RECORD OF PROCEEDINGS
         AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:	DOCKET NUMBER:  BC-2003-01560
		INDEX CODE:  110.00

		COUNSEL:  NONE

		HEARING DESIRED:  NO

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APPLICANT REQUESTS THAT:

Her medical condition for Bulimia Nervosa, diagnosed at the time of her disability discharge, be considered service-connected in order to qualify for Department of Veterans Affairs (DVA) medical treatment.

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APPLICANT CONTENDS THAT:

She completely disagrees with the statement “Disability, Existed Prior to Service.”  She was diagnosed with bulimia in the summer of 2001.  Never before had she seen a doctor for this disorder.  The reason she is asking for this change is because she still suffers from this disorder.  It has gotten even worse today.  She is seeking help from the VA and has filed a claim.  She is in fear that because it is stated on her DD Form 214, which might prevent her from receiving the help that she greatly needs.

In support of her application, she provided a personal statement.  Applicant's complete submission, with attachment, is at Exhibit A.

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STATEMENT OF FACTS:

The applicant enlisted in the Regular Air Force on 26 July 1995.  She was progressively promoted to the grade of senior airman on 26 July 1998.  She received seven Enlisted Performance Reports, in which the overall evaluations were 5, 5, 5, 5, 5, 3, and 3.

On 25 June 2002, the Secretary of the Air Force directed that the applicant be discharged for physical disability due to a condition that existed prior to service (EPTS) and not aggravated by service under the provisions of other than Chapter 61, Title 10, U. S. Code.  On 31 July 2002, the applicant was discharged from the Air Force because of physical disability due to a condition that existed prior to service (EPTS) under the provisions of AFI 36-3212.  She served seven years and six days on active duty.

Other remaining relevant facts pertaining to this application, extracted from the applicant's military records, are contained in the letter prepared by the appropriate offices of the Air Force.

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AIR FORCE EVALUATION:

The BCMR Medical Consultant states that Bulimia Nervosa more typically has its onset during mid to late adolescence and there was no recorded history of eating disorder or other mental health issues during adolescence.  A history of episodes of overeating before age 12 without other features of eating disorder is not sufficiently compelling in the absence of problems during adolescence to conclude that the condition existed at that time.  The applicant performed her duties in an exemplary fashion for the first five years of her seven-year career, demonstrating an absence of significant mental health issues until depression and Bulimia Nervosa developed.  With treatment her conditions essentially resolved, however, due to the requirement for a continued waiver from the weight management program she was referred for Medical Evaluation Board.  The Informal Physical Evaluation Board (IPEB) determined her condition, if service connected, was rated at the 10 percent level.  The BCMR Medical Consultant concluded that the evidence indicating the applicant’s condition existed prior to service was insufficient to achieve the preponderance-of-the-evidence confidence level.

The BCMR Medical Consultant is of the opinion that the preponderance of the evidence does not support a finding of EPTS and recommends a change of records to show a disability discharge for Bulimia Nervosa at 10 percent.  A complete copy of the evaluation is attached at Exhibit C.

AFPC/DPPD states that the purpose of the military disability evaluation system (DES) is to maintain a fit and vital force by separating or retiring members who are unable to perform the duties of their office, grade, rank or rating.  Those members who are separated or retired by reason of a physical disability may be eligible for certain disability compensation.  The decision to process a member through the military DES is determined by a Medical Evaluation Board (MEB) when he or she is determined disqualified for continued military service.  The decision to conduct an MEB is made by the medical treatment facility providing health care to the member.

After summarizing the facts of the case, DPPD indicated that individuals who enter the Service with a pre-existing condition and who are determined unfit for the condition shall not be entitled to disability separation or retired pay unless the military service aggravated the condition or hastened the condition’s rate of natural progression.  After reviewing the BCMR Medical Consultant advisory, dated 21 November 2003, they forwarded the case file to the IPEB for further adjudication of the record.  The IPEB further reviewed the preponderance of evidence and determined that this issue falls into a matter of opinion between medical officials and consideration of the applicant’s motivation.  While it is true that the applicant did not disclose any history of Bulimia Nervosa behaviors in her adolescent years, the fact that her binging/purging behavior began at the beginning of her Air Force career (1995) signifies it is clearly feasible that it is merely the natural progression of a pre-existing condition.  The IPEB also noted that her eating disorder chronology may not be typical, but it is not definitely ruled out as pre-existing.  If nothing else there is adequate evidence that the 180-day rule (DODI 1332-38, E3, P4.5.4.1) should apply.  Seeing that the member agreed with the initial findings, it is also clear that the member’s concerns over paying for medical treatment reflect secondary gain.

Veterans who incur service-connected medical conditions while on active duty are authorized compensation and medical care from the Department of Veterans Affairs (DVA) under the authority of Title 38, USC.  The DVA is chartered to provide continual medical care to veterans once they depart active duty.  Under Title 38, USC, the DVA may increase or decrease an individual’s disability rating based on the seriousness of the medical condition throughout their life span.  The DVA is also responsible to determine a veteran’s service connection and eligibility for compensation/treatment once they are released from active duty.

Having reviewed the disability processing records, DPPD concluded the applicant was treated fairly throughout the DES process, and she was properly rated under disability laws and policy at the time of her medical discharge.  Following their assessment, they determined no injustice or errors occurred during the DES process that would warrant changing her medical condition for Bulimia Nervosa to be determined service connected.  Therefore, they recommend denial of the applicant’s request.

A complete copy of their evaluation is attached at Exhibit D.

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APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

On 6 February 2004, copies of the Air Force evaluations were forwarded to the applicant for review and response.  As of this date, this office has received no response.

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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.  Sufficient relevant evidence has been presented to demonstrate the existence of probable error or injustice.  After reviewing the evidence presented, we are persuaded that the applicant may have been the victim of an injustice.  Based on the assessment by the BCMR Medical Consultant, it appears probable that the applicant’s unfitting condition did not exist prior to service or that, if it did, based on her excellent duty performance for the first five of her seven years on active duty before developing symptoms of depression and Bulimia Nervosa, at the very least, it was aggravated by service.  In view of the evaluation by the BCMR Medical Consultant and the totality of the evidence of record, and notwithstanding any motivation on her part when she filed this appeal, we believe the ends of justice would best be served by resolving any doubt in this matter in the applicant’s favor.  Therefore, we recommend the applicant’s records be corrected to the extent indicated below.

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THE BOARD RECOMMENDS THAT:

The pertinent military records of the Department of the Air Force relating to APPLICANT be corrected to show that:

    a.  On 25 June 2002, competent authority determined that her unfitting condition, Bulimia Nervosa, rated at 10%, was incurred while she was entitled to receive basic pay, rather than existing prior to service; that the disability was incurred in line of duty; that the degree of impairment was permanent; that the disability was not due to intentional misconduct or willful neglect; that the disability was not incurred during a period of unauthorized absence; and that the disability was not received in the line of duty as a direct result of armed conflict or caused by an instrumentality of war.

    b.  On 31 July 2002, she was honorably discharged by reason of physical disability with entitlement to disability severance pay under the provisions of AFI 36-3212 (Physical Evaluation for Retention, Retirement, and Separation).

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The following members of the Board considered this application, BC-2003-01560, in Executive Session on 25 March 2004, under the provisions of AFI 36-2603:

All members voted to correct the records, as recommended.  The following documentary evidence was considered:

   Exhibit A.  DD Form 149, dated 1 May 2003, w/atch.
   Exhibit B.  Applicant's Master Personnel Records.
   Exhibit C.  Letter, BCMR Medical Consultant, dated 21 Nov 03.
   Exhibit D.  Letter, AFPC/DPPD, dated 29 Jan 04.
   Exhibit E.  Letter, SAF/MRBR, dated 6 Feb 04.

                                   Panel Chair

AFBCMR BC-2003-01560
INDEX CODE:  110.00

MEMORANDUM FOR THE CHIEF OF STAFF

	Having received and considered the recommendation of the Air Force Board for Correction of Military Records and under the authority of Section 1552, Title 10, United States Code (70A Stat 116), it is directed that:

	The pertinent military records of the Department of the Air Force relating to, be corrected to show that:

	    a.  On 25 June 2002, competent authority determined that her unfitting condition, Bulimia Nervosa, rated at 10%, was incurred while she was entitled to receive basic pay, rather than existing prior to service; that the disability was incurred in line of duty; that the degree of impairment was permanent; that the disability was not due to intentional misconduct or willful neglect; that the disability was not incurred during a period of unauthorized absence; and that the disability was not received in the line of duty as a direct result of armed conflict or caused by an instrumentality of war.

	    b.  On 31 July 2002, she was honorably discharged by reason of physical disability with entitlement to disability severance pay under the provisions of AFI 36-3212 (Physical Evaluation for Retention, Retirement, and Separation).

		Director
		Air Force Review Boards Agency