RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2011-04893 COUNSEL: NONE HEARING DESIRED: NO ________________________________________________________________ APPLICANT REQUESTS THAT: 1. His Fitness Assessment (FAs) scores dated 3 Mar 11 and 2 Jun 11 be declared void and removed from the Air Force Fitness Management System (AFFMS). 2. His referral Enlisted Performance Report (EPR), rendered for the period 8 Jun 11 through 1 Aug 11, be declared void and removed from his records. 3. He be promoted to the rank of Master Sergeant (MSgt) with an effective date of rank of 1 Nov 11. ________________________________________________________________ APPLICANT CONTENDS THAT: He suffers with Post Traumatic Stress Disorder (PTSD), Panic Attacks, and Anxiety Disorder which resulted in his flunking the two FAs in question. The medication he takes for these disorders, selective serotonin reuptake inhibitors (SSRIs), caused him to gain weight. Therefore, he failed the two FAs, received a referral Enlisted Performance Report (EPR), and lost his line number to MSgt. The SSRI Celexa caused him to gain 30 pounds. When he was removed from Celexa in Sep 2009, he quickly lost the weight. In Jan 11, before his first FA failure, he notified his supervision and physicians about this unnatural weight gain, but received no support. In support of his request, the applicant provides a copy of a memorandum for the record (MFR) and a note from his physicians, excerpts from his Chronological Official Record of Medical Care, several AF Forms 422s, Notification of Air Force Member’s Qualification Status, and medical articles. The applicant’s complete submission, with attachments, is at Exhibit A. ________________________________________________________________ STATEMENT OF FACTS: The applicant entered active duty on 25 Sep 96, and is currently serving in the grade of Technical Sergeant (E-6). In 2008, the applicant was diagnosed with PTSD, Panic Attacks, and Anxiety Disorder. On 3 Mar 11, and again on 11 Jun 11, the applicant participated in the contested FAs. The applicant received a referral EPR for the period 8 Jun 10 through 7 Jun 11, on which he was rated as “Does Not Meet” standards in Block 3, FITNESS. The applicant appealed his referral EPR to the Evaluation Report Appeals Board (ERAB); however, the ERAB was not convinced the contested report was inaccurate or unjust. The remaining relevant facts pertaining to this application are described in the letters prepared by the Air Force offices of primary responsibility and AFBCMR Medical Consultant which are included at Exhibits C, D, E, and I. ________________________________________________________________ AIR FORCE EVALUATION: AFPC/DPSIM recommends denial, indicating there is no evidence of an error or injustice. The FAs in question were administered in accordance with the medical recommendation annotated on the AF Form 422. Both FAs were completed in compliance with Air Force policy. A complete copy of the AFPC/DPSIM evaluation, with attachment, is at Exhibit C. AFPC/DPSID recommends denial of the applicant’s request to remove the referral EPR that resulted from his FA failures. While the applicant does provide some documentation from competent medical authorities to demonstrate that a prescription of Zoloft given to him to treat his underlying medical conditions could have played a role in weight gain, his medical records include evidence that he was given ample consideration by competent medical authority, and they determined not to exempt the applicant from the abdominal circumference (AC) component of the FA. The applicant also provides a copy of an article from the Cleveland Clinic journal of Medicine in support of his case; however, said article indicates that medical opinions vary as to whether or not Zoloft may be likely to cause weight gain. Having waist measurements of 41.5 and 42.5 inches at the time of the FAs is not physically fit and not in keeping with Air Force standards. It is every Airman’s responsibility to maintain the standards set forth in AFI 36-2905, Fitness Program, for 365 days a year. The FA is presumed to be administered fairly and accurately unless evidence to the contrary is provided. Ultimately, an evaluation report is considered to represent the rating chain’s best judgment at the time it is rendered. The applicant has not substantiated the contested report was not rendered in good faith by all evaluators based on knowledge available at the time. The referral EPR in question was completely appropriate and within the regulatory Air Force requirements. A complete copy of the AFPC/DPSID evaluation is at Exhibit D. AFPC/DPSOE recommends denial based upon the advisories from DPSIM and DPSID. The applicant was considered and tentatively selected for promotion to MSgt during cycle 11E7. He received a Promotion Sequence Number (PSN) of 2636.5, which would have resulted in his pinning on MSgt on 1 Nov 11; however, the fact that he received the referral EPR rendered him ineligible for promotion and his line number was subsequently removed. A complete copy of the AFPC/DPSOE evaluation is at Exhibit E. ________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: He reiterates his original contention, and takes exception to two advisories. He agrees with DPSIM that both failed FAs were accomplished in accordance with Air Force policy, but does not think the advisory writers looked at the other pieces of evidence surrounding the FA failures. He reemphasizes that he was actively seeking help with his problem of not being able to lose weight, and submits his caloric intake for the period Jan 11 through Apr 11. In addition, he submitted his rebuttal letters for his Letter of Counseling and Letter of Reprimand/Unfavorable Information File (UIF) which he received for the two FA failures prior to receipt of his referral EPR, and asks the Board members to consider them. In addition, he notes he had no problem passing the FA administered under the new standards on 29 Apr 10, has passed his latest FA, and will pass his upcoming FA. Finally, he submitted two additional articles related to his medical condition (Exhibit G). ________________________________________________________________ ADDITIONAL AIR FORCE EVALUATION: The AFBCMR Medical Consultant recommends denial of the applicant’s request due to insufficient medical evidence to support his claim of significant weight gain solely due to use of an SSRI. The applicant has a medical history of PTSD, panic attacks and anxiety disorder diagnosed in 2008. However, this case hinges upon whether there is sufficient medical evidence to substantiate his claim that his significant weight gain resulted from SSRIs. Therefore, it is necessary to conduct a survey of scientific evidence for significant weight gain resulting from long term use of SSRIs. For the purpose of evaluating weight gain, significant weight gain is generally defined as a seven percent or greater increase in body weight. In the scientific literature, the pharmaceutical manufacturer of Celexa, Forest Pharmaceuticals, Inc. publishes scientific data regarding potential side effects, contraindications and warnings relative to this medication. In its publication, dated Aug 11, the literature states “Patients treated with Celexa in controlled trials experienced a weight loss of about 0.5 kilograms (1.1 pounds) compared to no change for placebo patients.” The present clinical evidence suggesting that significant weight gain with long-term SSRI use remains unclear according to established experts. In fact, other placebo-controlled studies using an SSRI for more than one year reported no weight gain. Therefore, the scientific evidence to support the claim that use of the SSRI was solely responsible for the applicant’s 30 pound weight gain is unsupported by scientific evidence. The AFBCMR Medical Consultant acknowledges the written opinions of treating health professionals involved in the applicant’s care during the period of unsatisfactory physical testing; however, the scientific literature should clearly support any medical opinions as to the impact and degree of any adverse effects attributed to use of a specific medication. Hence, we conclude there is no scientific evidence the SSRIs were solely responsible for the applicant’s weight gain and subsequent FA failures. A complete copy of the AFBCMR Medical Consultant’s evaluation is at Exhibit H. ________________________________________________________________ APPLICANT'S REVIEW OF THE ADDITIONAL AIR FORCE EVALUATION: A copy of the additional Air Force evaluation was forwarded to the applicant on 1 Oct 12 for review and comment within 30 days. As of this date, no response has been received by this office (Exhibit I). ________________________________________________________________ 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 an 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 the Air Force offices of primary responsibility (OPR) and the AFBCMR Medical Consultant and adopt their rationale as the basis for our conclusion the applicant has not been the victim of an error of injustice. We note the applicant has provided a written statement from his physician indicating the applicant’s medication played a significant role in the applicant’s weight gain and subsequent FA failures; however, we concur with the determination of the AFBCMR Medical Consultant that the applicant’s arguments are not supported by scientific evidence. Therefore, in the absence of evidence to the contrary, we find no basis to recommend granting the relief sought in this application. ________________________________________________________________ THE BOARD DETERMINES THAT: The applicant be notified the evidence presented did not demonstrate the existence of material error or injustice; the application was denied without a personal appearance; and 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-2011-04893 in Executive Session on 7 Nov 12, under the provisions of AFI 36-2603: The following documentary evidence was considered: Exhibit A. DD Form 149, dated 12 Feb 12, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Letter, AFPC/DPSIM, dated 24 Feb 12, w/atch. Exhibit D. Letter, AFPC/DPSID, dated 9 Apr 12. Exhibit E. Letter, AFPC/DPSOE, dated 18 Apr 12. Exhibit F. Letter, SAF/MRBR, dated 11 May 12. Exhibit G. Letter, Applicant, dated 18 May 12, w/atchs. Exhibit H. Letter, AFBCMR Medical Consultant, dated 18 Sep 12. Exhibit I. Letter, AFBCMR, dated 1 Oct 12.