RECORD OF PROCEEDINGS
         AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:	DOCKET NUMBER:  02-03351
		INDEX CODE:  128.10
		COUNSEL:  NONE

		HEARING DESIRED:  NO

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APPLICANT REQUESTS THAT:

He be released from recoupment of his debt for sponsorship in the Armed Forces Health Professions Scholarship Program (AFHPSP).  

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APPLICANT CONTENDS THAT:

He accepted the AFHPSP on the assumption that upon completion of medical school he would be allowed to complete any residency of his choice and then serve the Air Force in that medical specialty for four years.  Instead of being allowed to pursue his medical specialty he was forced to enter active duty as a general medical officer.  He accepted his duty and began his first assignment at --- Air Force Base and soon began to suffer terribly from what in retrospect were the early stages of depression, isolation and obsessive-compulsive disorder.  As his personal life deteriorated he petitioned the Air Force to release him from active duty.  He suffered chastisement from his colleagues as a result of his attempts to separate and sought a new assignment at RAF Lakenheath, UK.  His situation continued to deteriorate until he was in a deep major depression with suicidal ideation.  A psychiatrist treated him for seven months prior to being recommended for separation from the Air Force.  This major depression affected him physically, mentally, emotionally, and spiritually, but never impaired his ability to practice medicine for the Air Force.  In fact, he was used in the capacity of an unsupervised general medical officer in the emergency department until his medical separation was approved.  

He is slowly beginning to pick up the pieces of his shattered life.  He accepted the medical board’s finding that his condition existed prior to service because all he wanted was to leave the military since this was the cause of his suffering.  No mention was made that recoupment of scholarship money was going to be made at the time his medical separation from the Air Force was approved.  If anything, he should be compensated for the medical conditions that resulted as a direct effect of his military service.  He has tried his hardest to work in every possible way with the military to honorably complete his term of service, but it did not work out.  He requests the Board review his Medical Board, medical records, OPRs and specifically the letter he wrote while at --- AFB in an attempt to separate from the Air Force before his situation reached the point of desperation.  

In support of his appeal, applicant submits a personal statement, copies of his Department of Defense Application for Graduate Medical Education, copies of documents associated with his discharge, a copy of AFIT/RPB expense summary report and associated documents.  

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

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STATEMENT OF FACTS:

Records indicate that the applicant was appointed a second lieutenant, Reserve of the Air Force on 29 March 1995.  He participated in the HPSP program from 29 August 1995 – 27 March 1999.  On 27 March 1999, applicant was appointed a captain Reserve of the Air Force (Medical Corps) and was voluntarily ordered to extended active duty on 10 July 2000 with assignment to ----.  In August 2001, he was reassigned to Lakenheath UK.  Applicant was discharged on 25 October 2002, because of disability, which existed prior to service.  He was credited with 2 years, 3 months and 16 days of total active duty service.

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AIR FORCE EVALUATION:

AFPC/DPAME recommends the application be denied.  DPAME states that the applicant had an existing active duty service obligation of 10 July 2004.  DPAME reviewed the HPSP contract, which the applicant signed 29 August 1995, indicating, “I understand that, notwithstanding any other provision of this contract, my failure to disclose any fact that might have a bearing on my acceptance into the AFHPSP may be used as justification for recoupment of any, and/or all scholarship funds expended on my behalf.  I further understand that recoupment can occur under these circumstances even though I have successfully completed the program and have accepted an appointment in the Medical Corps.  (For example, failure to disclose any portion of my past history, medical or otherwise.)”  DPAME states that the applicant was discharged for a medical condition that existed prior to entering active duty.  Recoupment was requested based on his signed AFHPSP contract.  The applicant signed the contract on 29 August 1995, thereby agreeing to the terms of the contract and should be required to reimburse the government.  The AFPC/DPAME evaluation is at Exhibit C.

The BCMR Medical Consultant recommends the application be denied.  The BCMR Medical Consultant states that the applicant attended medical school on the HPSP which paid for his tuition and other expenses.  He completed medical school and received his medical degree and subsequently entered active duty to serve the active duty service commitment incurred as a result of his participation in the HPSP program.  While the applicant was on active duty he experienced progressive symptoms of depression, obsessive/compulsive behaviors, and anxiety in the context of ongoing conflict with the Air Force regarding specialty training and assignments.  Although his symptoms were severe, he maintained his ability to perform his duties as a physician.  Although he maintained his ability to perform as a physician his psychiatrist recommended separation from the Air Force because of concerns about deployability and the adverse impact his condition was having on his overall quality of life.  Two months following his discharge from the Air Force, the applicant reported progressive improvement in his symptoms and was employed as a practicing physician.  The BCMR Medical Consultant further states that the only evidence as to when his mental health condition began is the June 27, 2002 psychiatry narrative summary and the December 2002 email exchanges.  The narrative summary indicated that he presented for care in November 2001 with a 2-year history of intermittent depressive symptoms and over two years of fear of germs and subsequent cleaning compulsions placing the onset of symptoms into 1999, prior to entering active duty in July of 2000.  There is no evidence in the case file that there was a significant history of mental illness prior to August 1995 when the applicant signed his HPSP contract.  He was also diagnosed with “Cluster C personality traits” not of sufficient severity to warrant a diagnosis of a personality disorder.  Personality traits and disorders that are designated on Axis II of the formal psychiatric diagnosis reflect the presence of lifelong patterns of maladjustment in the individual’s personality structure that existed prior to entering active duty.  The BCMR Medical Consultant concurs with the conclusion the Informal Physical Evaluation Board (IPEB) drew from the psychiatry narrative summary that the applicant’s condition existed prior to entering active duty in July 2000.  The IPEB did not imply by a finding of EPTS that the condition existed prior to the signing of his HPSP contract.  Whether the applicant’s symptoms in the months prior to entering active duty were of such character or severity that would have warranted reporting by the applicant cannot be clearly determined from the available evidence, but evidence does suggest that onset of clinically significant symptoms occurred following entry onto active duty.  The IPEB also concluded that his condition was not permanently aggravated by military service and evidence of the record also supports that conclusion.  The BCMR Medical Consultant evaluation is at Exhibit D.

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APPLICANT'S REVIEW OF AIR FORCE EVALUATIONS:

Applicant requests that the Board review the attachments he provides and, in particular, the highlighted areas of each document.  Upon this review, the Board will find that absolutely no evidence of any mental health conditions existed prior to signing the AFHPSP contact on August 29, 1995.  The mental health conditions under which he was discharged were the direct effect of his service in the United States Air Force.  He did not fail to disclose any fact regarding his health status while associated with the United States Government.  Consequently, there is no breach of contract and no grounds upon which the United States Government can demand recoupment of $18,942.33.   Applicant’s complete submission, with attachments A-M is at Exhibit F.  

In an additional submission, the applicant contests the onset of symptoms timeline that the BCMR Medical Consultant believes to have occurred in 1999, prior to his entrance on active duty in July 2000.  In retrospect, the applicant believes that he began to experience intermittent depressive symptoms after January 2000, which is one year and ten months prior to November 2001.  He feels that the BCMR Medical Consultant’s reference of his email to a friend stating that he had gained employment at an emergency department earning double his Air Force salary, was inappropriate, irrelevant and unprofessional.  He feels it was inappropriate to cite a statement that was no more than a casual factual remark made by him to a friend.  It is irrelevant in that his salary after leaving the Air Force has no bearing on his case and it is unprofessional in that it has no business being stated in an advisory opinion which was requested only to comment on whether his condition existed prior to his acceptance and signing of the HPSP contract in August 1995.  Applicant states that although he separated from the Air Force in October 2002, it was not until January 2003 that he was able to find a position.  Lastly, the applicant disputes the BCMR Medical Consultant’s statement on personality traits and personality disorders and states that a distinction was not made between the two.  His personality traits did not reach a level of severity under which they could be labeled a personality disorder not until the onset of clinically significant depressive and obsessive-compulsive symptoms arose while serving on active duty (See Exhibit G).  

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ADDITIONAL AIR FORCE EVALUATION:

HQ USAF/JAA recommends the application be denied.  JAA states that the applicant’s medical records establish that he suffered from pre-service, service disqualifying mental disorders or conditions.  These disorders and/or conditions constituted conditions that the applicant was obliged to report to the Air Force under the terms and conditions of his Health Professions Scholarship Contract.  The applicant’s failure to do so was a material breach and recoupment is sustainable on this basis alone.  Additionally, states JAA, recoupment is also appropriate and warranted under HPSP Contract para. 11 because the applicant’s retention was “not clearly consistent with the interest of national security.”  HQ USAF/JAA review is at attachment H.

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APPLICANT'S REVIEW OF THE ADDITIONAL AIR FORCE EVALUATION:

Applicant states that he has nothing new to present to the Board regarding his case; however, his intent is to only provide comments and opinions on the USAF/JAA review.  He states he is fully aware that the HPSP contract is iron-clad and that the United States government may recoup money from him for any reason it sees fit.  However, the condition for which he was discharged did not exist prior to signing the HPSP contract or prior to entering active duty.  It was a direct result of his active duty service that impaired his ability to continue on active duty.  Applicant states that it was the Air Force’s recommendation that he be separated; therefore, he contends that reimbursement is inappropriate.  Applicant’s letter is at Exhibit J.  

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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 timely filed.

3.	Insufficient relevant evidence has been presented to demonstrate the existence of error or injustice that would persuade us that remission of the applicant's indebtedness is warranted.  The Armed Forces Health Professions Scholarship Program (HPSP) contract, is specific in which it states that if a member fails to meet the applicable standards of the US Air Force, including physical fitness, the Air Force may, at its option, separate the member and recoup the total cost of advanced education in lieu of active duty.  When the applicant entered into the HPSP contract, he was on notice of the requirement that he must meet, and continue to meet, Air Force physical standards. The contract additionally placed the applicant on notice of the consequences of being found physically unfit for service.  The Air Force made the determination that he was not physically qualified for continued service, a determination he did not dispute because he “wanted out of the military.”  We also note that prior to his disqualification for continued service, he had previously made application to resign his commission indicating he was not comfortable with continuing to practice in a general medical officer role and was fully aware that he was liable for reimbursing the Air Force for the cost of his medical school.  While the applicant’s disqualifying condition was not the result of misconduct or voluntary action, the condition did not arise through fault of the government.  The Board has routinely asserted its right to recoup the costs of education provided to medically disqualified individuals under the HPSP when their medical condition does not preclude them from practicing their profession.  The applicant has submitted no convincing evidence that the medical processing was unduly or intentionally protracted, or that he was treated differently than any other HPSP recipient similarly situated.  In view of the above and absent persuasive evidence to the contrary, 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 probable 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 Docket Number 02-00856 in Executive Session on 13 August 2003 and 6 January 2004, under the provisions of AFI 36-2603:

The following documentary evidence was considered:

	Exhibit A.	DD Form 149, dated 17 Oct 02, w/atchs.
	Exhibit B.	Applicant's Master Personnel Records.
	Exhibit C.	Letter, AFBCMR Medical Consultant, dated
               25 Jun 03.
	Exhibit D.	Letter, AFPC/DPAME, dated 26 Nov 02.
	Exhibit E.	Letter, SAF/MRBR, dated 6 Dec 02.
	Exhibit F.	Letter, Applicant, dated 1 Jan 03 w/atchs.
	Exhibit G.	Letter, Applicant, dated 21 Jul 03.
	Exhibit H.	Letter, USAF/JAA, dated 23 Sep 03.
	Exhibit I.	Letter, AFBCMR, dated 1 Oct 03.
	Exhibit J.	Letter, Applicant, dated 11 Oct 03.