RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:	DOCKET NUMBER:  BC-2002-03102
		INDEX NUMBER:  145.00
		COUNSEL:  NONE

		HEARING DESIRED:  NO

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APPLICANT REQUESTS THAT:

He be medically discharged for conditions resulting from a motor vehicle accident while on inactive duty training.

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APPLICANT CONTENDS THAT:

He was denied a medical evaluation that he believes would have resulted in a medical discharge from the Reserves.

In support of his request, the applicant submits a copy of      DD Form 261, Report of Investigation Line of Duty and Misconduct Status, a copy of --AMW Form 141, Ground Mishap Worksheet, a copy of AF Form 1971, Certification for Incapacitation Pay, excerpts from his medical records, and a copy of a letter from his attorney.  

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

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STATEMENT OF FACTS:

The applicant served on active duty in the Air Force as a Fire Protection Specialist from 5 August 1981 to 14 May 1986 (four years, nine months and ten days).  He enlisted in the Air Force Reserves January 1987, and reenlisted on 29 January 1993 for a six-year term in the Reserves.  He performed no active or inactive duty training until 1993.  The applicant was involved in a motor vehicle accident returning home from a unit training assembly (inactive duty training) on 22 August 1995 at 2330 hours.  His vehicle was struck on the right rear quarter panel by another vehicle that ran a red light.  He was transported by ambulance to the Emergency Department at Travis AFB for evaluation.  The applicant was discharged from the Air Force Reserves on 28 April 1999 at the expiration of his term of service.  On his discharge orders dated 17 May 1999, his reenlistment status was coded as “5A”, Reserve reenlistment eligible.  

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AIR FORCE EVALUATIONS:

The BCMR Medical Consultant recommends denial.  Injuries directly resulting from this motor vehicle accident would be considered to have been proximately caused by reserve duty and, if unfitting for duty and the reason for ending his Air Force career, eligible for evaluation in the disability system for disability rating and compensation.

Evidence of the record shows that the applicant was involved in a motor vehicle accident sustaining mild head trauma as evidenced by no loss of consciousness and his normal examination in the emergency department.  He experienced a persistent headache after the accident that improved substantially with treatment.  He also developed complaints of neck discomfort within two weeks of the accident that became a chronic discomfort.  His x-rays and subsequent MRI of the cervical spine were consistent with long-standing degenerative disc and degenerative joint disease as well as a disclosing of a congenitally narrow spinal canal that existed prior to the accident.  The x-ray in September 1995 disclosed a narrowed disc with associated osteophyte (bone spur) formation, a process that takes months to years to develop.  Evaluation by a neurosurgeon one year after the accident concluded there was no cervical spine neurologic injury or structural abnormality requiring therapy, but that he did have some “myofascial trigger points” (tender points in the muscles) due to chronic musculoskeletal strain of the neck.  His chronic musculoskeletal neck strain was clearly mild based on the absence of muscle spasm or loss of range of motion and lack of pain with range of motion.  Such mild chronic musculoskeletal strain could have resulted from the motor vehicle accident or been the result of his underlying degenerative spine disease.  The applicant was noted to have symptoms of depression in March 1996 and was started on an antidepressant medication (Paxil).  Within two weeks his symptoms were improved, notably sleep disturbance.  Evaluations by neurosurgery (August 1996) and psychiatry (March 1997) determined that the applicant was fit for continued military service.  There are no further service medical record entries.  The applicant performed no inactive duty or active duty training after February 1997, and was discharged from the Reserves effective April 1999 with a reenlistment status code that indicated he was eligible for reserve reenlistment.  Thus, there is no evidence that the reason his Air Force career was cut short was due to medical reasons including any directly related to injuries from the service connected motor vehicle accident.

Evidence in the record indicates that the applicant missed 3 weeks of work following the accident, and subsequently changed jobs from a firefighter to aircraft inspector.  He continued to be employed despite his symptoms of depression as of the time of the Kaiser psychiatry evaluation in 1999.  The applicant claims his depression is the direct result of his mild head trauma from the motor vehicle accident and requests disability compensation.  He was treated for symptoms of depression beginning March 1996, approximately six months after the accident.  However, evidence in the medical records show that he reported symptoms of depression in May 1993.  At the time of his Kaiser psychiatry evaluation in February 1999 he reported that with treatment with Paxil following the August 1995 motor vehicle accident, he “felt great” with decreased headaches and good sense of well being but experienced recurrent symptoms of depression in the year period 1998-1999 (apparently off Paxil), some three years after the accident.  His Kaiser medical plan psychiatrist identified maladaptive personality traits, possibly sufficient to diagnose personality disorder, that were significantly contributory to his symptoms of depression.  Such maladaptive personality traits are life-long patterns (that usually become manifest in late adolescence and early adulthood) of thinking, perceiving and coping in the individual's personality structure, which are not medically disqualifying or unfitting but interfere with the individual’s social and occupational functioning and predispose the individual to depression.  These traits may render the individual unsuitable for further military service and may be cause for administrative action by the individual's unit commander.  Although the severity of his symptoms as documented in the Kaiser psychiatry evaluation appear to have been sufficient to have made him disqualified for continued service, the preponderance of the evidence based on medical principles cannot establish a direct causal link to the mild head trauma.  It is true that individuals with moderate to severe brain trauma may suffer depression and cognitive deficits in the weeks to months after trauma.  However it is very controversial in mild head trauma, especially without loss of consciousness, whether persistent post concussive symptoms are injury specific in individuals after mild traumatic head injury since frequency of such symptoms in individuals with a history of mild head injury is comparable to uninjured groups.

The BCMR Medical Consultant concludes that the applicant’s depression was not the direct result of mild head trauma during his service connected motor vehicle accident.  He manifested symptoms of depression over two years before the accident, possesses maladaptive personality traits predisposing to depressive symptoms and did not present for depressive symptoms until six months after the accident.  Treatment with Paxil was effective, he maintained employment, and reported in February 1999 that he felt great while on the Paxil.  The psychological stress of the MVA, the associated litigation, and occupational stressors referred to by the applicant in the Kaiser evaluation may have transiently aggravated his preexisting depressive symptoms, but the MVA did not cause his underlying psychiatric condition.  His other post injury symptoms of headache and neck pain were not unfitting for continued duty.  The preponderance of the evidence does not support the applicant’s claim.

Action and disposition in this case are proper and equitable reflecting compliance with Air Force directives that implement the law.  

The BCMR Medical Consultant’s evaluation is at Exhibit C.  

AFPC/DPPD recommends denial.  The applicant failed to provide medical documentation to corroborate he was unfit at the time of his voluntary discharge from the Reserves, which would justify a medical discharge under military disability laws and policy.

Two items of interests were noted during the review of the applicant’s military personnel records.  Although his files show he extended his enlistment for the purpose of undergoing an MEB, records failed to show one was initiated or completed.  The DD Form 261, Report of Investigation, Line of Duty and Misconduct Status, dated 7 May 97, which relates to the motor vehicle accident is incomplete.  AFPC/JA confirmed the report was not appropriately processed and is currently incomplete according to prescribing directive.  Chapter 61, Title 10, United States Code (USC), requires a line of duty determination for each unfitting defect or condition.  Specifically, for compensability purposes the physical evaluation board must know whether or not the member incurred the disability as the result of his or her intentional misconduct or during a period of unauthorized absence.  

Although the incident appears to be due to no misconduct on the applicant’s part during the incident, that does not excuse the incomplete report for legal purposes, which protects both the individual as well as the Air Force.  Based on the limited preponderance of evidence, the consensus within this office is that the service member was reasonably capable of performing his Reserve military duties right up until his Honorable discharge.  This is assumed since he was eligible for reenlistment and his career was not curtailed for physical disability.  

The AFBCMR case file revealed no errors or irregularities at the time of his voluntary discharge that would justify a change to his military records to reflect he was awarded a disability discharge under the provisions of AFI 36-322.  The medical aspects of the case are thoroughly explained by the BCMR Medical Consultant and DPPD wholeheartedly agree with his advisory.

The DPPD evaluation is at Exhibit D. 

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APPLICANT'S REVIEW OF AIR FORCE EVALUATIONS:

He states that he is amazed that the BCMR Medical Consultant has diagnosed him from hundreds of miles away.  His friends and family can attest to his pain, headaches, shocks and depression that he has had to endure since the accident.  He claims that he is addicted to paxil, continues to suffer with headaches, and has 
very limited movement and other problems with his neck.  The Air Force prescribed him paxil for depression, for which he is dependent.

His complete submission is at Exhibit F.

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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.  After a thorough review of the evidence of record and applicant’s submission, we are not persuaded that the applicant should be given a medical discharge.  While we note the concerns of the Air Force in regards to not initiating or completing a medical evaluation board (MEB) and the incomplete line of duty investigation, we find insufficient evidence to conclude the applicant was unfit at the time of separation.  In this respect we note the Medical Consultant's opinion that the applicant's post injury symptoms of headaches and neck pain were not unfitting for continued duty. Based on the preponderance of the evidence, we believe the applicant has failed to sustain his burden that he has suffered either an error or an injustice.  Therefore, we find no compelling basis to recommend granting the relief sought.

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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.

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The following members of the Board considered this application in Executive Session on 1 July 2003, under the provisions of AFI 36-2603:

		Panel Chair
		Member
		Member

The following documentary evidence was considered for AFBCMR Docket Number BC-2002-03102:

	Exhibit A.  DD Form 149, dated 23 Sep 02, w/atchs.
	Exhibit B.  Applicant's Master Personnel Records.
	Exhibit C.  Letter, BCMR Medical Consultant, dated 13 Feb 03.
	Exhibit D.  Letter, AFPC/DPPD, dated 17 Apr 03.
	Exhibit E.  Letter, SAF/MRBR, dated 25 Apr 03.
	Exhibit F.  Letter, Applicant, dated 18 May 03, w/atchs.