RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:				DOCKET NUMBER:  BC-2015-04208
		
							COUNSEL:  NONE

							HEARING DESIRED:  YES

APPLICANT REQUESTS THAT:

His honorable discharge be changed to a medical retirement.

APPLICANT CONTENDS THAT:

The Air Force failed to treat his sarcoidosis even though he was diagnosed on 25 September 2012, while he was still on active duty.  A medical evaluation board was conducted for his Obstructive Sleep Apnea instead of for his Sarcoidosis, which was a major factor in his fitness assessment failures.  He was seen for these same symptoms in 2007; however, the clinic failed to follow-up with him after they scheduled him for a pulmonary function test.

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

STATEMENT OF FACTS:

On 24 June 1998, the applicant entered the Regular Air Force.

On 18 July 2012, the applicant’s commander notified him that he was recommending his discharge from the Air Force under the provisions of AFPD 36-32, Military Retirements and Separations, and AFI 36-3208, Administrative Separation of Airmen.  The specific reason for this action was the applicant’s failure to meet fitness standards.

On 27 July 2012, the applicant acknowledged receipt of the discharge notification and indicated that he did not waive his right to a hearing before an administrative discharge board or military counsel.

On 13-14 September 2012, an administrative discharge board convened to hear testimony and consider all evidence regarding the applicant's discharge proceeding.  The board recommended the applicant be separated from the Air Force and given an honorable discharge.

On 25 September 2012, the Staff Judge Advocate found the discharge legally sufficient.

On 26 September 2012, the discharge authority directed the applicant be discharged from the Air Force with an honorable characterization for “Unsatisfactory Performance: Failure to Meet Minimum Fitness Standards.”

On 4 October 2012, the applicant was furnished an honorable discharge, and was credited with 14 years, 3 months, and 11 days of active service.  His narrative reason for discharge is “Physical Standards.”

The remaining relevant facts pertaining to this application are described in the memorandum prepared by the BCMR Medical Consultant which is included at Exhibit C.

AIR FORCE EVALUATION:

The BCMR Medical Consultant recommends approval.  Before entering into a discussion of the applicant’s case, the BCMR Medical Consultant wishes to familiarize the Board with some of the basic policies and responsibilities governing fitness assessment that also may have relevance in the applicant’s case.  Prior to participation in the fitness assessment, individual service members are interviewed regarding any existing medical conditions or prescribed medications that may affect the outcome of the fitness assessment.  Specifically, the individual’s primary care manager conducts an evaluation and must clear the individual for fitness assessment testing. If there is a medical condition precluding participation in any given component of the fitness assessment, this information is annotated on the proper Air Force documents.  The provider is required to make a duty limiting condition determination at any patient encounter in which the medical condition impacts fitness activity (to include assessment and training) or when a fitness assessment is due.

Between 2010 and 2012, the applicant had exemptions to the run/walk, sit-up, and push-up components of the fitness assessment leaving the abdominal circumference measurement as the only measure of his fitness.  Under policy in effect at the time of the applicant’s service, AFI 36-2905, Fitness Program, dated 1 July 2010, “Airmen who have been exempted from 1 or more of the 4 components of the fitness test for a continuous 12-month period or have 4 component exemptions in a 24-month period will be reviewed by the Unit Fitness Program Monitor (UFPM).  The UFPM will notify the Unit Commander, who will in-turn request the exercise physiologist/Wing FPM review the case at the Deployment Availability Working Group (DAWG).  The DAWG will ensure an appropriate medical evaluation has been completed, decide whether or not a Medical Evaluation Board (MEB) is required, and refer the case to the individual’s primary care manager for MEB initiation or for additional medical work-up when necessary.”  The applicant was exempted for more than one component of the fitness assessment for more than a continuous 12-month period; likely due to his knees, yet this condition was not documented in a DAWG review or the subject of the applicant’s MEB summary [that resulted in his return to duty FIT].  The commander appears to have acted within his authority, to separate the applicant relying upon the incomplete assessment by the medical provider.  The testimony revealed by the applicant’s health care provider at the discharge review board hearing indicates a view that the applicant had no medical condition that precluded passing the fitness assessment and that calorie intake was the primary reason for the abdominal circumference failures.  There was no testimony addressing the applicant’s knees or the length of time he had been under exemptions.  Additionally, the fact that the applicant was still in the process of evaluation and treatment of a potentially serious pulmonary condition [not Obstructive Sleep Apnea, but Sarcoidosis] and yet, allowed to separate constitutes an injustice to the applicant.  Placing the applicant in a medical hold status would have been appropriate to determine and act upon the outcome of his pulmonary biopsies and to determine if an addendum to the DAWG, the reconvening of the DAWG, or a full MEB was appropriate.  The letter from the applicant’s doctor in 2015 indicates that the applicant’s medical condition had been or is now chronic, but with some uncertainty of stability and responsiveness to treatment.  Although the applicant’s knees have reflected some degree of clinical improvement since undergoing surgical treatment, had the applicant’s Sarcoidosis diagnosis been included in the DAWG review, he would likely have received a full MEB and would have been found unfit by a Physical Evaluation Board.  The proper action is to place the applicant back into the Integrated Disability Evaluation System by placement on the Temporary Disability Retired List (TDRL) with a 30 percent disability rating, under Veterans Administration Schedule for Rating Disabilities (VASRD) code 6846 (Sarcoidosis) effective 4 October 2012.  The applicant will then receive a TDRL re-evaluation by a pulmonary medicine specialist at an interval deemed appropriate by AFPC/DPFDD [USAF Disability Division] TDRL managers.  Existing medical evidence for other sources may be alternatively utilized in reaching an intervening or final disposition if deemed appropriate.

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

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

His pulmonologist states in part that requires high doses of prednisone therapy for improvement of his sarcoid-induced inflammation and the duration of treatment will likely be lifelong.

In further support of his request, the applicant provides a copy of a letter from his pulmonologist. 

The applicant’s complete response, with attachment, is at Exhibit E. 

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 an error or injustice to warrant changing the applicant’s discharge to a medical retirement.  We took notice of the applicant's complete submission, to include his rebuttal, in judging the merits of the case; however, we agree with the opinion and recommendation the BCMR Medical Consultant and adopt the rationale expressed as the basis for our conclusion the applicant has not been the victim of an error or injustice.  Therefore, in the absence of evidence to the contrary, we find no basis to favorably consider this portion of the application.

4.  Notwithstanding the above, sufficient relevant evidence has been presented to demonstrate the existence of error or injustice to warrant partial relief.  Having carefully reviewed this application, we agree with the BCMR Medical Consultant’s alternative form of relief that the applicant be placed on the TDRL with a 30 percent disability rating.  Accordingly, we recommend the applicant’s records be corrected to the extent indicated below.

5.  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 the APPLICANT be corrected to show that:

a. On 3 October 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 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 4 October 2012, he was not honorably discharged for Physical Standards, but rather, his name was placed on the Temporary Disability Retired List effective 5 October 2012, due to the diagnoses of Sarcoidosis, rated at 30 percent under Veterans Administration Schedule for Rating Disabilities (VASRD) code 6846.

The following members of the Board considered AFBCMR Docket Number BC-2015-04208 in Executive Session on 15 December 2016, under the provisions of AFI 36-2603:

, Panel Chair
, Member
, Member

All members voted to correct the records as recommended.  The following documentary evidence pertaining to AFBCMR Docket Number BC-2015-04208 was considered:

Exhibit A.  DD Form 149, dated 28 September 2015, w/atchs.
Exhibit B.  Applicant's Master Personnel Records.
Exhibit C.  Memorandum, BCMR Medical Consultant dated 6 April 
  2016.
Exhibit D.  Letter, AFBCMR, dated 8 April 2016.
Exhibit E.  Letter, Applicant, dated 27 April 2016, w/atch.

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 that the foregoing is a true and complete record of the Board's proceedings in the above entitled matter.