RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2012-04338 COUNSEL: NONE HEARING DESIRED: NO ________________________________________________________________ APPLICANT REQUESTS THAT: She be given a full military medical retirement back dated to her release from the Air Force on 2 December 2006. ________________________________________________________________ APPLICANT CONTENDS THAT: An injustice occurred with her military service, specifically with her medical evaluation board (MEB) status and lack of any results, ratings, or proper submittal of records before her release from active duty. She was released from the Air Force without a final rating decision or MEB documentation even after she requested a review of her MEB status several months before being released. The MEB paperwork was created for problems with her heart and lungs which should have resulted with the proper military retirement but no rating was ever given prior to her release. She was not placed on the Temporary Disability Retired List (TDRL), nor was she provided any guidance on steps to take to complete the MEB process. The applicant’s complete submission, with attachments, is at Exhibit A. ________________________________________________________________ STATEMENT OF FACTS: According to copies of documents submitted by the applicant, she is a former member of the Regular Air Force who enlisted on 3 December 2002, and was released from active duty on 2 December 2006, with an honorable characterization of service, a separation code of “MBK” and a narrative reason for separation of “Completion of Required Active Service.” She was credited with 4 years of active duty service. ________________________________________________________________ AIR FORCE EVALUATION: 1. The AFBCMR Medical Consultant recommends denial of the applicant's petition to supplant her established reason for separation with a medical retirement. The Medical Consultant states the applicant's medical case file strongly suggests she should have been placed on medical hold for either completion of a formal Medical Evaluation Board (MEB) or, as a minimum, receive a review in lieu of an MEB for either clearance of return to duty or referral to a Physical Evaluation Board. It is otherwise not clear why the applicant's MEB was never conducted as this was the documented plan of action over the course of two years. The Medical Consultant opines, that despite the characterization of the applicant's mitral valve prolapse and mitral insufficiency as “mild,” the fact that her alertness could be unpredictable, albeit for brief periods, should have prompted completion of the MEB, referral to a Physical Evaluation Board, and career termination. 2. Addressing the applicant's petition for a medical retirement, had she been found unfit by a Physical Evaluation Board, a disability rating would be applied utilizing the Veterans Administration Schedule for Rating Disabilities (VASRD) under the applicable rating code. The Medical Consultant is of the opinion that the applicant would not have qualified for a medical retirement based upon a preponderance of medical evidence at or about the time of her release from military service because the VASRD code utilized for syncope of vasovagal or neurogenic origin would likely have been analogized under VASRD Code 8210-8299, and likely assigned a 10 percent disability rating, for incomplete, moderate impairment. Alternatively, if the applicant was rated under Valvular Heart Disease (including rheumatic heart disease), VASRD code 7000, the evidence does not reflect an impairment of cardiac valvular function that would reach the minimum threshold for a 30 percent disability rating due to her mild mitral valve prolapse and mild mitral insufficiency; which also does not reflect an impairment of heart muscle contractility, e.g., ejection fraction, nor a rhythm disturbance that restricted the applicant's workload to greater than 5 metabolic equivalents (METs), but not greater than 7 METs, and resulting in dyspnea, fatigue, angina, dizziness, or syncope. 3. Although the applicant "became tired" after 8 minutes of treadmill testing, the Consultant opines, this was not the result of her mild valvulopathy impairment and should not be considered in the disability rating decision. Nevertheless, some might consider analogizing some causes of altered alertness under the neurological code for petit mal seizures, as in psychomotor or absence seizures. However, the supplied evidence does not support rating the applicant's condition utilizing this neurological code. Additionally, although there has been some discussion of asthma and a possible trial of treatment for the same, prior to entering military service, the supplied evidence fails to validate the existence of reversible airway hyper- responsiveness disorder (asthma), exercise-induced or otherwise, which occurred or was permanently aggravated during the applicant's military service, interfered with her military service, or which has required ongoing treatment with a bronchodilator, a leukotriene antagonist, mast cell stabilizer, or corticosteroid for control or prevention. 4. Operating under Title 10, United States Code (U.S.C.), Military Departments, by law, only assign disability ratings for the condition(s) that cause career termination; and then only to the degree of severity present at the "snap-shot" in time of final military disposition and not based upon future occurrences. On the other hand and operating under a different set of laws, (Title 38, U.S.C.), the DVA is authorized to conduct periodic evaluations for the purpose of adjusting (increase or decrease) the disability ratings, as the severity or level of impairment caused by a given medical condition may vary (worsen or improve) over the lifetime of the veteran. Moreover, the DVA also assigns compensation for any medical condition determined service-incurred, without regard to its demonstrated impact upon a service member's retainability, fitness to serve, or narrative reason for release from service. 5. The BCMR Medical Consultant concludes the applicant should have received an MEB and that her mitral valve prolapse and mild mitral insufficiency should have been the cause for career termination; but that she would have been assigned a disability rating of no greater than 10 percent, resulting in discharge with severance pay. Therefore, while the Medical Consultant does find error in the failure to conduct the applicant's MEB and referral to a Physical Evaluation Board, the evidence does not support the final outcome of a medical retirement. The complete AFBCMR Medical Consultant evaluation is at Exhibit C. ________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: A copy of the Air Force evaluation was forwarded to the applicant on 25 February 2013 for review and comment within 30 days (Exhibit D). To date, a response has not been received. ________________________________________________________________ THE BOARD CONCLUDES THAT: 1. The applicant has exhausted all remedies provided by existing law or regulations. 2. The application was not timely filed; however, it is in the interest of justice to excuse the failure to timely file. 3. Insufficient relevant evidence of an error or injustice has been presented regarding the applicant’s request to be granted a full medical retirement. We took notice of the applicant's complete submission in judging the merits of the case; however, we agree with the opinion and recommendation of the BCMR Medical Consultant and adopt the rationale as the basis for our conclusion that the applicant would not have qualified for a medical retirement based upon a preponderance of medical evidence at or about the time of her release from military service. Accordingly, the applicant’s request for a medical retirement is not favorably considered. 4. Notwithstanding our findings above, we believe sufficient evidence has been presented to warrant partial relief. In this regard, we note the BCMR Medical Consultant concludes the applicant should have received an MEB and that her mitral valve prolapse and mild mitral insufficiency should have been the cause for career termination; but that she would have been assigned a disability rating of no greater than 10 percent in accordance with the Veterans Administration Schedule for Rating Disabilities (VASRD) guidelines, resulting in discharge with severance pay. As such, we believe the applicant's medical condition may not have been rated properly at the time of her separation. Therefore, we accept the BCMR Medical Consultant's assessment and in the interest of equity and justice, recommend the applicant’s records be corrected to the extent 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: a. On 1 December 2006, she was found unfit to perform the duties of her office, rank, grade, or rating by reason of physical disability, incurred while she was entitled to receive basic pay; that the diagnosis in her case was mitral valve prolapse and mild mitral insufficiency (valvular heart disease) VASRD code 7000, rated at 10%; that the compensable percentage was 10%; that the degree of impairment was incomplete, moderate; that the disability was not due to intentional misconduct or willful neglect; that the disability was not incurred during a period of unauthorized absence; and that the disability was not received in the line of duty as a direct result of armed conflict or caused by an instrumentality of war. b. On 2 December 2006, she was separated by reason of physical disability, with entitlement to severance pay with a disability rating of 10 percent. ________________________________________________________________ The following members of the Board considered this application in Executive Session on 18 June 2013, under the provisions of AFI 36-2603: , Panel Chair , Member , Member The following documentary evidence was considered in AFBCMR Docket Number BC-2012-04338: Exhibit A. DD Form 149, dated 17 September 2012, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Letter, AFBCMR Medical Consultant, dated 25 February 2013. Exhibit D. Letter, SAF/MRBC, dated 25 February 2013.