RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2013-02042 COUNSEL: NONE HEARING DESIRED: NO APPLICANT REQUESTS THAT: Her Entry Level Separation (ELS) be changed to a medical separation. APPLICANT CONTENDS THAT: She sustained injuries while in Basic Military Training (BMT) and could not drill or perform her duties as required. The extent of her injuries was not adequately investigated or diagnosed until after her ELS. The applicant’s complete submission, with attachments, is at Exhibit A. STATEMENT OF FACTS: On 14 Feb 11, the applicant entered the Air Force Reserve. On 12 May 11, her commander notified her that he was recommending she be discharged from the Air Force under the provisions of AFI 36-3208, Administrative Separation of Airmen, for erroneous enlistment. The specific reason for the recommendation was a medical Narrative Summary (NARSUM) dated 10 May 11, stating the applicant did not meet minimum medical standards for enlistment due to recurring foot and knee pain which was contributed to flat feet. On 12 May 11, the applicant acknowledged the discharge recommendation. She waived her right to consult counsel and declined to submit statements in her own behalf. She acknowledged that if she was discharged for the reason cited, she would not be entitled to any disability, retirement or severance pay. In an undated letter, the discharge authority, approved the discharge recommendation. On 16 May 11, the applicant received an ELS with a narrative reason for separation of “Failed Medical/Physical Procurement Standards.” The applicant served 3 months and 3 days on active duty. According to a Department of Veterans Affairs (DVA) rating decision dated 15 Feb 13, the applicant received a combined 70 percent disability rating for left medial tibial plateau stress fracture, residual right medial tibial plateau stress fracture, back strain, degenerative joint disease of the left hip and degenerative joint disease of the right hip. In a letter dated 19 Jun 13, the applicant requested that her case be administratively closed to allow for more time to gather information in response to the Air Force evaluations. In a letter dated 18 Mar 14, the applicant requested her case be re-opened. AIR FORCE EVALUATION: AETC/SGPS recommends approval. Based on the documentation on file in the applicant’s records, her separation was done IAW established policy and administrative procedures. A review of the records provided and medical notes from Wilford Hall Medical Center (WHMC) reflects while in BMT she sustained injuries that prevented her from continuing in training and she was processed for an ELS. She declined an AETC/SGPS waiver to continue in BMT. Although she may not have been bothered by her feet and leg pain prior to entry, the condition was present and was aggravated by BMT and its rigorous activities. Once the condition is resolved and she is evaluated by her orthopedic doctor and released to full unrestricted activities, she is free to reapply for the military. The complete SGPS evaluation is at Exhibit C. The BCMR Medical Consultant recommends changing the applicant’s character of service to honorable, and that she be placed on the Temporary Disability Retired List (TDRL) with a disability rating of 40 percent effective 16 May 11. This should be followed by a TDRL re-evaluation at the soonest practical date by an orthopedic surgeon at the nearest military medical treatment facility. This information, along with the applicant’s most current DVA rating decision should then be forwarded to the AFBCMR for a final disposition of the applicant’s military service. The Medical Consultant notes that two separate Air Force policies, AFI 36-3208 and AFI 36-3212, Physical Evaluation for Retention, Retirement and Separation, may be at crossroads; one which justifies an ELS for the medical condition, pes planus (flat feet), which was likely to have Existed Prior to Service (EPTS) but contributed to her inability to complete training while serving a period of less than 180 days, and the other, the diagnosis of tibial plateau fractures which suggests that these related injuries were service-incurred or aggravated, warranting consideration for a medical separation; particularly noting the compensation ratings from the DVA. However, re-directing attention to the DVA rating decision, the applicant’s supplied service documentation makes no reference to bilateral hip pain or back pain as a cause for career termination; thus if processed through the Disability Evaluation System (DES), these conditions would not have been included as unfitting in the disability rating computation. The BCMR Medical Consultant concludes that she qualified for a medical separation under the provisions of AFI 36-3212 but not for the competing ELS policy. In searching for an appropriate remedy, the Medical Consultant opines that she should have received a Medical Evaluation Board (MEB) and referred to a Physical Evaluation Board (PEB), whereupon she would have likely been found unfit for further military service. Due to the expected temporary nature of her impairment, she would have been placed on the TDRL effective 17 May 11, and received a timely evaluation by an orthopedic surgeon at the nearest military facility. The complete Medical Consultant’s evaluation is at Exhibit D. APPLICANT'S REVIEW OF AIR FORCE EVALUATION: The advisory opinions make assumptions about her condition and contends that there were no medical tests available proving her injuries were incurred during BMT. She immediately reported her injury to her superior but was instructed to continue training for two weeks then it was discovered that her knee was fractured. Subsequently, bone scans, MRIs and x-rays were performed. These tests clearly show the injuries she received led to her discharge. This medical information is in the possession of the DVA and it could take 2-6 months before she receives it. In a letter dated 18 Mar 14, the applicant states that on 28 Feb 11 she heard her knee “pop” while running. She reported the injury to her Military Training Instructor (MTI) who instructed her to continue training but to go easier on it. After a couple of days, she again reported to her MTI that her knee was extremely swollen and painful. She was given an over the counter pain reliever and returned to continue training. She was not given permission to seek medical treatment until two weeks after the initial injury. By this time, her hips, right leg, both ankles and her heels had become painful from the stress of compensating for the instability of her knee. She was placed on convalescent leave for 30 days. Her understanding of the ELS was that she was leaving BMT prior to completion in order to heal at home rather than at Lackland AFB. She was advised that the report and recommendation would be completed to allow her to return to the Air Force as an officer once her schooling was completed. She was not aware until submitting her application to the Board that her medical report attributed her injury to an EPTS condition of flat feet. It would have been physically impossible for her to have completed BMT. The mismanagement of her injuries and not receiving the proper medical care left her with continuous muscle spasms in her lower back, misalignment of her lower spine/hips with accompanying deep muscle pain and numbness in her lower legs due to nerve damage. In addition, since there is no indication of pes planus, her injuries were not attributed to an EPTS condition but a pathological result of her initial injury and bilateral damage sustained due to delayed medical care. Therefore, she requests that her discharge be corrected to reflect that she separated due to medical injuries sustained at BMT and her separation be classified as a medical discharge. The applicant’s complete submission, with attachments is at Exhibit I. ADDITIONAL AIR FORCE EVALUATION: AFPC/DPSOR recommends denial. Her condition rendered her unsuitable for continued military service and her character of service should not be changed. Her separation was done IAW established policy and administrative procedures. The documentation on file in her master personnel records supports the basis for the discharge and the ELS characterization. The discharge was consistent with the procedural and substantive requirements of the discharge instruction and was within the discretion of the discharge authority. An airman is given an ELS/uncharacterized service characterization when separation is initiated in the first 180 days of continuous active service. The DOD determined if a member served less than 180 days continuous active service, it would be unfair to the member and the service to characterize their limited service. Therefore, her narrative reason for separation is correct and IAW DOD and Air Force instructions. The applicant did not submit any evidence or identify any errors or injustice that occurred in the discharge processing. She provided no facts warranting a change to her discharge. The complete DPSOR evaluation is at Exhibit G. APPLICANT'S REVIEW OF ADDITIONAL AIR FORCE EVALUATION: A copy of the Air Force evaluation was provided to the applicant on 17 Feb 15 for review and comment (Exhibit K). As of this date, this office has not received a 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. Insufficient relevant evidence has been presented to demonstrate the existence of error or injustice to warrant changing her ELS to a medical separation. We took notice of the applicant's complete submission in judging the merits of the case; however, based on the available evidence, we are not persuaded that relief is warranted at this time. Therefore we find no basis to act on this portion of the applicant’s request. 4. Notwithstanding the above, sufficient relevant evidence has been presented to demonstrate the existence of an error injustice to warrant partial relief. We note that DPSOR states that an airman is given an uncharacterized service characterization when separation is initiated in the first 180 days of continuous active service. However, we agree with the opinion and recommendation of the Medical Consultant and adopt the rationale expressed as the basis for our decision that the applicant has been the victim of either an error or an injustice. Accordingly, we recommend the applicant's records be corrected as indicated below. THE BOARD RECOMMENDS THAT: The pertinent military records of the Department of the Air Force relating to the APPLICANT be corrected to show that: a. On 16 May 11 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; the unfitting diagnosis in her case was bilateral tibial plateau fractures; the combined compensable percentage was 40 percent under VASRD code 5262 and VASRD code 5271; the degree of impairment is temporary; the disability was not due to intentional misconduct or willful neglect; the disability was not incurred during a period of unauthorized absence; and that the disability was in line of duty but not a direct result of armed conflict or caused by an instrumentality of war. b. She was not separated on 16 May 11; rather she was released from active duty on that date and on 17 May 11 was placed on the TDRL. Since this record correction is retroactive to 2011 she is now due for a TDRL re-evaluation under 10 U.S.C. 1210 and AFI 36-3212. Such re-evaluation must occur as soon as practicable and may be performed by a civilian, military, or Department of Veterans Affairs orthopedic surgeon. The purpose of the re-evaluation is to identify any residual functional impairments or impediments returning to duty. This information, along with the applicant's most current VA rating decisions should then be forwarded to the AFBCMR for final adjudication in the case. The following members of the Board considered AFBCMR Docket Number BC-2013-02042 in Executive Session on 17 Mar and 30 Mar 15 under the provisions of AFI 36-2603: , Panel Chair , Member , Member All members voted to correct the record as recommended. The following documentary evidence was considered: Exhibit A. DD Form 149, dated 25 Apr 13, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Memorandum, AETC/SGPS, dated 13 May 13. Exhibit D. Memorandum, BCMR Medical Consultant, dated 23 May 13. Exhibit E. Letter, SAF/MRBC, dated 24 May 13. Exhibit F. Letter, Applicant, dated 19 Jun 13, w/atch. Exhibit G. Memorandum, AFPC/DPSOR, dated 21 Jun 13. Exhibit H. Letter, SAF/MRBC, dated 23 Jun 13. Exhibit I. Letter, Applicant, dated 18 Mar 14. Exhibit J. Letter, Applicant, dated 8 May 14. Exhibit K. Letter, SAF/MRBC, dated 17 Feb 15.