ADDENDUM TO
RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:				DOCKET NUMBER:  BC-2013-04638
		
							COUNSEL:  NONE

							HEARING DESIRED:  NO

APPLICANT REQUESTS THAT:

The medical documentation he provides be reviewed to determine the final disposition of his testicular cancer.

RESUME OF CASE:

In an application dated 25 September 2013, the applicant requested that he be returned to active duty status so he could be processed through the Disability Evaluation System (DES).

On 27 October 2014, the Board directed the applicant’s record be corrected as follows:

a. On 14 April 2012, he was found unfit to perform the duties of his office, rank, grade or rating by reason of physical disability, incurred while he was entitled to receive basic pay; that the diagnosis of his condition was testicular cancer, metastatic, Veterans Administration Schedule for Rating Disabilities (VASRD) code 7524-7528, rated at 100 percent; 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 the direct result of armed conflict or caused by an instrumentality of war.

b. On 15 April 2012, he was not honorably discharged for Intradepartmental Transfer, but on 16 April 2012, his name was placed on the Temporary Disability Retired List (TDRL).

c. He be re-evaluated by a neurologist and an oncologist, as soon as practicable, for the purpose of determining his current clinical status and to assess the presence of any residual functional impairment resulting from either his testicular cancer or its treatment; he may alternatively supply medical assessments conducted by the Department of Veterans Affairs (DVA) or other civilian sources, if no greater than 90 days old, that may more closely reflect his current clinical status in lieu of acquiring new clinical evaluations.

d. It was further directed that all requested medical documentation be provided to the Air Force Board for Correction of Military Records (AFBCMR), as soon as available, in order to reach an appropriate final disposition of the applicant’s case.

For an accounting of the facts and circumstances surrounding the applicant’s request and the rationale of the earlier decision by the Board, see the Record of Proceedings at Exhibit E (with Exhibits A through D).

Pursuant to the Board’s directive, the applicant provides the following documentation:  (1) a letter dated 3 December 2014, from a nurse practitioner which states in part that the applicant had Stage IIA testicular cancer and completed chemotherapy in July 2012.  The nurse practitioner also states the applicant should continue follow-up visits every three months for cancer surveillance and (2) a letter from a clinical neurologist electronically signed on 9 December 2014, which states the applicant’s paresthesia symptoms and history are indicative of small sized fiber sensory neuropathy.  The neurologist states the applicant’s symptoms are asymptomatic and should not cause any significant limitations in daily functioning.  However, limitations with regard to his military service should be decided by a military physician.

AFI 36-3212, Physical Evaluation for Retention, Retirement, and Separation, Chapter 7.1 states “The law, 10 U.S.C. 1210, requires reexamination of all members on the TDRL at least once every 18 months to determine if there has been a change in the disability that resulted in their placement on the TDRL.  These periodic examinations continue until final disposition or until the statutory period expires (currently 5 years) whichever is earlier.”

The applicant’s complete submission, with attachments, is at Exhibit F). 

AIR FORCE EVALUATION:

The BCMR Medical Consultant recommends extending the applicant on the TDRL for an additional six months.  The requested clinical status assessment from the applicant’s oncologist is authored by a nurse practitioner in the clinical practice and simply reads the applicant has Stage IIA testicular cancer and completed chemotherapy in July 2012.  While the neurological evaluation suggests continuation of the applicant’s paresthesias of the lower extremity, which interferes with running or prolonged standing, the assessment provided from the applicant’s oncology group was woefully inadequate to make a reasoned determination of the applicant’s fitness and clinical status.  Consequently, the BCMR Medical Consultant was left with inadequate information upon which to provide a reasoned recommendation or final disposition regarding the applicant’s testicular cancer.

A DVA rating decision, dated 20 March 2013, indicates the applicant was still assigned a 100 percent disability rating, effective 26 May 2012, for testicular cancer, and a 10 percent disability rating for peripheral neuropathy of the right foot and left foot secondary to chemotherapy, effective 10 October 2012.  On 22 October 2015, the BCMR Medical Consultant spoke with one of the applicant’s clinicians, who disclosed that the applicant continues to require periodic surveillance and several follow-up studies are planned for December 2015.

In view of the impending re-evaluation of the applicant’s clinical status in December 2015, the Medical Consultant recommends extending the applicant on the TDRL for an additional six months.  Continuing the applicant in TDRL status also affords him the opportunity to negotiate the DES with the benefit of the full complement of DES appellate reviews, while preserving the opportunity for appeal to the AFBCMR should the need or inclination arise.  While in TDRL status, he shall receive a summary evaluation by his treating oncologist and a neurologist to determine existence of residual functional impairments, expectation for a sustained recovery, or risk for recurrent disease.  This information will be provided to appropriate authorities at the USAF Physical Disability Division, HQ AFPC/DPFD, Randolph AFB, TX, 78150 for the appropriate final disposition of the applicant’s case.

A complete copy of the BCMR Medical Consultant’s evaluation is at Exhibit G.

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

He was unable to obtain additional information from the DVA neurologist due to lack of appointment availability.  In addition, medical notes indicate he requires additional lab work prior to his neurology appointment.

The applicant’s complete response, with attachments, is at Exhibit I.

THE BOARD CONCLUDES THAT:

After again reviewing this application and the evidence provided in support of his appeal we find insufficient evidence to render a final decision in this case.  We note the applicant initially requested to be returned to active duty status so he could be processed for a Medical Evaluation Board.  However, the AFBCMR denied his request and agreed with the BCMR Medical Consultant’s alternative form of relief to place the applicant’s name on the TDRL effective 16 April 2012, so that he could be properly assessed and a determination be made as to what his final disposition should be.  The BCMR Medical Consultant has conducted a thorough review of the documentation provided by the applicant from the nurse practitioner and the clinical neurologist and determined it was inadequate to provide a reasoned recommendation or final disposition regarding the applicant’s testicular cancer.  The BCMR Medical Consultant recommends the applicant be extended on the TDRL for an additional six months to June 2016, in order to provide the appropriate final disposition on the applicant’s case. However, we disagree with this course of action.  Members are placed on the TDRL for 5 years and law requires reexamination at least once every 18 months.  In the applicant’s case he will be on the TDRL until April 2017.  Therefore, his summary reexamination will be provided to the appropriate authorities at the Physical Disability Division for the final disposition of the applicant’s case.  Accordingly, 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 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 AFBCMR Docket Number BC-2013-04638 in Executive Session on 18 February 2016 and 21 July 2016, under the provisions of AFI 36-2603:

, Panel Chair
, Member
, Member

The following documentary evidence was considered:

Exhibit E.  Record of Proceedings, undated, with exhibits A through D.
Exhibit F.  Letter, Applicant, dated 22 December 2014, 
  w/atchs.
Exhibit G.  Memorandum, BCMR Medical Consultant, dated
  22 October 2015.
Exhibit H.  Letter, SAF/MRBR, dated 28 October 2015.
Exhibit I.  Letter, Applicant, 25 February 2016, w/atchs.