RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:	DOCKET NUMBERS:  BC-2002-03829
		INDEX CODE 108.01  108.10
	 	COUNSEL: XXXX

	 	HEARING DESIRED:  No

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APPLICANT REQUESTS THAT:

Her records reflect her medical condition had not existed prior to service (EPTS).

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APPLICANT CONTENDS THAT:

Her disability occurred while she was entitled to basic pay.

The applicant’s complete submission is at Exhibit A. 

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STATEMENT OF FACTS:

The applicant enlisted for four years in the Regular Air Force on 7 Jun 00 in the grade of airman first class. She was assigned as a space systems operator to the 2nd Space Warning Squadron at Buckley AFB, CO.

The performance report for 7 Jun 00 through 28 Feb 02 reflects an overall rating of “5.”

A 4 Mar 02 evaluation by a civilian university hospital center indicated the applicant was referred for an evaluation regarding chronic pelvic pain which caused her to miss work frequently. Her condition appeared to be exacerbated by stress. The applicant indicated she had been psychologically evaluated in May 01 after experiencing a “nervous breakdown” in response to various stressors at the time. The applicant acknowledged a history of problematic depression over the past three years, with a shorter history of impulsive behavior. She also revealed she experienced anxiety, anger, and insomnia. The psychologist suggested therapy and consideration to rule out major depressive disorder vs. atypical bipolar disorder.

A follow-up entry dated 11 Mar 02 noted the applicant’s pain issues seemed related to significant periods of emotional stress over the past two years involving the dissolution of a brief marriage, high work stress, significant weight loss, marked family dysfunction, and financial stress related to her marriage. Her history of anger and impulsivity included hitting when angry, anorexia, and general inability to co-exist with work supervisors. Her description of herself as a “control junkie” was at odds with the military, which offered her little specific control over her own activities. The entry noted that on 11 Dec 01, she had been diagnosed with adjustment disorder. The applicant acknowledged persistent depression for the past four years, reporting that she felt lonely and despondent when she perceived her relationship with her adoptive parents was falling apart several years ago.

Medical entries of 18-10 Mar 02 from the civilian university hospital center advised that the applicant’s capacity for physical complaints to be greatly exacerbated following periods of psychological distress needed to be consistently addressed. Anger, anxiety and depression were all apparent and prognosis for long-term improvement was guardedly optimistic so long as the applicant remained in therapy and adhered to treatment recommendations for an active, distracting coping regimen.

An aerospace medicine clinic evaluation dated 27 May 02 noted that the applicant’s history of chronic pain for several years was moderate and controlled until recently when she moved to Buckley AFB.  Since then, she saw a dramatic increase in the severity and duration of her exacerbations. The applicant had been pulled from her space operator duties and was working half-days at the Family Support Center. The applicant reported a small improvement in the new location, but significant problems relating to workload stress and personal interaction with the staff. She apparently was evaluated extensively by obstetrics and urology, which confirmed a diagnosis of interstitial cystitis. No clear physiologic cause of her intense and incapacitating pain has been identified, although she had a very small amount of pelvic adhesions and tiny amounts of endometriosis in the pelvis, which may have caused some contributing discomfort. The applicant did have a medical history of menstrual cramps, recurrent urinary tract infections including hemorrhagic cystitis and urethritis as well as a sub-acute pelvic infection thought to be present for three years prior to treatment. Psychiatric diagnosis included adjustment disorder with mixed anxiety and depressed mood, narcissistic personality traits and inclined to depressive moods, uncontrollable anger and agitation. Bipolar disorder and major depressive disorder had not been ruled out. A Medical Evaluation Board (MEB) was recommended as the applicant was incompatible with military service and worldwide duty. Her prognosis was expected to improve when she was no longer in a controlling and stressful environment.

A military psychiatrist presented a 25 Jun 02 narrative summary for the MEB, noting that the pelvic pain seemed clearly linked to the mood symptoms; exacerbation of the anxiety and depressive disorders (not otherwise specified - NOS) seemed to worsen the pelvic pain and vice versa. The depressive symptoms started in Nov 00. Continued military service appeared to be aggravating all three of these conditions. Discharge was recommended to remove a potential source of stress and allow the applicant to possibly recover in a nonmilitary environment.

An MEB convened on 19 Jul 02 and referred the applicant to an Informal Physical Evaluation Board (IPEB) for chronic pelvic pain and depression. The MEB indicated the conditions had not EPTS and were incurred while entitled to basic pay.

However, the IPEB convened on 2 Aug 02 and determined the depression and chronic pelvic pain had EPTS and were not permanently aggravated by service. Her problems were incompatible with military service and her past medical history included a variety of pelvic and gynecological conditions that were estimated to be present for three years and would likely be the source of her pelvic pain. The IPEB also noted the applicant’s four-year history of depression. The IPEB recommended discharge under provisions other than Chapter 61, Title 10, USC (EPTS unfitting condition, without compensation).

On 12 Aug 02, the applicant agreed with the IPEB’s findings and recommendations and waived her right to a formal hearing. On 13 Aug 02, the Secretary of the Air Force (SAF), acting through the Air Force Personnel Council, directed the applicant’s discharge, without benefits, for EPTS physical disability. 

The applicant was discharged on 18 Oct 02 with 2 years, 4 months and 11 days of active service.

She currently has a Department of Veterans Affairs (DVA) rating of 10% for mood disorder.

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AIR FORCE EVALUATION:

The AFBCMR Medical Consultant notes that, although the MEB indicated the applicant’s conditions had not EPTS, the IPEB concluded otherwise. The Consultant gives a detailed medical history on the applicant and notes that, contrary to many active duty members who may develop anxiety and depression, the applicant showed little response to therapy over a prolonged period of time. This was consistent with complicating lifelong maladaptive personality traits. The civilian psychologist clearly documented symptoms of a reported duration that placed onset prior to entry into the Air Force. Medical evaluation of her pelvic pain did reveal some abnormalities that are associated with pain; however, these findings typically are associated with discomfort that is not incapacitating and would not interfere with the performance of duty. The applicant’s mild pelvic conditions had EPTS. The disposition of the case was proper and denial is recommended.

A complete copy of the evaluation is at Exhibit C.

HQ AFPC/DPPD agrees that the medical aspects of this case are clearly outlined in the Medical Consultant’s advisory and they wholeheartedly agree with his comments and determination that the application should be denied.

A complete copy of the evaluation is at Exhibit D.

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APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

Counsel advised that the Department of Veterans Affairs awarded a service-connected rating of 10% for depressive and anxiety disorders, NOS.  Counsel contends that the applicant’s records should be changed to show the disability did not EPTS.

Counsel’s complete response 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 timely filed.

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 the applicant’s submission, we believe her records accurately reflect her medical conditions as EPTS. The applicant’s contentions are duly noted; however, we do not find these assertions, in and by themselves, sufficiently persuasive to override the rationale provided by the Air Force. In this regard, the IPEB noted the applicant’s past medical history included a variety of pelvic and gynecological conditions estimated to have been present for three years and likely to be the source of her pelvic pain. Further, the applicant divulged a four-year history of depression. This would place the onset of these problems before the applicant joined the Air Force. Additionally, both the civilian psychologist and the Air Force psychiatrist concluded that the military environment was a stressor aggravating the applicant’s symptoms and opined that, once removed from that environment, her symptoms would improve. This suggests the situational and transient nature of her symptoms in response to that stressor and that her EPTS conditions were not permanently aggravated by military service. We therefore agree with the recommendations of the Air Force and adopt the rationale expressed as the basis for our decision that the applicant has failed to sustain her burden of having suffered 
either an error or an injustice. 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 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 30 July 2003 under the provisions of AFI 36-2603:

The following documentary evidence relating to AFBCMR Docket Number BC-2002-03829 was considered:

   Exhibit A.  DD Form 149, dated 12 Nov 02, w/atch.
   Exhibit B.  Applicant's Master Personnel Records.
   Exhibit C.  Letter, AFBCMR Medical Consultant, dated 2 Apr 03.
   Exhibit D.  Letter, HQ AFPC/DPPD, dated 10 Jun 03.
   Exhibit E.  Letter, SAF/MRBR, dated 11 Jun 03.
   Exhibit F.  Letter, American Legion, dated 1 Jul 03.