RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2010-04510 COUNSEL: NONE HEARING DESIRED: YES _________________________________________________________________ APPLICANT REQUESTS THAT: 1. Her uncharacterized entry level separation be changed to a medical discharge for a “service connected” disability. 2. Her narrative reason for separation of “Failed Medical/Physical Procurement Standards” be changed. _________________________________________________________________ APPLICANT CONTENDS THAT: The Narrative Summary states her condition of patellofemoral pain syndrome (PFPS) was not present at the time of the medical history intake and physical examination and the doctor crossed out “Existed Prior to Enlistment.” She did not have knee problems prior to her enlistment. Her Department of Veterans Affairs (DVA) claim was denied based on a preexisting condition; however, the narrative summary clearly says the condition “did not” exist prior to enlistment. In support of her request, the applicant provides a Narrative Summary from an Air Force physician, and a VA Form 21-4138, Department of Veterans Affairs (DVA) Statement in Support of Claim. The applicant's complete submission, with attachments, is at Exhibit A. _________________________________________________________________ STATEMENT OF FACTS: On 2 Dec 98, the applicant enlisted in the Regular Air Force. On 14 Dec 98, while in basic military training (BMT) the applicant presented to the Dispensary with the complaint of bilateral knee pain. On 4 Jan 99, a medical narrative summary found the applicant’s condition of PFPS was preventing her from training, was a disqualifying condition, and was not present at the time of the medical history intake and physical examination. On 11 Jan 99, the applicant was notified by her commander that she was recommending her discharge from the Air Force for erroneous enlistment. The reason for the proposed action was her commander received a medical narrative summary, dated 4 Jan 99 that found the applicant did not meet minimum medical standards to enlist and that the condition existed prior to entering military service. The applicant should not have been allowed to join the Air Force because of PFPS. She acknowledged receipt of the notification of discharge, waived her right to counsel, and her right to submit statements in her own behalf. The case file was found legally sufficient to support discharge and the discharge authority approved the separation. On 14 Jan 99, she was discharged with an uncharacterized entry level separation by reason of failed medical/physical procurement standards. She served on active duty for a period of 1 month and 13 days. _________________________________________________________________ AIR FORCE EVALUATION: AETC/SGPS recommends denial. SGPS states the applicant’s separation was completed in accordance with established policy and administrative procedures. Her history of the condition renders her unsuitable for military service. At the time of her induction examination she may not have been aware that she had the condition. It came to light during BMT and was aggravated by strenuous physical activity. The complete SGPS evaluation is at Exhibit C. AFPC/DPSOS recommends denial. DPSOS states the documentation on file in the master personnel records supports the basis for the discharge and the applicant’s entry level separation. The discharge was consistent with the procedural and substantive requirements of the discharge regulation and was within the discretion of the discharge authority. Airmen are given entry-level separation/uncharacterized service characterization when separation is initiated in the first 180 days of continuous active service. The Department of Defense (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 uncharacterized service is correct and in accordance with DoD and Air Force instructions. The applicant’s medical records from the training clinic were unavailable for review. Absent documentation, there is a presumption of regularity in which the applicant was afforded due process and the discharge was consistent with the procedural and substantive requirements of the discharge regulation. Although the applicant states the condition did not exist prior to her enlistment, her medical condition does not meet assessment standards. The complete DPSOS evaluation is at Exhibit D. _________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: She has talked to several benefits counselors that have confirmed her DD Form 214, Certificate of Release or Discharge from Active Duty, has been changed to reflect an honorable discharge. Therefore, someone at the Review Board Office must have agreed with her and the physician of record that her condition was not a pre-existing condition. In paragraph 5, of the AETC/SGPS memorandum, it clearly states “At the time of her induction examination she may not have been aware that she had the condition. It came to light during basic training at Lackland AFB, San Antonio, Texas and was aggravated by strenuous physical activity.” One of the qualifications for a service connected disability is that a veteran had to sustain an injury or disease that happened while on active duty, or was made worse/aggravated by active military service. At the time of her induction, she was given an examination and performed certain movements. The physician during intake passed her. If there was a problem, he should have caught it at this time. The AFPC/DPSOS memorandum states “the commander cited a medical narrative summary dated 4 Jan 99 that found the applicant did not meet minimum medical standards to enlist and stated the condition existed prior to entering military service.” The Narrative Summary states just the opposite. The commander marked through the Existed Prior to Enlistment and Erroneous Enlistment. The author of the DPSOS memorandum states “the applicant should not have been allowed to join the Air Force because of PFPS.” PFPS is not a condition she had prior to intake. The pain occurred during strenuous activity that aggravated to the point of discharge. Everyday the pain is a constant reminder of what she endured trying to serve her country. The Review Board is saying she should not have been allowed in the Air Force; however, as a result she has all the problems mentioned above. Who should be accountable? By denying her a service connected disability its sends a message the Air Force is not accountable, and they are; the Air Force made a mistake. The applicant’s complete response, with attachments, is at Exhibit F. _________________________________________________________________ ADDITIONAL AIR FORCE EVALUATION: The BCMR Medical Consultant recommends the application be denied. The BCMR Medical Consultant agrees the applicant’s knee pain, referred to a Patellofemoral Pain Syndrome (PFPS), likely did not clinically manifest until the applicant participated in recurring running activities required of BMT. However, individuals presenting with the condition so soon after entering military service, without a history of acute trauma, bring into question their ability to serve and are generally released as an entry level separation (within 180 days of enlistment). Under existing policies service in these instances is determined “uncharacterized.” Nevertheless, there remains the unanswered question of whether the applicant’s condition was permanently worsened by her physical activities (after one week of running). The Consultant states the anatomic malpositioning of both of the applicant’s patellae, referred to as a “lateral tilt” on X-rays of her knees [and which DID exist prior to service], was the substrate upon which the repeated motion of the malpositioned knee cap, as it glided within the femoral [trochlear] groove, predisposed her to experience knee pain. It is this repeated “maltracking” of the patella with activity that resulted in the pain. Without an arthroscopic evaluation at or about the time of the applicant’s separation, it is virtually impossible to determine whether the applicant’s physical activities then resulted in fraying of the cartilage, or permanent damage, or accelerated degenerateive changes within her knees, above and beyond the expected natural progression of the disorder. Failing conservative treatment measures, consideration of a surgical intervention could have been made, e.g., a release of the fibrous tissue retinaculum commonly causing the patellar tilt, thereby allowing the patella to assume a more anatomically correct position, with resultant improvement/resolution of symptoms. The Medical Consultant opines the applicant has not met the burden of proof of a permanent worsening of her knee functioning as a result of activities during BMT. Should the Board render the benefit of doubt in favor of the applicant, noting her apparent continued symptoms 11 years after discharge, she would not be eligible for disability compensation by the Military Department due to her short period of service; although it may open the door for care and compensation by the DVA. The BCMR Medical Consultant’s evaluation is at Exhibit G. _________________________________________________________________ APPLICANT’S REVIEW OF THE ADDITIONAL AIR FORCE EVALUATION: On 26 Aug 11, a copy of the BCMR Medical Consultant’s evaluation was forwarded to the applicant for review and comment within 30 days. To date, a response has not been received by this office (Exhibit H). _________________________________________________________________ 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 has been presented to demonstrate the existence of error or injustice. We took notice of the applicant's complete submission in judging the merits of the case; however, we agree with the opinions and recommendations of the Air Force offices of primary responsibility and the BCMR Medical Consultant and adopt their rationale 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 recommend granting the relief sought in this application. 4. 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 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 Docket Number BC-2010-04510 in Executive Session on 4 Oct 11, under the provisions of AFI 36-2603: The following documentary evidence pertaining to Docket Number BC-2010-04510 was considered: Exhibit A. DD Form 149, dated 4 Dec 10, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Letter, AETC/SGPS, dated 19 Jan 11. Exhibit D. Letter, AFPC/DPSOS, dated 18 Apr 11. Exhibit E. Letter, SAF/MRBR, dated 29 Apr 11. Exhibit F. Letter, Applicant, dated 24 May 11, w/atchs. Exhibit G. Letter, BCMR Medical Consultant, 25 Aug 11. Exhibit H. Letter, SAF/MRBR, dated 26 Aug 11.