RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2012-04038 COUNSEL: NONE HEARING DESIRED: NO ________________________________________________________________ APPLICANT REQUESTS THAT: Obstructive Sleep Apnea (OSA) be added to his military record so he would qualify for a medical retirement. _______________________________________________________________ APPLICANT CONTENDS THAT: He has medical expert evidence that proves OSA is a direct correlation to atrial fibrillation, which when combined with the 10 percent rating he received for this condition would result in a medical retirement. His discharge should have been based on his OSA and atrial fibrillation, resulting in a disability rating of 60 percent, which exceeds the 30 percent required for a medical retirement. The applicant's complete submission, with attachments, is at Exhibit A. _______________________________________________________________ STATEMENT OF FACTS: On 23 Jan 2002, the applicant entered the Regular Air Force. On 3 Sep 2009, the applicant was honorably discharged. His narrative reason for separation is “DISABILITY SEVERANCE PAY.” He served 7 years, 7 months and 11 days of active service. The remaining relevant facts pertaining to this application are contained in the letters prepared by the appropriate offices of the Air Force at Exhibits C and D. Accordingly, there is no need to recite these facts in this Record of Proceedings. _______________________________________________________________ AIR FORCE EVALUATION: AFPC/DPPD recommends denial. DPPD states that the preponderance of evidence reflects that no error or injustice occurred during the disability process. The member had a medical evaluation board on 20 Nov 2008, for atrial fibrillation. On 19 Feb 2009, the Informal Physical Evaluation Board (IPEB) reviewed the case and recommended discharge with severance pay (DWSP) with a disability rating of 10 percent. The member non-concurred on 5 Mar 2009 and requested a formal hearing with counsel. On 13 Apr 2009 the Formal Physical Evaluation Board (FPEB) reviewed the case with medical records and also recommended DWSP for atrial fibrillation requiring chronic Coumadin usage with a 10 percent disability rating. The FPEB did list his severe OSA requiring a Continuous Positive Airway Pressure (CPAP) machine as an unfitting condition, but not currently compensable or ratable. On 13 Apr 2009, the applicant non-concurred and requested his case be sent to the Secretary to the Air Force Personnel Council (SAFPC) for review. On 21 May 2009, the SAFPC directed the applicant be DWSP with a disability rating of 10 percent. The complete DPPD evaluation is at Exhibit C. The BCMR Medical Consultant recommends denial. The Medical Consultant states that it could not be established that the applicant was unable to reasonably perform his military duties as a result of OSA. His commander's letter indicates he did not demonstrate an impediment to performing either in-garrison or CONUS duties due to his medical condition(s). Moreover, it appears that only after initiation of the MEB for atrial fibrillation, that OSA was introduced as an additional unfitting and compensable medical condition. Under paragraph E3.P3.3.3, Adequate Performance Until Referral, "If the evidence establishes that the Service member adequately performed his or her duties until the time the Service member was referred for physical evaluation, the member may be considered fit for duty even though medical evidence indicates questionable physical ability to continue to perform duty." Further, under paragraph E3.P3.3.4, Cause and Effect Relationship, "Regardless of the presence of illness or injury, inadequate performance of duty, by itself, shall not be considered as evidence of unfitness due to physical disability unless it is established that there is a cause and effect relationship between the two factors. Based upon the supplied Service medical evidence, the Medical Consultant found no cause and effect relationship between the applicant's treated and controlled OSA, and the termination of his military service. Although the applicant has supplied an article and two letters from medical experts which establish OSA as a possible risk factor for Atrial Fibrillation, the reviewer finds this risk to be associated with the untreated or non-compliant OSA patient. Thus, the fact that the applicant requires a CPAP to prevent periods of apnea and the resultant reduced oxygen levels, the use of the device does not automatically infer unfitness for continued service. Undeniably, the preponderance of evidence suggests that it is the applicant's requirement for sustained use of an anticoagulant, and the risk for hemorrhage under acute trauma or thromboembolism if non-compliant, and not his OSA, that posed the signature impediment to his retainability and resulted in his release from military service. The complete BCMR Medical Consultant’s evaluation is at Exhibit D. _______________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: On 4 Feb 2013, copies of the Air Force and BCMR Medical Consultant’s evaluations were forwarded to the applicant for review and comment within 30 days. As of this date, this office has received no response (Exhibit E). _______________________________________________________________ THE BOARD CONCLUDES THAT: 1. The applicant has exhausted all remedies provided by existing law or regulations. 2. The application was not timely filed; however, it is in the interest of justice to excuse the failure to timely file. 3. Insufficient relevant evidence has been presented to demonstrate the existence of error or injustice. We took notice of the applicant's complete submission in judging the merits of the case; however, we agree with the opinions and recommendations of AFPC/DPDD and the BCMR Medical Consultant and adopt their rationale as the basis for our conclusion the applicant has not been the victim of an error or injustice. Therefore, in the absence of evidence to the contrary, we find no basis to recommend granting the relief sought in this application. _______________________________________________________________ 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 this application in Executive Session on 30 May 2013, under the provisions of AFI 36-2603: , Panel Chair , Member , Member The following documentary evidence was considered in AFBCMR BC- 2012-04038: Exhibit A. DD Form 149, dated 27 Aug 2012, w/atchs. Exhibit B. Applicant’s Master Personnel Records. Exhibit C. Letter, AFPC/DPPD, dated 4 Oct 2012. Exhibit D. Letter, BCMR Medical Consultant, dated 3 Feb 2013. Exhibit E. Letter, SAF/MRBC, dated 4 Feb 2013. Panel Chair