RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2009-00062 COUNSEL: NONE HEARING DESIRED: YES ________________________________________________________________ APPLICANT REQUESTS THAT: His Line of Duty (LOD) Determination be changed to reflect a service connection in order to be eligible for a medical retirement. ________________________________________________________________ APPLICANT CONTENDS THAT: His medical condition was incorrectly diagnosed by the base medical staff which forced him off of active duty. The medical board found his condition was caused after his enlistment and during the time he was on active duty, and he should be eligible for a medical retirement. In support of his appeal, the applicant provides copies of numerous military and civilian medical documents; documentation from the medical board; numerous DD Forms 214, Certificate of Release or Discharge from Active Duty, and documentation pertaining to an inquiry to/from his Member of Congress. The applicant’s complete submission, with attachments, is at Exhibit A. ________________________________________________________________ STATEMENT OF FACTS: The applicant entered the Air Force Reserve in 1991 and served in the structural maintenance and security forces career fields. He continued his service and was eventually reassigned to the Retired Reserve awaiting pay at age 60, (DOB 27 June 1956 – age 53), in the grade of technical sergeant. During the period 1 October 2005 to 25 August 2006, the applicant while serving on extended active duty orders was medically evaluated for multiple complaints, including right facial weakness, headaches, and memory difficulties. He was eventually diagnosed with an Antiphospholipid Antibody Syndrome and on 25 August 2006 a LOD determination was completed with the finding that his condition existed prior to service (EPTS) thus making him ineligible for medical retirement. Due to the fact he was determined to be unfit for duty, his case was processed through the Air Force Disability Evaluation System (DES). Although the applicant did not contest the finding that he was not fit for duty, he did contest his condition was EPTS and in a letter dated 11 June 2007, the Air Force found him unfit for duty but agreed his condition did not exist EPTS. As the applicant had served 15 years in the Air Force (Active and Reserve components), he was offered the opportunity to retire in lieu of an administrative separation, and he applied for retirement on 24 October 2007 which became effective on 7 November 2007. ________________________________________________________________ AIR FORCE EVALUATION: AFRC/A1K recommends denial. Based on the comments from AFRC/SG (Command Surgeon General), they did not find a service connection with the applicant’s medical condition. Therefore, he was not eligible for disability compensation through the Disability Evaluation System (DES), to include a medical retirement. After reviewing the information provided by the applicant and the previous LOD determination, AFRC/SG upheld the previous finding stating the exact cause of the applicant’s condition is thought to be genetic although it may be multi-factorial. Individuals suffering from Antiphospholipid Antibody Syndrome frequently have a history of strokes, deep venous or superficial venous thrombosis, or thrombophlebitis. The applicant had a history of these symptoms predating his activation thus making EPTS the most appropriate determination. The EPTS determination is not based upon entry into the military, but rather entry into the period of active duty service during which the condition was identified. There was no evidence the nature of the applicant’s military service permanently changed his condition beyond the natural progression; thus, a finding of service aggravation could not be made. As a part of the review of the applicant’s LOD determination, the stipulations outlined in a 26 July 2006 SAF/MR Memorandum, Disability Determinations for Air Force Reserve and Air National Guard Members, were also reviewed by the HQ AFRC LOD Board and found not to apply. This policy states that Air Reserve Component (ARC) members who are serving on active duty orders for a period of 31 days or more, who have eight years of active duty service and incur a disabling condition such as the one suffered by the applicant, will have the condition deemed “in the line of duty.” A review of the applicant’s military duty history revealed he did not meet these requirements. The AFRC/A1K evaluation, with AFRC/SG attachment, is at Exhibit C. ________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: A complete copy of the Air Force evaluation, with attachment, was forwarded to the applicant on 20 March 2009, for review and comment, within 30 days. However, as of this date, no response has been received by this office. ________________________________________________________________ ADDITIONAL AIR FORCE EVALUATION: The BCMR Medical Consultant recommends granting partial relief by approving the applicant’s request to have his medical condition determined to be in the “line of duty” but with denial of a medical retirement. There is no Medical Evaluation Board (MEB) documentation contained in the documents provided. The applicant’s case was referred through the DES solely for a determination of fitness to serve as his condition was not considered service connected by HQ AFRC. The Informal Physical Evaluation Board (IPEB) found the applicant unfit for continued military service and determined his condition was EPTS; however, the Formal Physical Evaluation Board (FPEB) determined the applicant was unfit for duty but indicated his condition was “in the line of duty.” The FPEB offered the following rationale in its decision memorandum to HQ AFRC: The member requested the Formal Board reconsider a previous finding that his condition, Antiphospholipid Antibody Syndrome, existed prior to service. The member concurs with the IPEB finding that he was unfit. While the applicant received several conflicting LOD determinations, AFRC/SGP found the condition not in the line of duty – EPTS – LOD “Not Applicable (N/A).” However, the evidence is clear the applicant’s condition did not exist prior to service, as there were no evidence of the antibodies in his system prior to entering service. Therefore, the syndrome did not exist prior to service. The applicant was continuously on active duty orders from 1 October 2003 to 25 August 2006 and there is documentation he was found fit for world-wide duty and occupational duties during this period of time. Although he had a previous history of stroke in 2000, documentation indicates he was adequately treated and returned to full duty without restrictions. Whether or not his Antiphospholipid antibodies existed prior to service will never be known and it cannot be determined when the applicant acquired his Antiphospholipid antibodies. Thus, whether in retrospect the applicant had an exacerbation of this condition or this was a de novo finding, it occurred while he was on active duty orders for more than 31 days and was not the result of misconduct on his part nor did it occur during a period of unauthorized absence. Therefore, the BCMR Medical Consultant agrees with the impression of the FPEB and that this condition was incurred, or aggravated, while on active duty and would therefore be found “In the Line of Duty.” In reference to the recommended disposition of the applicant’s case, it must be made clear the issue that has resulted in his career termination is not due to a particular functional deficit, but rather due to the risks attendant with his lifelong requirement for anticoagulants which military medical officials agree is incompatible with the rigors of military service and which poses an unreasonable life and mission risk. With reference to the disability rating determination in effect at the time of the applicant’s separation, (1) a minimum rating of 30 percent is given if there have been episodes of thrombophlebitis in the past year (2) a 0 percent rating is given if there have been no episodes of thrombophlebitis in the past year and (3) any higher ratings are based on residuals to emboli or thrombophlebitis. There is documented evidence the applicant recovered from his stroke which occurred in 2000 and although he did experience a set of symptoms referred to as a transient ischemic attack (TIA) in 2004, there were no permanent residuals at the time of separation upon which to apply any additional or higher disability ratings. Therefore, there is no objective basis upon which to justify a higher disability that qualifies for a medical retirement thus making his acceptance of the service connected severance pay disposition a less favorable option than his present assignment to the Retired Reserve awaiting pay at age 60. The BCMR Medical Consultant’s evaluation is at Exhibit E. ________________________________________________________________ APPLICANT'S REVIEW OF THE ADDITIONAL AIR FORCE EVALUATION: A complete copy of the BCMR Medical Consultant’s evaluation was forwarded to the applicant on 17 August 2009, for review and comment, within 30 days. However, as of this date, no response has been received by this office (Exhibit F). ________________________________________________________________ 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 change in the applicant’s LOD determination. Based on the available evidence of record and that provided by the applicant, we believe some relief is warranted. We note the comments from the Air Force Reserve office of primary responsibility (OPR); nonetheless, the BCMR Medical Consultant notes and the record reflect conflicting LOD determinations. Therefore, based on the totality of the facts and circumstances of the applicant’s case; we agree with the opinion and recommendation of the BCMR Medical Consultant, and recommend the applicant’s records be corrected to reflect his condition, Antiphospholipid Antibody Syndrome, was in the Line of Duty. In respect to the applicant’s request for a medical retirement; the applicant’s case has undergone an exhaustive review by the Air Force Reserve OPR and the BCMR Medical Consultant and we are in agreement with their assessment that no basis exists to justify a medical retirement. Therefore, we recommend the applicant’s 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 issue(s) 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 his medical diagnosis, Antiphospholipid Antibody Syndrome, was determined to be in the Line of Duty. ________________________________________________________________ The following members of the Board considered AFBCMR Docket Number BC-2009-00062 in Executive Session on 11 March 2010, under the provisions of AFI 36-2603: All members voted to correct the records as recommended. The following documentary evidence was considered: Exhibit A. DD Form 149, dated 22 Dec 08, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Letter, AFRC/A1K, dated 13 Mar 09, w/atch. Exhibit D. Letter, SAF/MRBR, dated 20 Mar 09. Exhibit E. Letter, BCMR Medical Consultant, dated 7 Aug 09. Exhibit F. Letter, SAF/MRBR, dated 17 Aug 09. Panel Chair