ADDENDUM TO RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2012-04477 COUNSEL: HEARING DESIRED: YES APPLICANT REQUESTS THAT: Through counsel, her official military records be corrected to show: 1.  Her Polycystic Ovary Syndrome (PCOS) condition was determined to be incurred in the line of duty (LOD). 2.  She was retained on active duty orders during the period 1 Oct 09 through 30 Jul 10 for the purpose of being processed through a Medical Evaluation Board (MEB)/Physical Evaluation Board (PEB). 3.  She was placed on the Temporary Disability Retirement List (TDRL), effective 31 Jul 10, due to PCOS symptoms. 4.  She received a TDRL evaluation and her case was reviewed by a PEB for possible medical retirement for her piriformis syndrome (compressed sciatic nerve) and PCOS. RESUME OF CASE: In the original case, the applicant requested, her records be corrected to show that: 1.  Her chronic back pain was not determined to have existed prior to service (EPTS), but was found to be incurred in the LOD, or was determined to be EPTS, but aggravated by her military service. 2.  She was continued on active duty service during the period 1 Oct 09 through 30 Jul 10 for medical continuation (MEDCON). 3.  She was placed on the TDRL on 30 Jul 10 and remained there through the present. 4.  She receive a TDRL evaluation and her case be reviewed by a Physical Evaluation Board (PEB). On 7 Mar 13, the Board considered the applicant’s original application, and granted her request to correct her record to show her back pain was incurred in the LOD. The Board concurred with the opinions and recommendations of AFMOA/SGH and the BCMR IMA Medical Advisor that, given the 8 Sep 09 Orthopedic Clinic MEB Narrative Summary Note in her records stating her condition was incurred “in the line of duty,” her back pain should have been LOD: Yes, and adopted their rationale as the basis for their conclusion the applicant’s back pain did occur within the LOD. However, the Board adopted the opinions and recommendations of the BCMR IMA Medical Advisor in denying the applicant’s remaining requests, which were to change her record to show she was continued on active duty on MEDCON orders, placed on the TDRL, and had her case reviewed by a PEB. The Medical Advisor noted that the applicant appeared to believe if her medical condition were determined to be within the LOD, she would inexorably be retained on MEDCON orders for further processing through an MEB; however, this is not the case. An MEB is not warranted in this case because, other than her own assertions, nothing in the applicant’s medical records or within the materials she submitted established that her medical condition was unfitting or disqualifying. For an accounting of the facts and circumstances surrounding the applicant’s original request and the rationale of the earlier decision by the Board, see the Record of Proceedings (ROP) at Exhibit H. On 25 Jul 14, the applicant submitted a request for reconsideration of the three requests from her original application which were denied by the 7 Mar 13 Board, as well as a request to have her PCOS condition determined to be LOD: Yes. In support of her request, she provides additional medical documentation, and contends her PCOS was diagnosed within the first year of her discharge from the Air Force due to the Air Force’s failure to properly diagnose the condition while she was on active duty. She was referred to the Endocrinology Clinic for studies, but her referral was then denied. She also contends the Board relied upon the advisory from the BCMR IMA Medical Advisor which stated she had no unfitting or disqualifying medical conditions and thus no MEB was medically indicated, while her AF Form 469, Duty-Limiting Condition Report, dated 6 Aug 09, clearly stated she was undergoing an MEB. In addition, her MEB was then improperly cancelled when her LOD determination for back pain was erroneously determined to be LOD: NO-EPTS. Finally, she contends her medical conditions should have been determined to be LOD: Yes because of the Eight Year Rule, since she had over nine years of total service time. The applicant’s complete submission, with attachments, is at Exhibit I. AIR FORCE EVALUATION: BCMR Medical Consultant recommends partially granting the applicant’s request. The applicant was released from active duty on 27 Jul 10. 1.  In the applicant’s original case, the Board determined an error had occurred, and directed her records be corrected to show her lumbago (back pain) was incurred in the LOD. She now contends she should have been retained on active duty to be processed through the MEB. The BCMR Medical Advisor concurs. At the time of the applicant’s release from active duty, an MEB for chronic back pain had not been properly completed, and the applicant should have been retained on active duty orders until the MEB was complete. Further, given the “LOD: Yes” determination by the original Board, the Medical Consultant opines the applicant’s back ailment would have been rated under criteria outlined in the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD), Diseases and Injuries of the Spine [which includes scoliosis], and been assigned a ten percent disability rating, based upon her range of motion and the absence of incapacitating episodes of a sufficient duration. 2.  Concerning the applicant’s implicit contention her PCOS should be found in the LOD and should be included as a justification for permanent or temporary retirement, the BCMR Medical Consultant recommends denial. The applicant further contends her PCOS should be found service-connected and justifies placing her on the TDRL [albeit diagnosed after her release from service]; based upon an alleged delay in diagnosis due to implicit wrongful denial of an examination by the Endocrinology Clinic. The Medical Consultant cannot validate alleged wrongful behavior by an unnamed official within the applicant’s servicing medical organization. Such allegations are best resolved through an Inspector General investigation, or addressed by the servicing medical facility commander. The Medical Consultant found no service evidence of an impediment to performance of her primary duties that warranted processing through the DES as a separate disqualifying medical condition. While it is conceivable there may be been a cause and effect relationship between the applicant’s steroid injections and the development of PCOS, examiners at the Department of Veterans Affairs (DVA) believed her condition was the result of its expected natural progression. Even if found in the LOD, it does not automatically warrant an unfit finding or bases for medical separation. Further, even if all of the allegations regarding her delayed diagnosis were found to be valid, the supplied documentation does not support an individual unfit finding for this medical condition. 3.  Concerning the applicant’s request for a medical retirement for piriformis syndrome, although granted service connection and a ten percent disability rating for piriformis syndrome by the DVA, the evidence does not prove the existence of an enduring and independent cause for cutting short the applicant’s military career. Indeed, in an entry dated 14 Apr 10, the applicant’s orthopedic surgeon noted she had no evidence of nerve compression on electromyography and that a “piriformis injection in her left side completely resolved her pain” and she had “been able to go back to doing what she considered normal activities with her children” and “has been able to do yard work.” In summary, based upon the error in this case of not completing the applicant’s initial MEB for chronic back pain, the Medical Consultant recommends the applicant’s records be corrected to show she was retained on active duty during the period 1 Oct 09 through her date of release from military service of 27 Jul 10. The applicant should also be found unfit by a PEB and assigned a disability rating of ten percent under the unifying diagnosis of myofascial pain syndrome. The applicant’s combined disability rating would still fall short of retirement eligibility, either individually or if combined with the recommended ten percent disability rating for her back pain. A complete copy of the BCMR Medical Advisory evaluation is at Exhibit C. APPLICANT'S REVIEW OF AIR FORCE EVALUATION: She agrees with the analysis and recommendation of the BCMR Medical Consultant; however, requests her date of separation be set at 30 Jul 10 Reserve Obligation Termination Date reflected in Block 6 of her DD Form 214, Certificate of Release or Discharge from Active Duty, rather than the date of 27 Jul 10 suggested by the Medical Consultant (Exhibit L). 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 concerning the applicant’s contentions concerning her Polycystic Ovary Syndrome and piriformis syndrome. We took notice of the applicant’s complete submission, to include her rebuttal response to the advisory opinion, in judging the merits of the case; however, we agree with the opinion and recommendation of the BCMR Medical Consultant and adopt his rationale as the basis for our conclusion the applicant has not been the victim of an error of injustice. While we note the applicant’s implicit contention of wrongful denial of an examination by the Endocrinology Clinic, the Board concurs with the position of the Medical Consultant that alleged wrongful behavior by an unnamed official within the applicant’s servicing medical organization cannot be validated without confirmation through a formal investigation. In addition, the supplied documentation does not support that these conditions rendered the applicant unfit for service and, by themselves, would have caused the early termination of her military career. Therefore, in the absence of evidence to the contrary, we find no basis to recommend granting these requests. 4.  However, sufficient relevant evidence has been presented to demonstrate the existence of an error or injustice concerning the applicant’s contention concerning her back pain and the requirement to retain her on active duty. Given our previous recommendation to correct the applicant’s records to reflect that her back pain was incurred in the line of duty (LOD), she should have been retained on active duty orders until processed through the disability evaluation system (DES) and, based upon the recommendation of the BCMR Medical consultant, we recommend she receive a ten percent disability rating for said condition. While the Board acknowledges the applicant’s request for a new date of separation of 30 Jul 10 based upon the date reflected in Block 6 of her DD Form 214, Certificate of Release or Discharge from Active Duty, we note her actual separation date was 27 Jul 10 and see no evidence the date of her separation should be changed given the relief being granted. Therefore, we recommend the applicant's records be corrected as 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 30 September 2009, she was found unfit to perform the duties of her office, rank, grade, or rating by reason of physical disability, incurred while she was entitled to receive basic pay; that the diagnosis in her case was chronic back pain, under Department of Veteran Affairs (DVA) diagnostic code 5299-5243; that the compensable percentage was 10 percent for her chronic back pain and associated myofascial pain syndrome; that the degree of impairment was permanent; 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 received in the line of duty as a direct result of armed conflict or caused by instrumentality of war. b.  On 27 July 2010, she was discharged from active duty, with a combined compensable disability rating of ten percent and discharged with entitlement to disability severance pay. The following members of the Board considered AFBCMR Docket Number BC-2012-04477 in Executive Session on 16 Apr 15 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 H.  Original Record of Proceedings, dated 9 Jul 13. Exhibit I.  DD Form 149, dated 25 Jul 14, w/atchs. Exhibit J.  Memorandum, BCMR Medical Advisor, dated 19 Feb 15. Exhibit K.  Letter, SAF/MRBR, dated 26 Feb 15. Exhibit L.  Letter, Applicant, dated 14 Mar 15.