RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2012-03087 COUNSEL: HEARING DESIRED: YES _________________________________________________________________ APPLICANT REQUESTS THAT: 1. She be medically retired and placed on the Permanent Disability Retired List (PDRL) as of the date of her separation. 2. She be awarded a disability rating of 30 percent for her condition of chronic depression. 3. She receive retirement pay since her date of separation, offset by the separation pay she previously received as a result of her medical separation. 4. Her DD Form 214, Certificate of Release or Discharge from Active Duty, be changed to reflect a medical retirement. _________________________________________________________________ APPLICANT CONTENDS THAT: The Formal Physical Evaluation Board’s (FPEB) findings that her condition of chronic depression was “mild impairment” and evaluated at a ten percent disability rating, is unsupported by the clinical record. At the date of the FPEB, she met the criteria for a 30 percent disability and a medical retirement. 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 entered active duty on 21 November 1996. The applicant was referred to a Medical Evaluation Board (MEB) for recurring patterns of psychological and interpersonal difficulties in both military and civilian settings; and, her inability to achieve a satisfactory score on her fitness test in 2009. The MEB, conducted on 16 February 2010, identified chronic depression as the unfitting condition and recommended referral to the Informal Physical Evaluation Board (IPEB). The IPEB reviewed the applicant’s case on 25 May 2010, for Depression Associated with Anxiety and Obstructive Sleep Apnea (OSA) requiring use of a Continuous Positive Airway Pressure (CPAP) device. The IPEB recommended the applicant be returned to duty noting: “the commander notes her condition does not prevent her from serving in her primary AFSC in future assignments…her military impairment is mild with occupational/social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. The OSA has responded well to CPAP.” On 4 June 2010, the applicant non-concurred with the IPEB findings and requested a formal hearing with counsel, contending she was unfit for duty and should receive a 30 percent disability rating for her Depression with Anxiety and another 30 percent for migraine headaches for a combined disability rating of 50 percent and a permanent retirement. An addendum to the initial MEB mental health assessment was conducted on 2 August 2010. The assessment conducted by a clinical psychologist described the applicant as having “numerous stressors that have increased her depressive and anxious symptoms.” The reports described details of substantial mental health challenges resulting in inadequate work performance, impaired social functioning, and in-patient psychiatric hospitalization for suicidal ideation. At this time, the applicant’s depression and anxiety was assessed to result in a moderate degree of military and social/industrial impairment. The FPEB considered the applicant’s case on 10 August 2010 and recommended discharge with severance pay with a disability rating of ten percent for depression associated with anxiety. The FPEB considered her OSA as a condition that could be unfitting but was not currently compensable or ratable at the time of the board. The FPEB noted: “After a review of the medical records and the member’s testimony, the board does not find evidence of occupational & social impairment with occupational tasks, which would be necessary for a rating of 30%.” On 12 August 2010, the applicant concurred with the FPEB recommendation. She was honorably discharged with severance pay effective 24 December 2010 after serving 11 years, 1 month, and 4 days on active duty. _________________________________________________________________ AIR FORCE EVALUATION: AFPC/DPSD recommends denial. DPSD states the preponderance of evidence reflects that no error or injustice occurred during the applicant’s disability processing. The documentation submitted by the applicant, through her counsel, is the same medical documentation that was reviewed by both the IPEB and FPEB during her disability processing. She did not submit any new documentation for consideration. The complete DPSD evaluation is at Exhibit C. The BCMR Individual Mobilization Augmentee (IMA) Medical Advisor recommends approval and states, in part, that based on the evidence of the applicant’s mental health assessment at the time of her separation, a moderate level of military and social/industrial impairment is more likely than not an accurate description of her mental health. Based on the MEB mental health addendum in August 2010, there was sufficient progression in the applicant’s mental health signs and symptoms to warrant an increased service connection at the 30 percent rating. It remains unclear as to whether the addendum to the MEB was considered in the 10 percent final rating decision. However, the conclusion that a 30 percent service connection is more appropriate based on the mental health state at the time of separation in addition to the history of prior psychiatric interventions and the progressive nature of the applicant’s signs and symptoms of chronic depression. A complete copy of the BCMR IMA Medical Advisor’s evaluation is at Exhibit D. _________________________________________________________________ COUNSEL'S REVIEW OF THE EVALUATIONS: He and his client are in full accord with the BCMR IMA Medical Advisor’s opinion and urge the Board to accept the wisdom of his conclusion. _________________________________________________________________ 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 an injustice to warrant relief. After considering the totality of the evidence before us, we agree with the opinion and recommendation of the BCMR IMA Medical Advisor that the applicant’s condition of Chronic Depression was moderate, rather than mild, at the time of her separation, warranting a 30 percent disability rating. Therefore, in view of the foregoing and based on the applicant’s concurrence of the recommended relief, we recommend her records be corrected as 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 10 August 2010, the diagnosis in her case was Chronic Depression, with a moderate degree of military and social/industrial impairment, VASRD Code 9434, rated at 30 percent. b. Her name was placed on the Permanent Disability Retired List, effective 25 December 2010. c. Her election of Survivor Benefit Plan option(s) will be corrected in accordance with her expressed preferences and/or as otherwise provided for by law or the Code of Federal Regulations. _________________________________________________________________ The following members of the Board considered AFBCMR Docket Number BC-2012-03087 in Executive Session on 16 April 2013, 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 AFBCMR Docket Number BC-2012- 03087 was considered: Exhibit A. DD Form 149, dated 11 Jul 12, with atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Letter, AFPC/DPSD, dated 9 Oct 12. Exhibit D. Letter, BCMR IMA Medical Advsr, dated 10 Jan 13. Exhibit E. Letter, SAF/MRBC, dated 11 Jan 13. Exhibit F. Letter, Counsel, dated 25 Jan 13. Panel Chair