RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2013-05476 COUNSEL: NONE HEARING DESIRED: NO APPLICANT REQUESTS THAT: His character of service be changed from uncharacterized to honorable. His narrative reason for separation and separation (SPD) code of JFW - Discharge failed Medical/Physical Procurement Standards, be changed. Any documentation stating that he had a pre-existing condition of anemia be removed from his records. APPLICANT CONTENDS THAT: He requests to have his discharge evaluated based on the evidence presented. He is willing to do what it takes to maintain and continue on as a member of the United States Air Force. After receiving clearance from the Military Entry Processing Station and reviewing his civilian medical records, the claims that anemia was a preexisting condition is inaccurate. His records do not show any signs of iron deficiency anemia. The blood test results indicate his Hemocrit and Hemoglobin are within the range of normal for a male at his age at the time of testing. He was cleared of any illnesses or possible medical conditions and had no physical symptoms that would warrant a more detailed internal probe. Once he was discharged from the Air Force, his test results did not indicate that he had anemia. He understands the minimum medical requirement, but would like to point out that he had never been diagnosed with iron deficiency anemia and had no reason to be treated. It was suggested that he have an endoscopy and or colonoscopy. He declined these procedures for two reasons: he preferred to be tested by his medical provider before having the procedure done and he disagreed with the diagnosis based on his prior medical history. He felt like the test results during training were inaccurate. The applicant’s complete submission, with attachments, is at Exhibit A. STATEMENT OF FACTS: Documentation from the applicant’s master personnel records indicate that he entered the Air Force on 15 February 2013; however, AFPC/DPSOR found the applicant entered the Air Force on 25 June 2013 and arrived at Basic Military Training on 1 July 2013. His Dated Entered Active Duty will be updated upon final Board action. On 27 September 2013, the applicant was notified of his commander’s intent to discharge him from the Air Force for Erroneous Enlistment. Specifically, a medical narrative summary dated 9 September 2013, found that he did not meet the minimum medical requirements to enlist because he had anemia. He was not given a disability separation because he was found unqualified. On 27 September 2013, the applicant acknowledged his right to counsel and to submit statements on his behalf and to waive those rights. He waived his right to counsel and to submit a statement on his behalf. The commander approved the discharge on 2 October 2013. He was separated on 4 October 2013 with an entry level separation and uncharacterized service. His SPD code and narrative reason for separation were listed as JFW – discharge failed medical/physical procurement standards. AIR FORCE EVALUATION: AETC/SGPS recommends approval. Based on the documentation in the applicant’s personnel records, the separation was in accordance with established policy and administrative procedures. While SGPS concurs with the applicant’s request, the applicant will need a waiver from the Reserves for reinstatement consideration. The complete AETC/SGPS evaluation is at Exhibit C. AFPC/DPSOR recommends denial of the applicants request to change his discharge characterization, to include the SPD code and his narrative reason for separation. The applicant completed Basic Military Training but was kept in a “holdover” status and not allowed to depart for technical training until his medical situation could be determined. The medical authorities concluded that the applicant had a preexisting condition that would have precluded him from joining the Air Force had the condition been known at the time of his enlistment. The applicant’s service characterization is correct as reflected on his DD Form 214. Airmen are given entry level separation with uncharacterized service when the separation is initiated within the first 180 days of continues active service. Based on the documentation in the applicant’s master personnel records, the discharge, to include the narrative reason for separation, were consistent with the procedural and substantive requirements of the discharge regulation. The applicant did not provide evidence of an error or injustice with regard to the processing of his discharge. The complete AFPC/DPSOR evaluation, with attachments, is listed at Exhibit D. The BCMR Medical Consultant recommends denial. Medical documentation that culminated in the applicant's discharge include notices of Temporary Duty Restriction, 59 MOW Forms 154; one issued on 30 July 2013, referring him to the Trainee Health clinic to see a medical specialist, and the other dated 13 August 2013, giving notice of a referral to gastroenterology for evaluation of a potentially disqualifying medical condition. A third, and final, Duty Restriction notice completed on 12 September 2013 identifies the applicant for Entry Level Separation. The applicant has supplied a copy of a preventive medicine physical examination, conducted on 3 January 2013, when he was 17, by his civilian physician. He also supplied a Chronological Record of Medical Care overprint document for the purpose of processing an administrative separation in lieu of a Medical Evaluation Board. This document indicates that the applicant had a diagnosis of anemia, which disqualified him for enlistment per DoD Instruction 6130.03, Enclosure 4.23; no consideration for enlistment waiver was recommended. A narrative comment on the applicant's medical issue by the evaluating military provider, 4 September 2013, reads: "Patient has a history of anemia consistent with iron deficiency found on screening labs during BMT. He denies having symptoms of anemia. Patient was advised to consider endoscopic evaluation by gastroenterology to ensure there is no serious underlying pathology. However, he declined any further evaluation of his anemia. We do not recommend waiver approval. He is medically cleared for separation." The applicant was officially disqualified for general service due to iron deficiency anemia. He has supplied a post-service metabolic panel and blood cell count collected soon after his date of separation, which shows his hemoglobin of 14.7 [normal 12.6 to 17.7] and hematocrit of 45.4 [normal 37.5 to 51.0], both falling within the normal range. Likewise, a measurement of the applicant's serum iron, iron saturation and iron binding capacity all also fell within normal range; as did measurements of his serum folate, vitamin B-12, and ferritin. A memo from the applicant's physician noted his [marginally] elevated serum calcium level, but also stated "Patient is no longer anemic. No further work-up necessary at this time." Another memo supplied by the applicant's civilian physician, states, "the applicant is under my medical care and this letter is to confirm that he does not have anemia." The applicant also supplied a copy of the results of blood testing from 26 December 2010, which also showed his hemoglobin [13.9] and hematocrit [42.6] to be within normal range. While the applicant has demonstrated that his previously identified iron deficiency has been corrected, there is no knowledge of whether he was under undisclosed treatment prior to the re­evaluation. There also remains a possibility of laboratory error during his military service, as there is also no evidence a repeat study was conducted to confirm the abnormality. Nevertheless, the Medical Consultant believes the Air Force officials acted within their authority to separate the applicant and had no recourse but to release him without a waiver for a disqualifying medical condition, iron deficiency anemia, IAW DoDI 6130.03, particularly in the context of his refusal to undergo recommended diagnostic evaluations to identify a possible treatable or serious cause of the deficiency, such as peptic ulcer disease or, worse, an occult malignancy. Moreover, since the disqualifying anemia was discovered within the first 180 days of service and without an opportunity to determine its cause, it was likely assumed to have existed prior to the applicant's entry to military service and resulted in the administrative separation in lieu of an MEB. Again, acknowledging that the military was denied the opportunity to consider existence of a medical condition incurred or was permanently aggravated during his brief period of active service. In conclusion, if it is proven the applicant no longer has iron deficiency anemia and does not require supplemental iron, then allowing him to reenlist is not unreasonable. None of the applicant's physical examinations documented a rectal evaluation and testing for occult blood in the stool, which is a serious clinical practice deficiency in the evaluation of anemia; particularly in a male patient. Therefore, the Medical Consultant recommends the applicant submit a more current complete blood count, serum iron, iron-binding capacity, and ferritin, the result of a rectal examination to confirm absence of blood in the stool, and a statement that he has not required treatment to receive a prompt favorable recommendation from this Medical Consultant. The Medical Consultant recommends denial of the applicants request pending receipt of more current information that he does not have anemia and has not required treatment for anemia. The complete BCMR Medical Consultant’s evaluation is at Exhibit E. APPLICANT'S REVIEW OF AIR FORCE EVALUATION: The applicant maintains he has never been diagnosed or treated for anemia prior to basic military training or after his discharge. He has followed the BCMR Medical Consultant’s advice and has had the recommended tests performed. Once he receives the results, he will forward for review; however, as of this date, those results have not been received. The applicant’s complete response is at Exhibit G. 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 error or injustice. We took notice of the applicant’s complete submission in judging the merits of the case; however, the majority of the Board is not persuaded by the evidence submitted in his appeal that a change in the record is warranted. While the majority of the Board notes AETC/SGPS’ recommendation to grant the request, the evidence of record indicates that the applicant was afforded due process at the time of his discharge and the majority finds the evidence submitted insufficient to determine otherwise. Therefore, the Board majority agrees with the opinion and recommendation of the AFPC/DPSOR and the BCMR Medical Consultant and adopts their rationale as the basis for our conclusion that the applicant has not been the victim of an error or injustice. Therefore, in the absence of evidence to the contrary, the Board majority finds no basis to recommend granting the relief sought in this application. THE BOARD DETERMINES THAT: The applicant be notified the evidence presented did not demonstrate the existence of material error or injustice; the application was denied without a personal appearance; and 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-2013-05476 in Executive Session on 16 September 2014 and 10 April 2015 and 28 April 2015, under the provisions of AFI 36- 2603: By a majority vote, the Board voted to deny the application. XX voted to partially grant and submitted a minority report which is located at Exhibit H. The following documentary evidence pertaining to AFBCMR Docket Number BC-2013-05476 was considered: Exhibit A. DD Form 149, dated 18 Nov 13, w/atchs. Exhibit B. Applicant's Master Personnel Record Excerpts. Exhibit C. Letter, AETC/SGPS, dated 6 Jan 14. Exhibit D. Letter, AFPC/DPSOR, dated 13 Jan 14, w/atchs. Exhibit E. Letter, BCMR Medical Consultant, 17 Jul 14. Exhibit F. Letter, SAF/MRBR, 25 Jul 14. Exhibit G. Letter, Applicant’s Response, dated 23 Aug 13. Exhibit H. Minority Report, dated 1 May 15.