RECORD OF PROCEEDINGS
         AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:	DOCKET NUMBER:  BC-2002-00661
		INDEX CODE:  131.09

		COUNSEL:  NONE

		HEARING DESIRED:  NO

_________________________________________________________________

APPLICANT REQUESTS THAT:

He be promoted to the grade of senior master sergeant (E-8).

_________________________________________________________________

APPLICANT CONTENDS THAT:

He was treated for an anterior wall myocardial infraction on 13 Apr 94.  He was put on a medical profile pending a determination of his medical condition.  In Jun 94, he was put in a vacant senior master sergeant position but not promoted.  On 3 Nov 94, his personal physician stated that he was medically qualified to serve worldwide in the Air Force Reserve.  He was also able to return to his civilian job as a letter carrier.  In May 95, the Air Force Medical Review Board determined that he was medically disqualified for worldwide duty.  He asked whether he would be put on active duty for out-processing, and he was advised that he would not, and that he would have to out-process on his own time.  He believes that since he was placed in an E-8 position from Jun 94 until he was discharged, his own personal physician said he was qualified for worldwide service, and he had to out‑process on his own time, he should have been promoted to the grade of senior master sergeant.

In support of his appeal, the applicant provided an expanded statement and statements from his medical doctor and first sergeant.

Applicant’s complete submission, with attachments, is at Exhibit A.

_________________________________________________________________

STATEMENT OF FACTS:

Applicant was relieved from his Reserve assignment and assigned to the Retired Reserve Section and his name was placed on the Reserve Retired List, effective 30 Jun 95, by reason of his physical disqualification from continued service in the Air Force Reserve.  He is eligible for retired pay at age 60, in the grade of master sergeant.

The remaining relevant facts pertaining to this application are contained in the letters prepared by the appropriate offices of the Air Force.

_________________________________________________________________

AIR FORCE EVALUATION:

AFRC/DPM recommended denial indicating that the applicant has not demonstrated any injustice or improper handling of his promotion.  AFRC/DPM noted the applicant’s assertion that he was selected to fill a senior master sergeant position contingent upon his clearance by a medical board, and, that the medical board found him unfit for continued military duty.

AFRC/DPM indicated that AFI 36-2502, table 4.2., defines promotion eligibility criteria.  Among the criteria are three that the applicant did not demonstrate he met at the time.  They were:  supervisor recommendation, commander approval, and satisfactory participation.  Since the applicant was meeting a medical evaluation board at the time of the alleged injustice, he would have been medically profiled as unfit for military duty and, therefore, unable to participate for pay or points.

A complete copy of the AFRC/DPM evaluation is at Exhibit C.

_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

A copy of the Air Force evaluation was forwarded to applicant on 26 Apr 02 for review and response.  As of this date, no response has been received by this office (Exhibit D).  

By letter, dated 6 Feb 03, the Board’s staff requested that the applicant provide any and all pertinent records that he had in his possession, as well as any medical documentation from any private physicians who may have provided him medical treatment (Exhibit E).

By letter, dated 11 Feb 03, the applicant provided additional documentary evidence, which is attached at Exhibit F.

_________________________________________________________________

ADDITIONAL AIR FORCE EVALUATION:

The Medical Consultant recommended denial noting that no primary medical documentation was available for review.  He indicated that based on a 3 May 94 medical statement, the applicant suffered an anterior myocardial infarction (heart attack, clot forms in an artery supplying the heart muscle with oxygen and the heart muscle supplied by that artery dies, in this instance the area of the heart that faces the front of the body) on 13 Apr 94, while not on active duty status.  He was treated with a thrombolytic medication (medication that dissolves the clot in the coronary artery and limits the amount of heart muscle damage).  While still hospitalized, he underwent cardiac catheterization to evaluate his coronary artery disease.  He was shown to have anterior wall hypokinesis (reduced heart muscle contraction consistent with death of heart muscle tissue resulting in impairment of normal heart contraction in the affected area).  The coronary artery supplying that affected area of the heart was “patent” (indicating successful dissolution of the clot) but had proximal dissection (a flap of the inner lining of the artery had partially torn off).  Complete details of the applicant’s coronary anatomy and extent of coronary disease was otherwise absent from the medical statement.  He was treated with Coumadin (blood thinner) and aspirin to prevent recurrent coronary thrombosis and the formation of a clot inside the heart next to the damaged heart muscle wall (a complication of anterior wall myocardial infarctions).  He was also treated with Procardia XL (calcium channel blocker) and Lopressor (a beta blocker) to prevent angina (chest pain), cardiac rhythm disturbances, and recurrent heart attack.  The cardiology medical statement listed work restrictions (no driving, no lifting, etc).

The Medical Consultant noted that the applicant’s heart attack triggered medical disqualification by the Air Force Reserve.  An Air Force Form 422, Physical Serial Report, dated 18 May 94 (expiration 18 August 1994), indicated that the applicant was formally medically disqualified due to anterior wall infarction (P4), not qualified for deployment (DIN KCC, “41”) and not qualified for reassignment (DIN ABA “31”).  On the form was a boilerplate statement that explains policy and procedure, which read “I have been advised of my disqualifying medical/dental condition and of the requirement to provide medical/dental information from my private physician/dentist to my supporting Reserve medical unit to aid in the evaluation of my medical/dental condition.  I understand that while I have this profile, I may not participate in the Reserve program, whether for pay or points, until the “4” has been removed from my profile.  I further understand that HQ AFRES/SGP will make the final determination on my medical qualifications for continued military duty.  If I fail to provide the requested medical/dental documentation to my supporting medical unit within 60 days from the date of initial request, my case will be immediately forwarded to HQ AFRES/SGP for appropriate action.”  Another AF Form 422, dated 7 Sep 94 (expiration 13 Oct 94), again continued his medical disqualification (P4) for mobility and reassignment and contained the same limitation codes and the same boilerplate statement.

A medical statement, dated 3 Nov 94, from the applicant’s cardiologist indicated that the applicant was diagnosed with atherosclerotic heart disease, status post anterior wall myocardial infarction.  As of the last appointment on 25 Oct 94, the applicant was engaging in usual activities “without significant symptoms.”  The applicant underwent an exercise test but the protocol used was not specified and limited the reviewer’s interpretation of the results, but the test was reported as a satisfactory result with good exercise tolerance and no evidence of ischemic changes on electrocardiogram (consistent with adequate blood flow to the heart muscle).  No overt signs of heart failure were noted on the physical examination.  The cardiologist recommended continuing his current medications that included the blood thinner Coumadin as well as Procardia XL, Lopressor, and aspirin.  Tapering and possible discontinuation of medications was planned after six months, but no further medical information was available for review.  The applicant’s civilian cardiologist released him back to his civilian occupation as a postal carrier and stated he was qualified to return to duty in the Reserve.

The Medical Consultant noted that the applicant was selected to fill a senior master sergeant position contingent upon medical clearance.  HQ AFRES/SGP determined he was unfit for continued duty in accordance with AFI 48-123.  He was medically profiled as unfit for military duty beginning on 18 May 94 and was not allowed to participate for pay or points since that date.  Although profiles continuously covering the entire time since his heart attack and his retirement are not evident, it was clear that his unit was aware that his retention and promotion was contingent on a final determination by HQ AFRES/SGP.

The Medical Consultant indicated that AFI 48-123 requires medical review on all active duty and Reserve members who suffer a myocardial infarction (formal MEB with Regular members, and review by AFRES SGP in the Reserves).  Maintenance on any type of medication for the treatment or prevention of angina (chest pain due to coronary artery disease), congestive heart failure (weak heart muscle due to extensive damage), or major rhythm disturbances is disqualifying.  The applicant was on Procardia, Lopressor and Coumadin which are medicines intended to prevent recurrent angina, rhythm disturbances and heart attack.

AFI 48-123 outlines very strict criteria that identifies members who may be considered for retention, usually with assignment limitations.  In the Regular Air Force, some members, depending on clinical status, duties, and other factors, may be determined fit to continue service in their rank, rate, or grade often with assignment limitation preventing deployability and other restrictions.  The memorandum from the HQ AFRES/SG clearly indicated that retention with assignment limitation was considered in their review and that they concluded that special assignment limitations were not appropriate.  Of note was the poorer prognosis for recurrent heart attacks and the higher risk for complications that anterior wall myocardial infarction implies compared to infarctions in other locations of the heart (i.e., inferior wall), and the fact that the applicant demonstrated evidence of abnormal heart muscle wall motion and continued maintenance on medications, all likely factors influencing the decision.

According to the Medical Consultant, it is the policy of the Air Force Reserve to disqualify reservists with any history of myocardial infarction due to atherosclerotic heart disease regardless of current functional ability pending review of the reservist’s case at HQ AFRC to determine the reservist’s fitness for continued military duty.  During this headquarters level determination process, all reservists are put in a no pay or point gaining status.  This status prevents a reservist from being involuntarily discharged or separated from military service while the evaluation processing is being conducted.  Unfortunately, this same status prevents a reservist from being promoted.

In the Medical Consultant’s view, action and disposition in this case were proper and equitable reflecting compliance with Air Force directives that implement the law, and that no change in the records is warranted.

A complete copy of the Medical Consultant’s evaluation is at Exhibit G.

_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

A copy of the Air Force evaluation was forwarded to applicant on 22 Apr 03 for review and response.  As of this date, no response has been received by this office (Exhibit H).

_________________________________________________________________

THE BOARD CONCLUDES THAT:

1.  The applicant has exhausted all remedies provided by existing law or regulations.

2.  The application was not timely filed; however, it is in the interest of justice to excuse the failure to timely file.

3.  Insufficient relevant evidence has been presented to demonstrate the existence of error or injustice.  We took notice of the applicant's complete submission in judging the merits of the case.  However, we do not find it sufficient to override the rationale provided by the Air Force offices of primary responsibility (OPRs).  The evidence of record indicates that the applicant suffered a heart attack and was medically profiled as unfit for military duty.  Subsequent to this, he was selected to fill a senior master sergeant position contingent on his medical clearance.  The applicant was eventually determined by the Office of the Surgeon General of the Air Force Reserve to be medically disqualified for continued service in accordance with the applicable Air Force Instruction.  The applicant asserts that since he held the senior master sergeant position until his separation from the Air Force Reserve for being medically disqualified, he should be promoted to that grade.  However, based on the evidence presented, the applicant was aware that his retention, as well as his promotion, was contingent on a final determination by the Office of the Surgeon General.  Therefore, in the absence of evidence that the information used as a basis for his medical disqualification for continued service in the Air Force Reserve was erroneous, we agree with the recommendations of the OPRs and adopt their rationale as the basis for our decision that the applicant has failed to sustain his burden of establishing that he has suffered either an error or an injustice.  Accordingly, we find no compelling basis to recommend granting the relief sought in this application.

_________________________________________________________________

THE BOARD DETERMINES THAT:

The applicant be notified that the evidence presented did not demonstrate the existence of material error or injustice; that the application was denied without a personal appearance; and that the application will only be reconsidered upon the submission of newly discovered relevant evidence not considered with this application.

_________________________________________________________________

The following members of the Board considered AFBCMR Docket Number BC-2002-00661 in Executive Session on 27 May 03, under the provisions of AFI 36-2603:

The following documentary evidence was considered:

    Exhibit A.  DD Form 149, dated 18 Feb 02, w/atchs.
    Exhibit B.  Applicant's Master Personnel Records.
    Exhibit C.  Letter, AFRC/DPM, dated 18 Apr 02.
    Exhibit D.  Letter, SAF/MRBR, dated 26 Apr 02.
    Exhibit E.  Letter, AFBCMR, dated 6 Feb 03.
    Exhibit F.  Letter, applicant, dated 11 Feb 03, w/atchs.
    Exhibit G.  Letter, Medical Consultant, dated 17 Apr 03.
    Exhibit H.  Letter, AFBCMR, dated 22 Apr 03.