RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2014-04334 COUNSEL: NONE HEARING DESIRED: NO APPLICANT REQUESTS THAT: She be evaluated by a Medical Evaluation Board (MEB). Her discharge be changed to a medical separation. APPLICANT CONTENDS THAT: She was separated from active duty under duress while experiencing mental and medical issues. She was removed from service before receiving treatment for her medical conditions which were aggravated or caused from active duty service. She signed an extension of her enlistment for military conflict. She has initiated investigations with the Air Force Inspector General (IG) and Office of Special Investigations (OSI). The applicant’s complete submission is at Exhibit A. STATEMENT OF FACTS: On 16 May 2006, the applicant entered the Regular Air Force. Per AF Form 1411, Extension or Cancellation of Extensions of Enlistment in the Regular Air Force/Air Force Reserve/Air National Guard, dated 28 September 2011, the applicant’s enlistment was extended 12 months, with Date of Separation (DOS) of 15 May 2013, for unit requirements. Per AF Form 1411, dated 23 October 2012, the applicant’s 12 month extension of enlistment was amended to seven months, with DOS of 15 December 2012, for best interest of the Air Force. On 15 December 2012, the applicant was honorably released from active duty with a narrative reason for separation of “Completion of Required Active Service.” She was credited with six years and seven months of active duty service. The remaining relevant facts pertaining to this application are contained in the memorandums prepared by the Air Force Offices of Primary Responsibility (OPR), which are attached at Exhibits C and E. AIR FORCE EVALUATION: The BCMR IMA Medical Consultant recommends denial of the applicant’s requests for a MEB and a medical separation or retirement. The applicant is requesting an MEB on the contention her separation from active duty interfered with her treatment for her medical conditions. Her records contain numerous entries of assessments and treatments for mental and physical health conditions which include thyroid disease, major depression, panic disorder with agoraphobia and anxiety disorder. The applicant’s medical records indicate she experienced an unexplained loss of consciousness in October 2007 and had a history of panic attacks with aphasia. The applicant was temporarily restricted from full duty pending outcome of medical evaluations. She was referred for a mental health evaluation and received a diagnosis of panic disorder with agoraphobia. This and other health conditions required outpatient and inpatient care during various periods starting in 2007 and continued through her term of service. The applicant was also placed in Duties Not to Include Flying (DNIF) status and returned to flight status during various periods depending on the status of her symptoms and treatment requirements. In February 2012, the applicant was diagnosed with a thyroid disorder, Hashimotos thyroiditis, and was found to have a mood disorder by mental health. She was hospitalized with Major Depressive Disorder (MDD) from 25 June 2012 to 11 October 2012. Although the extended hospitalization was required due to the applicant’s substantial decline in her ability to cope with the effect of this disorder, by her discharge date the applicant resumed an adequate level of functioning no longer requiring inpatient care. Following release from inpatient care, the applicant returned to duty and there were no reports identified that she was unable to perform her duties, although she remained in a DNIF status with an adjusted work schedule through her separation date. The applicant also expressed her desire to separate from the Air Force prior to hospitalization and had requested cancellation of a prior request to extend for an additional term of service. A separation physical on 9 November 2012 documented fatigue and multiple diagnoses including hypothyroidism and MDD, both assessed stable at the time; and no psychological symptoms or homicidal or suicidal ideations. The applicant remained on medical therapy for depression and thyroid disease through the period of release. Therefore, the BCMR IMA Medical Consultant concludes the applicant was not denied access to medical care as alleged and a MEB was not required given her response to treatment and her level of functioning at the time of separation. These chronic health conditions, though present in varying degrees, did not pose such an unacceptable level of risk to the service member or others warranting an MEB. The reason the applicant could be considered fit for duty despite the presence of a medical problem and later be granted a service-connected disability by the Department of Veterans Affairs (DVA) lies in the differences between Title 10 U.S.C. and Title 38 U.S.C. Under Title 10, the mere presence of a medical condition does not qualify a member for disability evaluation. For an individual to be considered unfit for military service there must be a medical condition so severe that it prevents performance of any work commensurate with rank and experience. Once an individual is determined fit, they are returned to duty and may even have physical duty limitations placed. In this instance, the applicant’s condition at the time of discharge did not appear to have rendered her unfit for continued military service and the plan for separation from the Air Force was continued. A complete copy of the BCMR IMA Medical Consultant’s evaluation is at Exhibit C. APPLICANT'S REVIEW OF AIR FORCE EVALUATION: A copy of the BCMR IMA Medical Consultant evaluation was forwarded to the applicant on 3 June 2015 for review and comment within 30 days (Exhibit D). As of this date, no response has been received by this office. ADDITIONAL AIR FORCE EVALUATION: The BCMR Psychiatric Consultant recommends denial of the applicant’s requests for a MEB and that her honorable discharge be changed to a medical separation. The Psychiatric Consultant finds the decisions of the Military Department did not represent an error or injustice. The applicant had behavioral health issues prior to her enlistment in 2006 but failed to indicate so during her medical evaluation in 2005-2006. In the first few years of her service, she developed some fainting episodes and anxiety which reportedly resolved for a few years. It is unclear when her anxiety and mood issues became clinically significant since the applicant admitted avoiding doctors for the fear of losing her flight status. Then, in early 2012, she was diagnosed with hypothyroidism and her psychiatric symptoms came to light. She returned back to the mental health clinic in June 2012. At first, her providers strongly believed her mood and anxiety symptoms were secondary to her medical condition (hypothyroidism) but as the treatment progressed there was recognition that her mental health illness was serious in its own right. Unfortunately, despite all of the outpatient interventions, the applicant failed to improve. The applicant’s deterioration of function led to residential treatment for nine weeks. The applicant made some progress during her residential treatment but continued to remain depressed and low functioning. It is presumed the only reason her command did not make any complaints about her work performance (at least not to clinicians) post hospitalization, was because her lack of any responsibility at work and fast approaching separation (only two months away). Upon review of the applicant’s clinical documentation, the Consultant infers she would not be able to work regular duty hours or carry out her normal assigned duties and responsibilities; or to frame it differently, her depression was unfitting at the time of her separation. This conclusion brings the Board to question whether the applicant was denied health care and was she supposed to undergo a MEB instead of being separated. The applicant’s claim about being denied medical care is very bold but not true; rather the applicant received exceptional level of care and in some instances her providers even exceeded what would be clinically necessary as evidenced by the 1600 pages of her medical records. To answer the question whether the applicant should have undergone a MEB is more complex. The applicant was completing her enlistment contract and was offered to extend. Around mid- 2012, when the applicant was ill and could not handle the stressors of work she regretted extending her contract and asked her command to let her separate at the original date which was denied. In fact, her commander expressed his concerns about her leaving the military at a time when she was battling medical problems. Following her hospitalization, her command and medical providers gave in to her request for separation and did not initiate an MEB. The applicant was not kicked to the curb with no medical care available to her. She was informed and knew well that she was eligible for DVA care and that she could apply for long-term disability through the DVA. The applicant wants the military to accept responsibility for her erroneous decision. However, it was the applicant who insisted on leaving the Air Force prematurely. Furthermore, the differences in the applicant’s psychiatric diagnosis between the different providers involved in her care at different times in her life are not all that uncommon. There are multiple reasons for it and can include inconsistent history provided, changes of the original symptoms, development of new symptoms and sometimes differences in professional opinions of the providers. This explains the long list of the psychiatric diagnosis carried by the applicant at this time. The Psychiatric Consultant cannot identify an error or injustice. Addressing the applicant’s implicit desire for a medical discharge, the military Disability Evaluation System (DES), established to maintain a fit and vital fighting force can, by law, under 10 U.S.C., only offer compensation for those service incurred diseases or injuries which specifically rendered a member unfit for continued active service and were the cause for career termination; and then only for the degree of impairment present at the “snap-shot” time of separation and not based on post-service progression of disease or injury. The DVA, under 38 U.S.C., can offer compensation for any medical condition with a nexus with military service, without regard to its proven impact upon a former service member’s fitness to serve. This is the reason why an individual may be released from service for one reason and later receive a compensation rating for one or more medical conditions that were not considered militarily unfitting or eligible for military disability processing at the time of military service. A complete copy of the BCMR Psychiatric Consultant’s evaluation is at Exhibit E. APPLICANT’S REVIEW OF ADDITIONAL AIR FORCE EVALUATION: A copy of the BCMR Psychiatric Consultant evaluation was forwarded to the applicant on 9 March 2016 for review and comment within 30 days (Exhibit F). As of this date, no response has been received by this office. 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. We took notice of the applicant’s complete submission in judging the merits of the case and do not find that it supports a determination that she was denied medical care or was improperly separated from active duty. The applicant contends she was discharged without a MEB while suffering from medical conditions; however, she has not provided substantial evidence showing her medical conditions were found unfitting and required processing through the DES, a prerequisite to a medical discharge. We acknowledge the applicant was diagnosed and treated for several medical conditions, to include hospitalization for her MDD and that she was placed in a Duties Not to Include Flying (DNIF) status during various periods of her service. However, in accordance with DODI 1332.38, Physical Disability Evaluation, the DES compensates disabilities when they cause or contribute to career termination. In this case, there is no evidence to substantiate the applicant’s medical conditions were the cause of her career termination. Instead it was the applicant who initiated the cancellation of her extension of enlistment and requested voluntary separation for completion of her enlistment even though her commander recommended she remain in service. While it is possible that the applicant would have been referred to a MEB if she had remained in service and if her medical conditions had worsened, the Board is unable to base a decision on conjecture about a possible future occurrence. Instead, the Board must consider the evidence based on the “snap-shot” of the evidence at the time. As the BCMR Medical Consultant pointed out, at the time of the discharge, the applicant’s condition had improved to the extent that she was not eligible for an MEB at the time of her discharge. Also, the BCMR Psychiatric Consultant advised that symptoms can vary over time. There is no basis for assuming the applicant would have deteriorated to the point of requiring MEB processing, even if she had not been separated as requested. Accordingly, we find no evidence of an error or injustice in the processing of the applicant’s voluntary separation. Furthermore, as pointed out by the BCMR Medical and Psychiatric Consultants, the DVA is empowered to award disability compensation for any medical condition with a nexus with military service and without regard to its proven or demonstrated impact upon a service member’s retainability. The applicant’s records reflect she is receiving care for her medical conditions from the DVA which is fitting. Therefore, we agree with the opinions and recommendations of the BCMR Medical and Psychiatric Consultants that the applicant has failed to sustain her burden of proof that she has been the victim of an error or injustice. In the absence of evidence to the contrary, we find no basis to recommend granting the requested relief. 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-2014-04334 in Executive Session on 5 April 2016 under the provisions of AFI 36-2603: , Panel Chair , Member , Member The following documentary evidence pertaining to AFBCMR Docket Number BC-2014-04334 was considered: Exhibit A. DD Form 149, dated 21 October 2014. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Memorandum, BCMR IMA Medical Consultant, dated 6 April 2015. Exhibit D. Letter, SAF/MRBR, dated 3 June 2015. Exhibit E. Memorandum, Psychiatric Advisor, 7 March 2016. Exhibit F. Letter, AFBCMR, dated 9 March 2016.