RECORD OF PROCEEDINGS

IN THE MATTER OF:	DOCKET NUMBER: BC-2021-03008

xxxxxxxxxxxxx	COUNSEL: NONE

	HEARING REQUESTED: YES	

APPLICANT’S REQUEST

Her Crohn’s disease be found in the line of duty (ILOD).

APPLICANT’S CONTENTIONS

She was first diagnosed with Crohn’s disease while on active duty orders.  Her gastroenterologist confirmed this was not a pre-existing condition.  By definition, in line of duty is applied to “Air Reserve Component (ARC) members who die, incur, or aggravate an illness, injury or disease while on published orders for any period of time.” At a minimum, this disease was severely aggravated while on active duty orders. The official diagnosis was made on 31 Oct 19.

In support of her request, the applicant provides a letter from the Chief, Gastroenterology dated 18 May 21, stating he has been treating her since Oct 19 for small bowel Crohn’s disease. Her initial presentation was to the emergency department in early October. The Chief Gastroenterology states it is nearly impossible to say if the applicant had Crohn’s prior to that time and her symptoms previous to the emergency department visit were more consistent with Irritable Bowel Syndrome (IBS). She had alternating diarrhea and constipation with abdominal pain that was relieved by bowel movement. This is, by Rome IV criteria, diagnostic of IBS – alternating or mixed type. Despite this, if her symptoms prior to Oct 19 were from Crohn’s disease, her symptoms have clearly worsened or been exacerbated during her time in the Air Force.

The applicant also submits copies of her line of duty determinations, appeals, medical records and various other documents associated with her request. The applicant also indicated that copies of her orders were attached; however, they were not.

The applicant’s complete submission is at Exhibit A.

STATEMENT OF FACTS

The applicant is a former Air National Guard (ANG) staff sergeant (E-5).

Dated 8 Jul 20, AF Form 348, Line of Duty Determination, provided by the applicant, indicates she was diagnosed with Crohn’s disease of the small intestine without complications.  The form indicates in block 11 and 14, the disease did not exist prior to service.  On 10 Jul 20 and 29 Sep 20, the commander and appointing authority signed the form recommending an in line of duty (ILOD) determination.  However, on 19 Oct 20, the approval authority non-concurred with the previous ILOD recommendation and determined it was not in the line of duty (NILOD)-not due to own misconduct.

On 31 Jan 21, DD Form 214, Certificate of Release or Discharge from Active Duty, reflects the applicant was honorably discharged in the grade of E-5 after serving one year, seven months, and three days of active duty.  She was discharged, with a narrative reason for separation “Completion of Active Duty.”

On 30 Apr 21, two Notification of Determination of NILOD Memorandums, provided by the applicant, indicate her diagnosis of Crohn’s Disease did not occur ILOD.  Both memorandums were digitally signed by the commander on 16 Oct 20.  On 19 May 21, the applicant acknowledged receipt and checked the box indicating she would submit new and significant evidence to the appointing authority within 45 days.  On 21 May 21, the applicant acknowledged receipt of the second memorandum by checking the box stating she would submit an appeal to the appellate authority in writing within 30 days.

On 25 May 21, according to a memorandum provided by the applicant, she prepared an appeal of the NILOD determination addressed to the appellate authority.  However, there is no evidence of a response.

On 28 May 21, according to a memorandum provided by the applicant, she drafted an appeal of the NILOD determination to the appellate authority; however, the form is not signed.

On 12 Aug 21, NGB Form 22, National Guard Bureau Report of Separation and Record of Service, reflects the applicant was honorably discharged from the ANG after serving seven years of total service for pay.  She was discharged, with a narrative reason for separation “Expiration of Enlistment.”

For more information, see the excerpt of the applicant’s record at Exhibit B and the advisories at Exhibits C and D.

AIR FORCE EVALUATION

NGB/SGPS recommends upholding the applicant’s NILOD determination, not due to misconduct, EPTS, Not Service Aggravated determination for the diagnosis of Crohn’s disease.  The applicant was diagnosed with Crohn’s disease following her 31 Oct 19 Gastroenterology appointment.  However, on her Standard Form 600, Chronological Record of Medical Care, a clinical note dated 24 Oct 19 stated she reported that for years she has had alternating diarrhea and constipation, about 50 percent of the time for each, rarely having normal stools and rare intermittent pain until about three weeks ago.  She then developed more severe pain in the right lower quadrant and epigastrium which she described initially as indigestion.  Her diagnosis of Crohn’s disease may have been confirmed while on active duty orders, but her condition clearly existed prior to service (EPTS), and, in accordance with DAFI 36-2910, Line of Duty (LOD) Determination, Medical Continuation (MEDCON), and Incapacitation (INCAP) Pay, was not worsened over and above natural progression due to trauma or the nature of military service.  NGB/SG acknowledges the memorandum in the case file from her gastroenterologist stating that her symptoms have clearly worsened or been exacerbated during her time in the Air Force.  While this may be the case, her worsening was not due to trauma or the nature of military service but rather consistent with natural progression of this chronic progressive disease.  

The complete advisory opinion is at Exhibit C

NGB/A1PS recommends denying the application finding no evidence of an error or injustice.  According to her appeal case file, her case was returned without action. The Chief, Gastroenterology memo dated 18 May 21 clearly states “while it is nearly impossible to say if she had Crohn’s prior to that time, her symptoms previous to that emergency department visit were more consistent with Irritable Bowel Syndrome (IBS).”  This LOD determination is not for IBS it is for the diagnosis of Crohn’s disease while the member was on three months of active duty orders. The appeal was not submitted within 30 days of the notification of the NILOD determination from the original case. According to DAFI 36-2910 paragraph 3.2.5.2, the appellant must provide the appeal in writing for any reason to the LOD Program Manager. The written appeal must be submitted within 30 days of receipt of the LOD determination. The appeal case was canceled on 9 Jan 22.

Additionally, the Notification of Determination of NILOD dated 30 Apr 21 has conflicting dates.  On 16 Oct 20, it was digitally signed by commander; however, the applicant signs to submit new and significant evidence within 45 Days from 30 Oct 21.

The complete advisory opinion is at Exhibit D.

APPLICANT’S REVIEW OF AIR FORCE EVALUATION

The Board sent a copy of the advisory opinion to the applicant on 25 Jul 22 for comment (Exhibit E), and the applicant replied on 29 Jul 22.  In her response, the applicant contends she had alternating issues with IBS in the past which was not connected to Crohn’s disease.  This is a new medical issue that was first diagnosed when she was on active duty orders.  This is not a progression of the disease; it is new and she is in the early stages of Crohn’s disease.  Her IBS was managed when she changed her diet and added strong probiotics.  One of the triggers of Crohn’s disease is stress which she experienced while on active duty orders.  Her guard unit refused to extend her enlistment to fix this issue and she is now trying to fix it after being separated from the service.  Crohn’s disease is not the same as IBS as she is currently suffering from both.

The applicant’s complete response is at Exhibit F.

FINDINGS AND CONCLUSION

1.  The application was timely filed.

2.  The applicant exhausted all available non-judicial relief before applying to the Board.

3.  After reviewing all Exhibits, the Board concludes the applicant is not the victim of an error or injustice.  The Board concurs with the rationale and recommendations of NGB/SGPS and NGB/A1PS and finds a preponderance of the evidence does not substantiate the applicant’s contentions.  Specifically, the Board did not find her Crohn’s disease incurred in the line of duty; the applicant appears to have a long history with this disease that EPTS and was not worsened over and above natural progression due to trauma or the nature of her military service.  Therefore, the Board recommends against correcting the applicant’s records.

RECOMMENDATION

The Board recommends informing the applicant the evidence did not demonstrate material error or injustice, and the Board will reconsider the application only upon receipt of relevant evidence not already presented.

CERTIFICATION

The following quorum of the Board, as defined in Air Force Instruction (AFI) 36-2603, Air Force Board for Correction of Military Records (AFBCMR), paragraph 1.5, considered Docket Number BC-2021-03008 in Executive Session on 18 Aug 22:

, Panel Chair
, Panel Member
, Panel Member

All members voted against correcting the record.  The panel considered the following:

Exhibit A:	Application, DD Form 149, w/atchs, dated 7 Oct 21.
Exhibit B:	Documentary evidence, including relevant excerpts from official records.
Exhibit C:	Advisory Opinion, NGB/SG, dated 14 Jun 22.
Exhibit D:	Advisory Opinion, NGB/A1PS, w/atch, dated 21 Jul 22.
Exhibit E:	Notification of Advisory, SAF/MRBC to Applicant, dated 25 Jul 22.
Exhibit F:	Applicant’s Response, dated 29 Jul 22.

Taken together with all Exhibits, this document constitutes the true and complete Record of Proceedings, as required by AFI 36-2603, paragraph 4.11.9.