RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:			DOCKET NUMBER:  BC-2015-04003
		
   						COUNSEL:  NONE

						HEARING DESIRED:  NO

APPLICANT REQUESTS:

Her narrative reason for discharge on her DD Form 214, Certificate of Release or Discharge from Active Duty, be changed from “Erroneous Entry” to “Medical Discharge,” and she receive the pay and benefits associated with a medical discharge. 

APPLICANT CONTENDS:

She was injured during her military training and suffers greatly to this day from that injury.  The injury was 100 percent service-connected and did not exist prior to her service.  Now, she is unable to work due to her injury. 

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

STATEMENT OF FACTS:

The applicant initially entered the Regular Air Force on 10 Aug 10.  

On 5 Apr 11, the applicant was furnished an honorable discharge, with a narrative reason for separation of “Erroneous Entry (Other),” and was credited with 7 months and 26 days of active service.

The remaining relevant facts pertaining to this application are described in the memorandum prepared by the Air Force office of primary responsibility (OPR), which is included at Exhibit C.

AIR FORCE EVALUATION:

The BCMR Medical Consultant recommends granting the applicant’s request, indicating there is evidence of an error or injustice.  The applicant’s Prescreen of Medical History document, dated 11 Jan 10, reflects check marks in the appropriate spaces to indicate no history of dislocated joints; swollen, painful, or dislocated joints; or, motion of any joint, including knee, shoulder, wrist, elbow, hip, or other joint.  

	a.  On 7 Jan 11, a medical entry appears in her record depicting the applicant’s presentation with a complaint of Left>Right [bilateral] hip pain.  X-ray views of both hips showed “normal” alignment bilaterally, with no evidence of acute or stress-related injury, [and] no evidence of degenerative change.”  

	b.  On 11 Jan 11, the results of the applicant’s MRI are captured in the following statements.  “Airman with 4 months chronic left hip pain and painful clicking.”  Another entry made the same date reads, “18 y/o PRP student [with] c/o bilateral hip pain for the past 4 months [Sep 10] worsened after running 1 week ago at Camp Bullis.”  

	c.  On 20 Jan 11, the provider noted the applicant’s report that her bilateral “hip pain [became] worse in the last 2 weeks” and was “not relieved by conservative measures.”  The provider entered, “Patient seen on 7 Jan by Clinic at Camp Bullis after injuring her hip while doing PT.”  

d.  On 1 Feb 11, a medical evaluation was conducted for administrative separation in lieu of Medical Evaluation Board (MEB), in accordance with AFI 36-3208, Administrative Separation of Airman, for the diagnosis of “Bilateral hip pain secondary to bone defect.”  The provider commented, “Current bilateral hip pain secondary to bone defect has significantly interfered with successful performance of military duty.” 

e.  On 2 Feb 11, a Medical entry indicates the applicant was placed on medical hold for her bilateral hip pain.  With respect to the applicant’s pain, the record indicates she “reports on first week of BMT due to running then resolved and [that] bilateral pain returned while at Camp Bullis; recent reports 2 weeks ago after jumping off vehicles.” The entry also discloses the bilateral hip MRI arthrogram was done and that there was “no stress fracture noted.”

f.  A Physical Therapy Clinic entry discloses yet another variation in the clinical history in the following: “Bilateral hip pain and radiating pain into legs.  Running at Bullis and she hit a pot hole with her right hip and it made her start running funny on 10 January.”  [At this juncture, the Medical Consultant can only conclude medical officials determined the defect(s) in the applicant’s hip(s) existed prior to entering military service.  Subsequent episodes of care raise additional questions regarding the true origin, cause, and severity of the applicant’s hip pain].  

	g.  On 28 Feb 11, the provider noted “She is not having any more pain in them [hips] anymore or back.  She feels ready to return to training,” and “Running at Bullis and she hit a pot hole with her right hip and it made her start running funny on 10 Jan.  This made her favor her right leg.  The following day she was doing convoy training and she further hurt her legs jumping out of vehicles.  She got an MRI one week after the injury.”  

	h.  On 8 Mar 11, the “Member denies any problems with pain in her hips at this time and is able to do all ADL’s [activities of daily living] denies taking any medication for the pain.  Member is requesting to go back on team.”

	i.  On 30 Mar 11, the applicant presented for her separation physical. The provider noted:  “Patient reports she has no pain in her hip at this time and she has been slightly upset about being discharged from the Air Force.  

	j.  On 31 May 15, medical entry discloses the applicant’s hip pain in the following manner, “Presents with ongoing hip pain existing from January 2011 after jumping out of a vehicle and hitting ground hard.  Patient states since then the pain started in the left hip and is getting progressively worse to be bilateral hip pain that is radiating up the lower back and down the left leg”, history of chronic intermittent low back pain with radiculopathy and bilateral hip pain which started after falling from a truck.”  

	k.  On 16 Jun 15, her orthopedic surgeon offered the following opinion, “The patient was [an] entirely well very active female cheerleader until a military accident on January 2011 when she jumped off the back of a truck with a machine gun and injured her left hip and had an acetabular fracture.”

It is interesting to note the applicant has not supplied evidence of service-connection from the Department of Veterans Affairs (DVA); the usual evidence brought forth to bolster a contention such as hers.  In a memo addressed to the Board, dated 22 Aug 15, the applicant asserted, “My condition was caused by an injury during the Camp Bullis portion of my training.  I had no prior incidents or issue with my hip until I injured it in January 2011.”  The aforementioned statement is in vast conflict with statements documenting hip pain onset during the first week of BMT and in other Jan 11 entries showing hip pain onset “4 months” prior to Jan 11.  The applicant’s claim she had “no prior incidents or issue with my hip until I injured it in Jan 11” simply does not match the facts disclosed in the record indicating her pain began while running during the 1st week of Basic Military Training (BMT).  However, there is also no documentation she sought care for any lower extremity pain or injury until performing duties in Jan 11; at which time she also reported pain onset 4 months prior.

The applicant was discharged by reason of Erroneous Entry.   The usual rationale accompanying this type of discharge includes words to the effect that had it been known the applicant had the osteochondral defects of the hips prior to entering military service, the Air Force would not have accepted her onto active military service.  When considering changing the disclosures by the applicant regarding the cause of her medical condition and the date of onset of symptoms, the fact she first reported hip pain during the first week of BMT [Aug 10] while running, then reported its recurrence or exacerbation on or about 7 Jan 11, again, while performing PT [with no initial reference to a fall, stepping into a pot hole, or jumping from a vehicle], and for it to become totally resolved at the time of release from service in Mar 11, leads this reviewer to conclude the applicant’s acetabular defects existed prior to entering service and the painful episodes she experienced, with running, represented the expected natural expression of her condition and not permanent service aggravation.  Nevertheless, the Medical Consultant acknowledges such a condition could have been worsened through performance of military activities.

While there is an absence of prior treatment of an injury in the supplied pediatric medical records and there is denial of bone or joint problems on the applicant’s entrance medical documents, this does not exclude the possibility the applicant’s physical activity after entering military service may have worsened an existing condition.  Consequently, the Board may consider either an outright denial of the applicant’s petition or consider her condition may have been permanently aggravated by military service.  Given current Department of Defense policy regarding determinations of pre-existing conditions, this Consultant could not determine through clear and unmistakable evidence that the applicant did not permanently aggravate her hips during her military service.

Should the Board agree the applicant’s medical condition may have been permanently aggravated by her military service, the next task would be to find her unfit for further military service and to assign an appropriate disability rating under the appropriate Veterans Affairs Schedule for Rating Disabilities (VASRD) code. The Medical Consultant recommends assigning a disability rating of 0% [zero] under VASRD analogous code 5099-5003; acknowledging it anatomic, symptomatic, and functional kinship with degenerative arthritis.  When a given service-incurred or aggravated medical condition presents with no discernable functional impairment on examination, e.g., no disturbance of gait, strength, and range of motion, yet is unfitting, as was likely the case at the time the applicant was released from service, the Military Department may offer compensation in the form of severance pay for any medical condition rated at less than 30% and not entitled to retirement.

Unlike the finality of the decision of the Military Department, operating under Title 38, United States Code (USC), the DVA would be authorized to adjust her disability rating, as the level of impairment from a given medical condition improves or worsens over the lifetime of the veteran.  Thus, the fact the applicant’s condition may have worsened or she has become more symptomatic since leaving military service is not representative of her level of impairment at the “snap shot” time of her release from military service.  Therefore, the Medical Consultant recommends changing the record to reflect the applicant was not discharged by reason of Erroneous Entry, but she was found unfit for continued military service, assigned a disability rating of 0 percent, and discharged under the authority of AFI 36-3212, Physical Evaluation for Retention, Retirement, and Separation, by reason of Disability – Entitled to Severance Pay.

A complete copy of the BCMR 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 14 Jun 16 for review and comment within 30 days (Exhibit D).  As of this date, no response has been received by this office.

THE BOARD CONCLUDES:

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.  Sufficient 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 and agree with the opinion and recommendation of AFBCMR Medical Consultant and adopt his rationale as the basis for our conclusion the applicant has been the victim of an error or injustice.  Therefore, we recommend the applicant's records be corrected as indicated below.	

THE BOARD RECOMMENDS:

The pertinent military records of the Department of the Air Force relating to the APPLICANT be corrected to show she was not discharged for “Erroneous Entry (Other)” on 5 April 2011, but she was found unfit for continued military service, assigned a disability rating of zero percent under Veterans Affairs Schedule for Rating Disabilities (VASRD) code 5099-5003, and on 5 April 2011 received a medical discharge under the authority of AFI 36-3212, Physical Evaluation for Retention, Retirement, and Separation, by reason of Disability – Entitled to Severance Pay.

The following members of the Board considered AFBCMR Docket Number BC-2015-04003 in Executive Session on 18 Aug 16 under the provisions of AFI 36-2603:

	Panel Chair
	Member
	Member

All members voted to correct the records as recommended.  The following documentary evidence was considered:

	Exhibit A.  DD Form 149, dated 15 Sep 15, w/atchs.
	Exhibit B.  Applicant's Master Personnel Records.
Exhibit C.  Memorandum, AFBCMR Medical Consultant, dated 16 Mar 16.
	Exhibit D.  Letter, SAF/MRBR, dated 14 Jun 16.

Pursuant to paragraph 1 of AFI 36-2603 (Title 32 Code of Federal Regulations, Part 865.1), it is certified that a quorum was present at the Board's review and deliberations, and the foregoing is a true and complete record of the Board's proceedings in the above entitled matter.