RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:	DOCKET NUMBER:  BC-2005-00236
		INDEX CODE:  108.02

		COUNSEL:  NONE

		HEARING DESIRED:  NO

MANDATORY CASE COMPLETION DATE: 22 JUL 06

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APPLICANT REQUESTS THAT:

Her discharge with severance pay be changed to reflect that she was medically retired.

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APPLICANT CONTENDS THAT:

The Air Force failed to properly diagnose and treat her condition.  She was medically discharged for a condition she does not have.  The AF Form 356 shows evidence was found of right ulnar neuropathy, and then suspects psychological factors.  However, no psychological or medical evaluation was ever performed.  She was allowed to meet with the Physical Evaluation Board (PEB) for only 20 minutes.  The PEB failed to review her medical records from the Department of Veterans Affairs (DVA) and her pain management doctor.  The Medical Evaluation Board (MEB) just sent her to Neurology for a test for right ulnar neuropathy, they found nothing, and recommended a discharge.  The neurologist stated the condition was psychological.  She has had a spinal cord stimulator implanted but the DVA does not work with spinal cord stimulators.  

In support of her request, applicant provided documentation associated with her disability evaluation system processing and documentation extracted from her medical records.  Her complete submission, with attachments, is at Exhibit A.

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STATEMENT OF FACTS:

Applicant contracted her initial enlistment in the Regular Air Force on 5 Jul 00 and was progressively promoted to the grade of senior airman.

An MEB was convened on 21 Jun 01 and referred applicant's case to an Informal PEB (IPEB) with a diagnosis of right ulnar neuropathy.  On 7 Aug 01, the IPEB found her unfit for further military service and recommended that she be placed on the Temporary Disability Retired List (TDRL) with a combined compensable rating of 30 percent.  The applicant agreed with the findings and recommended disposition of the IPEB and was placed on the TDRL effective 6 Nov 01.  A TDRL reevaluation was conducted on 26 Mar 03.  On 2 May 03, the Air Force PEB recommended that she be discharged with severance pay, based on a diagnosis of right ulnar neuropathy, with a compensable disability rating of 10 percent.  The applicant did not agree with the recommendation of the IPEB and her case was referred to a Formal PEB (FPEB).  On 22 Jul 03, an FPEB considered her case and recommended she be discharged with severance pay with a compensable percentage of 10 percent.  On 21 Sep 01, she was removed from the TDRL and retired in the grade of senior airman with a compensable rating of 10 percent.  She served 1 year, 2 months, and 17 days on active duty

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AIR FORCE EVALUATION:

The BCMR Medical Consultant recommends denial.  The Medical Consultant states she struck her right elbow and right ulnar nerve at the elbow while performing military duties in July 2000.  Although there was no detectable permanent damage, she experienced persistent neuralgic pain in the distribution of the right ulnar nerve variously diagnosed as ulnar neuralgia, causalgia, reflex sympathetic dystrophy and complex regional pain syndrome.  Treatment did not relieve her pain and she was placed on the TDRL.  While on the TDRL a spinal cord stimulator was implanted by her civilian pain specialist and subsequent pain clinic entries indicated significant relief of pain.  At the time of her TDRL reevaluation she reported the stimulator did not relieve her pain.  The PEB concluded her condition had improved and rated her pain syndrome under the VASRD code for ulnar neuralgia at 10 percent.  The applicant is correct in asserting that the diagnosis of ulnar neuropathy inaccurately describes her condition.  She has a pain syndrome limited to the distribution of the right ulnar nerve that has been classified as causalgia/reflex sympathetic dystrophy, which is a pain syndrome currently classified under the term Complex Regional Pain Syndrome (CRPS).  Although her pain syndrome is classified as CRPS affecting the distribution of the ulnar nerve, in the absence of demonstrable ulnar neuropathy, the PEB rated her condition under the appropriate VASRD code, the code for neuralgia of the ulnar nerve.  There is no dedicated VASRD code for rating reflex sympathetic dystrophy or CRPS and this group of pain syndromes is rated by analogy to neuralgia of the affected peripheral nerve distribution.  Her records show her pain syndrome was restricted to the distribution of the originally injured nerve, the right ulnar nerve.  Whether diagnosed as neuralgia of the ulnar nerve or as CRPS in the ulnar nerve distribution, the conditions are rated the same using the same VASRD code for neuralgia of the ulnar nerve.  The VASRD guidance for rating ulnar nerve conditions shows the rating for incomplete mild paralysis is 10 percent and the rating for moderate incomplete paralysis of the dominant ulnar nerve is 30 percent.  Disability ratings are based on loss of function.  Her complaint is one of pain, from which her functional impairment follows.  All the exams available for review in her military and DVA records attribute her muscular weakness to loss of volitional movement of the right upper extremity due to pain and the anticipation of pain with use.  Pain is a subjective sensation, not amenable to objective measurement.  While there is no dispute her pain is real, the quantification of her symptoms is dependent entirely on her reporting.  Evidence of record shows her condition was limited to the distribution of the ulnar nerve and that secondary manifestations that were previously present were mild and were subsequently no longer observed on examinations after September 2002.  Despite the presence of chronic pain, examination objectively showed the absence of effects that would be expected from long term decreased use of the extremity.  Findings at the time of her TDRL reexamination are consistent with the rating.  The IPEB, FPEB, and Personnel Council's recommendations are consistent with the available medical information and her disability rating of 10 percent is supported by the preponderance of the evidence of record.  Situational exacerbation of depression during administrative proceedings/action is not considered a basis for disability.  

The DVA granted her a higher rating based on a compensation and pension examination prior to placement of the spinal cord stimulator.  The FPEB had the DVA rating and rationale for their review.  Military disability systems operate under different laws with a different purpose.  Independent decisions made by the DoD and the DVA are not binding on the other.  The mere fact that the DVA may grant compensation ratings at one level does not establish eligibility for similar action from the Air Force.  The DoD is required to use the VASRD as a guideline to rate disabilities that are unfitting for continued military service.  The intent is to rate the degree of civilian occupational disability.  It is not intended to rate for limitations for a specific occupational specialty or in recreational activities.  Rating guidance in DoD Instruction 1332.39 states "When the circumstances of a case are such that two percentage evaluations could be applied, the higher percentage will be assigned only if the Service member's disability more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned".  The preponderance of the evidence does not support a higher rating at the time of permanent disposition.  Her case was properly evaluated, appropriately rated, and received full consideration under the provisions of AFI 36-3212.

The Medical Consultant's evaluation is at Exhibit C.

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APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

A copy of the Air Force evaluation was forwarded to the applicant on 16 Feb 06 for review and comment within 30 days.  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.	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 agree with the opinion and recommendation of the BCMR Medical Consultant and adopt his rationale as the basis for the conclusion that the applicant has not been the victim of an error or injustice.  Therefore, in the absence of evidence to the contrary, we find no basis to recommend granting the relief sought in this application.

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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 9 May 2006, under the provisions of AFI 36-2603:

			Panel Chair
			Member
			Member

The following documentary evidence pertaining to AFBCMR Docket Number BC-2005-00236 was considered:

	Exhibit A.	DD Form 149, dated 5 Jan 05, w/atchs.
	Exhibit B.	Applicant's Master Personnel Records.
	Exhibit C.	Letter, BCMR Medical Consultant, dated 9 Feb 06.
	Exhibit D.	Letter, SAF/MRBR, dated 16 Feb 06.

					Panel Chair