RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2011-04826 COUNSEL: NONE HEARING DESIRED: YES _________________________________________________________________ APPLICANT REQUESTS THAT: Her condition of acute Cytomegalovirus (CMV), which she had during the fall of 2010 though the spring of 2011, be acknowledged as a confounding factor in determining any psychiatric diagnoses. The applicant amended her request by correspondence, dated 16 February 2012 and requests her DD Form 356, Findings and Recommended Disposition of USAF Physical Evaluation Board be amended as follows: 1. The diagnosis of “Nonspecific Brain MRI Abnormalities” be added with a byline that indicates that such abnormalities were “not known or considered at the time of psychological evaluation,” with an appropriate Category II rating, Department of Veteran Affairs (DVA) diagnostic code of ICD-9 and be found in the line of duty. 2. The diagnosis of “Nonspecific Brain MRI Abnormalities” be added with a by-line that states “Organic Medical disorder not known or considered at the time of psychological evaluation.” _________________________________________________________________ APPLICANT CONTENDS THAT: 1. The Physical Evaluation Board (PEB) recommended her for retirement for her condition of depression; however the PEB, along with all of her treating physicians and psychiatrists were unaware she had the CMV infection. According to “good psychiatric standards of care,” a psychiatric diagnosis should not be made without first ensuring there is not an organic medical diagnosis to explain the symptoms. She sustained brain injury and financial and social loss due to this failure to diagnose. 2. The CMV viral infection must have been present in her body for at least four weeks in order to produce the acute antibody (IgM) response seen in her November 2010 laboratory results. It was negligence in the coordination of her care that led to the misdiagnosis of depression rather than CMV as the reason for her fatigue, pain, and supposed abnormal affect. In support of her appeal, the applicant provides copies of a physician’s statements, CMV information sheets, medical records, an excerpt of a phone bill, a Delaware family court custody petition, and a Letter of Counseling. The applicant’s complete submission, with attachments, is at Exhibit A. _________________________________________________________________ STATEMENT OF FACTS: The applicant is a former member of the Regular Air Force who served in the grade of major (O-4). On 15 January 2010, the Medical Evaluation Board (MEB) diagnosed the applicant with Major Depressive Disorder (MDD), Recurrent, Severe with Psychotic Features; and, referred her case to the Informal Physical Evaluation Board (IPEB). On 4 May 2010, the IPEB diagnosed the applicant with a Category I Condition of MDD Recurrent, Severe with Psychotic Features, which was unfitting, compensable and ratable; a Category II Condition of Post Traumatic Stress Disorder (PTSD), that could be unfitting, but which was not compensable or ratable; and a Category III Condition of Paranoid Personality Disorder that was not separately unfitting and not compensable or ratable. The IPEB found her conditions were permanent, incurred in the line of duty while entitled to receive basic pay; and, recommended she be permanently retired with a 30 percent compensable disability rating. On 10 May 2010, the applicant disagreed with the IPEB’s findings and recommendation, and requested a formal hearing of her case. On 1 July 2010, the Formal Physical Evaluation Board (FPEB) agreed with the IPEB findings and recommendations. On 19 July 2010, the applicant disagreed with the FPEB’s findings and recommendation and, requested her case be referred to the Secretary of the Air Force Personnel Council (SAFPC) for final review. On 4 April 2011, SAFPC agreed with the previous board’s findings and recommendations to permanently retire the applicant with a disability rating of 30 percent. Effective 23 June 2011, the applicant was relieved from active duty and retired effective 24 June 2011 in the grade of major, in accordance with Air Force Instruction 36-3212, with a compensable percentage for physical disability of 30 percent. The applicant served 10 years, 10 months and 25 days on active duty. _________________________________________________________________ AIR FORCE EVALUATION: AFPC/DPSD (USAF Physical Disability Division) recommends denial. DPSD states that a positive diagnosis of CMV antibody alone does not definitely prove a causal link between CMV and the depressive symptoms which rendered the applicant unfit for duty. Further, regardless of the underlying cause of her condition, the applicant was found unfit based on the functional impact of depression on her ability for continued military service. The diagnosis of depression does not rely on or require tests to identify specific causal factors. This diagnosis was based on existing symptoms and depressive mood which had been present for years and had responded to standard treatment of anti-depressant medications. The complete DPSD evaluation is at Exhibit C. _________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: Per the Air Force board and her current and former treating and forensic psychiatrists, she does not have a diagnosis of any psychotic or delusional disorder. She suffered from depression, from which she has miraculously recovered. The three-member physician and psychiatrist-led PEB made a careful decision about her condition of Major Depression, which included the decision to remove and not include any diagnosis of delusional disorder as criteria of the Diagnostic and Statistical Manual of Mental Disorders IV. Those three physicians were not given the opportunity to make their decision in light of the radiological abnormalities. The Air Force office of primary responsibility and other lay persons need to recognize this. She continues to face professional career and legal (civil and custody) hardships related to the diagnoses which the medical board already struck from her record and, the depression which she has recovered from thanks to the excellent care from the DVA. She hopes the AFBCMR will be as careful and thorough as the previous board and DVA professionals. The applicant’s complete rebuttal, with attachments, is at 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. Insufficient relevant evidence has been presented to demonstrate the existence of an error or an injustice. After a thorough review of the evidence of record, we see no evidence of error or impropriety in the Disability Evaluation System process and are not persuaded by the applicant’s contentions, that she has been the victim of an injustice. It appears the applicant’s medical case was properly evaluated under the appropriate Air Force regulations which implement the law. In our opinion, the Air Force office or primary responsibility has adequately addressed these allegations. Therefore, we agree with the opinion and recommendation of the Air Force office of primary responsibility and adopt its rationale as the basis for our conclusion that the applicant has not been the victim of an error or injustice. Accordingly, in the absence of evidence to the contrary, we find no basis to recommend granting the relief sought in this application. 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 DETERMINES THAT: The applicant be notified that the evidence presented did not demonstrate the existence of material error or injustice; that the application was denied without a personal appearance; and that 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-2011-04826 in Executive Session on 9 August 2012, under the provisions of AFI 36-2603: , Panel Chair , Member , Member The following documentary evidence was considered in connection with AFBCMR Docket Number BC-2011-04826: Exhibit A. DD Form 149, dated 8 Dec 11, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Letter, AFPC/DPSD, dated 20 Jan 12. Exhibit D. Letter, SAF/MRBR, dated 10 Feb 12. Exhibit E. Letter, Applicant, dated 16 Feb 12, w/atchs. Exhibit F. Letter, Applicant, dated 5 Mar 12, w/atchs. Panel Chair