RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2012-02590 COUNSEL: NONE HEARING DESIRED: YES ________________________________________________________________ APPLICANT REQUESTS THAT: Correct the Line of Duty (LOD) finding of existed prior to service (EPTS – LOD Not Applicable) for chronic asthmatic bronchitis and chronic sinusitis, to reflect in the line of duty (ILOD), in block 11 of the AFRC IMT 348, dated 24 September 2008. ________________________________________________________________ APPLICANT CONTENDS THAT: The LOD board finding of EPTS – LOD NA was made in error. The AFRC IMT 348 that was submitted contained false statements in blocks 5 and 6; a. The Anthrax booster was given on 29 April 2000, approximately two years prior to his deployment to Qatar, not in 2002 as stated. b. At that time, his primary medical doctor was treating him for upper and lower respiratory issues and not just sinusitis as stated. c. The pulmonary specialist diagnosed him with chronic asthmatic bronchitis secondary to reactive airway dysfunction syndrome (RADS) caused by exposure to silica (dust particles), not chronic bronchitis secondary to anthrax vaccination as described in blocks 5 and 6. d. He submitted a request for reinvestigation on 26 September 2009. His request was reviewed by the wing commander and the JAG and found to warrant a reinvestigation. The reinvestigation was not given due process as it was denied by AFRC/CV. The LOD board made a determination based on false statements. This was evidenced by the Air Force’s response to a congressional inquiry into the matter dated 21 February 2012, which stated his claim of chronic bronchitis and chronic sinusitis were linked to the Anthrax vaccination. This was untrue and unsupported. The applicant’s complete submission, with attachments, is at Exhibit A. ______________________________________________________________ STATEMENT OF FACTS: According to copies of documents extracted from his Military Personnel Record (MPR) the applicant is a former member of the Air Force Reserves. The applicant was activated from May through September 2002; the LOD determinations were initiated on 22 May 2008. The recommended finding of “In Line of Duty” (ILOD) was approved by the appointing authority. Subsequent to completion of the coordination process, the approving authority’s decision was “EPTS - LOD Not Applicable.” Effective 29 January 2013, the applicant was permanently disability retired in the grade of TSgt per AFI 36-3212, Physical Evaluation for Retention, Retirement, and Separation, with a compensable percentage for physical disability of 100 percent. ________________________________________________________________ AIR FORCE EVALUATION: AFRC/SG recommends denial. SG states no injustice has occurred to the applicant. The applicant received extensive consideration and reconsideration of his case and failed repeatedly to meet the standard of medical evidence to find in the line of duty. a. A review of the history indicates that the applicant was mobilized from 21 May through 21 December 2002, and was deployed to Al Udeid Air Base, Qatar, for 90 days during this mobilization. Between April 2000 and February 2009, the applicant received five anthrax vaccinations. He began to feel ill in Dec 2002 and felt he was having recurrent cold or allergy symptoms. For the next year, the applicant treated these symptoms with over the counter medication. Due to worsening symptoms, in December 2003, the applicant saw his primary care physician and after months of treatment for a respiratory infection/bronchitis with various medications and little improvement, he was referred to a pulmonary specialist. b. In conjunction with the respiratory issues, in September 2008, the applicant complained of soreness in his legs and feet. He was seen by a Rheumatologist for a diagnosis of rheumatoid arthritis. In that same time period, the applicant was also diagnosed with thyroiditis. The applicant filed a total of seven LOD cases, five for separate diagnoses and two for reinvestigation during the period of 2005 through 2010. Two of the cases were found in line of duty: Adenopathy secondary to a vaccination (Dec 2007) and Reactive Polyarthralgias (Nov 2008). c. The finding of EPTS for a Reserve member is based on entry into the period of service during which the conditions manifested and the symptoms presented themselves IAW AFI 36- 2910, Line of Duty (Misconduct) Determination, paragraph 3.4.1. Furthermore, DODI 1332.38, Physical Disability Evaluation, E3.P4.5.2, notes that conditions which exhibit signs or symptoms within less than medically recognized incubation periods after entry into active service will be accepted as evidence that the disease existed prior to military service unless overcome by evidence to the contrary. (1). The initial claim for a service connection to the applicant’s Chronic Sinusitis, Asthmatic Bronchitis, and Thyroid Disease attempted to overcome this connection by linking the conditions to the anthrax vaccination. (2). The work-up at the vaccine health centers at Wilford Hall Medical Center and Walter Reed in April 2007 found no connection between any of these conditions and the anthrax vaccination. (3). There was no scientific literature or case study that supported this claim. When the claim for anthrax connection was denied, a claim for silica exposure was put forward without any substantial medical documentation. This claim was also thoroughly reviewed. d. Following the January 2008 EPTS determination, the applicant’s case was reviewed for potential service aggravation defined in DODI 133.38, E2.1.32., as the permanent worsening of a pre-service medical condition above the natural progression of the condition caused by trauma or the nature of military service. There was no evidence presented for service aggravation. The finding of EPTS-LOD NA and evidence to support such findings was IAW with all applicable guidance and policy. e. With respect to the reinvestigation process, they did in fact review the documents provided in accordance with AFI 36- 2910. This AFI establishes a requirement for information that had not been considered previously. This is not a mechanism to simply have a finding overturned. The applicant did not provide new medical information that hadn't been previously reviewed and considered, and the decision was made to deny reinvestigation, also in accordance with the same AFI. It is notable therefore that although a formal rendering was not made, the documents were in fact reviewed from the applicant’s medical unit, through the chain to the Air Force Reserve Vice Commander. The complete AFRC/SG evaluation is at Exhibit C. ________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: In his response, the applicant reiterated his contentions and indicated that the AFRC/SG advisory contained incorrect statements. a. A thorough review of his medical conditions and an extensive review of his case were not accomplished. b. His squadron turned a blind eye and a deaf ear to the numerous reports and test results from his doctor which stated that his chronic sinusitis and chronic bronchitis was caused by his deployment exposure. c. His email to CSAF was a request for personal attention to this matter as the principal military advisor and supervisor of the Air Force Reserve organizations as his case has been in process for six years due to numerous errors, lack of attention to detail, and an overall lack of competence and urgency by his squadron. There was no complaint as insinuated by AFRC/SG. He requests the AFBCMR perform a meticulous and complete review of all medical documentation prior to making a decision and welcomes the opportunity to discuss this case with the AFBCMR to ensure all information has been presented and reviewed. The applicant’s complete response, with attachments, is at Exhibit D. ________________________________________________________________ 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. After a thorough review of the evidence of record and the applicant’s submission, we believe that relief is warranted. AFRC/SG pointed out that the applicant filed a total of seven LOD cases during 2005 through 2010. Two of the cases were found in line of duty: Adenopathy secondary to a vaccination (Dec 2007) and Reactive Polyarthralgias (Nov 2008). The applicant asked this Board to review and address two of the five cases where there was a finding not in the line of duty. Specifically, this Board is reviewing the LOD case regarding chronic bronchitis and the case regarding chronic sinusitis, both of which the unit Medical Officer signed on May 22, 2008. Based on his review of the applicant’s medical records including referral to a specialist in pulmonary disease, the unit Medical Officer reported the applicant had been “diagnosed with Asthmatic Bronchitis secondary to Anthrax vaccination.” The Medical Officer, unit Commander, unit Staff Judge Advocate, and Appointing Authority concluded the applicant’s chronic bronchitis and sinusitis were in the line of duty and were not existing prior to service. Without explanation, rationale or supporting facts, the reviewing officials at Air Force Reserve Command announced a different, opposite finding. They concluded the bronchitis and sinusitis were existing prior to service (EPTS). Subsequently, the applicant’s pulmonary specialist found there is a direct causal relationship between the bronchitis and sinusitis and the applicant’s exposure to dust particles while overseas on active military duty. The Board took note that the Air Force office of primary responsibility recommends denial. However, there is no evidence in this record of pre-existing chronic sinusitis, chronic asthmatic bronchitis, or reactive airway dysfunction syndrome (RADS). Absent such pre-existing evidence, and in light of the evidence that the sinusitis, bronchitis and RADS were caused by exposure to silica, the fact that the applicant first presented for treatment while serving a period of active service, is determinative that his conditions, as likely as not, occurred in line of duty. We understand that the unit Medical Officer’s report that the bronchitis may have been “secondary to” vaccination may merely be a comment that the applicant’s immune system had been primed by the many vaccinations he received, particularly as confirmed by the LOD case in which Lymphadenopathy was found to have been secondary to vaccinations related to the overseas tour. Thus, the comments about vaccination as a “secondary” cause are not inconsistent with the final diagnosis that silica was the “primary” cause of the bronchitis. Based on the above, we recommend that the applicant’s record be corrected as indicated below. 4. The applicant's case is adequately documented and it has not been shown that a personal appearance with or without counsel will materially add to our understanding of the issues involved. Therefore, the request for a hearing is not favorably considered. ________________________________________________________________ THE BOARD RECOMMENDS THAT: The pertinent military records of the Department of the Air Force relating to APPLICANT be corrected to show that on 20 January 2009 his conditions of chronic sinusitis and chronic asthmatic bronchitis were found to be service-connected and incurred in the line of duty. ________________________________________________________________ The following members of the Board considered this application in Executive Session on 5 March 2013, under the provisions of AFI 36-2603: , Panel Chair , Member , Member The following documentary evidence was pertaining to AFBCMR Docket Number BC-2012-02590 was considered: Exhibit A. DD Form 149 dated 11 June 2012 w/atchs. Exhibit B. Applicant’s Master Personnel Records. Exhibit C. Letter, HQ AFRC/SG, dated 24 July 2012. Exhibit D. Letter, SAF/MRBR, dated 7 August 2012. Exhibit E. Letter, Applicant, dated 4 September 2012 w/atchs.