RECORD OF PROCEEDINGS
         AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:      DOCKET NUMBER:  95-02908
            INDEX CODE:  108.04

            COUNSEL:  NONE

            HEARING DESIRED:  NO


_________________________________________________________________

APPLICANT REQUESTS THAT:

His voluntary retirement  for  length  of  service  be  changed  to  a
physical disability retirement.
_________________________________________________________________

APPLICANT CONTENDS THAT:

The first time he learned that there might be a problem with his heart
was in July 1990.  He became ill  with  bronchitis  and  went  to  the
clinic at Kelly AFB.  As part of the tests to diagnose the bronchitis,
he was given a chest x-ray.  At that time, the radiologist, Dr. R.  S.
R---, saw that his heart was enlarged on the x-ray and  “suggested”  a
follow-up.  Follow-up/EKGs were accomplished on 31 July 1990, 3 August
1990, 9 August 1990 and 14 August 1990.  All five  EKGs  showed  “left
ventricular hypertrophy” and “abnormal ECG.”  Even though  he  had  an
abnormal  chest  x-ray   that   showed   cardiomegaly   as   well   as
electrocardiographic abnormalities, he was told  by  Dr.  S.  M---  at
Kelly AFB that this was due to “increased muscle mass” because of  his
“athletic heart.”  Additional tests, particularly  an  echocardiogram,
that would have diagnosed his heart was  enlarged  because  of  damage
from a virus were not done.

Had the proper follow-up test been done by the doctor at Kelly AFB  in
July 1990, his  dilated  idiopathic  cardiomyopathy  would  have  been
diagnosed while he was on active duty and he would have been medically
retired.  His medical condition was not correctly diagnosed  until  10
months after his retirement, 25 September  1992,  when  he  went  into
ventricular tachycardia.

His retirement physical on  15  August  1991  consisted  of  answering
health questions.  He was denied a discharge physical because  he  had
received a physical within the year and another  physical  was  deemed
unnecessary.

In support of his request, the applicant submits a personal statement,
a letter from his cardiologist  at  Brooke  Army  Medical  Center  and
copies of medical records (Exhibit A).
_________________________________________________________________
STATEMENT OF FACTS:

On 24 April 1970, the applicant was  appointed  a  second  lieutenant,
Reserve of the Air Force, and  was  voluntarily  ordered  to  extended
active duty.  He was integrated into the Regular Air Force on 19  July
1985 and was progressively promoted to the grade of  major,  effective
and with a date of rank of 1 June 1985.

The following is a resume of his OER/OPR  ratings  subsequent  to  his
promotion to the grade of major.

            Period Ending    Evaluation

                  1 Oct 85   1-1-1
                 25 Jul 86   1-0-1
                 25 Jul 87   1-1-1
                 30 Apr 88   1-0-1
                 30 Apr 89   Meets Standards (MS)
                 30 Apr 90     MS
                 30 Apr 91     MS

Entries in applicant’s medical records  indicates  that,  on  13  July
1990, he was seen at the Acute Care Services, USAF Clinic, Kelly  AFB,
for  bronchitis.   On  31  July  1990,  applicant  received  follow-up
cardiomegaly - Impression: normal chest; and, on 9 August 1990, follow-
up on EKG/chest x-ray.  Applicant’s 13 September  1990  periodic  non-
flying examination qualified him for worldwide service.

On 17 June 1991, the applicant applied for voluntary retirement,  with
the effective date of 1 January 1992.

On 22 July 1991, at the Flight  Medicine  Clinic,  Kelly  AFB,  Texas,
applicant received Part One - “short retirement” physical examination.
 On the Report of Medical History (Standard Form 93), with the 22 July
1991 date of examination,  the  applicant  indicated  his  health  was
“excellent.”  Part Two of the retirement physical was conducted on  15
August 1991 at the Primary Care Clinic, Kelly AFB.

On 31 December 1991, the applicant was relieved from  active  duty  in
the grade of major and retired on 1 January 1992 under the  provisions
of AFR 35-7 (mandatory retirement on established date of maximum years
of service).  He had completed a total of 21 years  11  months  and  3
days of active service for retirement.

The Department of Veteran’s Administration (DVA) records reflect  that
the applicant was  diagnosed  on  25  November  1992  with  idiopathic
dilated  cardiomyopathy,   with   secondary   paroxysmal   ventricular
tachycardia, which led to the pacemaker  implantation  on  2  December
1992.  The DVA granted the applicant a disability rating of 10% from 1
January 1992; 100% from 25 November 1992; 100% from 1  February  1993;
and 30% from 1 February 1994.
_________________________________________________________________

AIR FORCE EVALUATION:

The AFBCMR Medical Consultant, stated that the applicant is requesting
medical retirement because of  the  diagnosis  of  idiopathic  dilated
cardiomyopathy (a condition of  the  heart  apparently  due  to  viral
infection, whereby the  heart  muscle  becomes  too  thin  to  sustain
forceful contractions or pumping action, treated by heart  replacement
when symptoms become severe and medications no longer are effective).

The Medical Consultant stated that review of medical records does  not
disclose any evidence to support correction of records from retirement
for length of service to disability  retirement.   The  applicant  has
provided no documentation that  he  was  unfit  at  the  time  of  his
retirement.  The medical records show no indication that the applicant
was unable to perform any portion of  his  duty.   The  Department  of
Veterans Affairs (DVA) does not begin providing medical disability  to
the applicant until December 1992, while the  diagnosis  was  made  in
September  1992.   Applicant  claims  that  he  was  not  followed  or
evaluated properly prior to discharge when there had been an  abnormal
EKG and an abnormal chest x-ray.   The  EKG  was  abnormal  indicating
findings compatible with an athletes heart or heart disease.  Since he
was an avid exerciser, the former condition was suspected.  A chest x-
ray was done as a follow-up to the impression (possible diagnosis)  of
enlarged heart (cardiomegaly).  That x-ray was done in July  1990  and
cardiomegaly was not found.  Information regarding  the  EKG  and  the
chest x-ray are moot since the determination of fitness does not  rely
on EKGs and x-rays, but whether the applicant was able to perform  his
duty satisfactorily.  Also, there  were  no  AF  Form  422s,  Physical
Profile  Serial  Reports,  restricting  applicant’s  duty  because  of
symptoms which  might  relate  to  heart  disease.   Evidence  of  the
available medical records from applicant’s active duty years  did  not
indicate that he had any physical or mental defects which  would  have
warranted consideration under the provisions  of  AFR  35-4  (Physical
Evaluation for Retention, Retirement and Separation).  Retirement  for
length  of  service  is  proper  and  in  accordance  with  Air  Force
directives which implement the law.  It is the opinion of the  Medical
Consultant that no change in the applicant’s records is warranted  and
the application should be denied (Exhibit C).

The Physical Disability Division, HQ AFPC/DPPD, stated that nearly two
years after his retirement, the applicant had cardiac incidents  which
led to the implantation of a pacemaker.  The  Department  of  Veterans
Affairs (DVA) determined  his  condition  was  service  connected  and
awarded him disability compensation.

DPPD  indicated  that  eligibility  for   disability   processing   is
established by a Medical Evaluation Board (MEB) when that board  finds
that the member may not be qualified for continued  military  service.
The decision to conduct an  MEB  is  made  by  the  medical  treatment
facility providing health care to the member.  The applicant has never
been referred to or considered by  the  Air  Force  Disability  System
under the provisions of AFI 36-3212.  DPPD noted  that  the  applicant
did have medical conditions requiring treatment while on active  duty;
however, none of  them  were  of  the  degree  to  warrant  disability
processing.  Although the possibility of an enlarged heart muscle  was
entertained, it was not confirmed by other medical testing.  There  is
no evidence in the medical or personnel record of a medical  condition
of sufficient severity to impact or otherwise  limit  the  applicant’s
duty performance.  DPPD recommended that the  applicant’s  request  be
denied (Exhibit D).
_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

The applicant reviewed the advisory  opinions  and  indicated  that  a
letter from  the  DVA,  dated  25  August  1993,  shows  that  his  VA
disability began effective 1 February 1992, with his first  retirement
check.  His medical records show that he was not  only  unfit  at  the
time of his retirement, but that he was put at risk by the  Air  Force
medical system.  There is ample evidence in his medical records  of  a
medical condition of sufficient severity to have retired him.  When he
retired from active duty, his medical records  were  reviewed  and  an
abbreviated physical was given in lieu of a complete physical.  It was
explained to him that a physical had been given in the last  year  and
another one was not required even though he requested one.   A  simple
test would have made the difference in determining whether  his  heart
was healthy or diseased—and also whether or not  he  would  have  been
medically retired.  It was not two years after his retirement that  he
had cardiac incidents which led to the implantation  of  a  pacemaker.
He retired 31 December  1991  and  less  than  ten  months  later,  on
25 September 1992, he  had  the  cardiac  incident  that  led  to  the
implantation of a pacemaker on 2 December 1992, which was less than  a
year after his retirement.  The severity of his condition,  which  was
of the degree to warrant disability processing, cannot be denied  just
because it was misdiagnosed.  After the  possibility  of  an  enlarged
heart muscle was shown, several follow-up  EKGs  confirmed  a  problem
with his heart.  However, the  Air  Force  failed  to  do  appropriate
testing to show the severity of the problem.  If the proper  diagnosis
had been made, his active duty service would have been  curtailed  and
he would have been medically retired (Exhibit F).
_________________________________________________________________

ADDITIONAL AIR FORCE EVALUATION:

Pursuant to the Board’s request, the additional advisory  opinion  was
provided in response to the Board’s specific questions.

The AFBCMR  Medical  Consultant  stated  that  AFI  48-123  stipulates
hypertensive cardiovascular disease and hypertensive vascular  disease
as  disqualifying  for  continued  military  service  (if)  prosthetic
devices are attached to or implanted  for  cardiovascular  therapeutic
purposes, regardless of result.  The Medical Consultant indicated that
had a pacemaker been implanted while applicant was on active duty,  he
would not have been qualified  for  worldwide  duty.   It  is  common,
however, to waive  this  condition  with  assignment  code  limitation
depending  on  the  underlying  defect  that  led  to  the   pacemaker
implantation.   A  person  who  has  cardiomyopathy  diagnosed  and  a
pacemaker inserted would very likely  not  be  returned  to  duty  and
medically retired or separated with disability at that point  in  time
dependent on his functional state, i.e., 10,  30,  60  or  100%  using
analogous VASRD code 7015.  It is unusual,  but  not  unheard  of,  to
return a member to duty with a pacemaker, depending on  not  only  the
heart disease itself, but also the career status of the individual.

The Medical Consultant stated that while it  is  potentially  possible
that applicant’s condition could have  been  detected  by  appropriate
tests in 1990 (e.g. echocardiogram), there was really no indication to
proceed with those tests.  He had a single chest  x-ray  (while  being
treated for bronchitis) on 13 July 1990 that showed some  evidence  of
an enlarged heart, but a repeat x-ray 18 days later,  done  to  concur
with the recommendation for follow-up made by the radiologist,  showed
no cardiomegaly (enlargement),  and  the  test  was  read  as  normal.
Applicant had absolutely no symptoms of impending heart failure at the
time of his periodic physical examination on 15 August 1991, 13 months
later, nor are medical record entries found that would  have  provided
evidence of such impending disease.  The AFBCMR Medical Consultant  is
of the opinion that no change in the  records  is  warranted  and  the
application should be denied.  A complete copy  of  this  response  is
appended at Exhibit C.
_________________________________________________________________

APPLICANT'S REVIEW OF THE ADDITIONAL AIR FORCE EVALUATION:

He stated that although the medical consultant indicated it is  common
to waive  the  worldwide  assignment  code  limitation  because  of  a
pacemaker implantation, the limitation would not have been  waived  in
his case because of his  underlying  heart  defect  that  led  to  his
pacemaker implantation.  His pacemaker does not keep  his  heart  from
going into its death-causing arrhythmia.  It was implanted because  he
has to take so much medicine that it slows down his heart, which beats
only 30-35 times per minute, causing him to pass out.   The  pacemaker
literally brings on every beat of his heart.  As the letter  from  his
physician shows, he had cardiomyopathy while on active  duty,  but  it
was wrongly diagnosed as an “athletic heart.”  It  is  his  underlying
medical condition, which necessitated the pacemaker,  that  keeps  him
from worldwide duty.  Why would the doctor assume the second x-ray was
correct and the first one was not?  Wouldn’t the appropriate plan have
been to follow up with additional tests and see  if  he  had  a  heart
problem, since one x-ray clearly indicated that he had cardiomyopathy?
 If the follow-up test would have been done, a correct diagnosis could
have been made and he would have been medically retired and started on
the treatment he needed.  He asks that the Board correct  the  mistake
and  change  his  retirement  status  to  medical,  with   appropriate
disability and compensation, effective with his  retirement  date.   A
complete copy of this response is appended at Exhibit F.
_________________________________________________________________

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 probable error or injustice.  After a thorough review
of the evidence of record and applicant’s submission, the majority  of
the Board is not persuaded that his voluntary retirement for length of
service should be changed to a physical  disability  retirement.   His
contentions are duly noted; however, the Board majority did  not  find
these assertions sufficiently persuasive  to  override  the  rationale
provided by the AFBCMR Medical Consultant.  In this  respect,  it  was
noted that the applicant had absolutely no symptoms of impending heart
failure at the time of his  periodic  physical  examination  nor  were
medical record entries found that would have provided evidence of such
impending disease.  In addition, the Board majority is  not  persuaded
that the applicant was unfairly treated during his medical  assessment
and finds no evidence that his retirement for length  of  service  was
erroneous or contrary to the governing regulation and accepted medical
principles in effect  at  the  time  of  his  separation.   The  Board
majority therefore agrees with the opinions and recommendations of the
Medical Consultant and adopts the rationale expressed as the basis for
their decision that the applicant has failed  to  sustain  his  burden
that he has suffered either an error or injustice.  Therefore,  absent
sufficient evidence to the  contrary,  the  Board  majority  finds  no
compelling basis to recommend  granting  the  relief  sought  in  this
application.
_________________________________________________________________

RECOMMENDATION OF THE BOARD:

A majority of the panel finds  insufficient  evidence  of  error  or
injustice and recommends the application be denied.
_________________________________________________________________

The following members of the  Board  considered  this  application  in
Executive Session on  11  July  1997  and  11  June  1998,  under  the
provisions of AFI 36-2603:

                  Ms. Martha Maust, Panel Chair
                  Mr. David W. Mulgrew, Member
                  Ms. Patricia J. Zarodkiewicz, Member

By a majority vote, the members voted  to  deny  applicant's  request.
Ms. Maust voted to grant  the  applicant's  request  and  submitted  a
minority report.  The following documentary evidence was considered:

   Exhibit A.  DD Form 149, dated  16 Sep 95, w/atchs.
   Exhibit B.  Applicant's Master Personnel Records.
   Exhibit C.  Letters, AFBCMR Medical Consultant, dated
                   25 Mar 96 and 18 Jul 97.
   Exhibit D.  Letter, HQ AFPC/DPPD, dated 17 Apr 96.
   Exhibit E.  Letters, SAF/MIBR, dated 6 May 96 and 9 Sep 97.
   Exhibit F.  Letters from applicant, dated 31 May 96, w/atchs,
               and 4 Nov 97.
   Exhibit G.  Minority Report.




                                   MARTHA MAUST
                                   Panel Chair



AFBCMR 95-02908
INDEX CODE:  108.04



MEMORANDUM FOR THE CHIEF OF STAFF

      Having received and considered the recommendation of the Air
Force Board for Correction of Military Records and under the authority
of Section 1552, Title 10, United States Code (70A Stat 116), it is
directed that:

      The pertinent military records of the Department of the Air
Force relating to APPLICANT be corrected to show that:

            a.   On 30 December 1991, he was found unfit to perform
the duties of his office, rank, grade or rating by reason of physical
disability incurred while entitled to receive basic pay; that the
diagnosis in his case was cardiomyopathy, VA Diagnostic code 7020,
rated at 30 percent; that the compensable percentage was 30 percent;
and that the degree of impairment was permanent.

            b.   On 31 December 1991, he was honorably discharged and,
effective 1 January 1992, he was permanently retired by reason of
physical disability under the provisions of (AFR 35-4) and 10 USC
1201, rather than for length of service under the provisions of AFR 35-
7.





            JOE G. LINEBERGER
                                        Director
                                        Air Force Review Boards Agency