within the purview of this Board.  

3.  She requested a review of her MH diagnosis and agreed to an evaluation by the SRP.  The SRP conducted a thorough review of her service medical records, VA medical records, and the evidence she provided.  The SRP determined there was insufficient cause to recommend a change in the PEB fitness determination for the MH condition and therefore no disability rating could be recommended.  

4.  Although she now makes an argument and provides a statement from her spouse, no medical evidence is provided to corroborate such statement.  In effect, the applicant is dissatisfied with the SRP's finding but provides no medical evidence to support a diagnosis of a MH.  She may have had problems at home, but it appears no MH condition rendered her incapable of performing her military duties.  Her evaluation reports indicate very fine performance of her duties.  As a result, there is insufficient evidence to overturn the Board's previous decision.









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 AR20140011793, dated 6 August 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)                                         AR20140017076





3


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1

ABCMR Record of Proceedings (cont)                                         AR20140017076



2


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1