RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2014-00978 COUNSEL: NONE HEARING DESIRED: NO APPLICANT REQUESTS THAT: Her narrative reason for separation of Disability, Existed Prior to Service (EPTS), Physical Evaluation Board (PEB) be changed to a service connected disability. APPLICANT CONTENDS THAT: Her pre-entry physical indicates that she had no knee issues but her Medical Evaluation Board (MEB) and outpatient physical states her injury occurred in the Line of Duty (LOD). The applicant’s complete submission, with attachments, is at Exhibit A. STATEMENT OF FACTS: According to the applicant’s DD Form 214, Certificate of Release or Discharge from Active Duty, on 5 Feb 02, she entered the Regular Air Force. On 9 May 03, a MEB diagnosed the applicant with bilateral knee pain that was found in the LOD and recommended referral to an Informal Physical Evaluation Board (IPEB). On 15 May 03, an IPEB found the applicant unfit and recommended she be discharged under provisions other than 10 USC 61. The IPEB indicated the applicant’s condition EPTS, had not been permanently aggravated through military service, and is incompatible with the rigors of military service. On 20 May 03, the applicant agreed with the findings and recommendation of the IPEB and waived her right to a Formal PEB (FPEB). On 21 May 03, the Secretary of the Air Force directed the applicant be separated from active service for physical disability due to a condition that EPTS under the provisions of 10 USC 61. On 2 Aug 03, the applicant was honorably discharged with a narrative reason for separation of “Disability, Existed Prior to Service, PEB.” She was credited with 1 year, 6 months, and 27 days of total active service. On 26 Mar 14, the Department of Veterans Affairs evaluated the applicant’s diagnosis of patellofemoral syndrome of the right and left knees and determined them to be service connected. The DVA assigned a 20 percent combined disability rating, effective 16 Aug 13. AIR FORCE EVALUATION: AFPC/DPFD recommends denial indicating the preponderance of evidence reflects no error or injustice occurred during the disability process. The IPEB found the applicant unfit and recommended discharge noting the applicant’s medical condition, EPTS and had not been permanently aggravated through military service, is incompatible with the rigors of military service. The board also noted the applicant had knee pains within weeks of entering active duty, despite no specific injury/trauma which indicates natural progression of a pre-existing condition/weakness. The board opined that the 180 day rule (DODI) 1332.38, E3.P4.5.4.1) applied. The board also noted that the applicant did not use her two appeal rights through the FPEB and the Secretary of the Air Force Personnel Council. The complete DPFD evaluation is at Exhibit C. The BCMR Medical Consultant recommends approval indicating that under today’s standard of clear and unmistakable evidence, there remains a reasonable uncertainty in the applicant’s favor. The applicant remained symptomatic one year following the onset of pain. The anatomic relationship between the applicant’s femur, patella, quadriceps tendon, and patellar tendons [bilaterally], which predated her entry to military service, predisposed her to developing the clinical condition referred to as patellofemoral syndrome with her increased activity in Basic Military Training (BMT) and technical school training. In Jun 02, she had a normal Magnetic Resonance Imaging (MRI) scan of the knees and in Apr 03, a bone scan failed to show evidence of worn or torn cartilaginous or bone structures, but showed a preserved joint space, suggesting that no detectable permanent anatomic damage or new defect was present at either point in time. Although it was over a decade after the applicant’s discharge, the DVA concluded that her condition is considered permanent service aggravation. This conclusion was reached at a time the applicant was also apparently asymptomatic at the Mar 13 Compensation and Pension examination. The presumption that a disease is incurred or aggravated in the line of duty may only be overcome by competent medical evidence establishing by a preponderance of evidence that the disease was clearly neither incurred nor aggravated while serving on active duty or authorized training. Due to the significant passage of time and the likelihood that the applicant’s medical condition may have worsened over the ten years since her discharge, a definitive conclusion cannot be made that at the time of discharge, her knee ailment had already been permanently worsened. However, with the absence of symptoms or a history of the disorder prior to entering the military service, the preponderance of evidence policy rests in the applicant’s favor. The complete BCMR Medical Consultant evaluation is at Exhibit D. APPLICANT'S REVIEW OF AIR FORCE EVALUATION: Copies of the Air Force evaluations were forwarded to the applicant on 27 Oct 14 for review and comment within 30 days. As of this date, no response has been received by this office (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. Sufficient relevant evidence has been presented to demonstrate the existence of an error or injustice warranting relief. We note the Air Force office of primary responsibility recommends denial stating that the preponderance of evidence reflects no error or injustice in the disability process. However, after carefully reviewing this application, we agree with the opinion and recommendation of the BCMR Medical Consultant and adopt the rationale expressed as the basis for our decision that the applicant has been the victim of either an error or an injustice. Therefore, we recommend the applicant's records be corrected as set forth below. THE BOARD RECOMMENDS THAT: The pertinent military records of the Department of the Air Force relating to the APPLICANT, be corrected to reflect that she was found unfit to perform the duties of her office, rank, grade, or rating by reason of physical disability for her diagnosis of bilateral patellofemoral syndrome, that the condition was permanently aggravated through military service, that the condition was rated 20 percent under VASRD code 5003- 5299, and that she was discharged with entitlement to severance pay, effective 2 Aug 03. The following members of the Board considered AFBCMR Docket Number BC-2014-00978 in Executive Session on 14 Jan 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 A. DD Form 149, dated 4 Mar 14, w/atchs. Exhibit B. Applicant's Available Master Personnel Records. Exhibit C. Letter, AFPC/DPFD, dated 9 Apr 14. Exhibit D. Letter, BCMR Medical Advisor, 6 Oct 14, w/atch. Exhibit E. Letter, SAF/MRBR, dated 27 Oct 14.