RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2010-03405 COUNSEL: NONE HEARING DESIRED: NO _________________________________________________________________ APPLICANT REQUESTS THAT: Her diagnosis of “Adrenal Insufficiency” be added to her AF Form 356, Findings and Recommended Disposition of USAF Physical Evaluation Board, dated 22 Jul 10,” and included as part of her overall disability rating. _________________________________________________________________ APPLICANT CONTENDS THAT: The Medical Evaluation Board (MEB) did not have the necessary paperwork to make a decision about her adrenal insufficiency. Her military medical provider is willing to do whatever is needed to help correct her military record. She is currently seeing a civilian endocrinologist, whom she has been seeing on a regular basis for over a year. In support of her request, the applicant provides a personal statement, a letter from her civilian medical provider, and medical documents. The applicant's complete submission, with attachments, is at Exhibit A. _________________________________________________________________ STATEMENT OF FACTS: On 21 Nov 09, the applicant underwent a MEB for the following conditions: adrenal insufficiency, asthma, lumbago, obstructive sleep apnea (OSA), and post-traumatic stress disorder (PTSD). On 9 Feb 09, the Informal Physical Evaluation Board (IPEB) found the applicant unfit for PTSD (assigned a 50 percent rating), chronic low back pain (assigned a 40 percent rating), and adrenal insufficiency (assigned a 20 percent rating), and recommended placement on the Temporary Disability Retired List (TDRL) with a combined (not added) disability rating of 80 percent. The IPEB considered her OSA (controlled with a continuous positive airway pressure (CPAP) machine and asthma to be conditions that can be unfitting but were not currently compensable or ratable at the time. The applicant did not contest the findings and recommended disposition of the IPEB, and on 29 May 09 she was placed on the TDRL. On 22 Jul 10, the applicant received a TDRL re-evaluation of her conditions, the decision was made to remove her from the TDRL and permanently retire her with a combined (not added) disability rating of 70 percent, which included 50 percent for PTSD, 40 percent for chronic low back pain. The IPEB noted that the adrenal insufficiency had resolved. It was noted in the medical narrative summary on 10 Mar 10: “Pt with h/o corticosteroid- induced adrenal insufficiency. Currently followed by a civilian endocrinologist. Corticosteroid replacement was slowly decreased over several months and was ultimately discontinued in Nov 2009. Per patient’s report, a cosyntropin stimulation test resulted in normal adrenal cortisol response after discontinuation of prednisone [records are not available at this visit]. Given this information, pt’s adrenal insufficiency has likely resolved. Pt’s endocrinologist plans to continue following her for the next 2-3 years to ensure adrenal insufficiency does not recur.” On 24 Aug 10, the applicant concurred with the IPEB’s recommendation. On 19 Sep 10, the applicant was removed from the TDRL, and was permanently retired with a 70 percent disability rating. Additional facts relevant to the applicant’s case are contained in the evaluations prepared by the Air Force office of primary responsibility and the BCMR Medical Consultant at Exhibits C & E. _______________________________________________________________ AIR FORCE EVALUATION: AFPC/DPSD recommends denial and states the preponderance of evidence reflects that no error or injustice occurred during the disability process or the rating applied at the time of the board and removal from the TDRL. While the applicant may continue to require follow-up from her physicians, the diagnosis alone was not sufficient for the IPEB to find the condition unfitting for continued service. It should also be noted that had the applicant felt her adrenal insufficiency should have been included as an unfitting condition and rated, she had the right to appeal at the Formal Physical Evaluation Board (FPEB) and could have appealed their findings to the Secretary of the Air Force Personnel Council. The applicant did not exercise either of these appeal rights. The Department of Defense (DoD) and the Department of Veterans Affairs (DVA) disability evaluation systems operate under separate laws. Under Title 10, United States Code (USC), Physical Evaluation Boards must determine if a member’s condition renders them unfit for continued military service relating to their office, grade, rank or rating. The fact that a person may have a medical condition does not mean that the condition is unfitting for continued military service. To be unfitting, the condition must be such that it alone precludes the member from fulfilling their military duties. If the Board renders a finding of unfit, the law provides appropriate compensation due to the premature termination of their career. Further, the USAF disability boards must rate disabilities based on the member’s condition at the time of evaluation; in essence a “snap shot” of their condition at that time. It is the charge of the DVA to pick up where the AF must, by law, leave off. Under Title 38, USC, the DVA may rate any service-connected condition based upon future employability or reevaluate based on changes in the severity of a condition. This often results in different ratings by the two agencies. The complete DPSD evaluation is at Exhibit C. _________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: On 8 Apr 11, a copy of the Air Force evaluation was forwarded to the applicant for review and comment within 30 days. To date, a response has not been received (Exhibit D). _________________________________________________________________ ADDITIONAL AIR FORCE EVALUATION: The BCMR Medical Consultant recommends denial. The applicant has not met her burden of proof of an error or injustice that warrants the desired change of the record. The IPEB opined based upon the evidence supplied, that the applicant’s adrenal insufficiency was no longer unfitting. The applicant’s current endocrinologist states she will likely require continued periodic follow-up of her condition and even may require treatment at a future date. However, the fact the applicant will require long-term-follow-up and observation of the condition and may require treatment at an indeterminate future date is not determinative of unfitness to serve. Although conditions justifying initial TDRL placement have generally not yet been stabilized, the Consultant opines at the time of the applicant’s TDRL assessment the adrenal insufficiency had been reasonably brought under control (no longer required steroid replacement therapy since Nov 09) to the extent that removing this as an unfitting condition was appropriate. The applicant will retain her eligibility to receive disability compensation by the DVA, for this and her other service connected medical conditions which were not found unfitting; bearing in mind that even the DVA may assign a zero percent rating (no compensation) for a service connected medical condition that no longer presents a functional impairment or does not meet minimum disability rating criteria. The complete BCMR Medical Consultant’s evaluation is at Exhibit E. _________________________________________________________________ APPLICANT'S REVIEW OF ADDITIONAL AIR FORCE EVALUATION: On 29 Jul 11, a copy of the BCMR Medical Consultant evaluation was forwarded to the applicant for review and comment within 30 days. To date, a response has not been received. (Exhibit F) _________________________________________________________________ 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 and do not find that it supports a change in her military record. As indicated by the BCMR Medical Consultant, the fact the applicant will require long-term-follow-up and observation of the condition and may require treatment at an indeterminate future date is not determinative of unfitness to serve. In this respect, we note that although at the time of her initial TDRL placement her adrenal insufficiency was found to be unfitting; at the time of her TDRL reassessment it was reasonably brought under control, and determined not to be unfitting at the time. Therefore, we agree with the opinion and recommendation of the BCMR Medical Consultant and the Air Force office of primary responsibility and adopt their rationale as the basis for our conclusion that the applicant has not been the victim of an error or injustice. In the absence of evidence to the contrary, we find no basis to recommend 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 Docket Number BC-2010-03405 in Executive Session on 13 Sep 11, under the provisions of AFI 36-2603: The following documentary evidence pertaining to Docket Number BC-2010-03405 was considered: Exhibit A. DD Form 149, dated 15 Sep 10, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Letter, AFPC/DPSD, dated 21 Mar 11. Exhibit D. Letter, SAF/MRBR, dated 8 Apr 11. Exhibit E. Letter, BCMR Medical Consultant, dated 22 Jul 11. Exhibit F. Letter, SAF/MRBR, dated 29 Jul 11.