RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2011-00229 COUNSEL: NONE HEARING DESIRED: YES _________________________________________________________________ APPLICANT REQUESTS THAT: His records be evaluated for medical boarding and entry into the Wounded Warrior Program. _________________________________________________________________ APPLICANT CONTENDS THAT: 1. During his retirement physical his attending physician stated “he was not ready to separate” due to ongoing medical conditions for Traumatic Brain Injury (TBI), Post-Traumatic Stress Disorder (PTSD), and neck injury. 2. In Nov 08, he was seen by a doctor in the TBI clinic at Womack Army Hospital. He had several tests, to include a Magnetic Resonance Imaging (MRI), which indicated no signs of physical trauma. His wife asked if they could do a MRI with contrast to determine if there was any shrinkage or lesions on his brain. However, the doctor stated that “they were not equipped to do that that kind of testing and the only location that could was Duke Hospital in Raleigh, North Carolina, however, it was very expensive. 3. He went through the cognitive testing, which resulted in him being diagnosed him with TBI. He was given a shot for migraines and told to track them on a chart before his next appointment. He was seen at physical therapy to measure his balance and dizziness. The physical therapist stated he needed to be seen by an orthopedic doctor for his neck pain and limited range of motion. 4. He was issued a profile by the Army due to his illness; however, the Air Force would not accept it because it was written by an Army physician and not an Air Force physician. The Air Force physician would not put him on a profile. In support of his request, the applicant provides a five-page list of events and copies of his medical records. The applicant's complete submission, with attachments, is at Exhibit A. _________________________________________________________________ STATEMENT OF FACTS: On 31 Aug 10, the applicant voluntarily retired from the Air Force in the grade of master sergeant after completing 21 years, 9 months and 8 days of total active service. The remaining relevant facts pertaining to this application are contained in the letters prepared by the BCMR Medical Consultant and the appropriate office of the Air Force, which are attached at Exhibits C and F. _________________________________________________________________ AIR FORCE EVALUATION: HQ AFPC/DPAMM states the applicant’s medical records do not indicate he met the criteria for needing an MEB and entry into the wounded warriors program is not under the purview of their office. DPAMM states a review of the applicant’s medical records reveal he was followed by mental health providers and diagnosed with Anxiety Disorder Not Otherwise Specified (NOS). He was repeatedly determined to be worldwide qualified and there was no indication in his medical record that mental health was considering him for an MEB. In addition, DPAMM has no record of ever being contacted to place the applicant on medical hold for disability processing. The applicant’s retirement physical stated he was not cleared for separation but the concern appeared to be related to the applicant’s pending evaluation of his neck pain. On-going evaluation of his neck by orthopedics determined he was a non- surgical candidate and he was referred to a pain management specialist. No MEB action was mentioned or appears indicated since the applicant had an approved retirement date and did not overcome the presumption of fitness. The complete DPAMM evaluation is at Exhibit C. A copy of the HQ AFPC/DPAMM evaluation was forwarded to the applicant on 24 Oct 11 for review and comment within 15 days (Exhibit G). As of this date, no response has been received by this office. The BCMR Medical Consultant recommends denial. The Medical Consultant states there is a lack of clear and convincing evidence of an unfitting condition at the time of retirement from active duty service. The BCMR Medical Consultant opines no objective evidence of TBI was present before or at the time of retirement. This opinion is consistent with the DVA rating decision which denied service connection due to the absence of medical evidence demonstrating that a brain injury had occurred during deployment or anytime thereafter. Furthermore, the Department of Veterans Affairs (DVA) rating report stated, “further psychiatric and neuropsychiatric testing indicated your symptoms were not due to a traumatic brain injury.” The specialist offers the expert opinion that the episodes of dizziness were possibly due to post traumatic vertigo not TBI. In considering the functional impact of this finding, there is no indication of an inability to perform job related duties due to this transient condition. No enlisted performance reviews or other documentation were provided to support a contention of unfitness or a demonstrated inability to perform assigned duties. Regarding PTSD, the reviewer agrees that documentation does support this diagnosis. However, on the matter of whether the condition rendered the applicant unfit for duty and thus required a Medical Evaluation Board (MEB), there is no objective evidence to support this claim (i.e. performance reports or duty reassignment, etc). AFI 41-210, Patient Administration Functions, paragraph 10.1.3., states, “The existence of a physical defect or condition does not of itself necessarily provide justification for or entitlement to an MEB. If a member has performed his or her duty satisfactorily prior to scheduled retirement or an approved separation date, a presumption of fitness is established. This presumption of fitness can be overcome only if clear and convincing evidence exists to the contrary.” No such evidence was submitted documenting the existence of inadequate performance of assigned duties post- deployment or unfitness for duty. A history of prior neck surgery in 2001 was documented in the record. However, there was no indication of any duty limiting neurological defects necessitating an MEB for separation due to this condition. The presence of medical conditions that were unfitting while in service, and were not the cause of separation or retirement, that later progressed in severity causing disability resulting in service connected DVA compensation is not a basis to retroactively grant a military disability discharge or disability compensation. The complete BCMR Medical Consultant’s evaluation is at Exhibit D. _________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: The applicant states he returned from Bagram Air Force Base, Afghanistan in Sep 09 and did not realize the extent of his injuries until he returned to his job as Production Superintendent. He was having trouble remembering things about the F-15 aircraft he had worked on for 21 plus years, simple tasks and would get lost several times on his way to work. The applicant states he reached out to his senior enlisted manager for advice and was referred to mental health. His supervisor removed him from Production Superintendent to Senior Noncommissioned Officer (SNCO) of Aircraft in which he shared responsibilities with another SNCO due to his inability to recall maintenance and scheduling information, communicate maintenance actions and the extensive headaches and pain. One time he was sent to Womack Army Hospital for TBI testing but they deployed his original doctor, so he lost continuity of care. His Army doctor put him on a profile, however, his Air Force doctor and the Air Force Fitness Center would not accept it. The lack of communication between the Army and Air Force and the three hour trips to the facility has caused further stress and hardship to him and his family. The applicant’s complete evaluation 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. The applicant’s case has undergone an exhaustive review by the BCMR Medical Consultant and we note that the applicant disagrees with his recommendation. However we do not find the evidence provided by the applicant sufficiently persuasive to override the rationale provided by the BCMR Medical Consultant. Regarding his request for entry into the Air Force Wounded Warrior (AFW2) program, since the Medical Consultant found no evidence of an unfitting condition at the time of his retirement from active duty that would warrant a MEB, there exists no basis upon which to direct entry into the AFW2 program. Therefore, we agree with the opinion and recommendation of the BCMR Medical Consultant and adopt his rationale as the basis for our conclusion that the applicant has not been the victim of an error or injustice. 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 the Board's 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 AFBCMR Docket Number BC-2011-00229 in Executive Session on 15 Nov 11, under the provisions of AFI 36-2603: Panel Chair Member Member The following documentary evidence pertaining to AFBCMR Docket Number BC-2011-00229 was considered: Exhibit A. DD Form 149, dated 4 Oct 10, w/atchs. Exhibit B. Applicant's Military Personnel Records. Exhibit C. AFPC/DPAMM Letter, dated 8 Feb 2011. Exhibit D. AFBCMR Medical Consultant, Letter, dated 19 Sep 11. Exhibit E. SAF/MRBC, Letter, dated 23 Sep 11. Exhibit F. Applicant’s Rebuttal, Letter, 4 Oct 11, w/atchs. Exhibit G. SAF/MRBC, Letter, dated 20 Oct 11. Panel Chair