RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2009-01037 COUNSEL: HEARING DESIRED: YES ___________________________________________________________________ APPLICANT REQUESTS THAT: 1. She be medically retired with a 50 percent disability rating. 2. As an alternatative, she be continued on the Temporary Disability Retired List (TDRL). ___________________________________________________________________ APPLICANT CONTENDS THAT: In a 14 page brief, the applicant’s counsel makes the following key contentions: 1. The applicant requests to be medically retired under Chapter 61 of Title 10, with a disability rating of 50 percent for a Major Depressive Disorder and an Eating Disorder. She believes the opinion of the Formal Physical Evaluation Board (FPEB) that found her unfit for duty and recommended her for discharge with 10 percent severance pay to be arbitrary, capricious, and contrary to law and regulation. 2. The applicant was a four-year varsity athlete attending the Air Force Academy as a cadet who was very impressive; she was on the Dean’s List for two of seven semesters and on the Commandant’s List for four of seven semesters. Her lifelong dream was to become an astronaut; however, she began having troubles at the academy when she found out that she no longer qualified as a pilot, thus, questioning her self-worth and feeling like she had been abandoned which led to a cycle of hypomanic periods punctuated at varying intervals by plummeting depression, which led to serious suicide ideations. 3. According to her medical records, her eating disorder existed in a milder form during high school, but was aggravated by her major depressive disorder. 4. The applicant was formally evaluated by the Cadet Mental Health Clinic in late 2006 and was found to be suffering from Major Depressive Disorder, recurrent, moderate. The Medical Evaluation Board (MEB) found both her military and social impairment to be rated as “considerable.” Thus, the MEB placed her on the TDRL with a 30 percent disability rating. Noted by the applicant’s counsel, the doctor who signed off on the diagnosis and who is a psychiatrist did not conduct a single clinical interview with the applicant which is in direct contradiction of the governing regulation. 5. The academy involuntarily hospitalized her right after she was notified that the MEB found her unfit for duty and recommended her for discharge. Noting an oversight in processing her for discharge, the academy forgot that she was a senior cadet who was entitled to consideration to permit her to graduate if she were otherwise qualified. This oversight led to a tragic-comical series of mistakes until she was finally disenrolled from the academy on 26 Jan 07. 6. In 2008, she was reevaluated by an MEB at Dover AFB, DE. She was found to have Major Depressive Disorder, recurrent, severe, in full remission. The board’s assessment of the chances of recurrence was 90 percent. The board also concluded the occupation and social impairment due to “mild or transient symptoms” would reduce her work effectiveness “only during periods of significant stress.” The applicant appealed to a FPEB which voted 2-1 to sustain the decision of the reevaluating IPEB that convened on 31 Mar 08. 7. The FPEB found her medically disqualified for service, but only rated her disability at 10 percent. The decision did not mention the 90 percent risk of a relapse into suicidal despondency or the evaluation that rated her with a 50 percent disability rating for “considerable” and “significant” impairment. The physician on the FPEB recommended continuation on the TDRL stating the applicant still exhibited occupational and social instability as reflected in three different occupations, one prolonged travel overseas, and inability to complete school, all within the current TDRL period and while taking all her prescribed medications. The physician concluded by stating “she has not stabilized yet and that further time with her new psychiatry and psychology team should be granted in order to see if her three Axis I condition[s] have reached a maintenance therapy stage.” The applicant had several episodes of major depressive acts (see pages 3-5 of her counsel’s brief) after receiving the FPEB’s decision. 8. The Secretary of the Air Force Personnel Council (SAFPC) adopted an entirely different rationale for denying the applicant’s request which is likewise unsupportable based on an incomplete and incorrect diagnosis of a borderline personality disorder and is further an unacceptable supposition that the disabling symptomology is the product of the personality disorder and not the mood disorder. 9. Pages 9-13 of her counsel’s brief supports the reasons she should be medically retired. Her counsel believes the applicant was misdiagnosed by the Air Force and she should receive at least a 50 percent medical retirement for Occupational and Adjustment Disorder. 10. Substantial error has occurred in this case, as neither the FPEB nor SAFPC ever looked at the applicant’s medical records which reflect accredited professional diagnoses. 11. Further specific information can be found in her counsel’s brief at Exhibit A. In support of her request, applicant provides a copy of her counsel’s brief and a letter from her psychiatrist. Her complete submission, with attachments, is at Exhibit A. ___________________________________________________________________ STATEMENT OF FACTS: The applicant met an IPEB on 13 Nov 06 and was found unfit for duty and was placed on the TDRL with a 30 percent disability rating for Major Depressive Disorder, an Eating Disorder not otherwise specified and an Anxiety Disorder not otherwise specified. The IPEB recommended her for a 50 percent disability rating, but deducted 20 percent for an Eating Disorder, which resulted in a 30 percent compensable disability rating. However, after she was reevaluated, the IPEB found the applicant’s medical condition had improved and recommended she be removed from the TDRL and separated with a 10 percent disability rating with severance pay. The applicant appealed to the FPEB; however, on 8 Jul 08, the FPEB agreed with the IPEB findings and upheld the decision to separate her with a 10 percent disability rating. The applicant appealed the FPEB’s decision to SAFPC which also denied her appeal and recommended her for separation with severance pay. ___________________________________________________________________ AIR FORCE EVALUATION: In a four page evaluation, the BCMR Medical Consultant recommends placing her on the TDRL with a 30 percent disability rating effective the date of her removal from the TDRL, followed by a repeat psychiatric evaluation and adjudication through the Military Disability Evaluation System (MDES). The Medical Consultant recommends the applicant’s evaluation be concluded with a V-Axis diagnostic format and her level of impairment in civilian social and industrial or occupational adaptability be determined. The Medical Consultant finds this approach particularly valuable in correctly diagnosing the applicant’s medical condition and removing medications that may have seriously exacerbated her symptoms. If the applicant actually has a bipolar disorder and not a personality disorder, it would seem to be unfair to attribute her medical condition to one disorder that may overlap another disorder. The Medical Consultant’s complete evaluation is at Exhibit C. ___________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: The applicant’s counsel responded by concurring with the Medical Consultant’s recommendation to place her on the TDRL for further evaluation. Counsel’s complete rebuttal is at 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 error or injustice warranting a measure of relief. In this regard, when the applicant was initially placed on the TDRL her condition was diagnosed with a “moderate” major depressive disorder, recurrent, associated with anxiety disorder, not otherwise specified, which coincides with a 50% disability rating in accordance with the VASRD; however, her eating disorder was considered to be EPTS, thus, 20% disability rating was subtracted from her current rating giving her a 30% combined compensable disability rating. Upon reevaluation it was determined by the IPEB and FPEB that her condition was at the “severe” level; though, it was noted to be in full remission. Consequently, her overall rating was reduced to a 10% disability rating. However, as noted by the BCMR Medical Consultant, the applicant’s diagnosis of major depressive disorder stood from 2006 until it was challenged by a board certified psychiatrist in 2008. The disparity between the determination of the attending psychiatrist and the FPEB appears to be based upon the fact that the psychiatrist actually conducted clinical interviews and testing, resulting in a different diagnosis and treatment. Based on this, we are unable to ascertain whether or not the severity of the applicant’s condition was properly adjudicated during her reevaluation. It is our opinion that because of the differing medical opinions, the applicant should have remained on the TDRL for further observation and evaluation. Restoring the applicant’s TDRL status would enable the Air Force to more accurately reevaluate the diagnosis. Therefore, we recommend her records be corrected to the extent indicated below. 4. 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 APPLICANT be corrected to show that: a. On 6 Dec 06, she elected not to participate in the Survivor Benefit Program. b. She was not removed from the Temporary Disability Retirement List (TDRL) and discharged with severance pay on 23 Nov 08, but on that date was continued on the TDRL. c. A TDRL reevaluation be performed and the results of the re- evaluation be forwarded to the Air Force Board for Correction of Military Records at the earliest practicable date so that all necessary and appropriate actions may be completed. ______________________________________________________________ The following members of the Board considered AFBCMR Docket Number BC-2009-01037 in Executive Session on 24 Nov 09, under the provisions of AFI 36-2603: , Panel Chair , Member , Member All members voted to correct the records, as recommended. The following documentary evidence for Docket Number BC-2009-01037 was considered: Exhibit A. DD Form 149, dated 11 Mar 09, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Letter, BCMR Medical Consultant, dated 30 Jun 09. Exhibit D. Letter, SAF/MRBR, dated 2 Jul 09. Exhibit E. Letter, Applicant’s Counsel, dated 16 Sep 09. Panel Chair