RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2011-01350 COUNSEL: NONE HEARING DESIRED: NO _________________________________________________________________ APPLICANT REQUESTS THAT: Her condition of Factor V Leiden Blood Clotting Disorder and the damage she received from thrombus to her right jugular vein be reevaluated and categorized as Existed Prior to Service (EPTS)- Service Aggravated. _________________________________________________________________ APPLICANT CONTENDS THAT: She believes her line of duty (LOD) determination was not taken seriously because she was a Reservist that was getting ready to retire. Her LOD consideration was to include damage from thrombus which occurred to her right jugular vein. She now has Post Phlebotic Syndrome because the vein was stretched out. Her original blood clot was from a mutation called Factor V Leiden, but her condition worsened by the size of the clot, which caused her vein to be enlarged. This has caused constant pain that is not getting any better. She would like her LOD to follow normal procedures and be looked at seriously. In support of her appeal, the applicant provides copies of the Informal LOD Determinations; extended active duty orders; DD Form 214, Certificate of Release or Discharge from Active Duty; civilian and military medical records; electronic communications; and a personal memorandum. The applicant’s complete submission, with attachments, is at Exhibit A. _________________________________________________________________ STATEMENT OF FACTS: The applicant is a former member of the Air Force Reserve (AFRES) who retired in the grade of master sergeant (E-7). According to the Informal LOD Determinations, dated 1 June 2010 and 14 June 2010, the applicant’s condition of Factor V Leiden Mutation was found to be “EPTS-LOD not applicable” due to the fact the applicant’s condition was genetic and clearly pre-existed prior to service. Therefore, the LOD consideration was cancelled. _________________________________________________________________ AIR FORCE EVALUATION: AFRC/SGP recommends denial. SGP states that an Informal LOD was cancelled by the Readiness Management Group (RMG) on 30 June 2010. There was no evidence provided indicating the applicant’s genetic and clearly pre-existing condition was permanently worsened beyond natural progression as a result of her military duties. A formal review by the Headquarters Air Force Reserve Command LOD Board medical and legal officers was never accomplished due to this case being cancelled. The complete SGP evaluation is at Exhibit B. _________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: She understands that Factor V Leiden Blood Clotting Disorder is hereditary, but the LOD should be about the damage the blood clot caused, not because of the Factor V Leiden Blood Clotting Disorder. She is at high risk for blood clots and is now currently taking 12 milligrams of Warfarin daily to keep her blood running thin and to prevent another mishap like the one that happened while she was on active duty. The applicant’s complete rebuttal is at Exhibit D. _________________________________________________________________ BCMR MEDICAL CONSULTANT’S EVALUATION: The BCMR Medical Consultant recommends granting the applicant relief in the form of assigning a finding of in-the-line-of-duty (ILOD) for her secondary condition of Post-Phlebitic Syndrome and venous insufficiency of the right internal jugular vein. The BCMR Medical Consultant acknowledges that the applicant’s Factor V Leiden mutation is genetic in origin which, by definition, is considered to have existed prior to service. However, with respect to the applicant’s claimed diagnosis of Post-Phlebitic [or Phlebotic] Syndrome, the BCMR Medical Consultant opines that, but not for the venipuncture that resulted in thrombophlebitis in the right upper extremity (site of attempted blood collection), the applicant may not have developed the internal jugular vein thrombosis; given there was no direct precipitating trauma to her internal jugular or subclavian veins, as may occur with central vein catheterization, infection, or an indwelling venous line. Additionally, the fact the applicant was pregnant with twin gestations introduced an additional factor contributing to her hypercoagulable state. Thus, while the applicant’s Factor V Leiden mutation is clearly EPTS her newly diagnosed thrombophlebitis, which initially involved only the right upper extremity, but which has been implicated in the clot development within her right internal jugular vein, should be considered a de novo service-incurred event with the resultant sequalae of residual Post-Phlebitic Syndrome with venous insufficiency, as demonstrated on duplex ultrasound. The complete BCMR Medical Consultant’s evaluation, with attachment, is at Exhibit E. _________________________________________________________________ APPLICANT'S REVIEW OF BCMR MEDICAL CONSULTANT’S EVALUATION: She agrees with the BCMR Medical Consultant’s findings and recommendation. The applicant’s complete response to the BCMR Medical Consultant’s evaluation is at Exhibit F. _________________________________________________________________ THE BOARD CONCLUDES THAT: 1. The applicant has exhausted all remedies provided by existing law or regulations. 2. The application was timely filed. 3. Sufficient relevant evidence has been presented to demonstrate the existence of error or injustice. After considering the totality of the evidence before us, the Board agrees with the opinion by the BCMR Medical Consultant that although the applicant’s condition of Factor V Leiden Blood Clotting Disorder is a genetic disorder and existed prior to service, her secondary condition of Post-Phlebitic Syndrome and venous insufficiency was more than likely caused by a venipucture that resulted in thrombophlebitis of the right jugular vein and should be considered service-incurred. Therefore, in the interest of equity and justice, we recommend the applicant’s records be corrected as indicated below. _________________________________________________________________ THE BOARD RECOMMENDS THAT: The pertinent military records of the Department of the Air Force relating to APPLICANT be corrected to show that on 30 June 2010 her condition of Post-Phlebitic Syndrome and venous insufficiency of the right internal jugular vein was found to be service- connected and in the line of duty. _________________________________________________________________ The following members of the Board considered this application in Executive Session on 9 February 2011, under the provisions of AFI 36-2603: , Panel Chair , Member , Member All members voted to correct the records, as recommended. The following documentary evidence for AFBCMR Docket Number BC-2011- 01350 was considered: Exhibit A. DD Form 149, dtd 29 Mar 11, w/atchs. Exhibit B. Letter, AFRC/SG, dtd 13 Sep 11. Exhibit C. Letter, SAF/MRBR, dtd 28 Oct 11. Exhibit D. Letter, Applicant, dtd 7 Nov 11. Exhibit E. Letter, BCMR Medical Consultant, dtd 24 Jan 12, w/atch. Exhibit F. Email, Applicant, dtd 26 Jan 12. Panel Chair 7 4