RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS
IN THE MATTER OF:	DOCKET NUMBER:	BC-2008-01150 INDEX CODE:	134.02

COUNSEL:	XXX HEARING DESIRED: NO

APPLICANT REQUESTS THAT:
Any and or all information related to an adverse privileging action against his clinical privileges be expunged from his Provider Credential File, Provider Activity File and from those offices involved in such process, including the 55th Medical Group, Air Combat Command, and AFMOA/SG3OQ.

APPLICANT CONTENDS THAT:
The diagnosis of a mental health impairment that led to the adverse privileging action against him was false and inaccurate and he did not receive due process during his March 2006 Formal Physical Evaluation Board (FPEB) hearing. The injustices led to an inappropriate revocation of his clinical privileges. The fact that he was eventually found fit for duty challenges the notion he ever suffered from a bipolar issue to begin with. He also questions the propriety of medical command officials to revoke his clinical privileges based on the recommendation of an ad hoc committee comprised of only four officers, instead of acting upon a previous recommendation to “restrict” his clinical privileges by a full Credentialing Function.

In support of his appeal, the applicant provides a lengthy personal statement with numerous attachments.

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

STATEMENT OF FACTS:
The applicant joined the Regular Air Force on 9 February 2003 as an Internist. He has been progressively promoted to the grade of major, effective and with a date of rank (DOR) of 27 February 2004. On 20 June 2006, his name was placed on the Temporary Disability Retired List (TDRL), until 24 November 2007, when an Informal Physical Evaluation Board (IPEB) found him fit for duty.

He is currently serving in the Regular Air Force in the grade of major and has over eight years of service.

On 21 November 2005, the applicant underwent a Medical Evaluation Board (MEB) by reason of a diagnosis of Major Depressive Disorder along with a co-morbid diagnosis of Generalized Anxiety Disorder, and traits of an Obsessive Compulsive Personality Disorder. The applicant did not agree with an additional diagnosis of Bipolar Disorder. On 14 December 2005, his case went before an Informal Physical Evaluation Board (IPEB) that determined the applicant was unfit for further military service, that his “considerable” level of impairment warranted a 50% disability rating, and that his medical condition had not yet stabilized. Consequently, a recommendation was made for his temporary retirement with a 50% disability rating. The applicant appealed the IPEB decision to the Formal PEB (FPEB) expressing his desire to return to duty. He sought inclusion of additional evidence to support his contention, but reportedly was deprived of the opportunity to submit two medical records entries, dated 7 Feb 06 and 27 Feb 06, wherein was included evidence the applicant’s medical condition was in partial remission. The FBEB upheld the IPEBs findings and recommendation to place his name on the TDRL.

On 24 March 2006, the applicant was hospitalized for a commander- directed mental health evaluation. He was prescribed Depakote for his new diagnosis of Bipolar Disorder. The applicant appealed the diagnosis to the FPEB and eventually to the Secretary of the Air Force Personnel Counsel (SAFPC) with a contention he be returned to duty. While considering his appeal, SAFPC was presented with a supplemental narrative assessment of the applicant’s condition, dated 5 April 2006, indicating that his medical condition had deteriorated to the extent that his disability rating warranted an increase to 70%. SAFPC eventually ruled the placement of his name on the TDRL offered the applicant the best opportunity to receive optimum care with the goal of achieving a full remission of his condition.

On 9 June 2006, following a recent hospitalization where the applicant had shown minimal improvement and had refused to take his medications his commander revoked his clinical privileges. A Credentials Functional Review was undertaken based on substantiated allegations the applicant was unable to safely care for patients because of his psychological condition and his failure to comply with medical recommendations and treatment. The applicant requested a hearing that, on 31 October 2006, resulted in a recommendation that his clinical privileges be restricted rather than revoked. Consequently, the Credentials Functional Review was reconvened on 29 November 2006 and reversed the earlier decision on appeal to restrict his clinical privileges to a recommendation for revocation of privileges, again citing the applicant’s non-compliance with prescribed treatment and the potential danger to patient care his medical condition imposed.

On 5 January 2007, the medical commander made the final decision to revoke the applicant’s clinical privileges. On 21 January 2007, the applicant appealed the action of his commander to AFMOA/SG3OQ. In his appeal, he raised objections to the action to revoke his privileges, claiming it was unfair to make a final action contrary to the hearing committee (revocation verses restriction) recommendation and that his mental health condition was misdiagnosed.

On 22 March 2007, a Medical Practice Review Board (MPRB) was convened to consider the evidence, provide a final review, and make a recommendation to the Air Force Surgeon General (AF/SG) regarding upholding, remanding, or reversing the decision of the commander. The MPRB upheld the commander’s decision to revoke the applicant’s privileges, finding the decision reasonable and warranted based on the evidence. AF/SG agreed with  the revocation and directed the revocation action be reported to the National Practitioner Data Bank.

In early 2007, the applicant underwent a TDRL re-evaluation to assess his fitness to serve. The IPEB found the applicant had shown no evidence of an Axis I diagnosis (including Bipolar Disorder) and had not required any medications during the previous year. Therefore, the IPEB found the applicant fit for duty. He was removed from the TDRL and given the opportunity to return to active military service, which he did.

AIR FORCE EVALUATION:
AFMOA/SG3OQ recommends denial. SG3OQ states the importance in noting the Air Force Medical Service (AFMS) does not undertake an adverse privileging action lightly. The sole purpose is to fulfill the AF/SG’s responsibility to provide safe patient care. AFI 44-119 makes no provision for the removal or reversal of the final decision of the AF/SG. Under the circumstances of the applicant’s case, a record of the adverse privileging action that resulted in revocation of his privileges is to be kept in the medical facility Provider Credential Folder for 10 years. AFMOA/SG3OQ maintains such files indefinitely.

SG3OQ states the actions taken by the AFMS were appropriate, reasonable and required by law. The applicant has not been punished or unfairly labeled but, rather, the AFMS has acted to fulfill its obligation to their patients, the system and to the applicant. The adverse action process worked according to policy.

SG3OQ’s complete evaluation, with attachments, is at Exhibit C.
The BCMR Medical Consultant recommends denial. In searching for an error or an injustice in this case, the Medical Consultant finds it reasonable, based on the intervening clinical features reportedly displayed by the applicant, that a diagnosis of

bipolar disorder could be made. As with the evaluation and treatment of any medical condition, changes in an initial diagnostic impression may occur, depending upon the presenting clinical signs and symptoms at a given time. When such an error or a change in diagnosis occurs in clinical practice, it is not erased from the record as not having occurred. Thus, although recognizing retrospectively that it is unlikely that the applicant indeed had a bipolar disorder, noting the year-long period during which he did not require medical treatment and the subsequent “full remission” of his true illness, the fact the diagnosis was made does not change. The Medical Consultant can only speculate however, whether the applicant’s commander would have chosen to execute the initially recommended “restriction” of clinical privileges versus choosing revocation of privileges, had the applicant’s diagnosis instead remained a major depressive disorder; particularly in the context of the reported belief that the applicant’s refusal to take his prescribed medications would cause unacceptable risks to the patient care population. Although time has indicated that he has not demonstrated evidence of having a bipolar disorder, the Medical Consultant finds it improper to remove from the record the events that occurred which resulted in the errant diagnosis.

The Medical Consultant’s complete evaluation is at Exhibit D.

APPLICANT'S REVIEW OF AIR FORCE EVALUATIONS:
Copies of the Air Force evaluations were forwarded to the applicant on 22 May 2009 for review and comment within 30 days. As of this date, no response has been received by this office.

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 opinions and recommendations of Air Force Offices of Primary Responsibility (OPRs) and the BCMR Medical Advisor and adopt their rationale as the basis for our conclusion the applicant has not been the victim of an error or injustice. Accordingly, it appears to us that pertinent medical officials acted in a manner consistent with their responsibilities based on the evidence provided at the time. We considered the BCMR Medical Consultant’s recommendation to amend rather than expunge the applicant’s record but we believe his record  accurately  reflects  his  current  medical  status  and
1.	
requires no further correction. Therefore, in the absence of evidence to the contrary, we find no basis upon which to recommend granting the relief sought in this application.

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.

The following members of the Board considered AFBCMR Docket Number BC-2008-01150 in Executive Session on 29 July 2009, under the provisions of AFI 36-2603:

Panel Chair 
Member 
Member
The following documentary evidence was considered: Exhibit A.	DD Form 149, dated 16 Mar 08, w/atchs.
Exhibit B.	Letter, AFMOA/SG3OQ, dated 5 Jun 08, w/atchs. Exhibit C.	Letter, BCMR Medical Consultant,
dated 18 May 09.
Exhibit D.	Letter, SAF/MRBR, dated 22 May 2009.