RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2010-00509 COUNSEL: NONE HEARING DESIRED: NO ___________________________________________________________________ APPLICANT REQUESTS THAT Her disability discharge with severance pay be changed to reflect she was medically retired. ___________________________________________________________________ APPLICANT CONTENDS THAT: Her medical conditions are permanent in nature and warrant placement on the Permanent Disability Retired List (PDRL). She needs to qualify for Tri-Care medical benefits in order to receive proper medical treatment without the affect of a financial burden. While being hospitalized she followed protocol and met standards required in order to be discharged. She was reevaluated twice while on the TDRL; however, her medical condition did not improve. Her final medical TDRL reevaluation paperwork is incomplete but recommended her medical retirement based on her continued poor functioning and poor prognosis in terms of her eating disorder; the chronic course of her psychiatric illness; and the fact that she will likely require multiple methods of treatment to include outpatient care, inpatient care, and partial hospitalization programs. She is totally reliant on the Department of Veterans Affairs (DVA) for her medical care. She has not been assigned to a primary health care provider or been scheduled for an initial appointment even though she has been designated as priority one in the DVA medical system. The closest DVA medical treatment center is 3 hours away and she does not know of any DVA affiliated medical facilities that provide any of the recommended treatments mentioned in the 3 Aug 07 statement. If she were permanently retired she could receive proper medical care without delay by health care providers who specialize in her disorder. In support of her request, the applicant provides excerpts from her medical records and a chronological list of events from the time she joined the Air Force to present. Her complete submission, with attachments, is at Exhibit A. ___________________________________________________________________ STATEMENT OF FACTS: The applicant entered the Regular Air Force on 1 Jul 98. She underwent a Medical Evaluation Board (MEB) on 27 Mar 06 and based on the diagnosis of Anorexia Nervosa, purging type (2) Major Depressive Disorder (MDO), single episode, moderate, and (3) Generalized Anxiety Disorder (GAD), referred her to an Informal Physical Evaluation Board (IPEB). The IPEB found her unfit for duty and recommended she be placed on the Temporary Disability Retired List (TDRL) with a diagnosis of Anorexia Nervosa, Restricting Type with major depressive disorder in full remission, with a 50 percent disability rating. The applicant underwent subsequent TDRL reevaluations and, on 3 Aug 07, the IPEB found her unfit for duty and recommended she be retained on the TDRL. Another IPEB convened on 4 Mar 09 and reviewed the applicant’s TDRL reevaluation, found her unfit for duty and recommended she be discharged with severance pay with a zero percent disability rating. She disagreed with the findings; however, she waived her right to appeal to a formal hearing and did not submit a written rebuttal. On 30 Apr 09, the Secretary of the Air Force Personnel Council (SAFPC) considered the applicant’s appeal; however, after a review of all facts and evidence in the case, to include the remarks by the IPEB, the applicant’s medical records, and the narrative summary, the board determined the applicant should be discharged with severance pay with a 10 percent disability rating. ___________________________________________________________________ AIR FORCE EVALUATION: BCMR Medical Consultant recommends granting the applicant a permanent retirement with a 30 percent disability rating. The Medical Consultant states that according to the TDRL reevaluation summary of 2008, the applicant’s depressive disorder and anxiety disorder improved or resolved and no longer presented any significant impact upon her social and occupational functioning. That then brings attention to the rating determination for her Anorexia Nervosa; after reviewing the disability rating criteria for Anorexia and Bulimia Nervosa, it is likely the previously determined “0” rating made by the IPEB was because there were no incapacitating episodes during that period. In order to receive a 30 percent disability rating there must be “self-induced weight loss to less than 85 percent of expected minimum with incapacitating episodes of more than two, but less than six weeks total duration per year.” An “incapacitating episode” is defined as “a period during which bed rest and treatment by a physician are required.” In this case, the Medical Consultant recommends a collective consideration of the probative value of the DVA evaluations, the GAF determinations, and the statement made in the narrative summary by the military psychiatrist. Consequently, he believes the benefit of doubt warrants either a return to TDRL status or permanent retirement with a 30 percent disability rating; reflecting a persistence of the underlying medical disorder, while acknowledging resolution of the associated depression and anxiety. The BCMR Medical Consultant’s complete evaluation, with attachments, is at Exhibit C. ___________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: A copy of the Air Force evaluation was forwarded to the applicant on 1 Nov 10 for review and comment within 30 days. As of this date, this office has received no response. ___________________________________________________________________ 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 error or injustice to warrant relief in this case. After carefully reviewing the available evidence, we acknowledged the applicant’s social and industrial adaptability was characterized a mild. However, we rendered the benefit of doubt in favor of the applicant upon consideration of the conflicting clinical information provided by the mental health provider, who also stated that the applicant’s Anorexia Nervosa “appears to have continued unabated and possibly worsened” since her last evaluation, “as evidenced by her continued weight loss.” The evaluating mental health provider also assigned a Global Assessment of Functioning (GAF) of 45, depicting a severe level of overall impairment. While the GAF is only one measure in the assessment of an individual’s level of impairment, we collectively considered, as recommended by the BCMR Medical Consultant, the probative value of the disability rating determinations, the rationale of the Department of Veterans Affairs and the aforementioned comments of the applicant’s mental health provider in rendering the benefit of doubt in her favor for assignment of a disability rating of 30% for Anorexia Nervosa. Therefore, we recommend her records be corrected as indicated below. ___________________________________________________________________ THE BOARD RECOMMENDS THAT: The pertinent military records of the Department of the Air Force relating to APPLICANT be corrected to show that she was not removed from the TDRL on 26 May 09 and discharged with severance pay, but on 27 May 09 her name was placed on the Permanent Disability Retired List, with a 30 percent compensable percentage. ___________________________________________________________________ The following members of the Board considered AFBCMR Docket Number BC-2010-00509 in Executive Session on 2 Dec 10, 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 4 Feb 10, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Letter, BCMR Medical Consultant, dated 26 Oct 10. Exhibit D. Letter, SAF/MRBR, dated 1 Nov 10.