AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS 

RECORD OF PROCEEDINGS 

IN THE MATTER OF: 

DOCKET NUMBER:  96-01176 

,. 

COUNSEL:  NONE 

HEARING DESIRED:  YES 

APPLICANT REQUESTS THAT: 

It appears that  applicant  is requesting  his  retirement for length 
of service be changed to a disability retirement. 

He also requests changes be made to entries in his medical records 
with respect to times and locations of medical treatments. 

APPLICANT CONTENDS THAT: 

The  Chronological  Record  of  Medical  Care  and  Summary  Translation 
contain  errors  with  respect  to  times  and  places  of  medical 
treatments.  He  believes  the  errors were  caused by  the  fact  that 
the attending physician could not speak English and the interpreter 
was  trying  to  assist  in  relating  the  incidents  of  the  previous 
month  and  a half, while  he  (applicant) was  on duty  at  Task  Force 
Builder. 

In  support  of  his  request,  applicant  provided  his  personal 
statement  and  copies  of  the  contested  chronological  record  of 
medical care and summary translation.  Also provided were copies of 
correspondences  between  the  applicant  and  his  Congressman,  which 
included documentation:'pertaining  to his periods of active duty and 
extracts of his medical records.  (Exhibit AA 

STATEMENT OF FACTS: 

Prior  to  enlisting  in  the Air  Force  Reserve,  applicant had  prior 
periods  of  service  in  the  US  Navy  Reserve,  US  Navy,  and  Army 
National Guard. 

He  contracted his  initial  enlistment in  the  Air  Force  Reserve  on 
2 3   December 1 9 8 5   for a period of six years.  Upon comp1etion:of his 
contract, he reenlisted on 1 4   September 1 9 9 1  for another six years. 
Documents provided by  the applicant .reflect that on 17 March  1995, 
the  Chief,  Aerospace  Medicine  Division., determined  applicant  was  - 
medically  disqualified  for  military  duty  in  accordance  with  AFI 
48- 123,  by  reason of  Idiopathic Myocardiopathy -  Symptomatic; that 

special  assignment  imitations were  not  appropriate;  his  medical 
condition was  incompatible with  continued military  service in  the 
Air  Force  Reserve;  and  that  disability  processing  in  accordance 
with AFI 36- 3212  was not authorized. 
On  that  same  date,  the  Assistant  Director,  Health  Services 
recommended  applicant  be  administratively discharged  for  physical 
disqualification  for  continued military  duty.  On  28  March  1995, 
the  JA Member, Physical Disqualification Review Board, stated that 
appropriate  medical  authority  correctly  determined  that  the 
applicant  was  physically  disqualified  for  further  service  and 
should be processed for discharge.  On 3  April  1995,  applicant was 
notified that discharge action had been initiated to discharge him 
from the Air  Force Reserve by  reason of physical disqualification. 
At  that  time,  he  was  also  notified  that  he  was  eligible  for 
retirement  and  was  provided  an  application  for  transfer  to  the 
Retired  Reserve.  He  was  further advised  that  should he  elect  to 
retire,  he  would  be  transferred  to  the  Retired  Reserve  and  no 
further processing of the discharge action would occur. 

The  pertinent  medical  facts  surrounding  the  applicant's  physical 
disqualification  for  worldwide  duty  and  continued  service  in  the 
Air  Force  Reserve  are  contained in  the  discussion  section of  the 
evaluation  prepared  by  the  BCMR  Medical  Consultant  attached  at 
Exhibit G .  
Effective 2 1  April 1995,  applicant was relieved from his assignment 
and assigned to the USAF Reserve Retired List  (retired awaiting pay 
At  the  time  of  his  assignment  to  the  USAF  Reserve 
at  age  6 0 ) .  
Retired List, he was credited with 2 0   years, 11 months, and 1 9   days 
of satisfactory Federal service for retirement. 
The DVA rating of 29  January 1997,  diagnosed applicant's  condition 
as service-connected for residuals right  (major) rotator cuff tear 
with acromioplasty repair rotator cuff tear and resection of distal 
clavicle,  rated  at  10%  from  3  April  1995. 
He  was  denied 
service-connection  for  discogenic  and  facet  joint  degenerative 
area; 
changes 
passive-aggressive  personality;  athlete's  foot  right;  residuals 
pharyngitis,  lung  mass,  possibly  due  to  histoplasmosis;  and 
congestive heart failure. 

lumbosacral 

spine; 

of 

s colT o s i s 

lumbar 

AIR FORCE EVALUATION: 

The BCMR Medical Consultant, noting that the entire medical record 
and  service  record  were  not  available  for  review,  stated 
applicant's  medical claims center around a cardiac condition and a 
shoulder injury. 

The  cardiac  condition  is  first mentioned  in  the  portions  of  the 
records submitted in September 1 9 9 3   when the applicant was returned 
early  from a deployment in El  Salvador because  he  had  experienced 

2, 

AFBCMR 96- 01176 

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chest  pain.  He  was  seen  by  a  local  doctor  who  noted  that  t,,e 
applicant had  deployed with  a  supply of  nitroglycerin medication. 
The unconfirmed diagnosis of angina was made.  Following return to 
the  states,  applicant  had  further  medical  studies  including  an 
exercise  electrocardiogram  which  was  considered  normal  dn'd  the 
interpretation stated \\NO evidence of  cardiac source of  symptoms ." 
This  evaluation  resulted  in  a  normal  physical  profile  and  a 
worldwide qualified status.  The applicant was again evaluated for 
chest pain when he reported to the Emergency Department on 11 April 
This  led  to  a  Stress  Thallium  Myocardial  Perfusion  Study 
1 9 9 4 .  
which was interpreted as showing \\no significant change compatible 
with  ischemia"  and  \\He may  assume  normal  duties."  During  a 
subsequent deployment to Antigua, applicant was evaluated by a Navy 
physician for chest pain  and palpitations who clinically diagnosed 
"stable angina and possible symptomatic arrythmias" and recommended 
early return to CONUS because of the limited medical  facilities in 
the Antigua medical clinic. 

Although  the  applicant  requests  numerous  minor  changes  to  the 
medical  records for perceived or actual inaccuracies none of these 
changes will have an impact on the administrative action requested. 
None  of  the  changes  requested  by  the  applicant  are  germane  to 
arriving  at  the  correct  diagnosis  or  establishing  a  disability 
basis. 

It is apparent from documents submitted from the VA  evaluation for 
disability rating that the applicant now has a significant cardiac 
condition. 
There  are  many  chronic  conditions  which  may  arise 
during the active duty years and may worsen after retirement to the 
point of being  disabling but  it  is the status of  these conditions 
at the time of retirement that determines whether a member received 
disability  processing. 
The  BCMR  Medical  Consultant  noted  that 
applicant did have medical conditions requiring treatment while  on 
active  duty;  however, none  of  them were  of  the  degree  to warrant 
disability processing. 

The complete evaluation is at Exhibit C. 

- 

The  Physical  Disability  Division,  AFPC/DPPD,  reviewed  this 
application  and  recommended  denial. 
DPPD  verified  that  the 
applicant had never been referred to or considered by the Air Force 
Disability System. 

DPPD provided  an  explanation of  the differences between  Title  10, 
USC, which  charges the  Service Secretaries with  maintaining  a  fit 
and  vital  force,  and  Title  3 8 ,   USC,  which  governs  the  DVA 
compensation  system  to  allow  awarding  compensation for  conditions 
that  are  not  unfitting  for  military  service. 
DPPD  stated  the 
applicant has  not  submitted any material  or  documentation to show 
he  was  unfit  for  continued  military  service  as  a  result  of  a 
physical  disability  at  the  time  of  his  retirement  for  years  of 
service.  (Exhibit D) 

3 

AFBCMR 96- 01176 

APPLICANT'S REVIEW OF AIR FORCE EVALUATION: 

In his  response to the  evaluations, applicant  stated the  evidence 
shows there was a cardiac problem and he was unable to perform the 
duties of his office, grade and rank. 

In support of his  request, he  provided  additional medical  records 
associated  with  his  physical  disqualification  for  continued 
service.  His complete response is at Exhibit F. 

ADDITIONAL AIR FORCE EVALUATION: 

The BCMR Medical Consultant noted that the previous review  Exhibit 
C) was conducted in late 1 9 9 6   without full service medical records 
being  available.  This review has been  done with  these voluminous 
records on hand. 
Service medical  records  reflect  that  as  early  as  1977,  applicant 
was  seen  for  episodes  of  chest  pain  which  were  found  to  be 
non-cardiac  in  nature  and  was  continued  on  duty. 
A  periodic 
medical  examination  in  February  1 9 9 0   comments  on  his  having  an 
irregular heart beat with "angina" treated since 1983,  and cardiac 
evaluation  in  1 9 9 0   showed  frequent  extra  heart  beats  with  a 
negative  echocardiogram. 
He  was  found  qualified  for  worldwide 
duty.  Previously,  in  1985,  he  had  undergone  cardiac  evaluation 
finding no evidence of heart disease other than an irregular beat. 
At that time he noted a history of lung disease from 1 9 8 3   that was 
felt to be  histoplasmosis  (a fungal-like infection) and  which  had 
apparently cleared without  treatment.  A  firm diagnosis was  never 
made  in  spite  of  biopsies  done  at  the  time  of  bronchoscopy.  In 
1987,  there are a couple of notes relating to him having chest pain 
which was felt to be unrelated to cardiac disease.  In April  1990, 
he  was  hospitalized  for  erythema  nodosum,  and  cellulitis  in  a 
civilian hospital.  Applicant was  deployed  to El  Salvador in Aug- 
Sep  93,  and  it  is  this  period  when  he  Riels  his  cardimyopathy 
developed. 
He  was  seen  on  sick  call  there  with  chest  pains, 
shortness  of  breath  and  fatigue  on  2 3   September  1 9 9 3   and  was 
returned  to  the  States  where  he  underwent  another  exercise 
treadmill test  finding no  abnormality after which  he was  returned 
to  duty  on  6  Oct 
n  April  1994,  he  was  seen  in  the 
B  with  chest  pain  and  started  on 
emergency  room  at 
nitroglycerin  (NTG 
ed  angina  and  given a  referral for 
follow-up.  An exercise test with thallium administration showed a 
myocardial  perfusion  defect  of  the  anterior  wall  of  the  left 
ventricle plus a reversible defect of other areas of heart nquscle. 
He  saw  a  civilian  cardiologist  who  reviewed  the  thallium  test, 
declared  "no  significant  change  compatible  wizh  ischemia"  and 
returned  him  to duty  on  1 0   May  1994. 
As  no  duty  limitation was 
imposed after 6 October 1993,  applicant deployed to Antigua W.I.  in 
August  1994,  and  almost  immediately was  seen  for  chest  pain  and 
palpitations  (feeling of heart pounding), noted to still be on the 

4 

AFBCMR 96- 01176 

- 

NTG, and was shipped stateside immediately for evaluatio .  He was 
dec 
lified for duty and subsequent cardiac workup done 
at 
Medical  Center  showed dilated heart  chambers with 
normal  coronary  arteries  found  on  cardiac  catheterization.  The 
diagnosis  of  idopathic  (cause  undetermined)  cardiomyopathy 
(malfunction of  heart muscles)  was made,  applicant was  determined 
permanently  unsuitable  for military  duty  due  to  a  condition that 
existed prior to active duty, and discharged without possibility of 
disability  processing  after  the  case  was  reviewed  by  HQ  AFRES 
Discharge Review Board on 1 7   March 1995. 
The  real  question of  this often  confusing and  convoluted case  is 
whether  applicant suffered a  debilitating illness while  on active 
duty or during a time he was not in uniform.  Certainly there is a 
very  prolonged  history  of  chest  pain  dating  back  into  the  late 
1 9 7 0 s   with  intermittent visits  for  this  over  almost  the  next  two 
decades.  Applicant's  claim that the myopathy began in El Salvador 
in 1 9 9 3   is impossible to confirm, or to deny.  It was this episode 
that seems to have been the most severe as far as symptoms, and his 
course thereafter was steadily downhill.  It is unequivocal that he 
had  severe cardiac disease when  evaluated  at Wilford  Hall Medical 
Center in October 1 9 9 4 .  
It  seems  rather  arbitrary  to  conclude  that  applicant's  condition 
existed prior  to a period  of  active duty  looking at  the  facts as 
outlined  above  and  to  exclude  him  from  consideration  under  the 
disability evaluation system.  The very meaning of idiopathic makes 
determination of the onset of his disease uncertain, and it is just 
as likely to have occurred while on active duty as not.  Even the 
narrative summary prepared by an Air Force physician notes that the 
onset  of  his  significant  pain  began  while  on  active  duty  and, 
therefore, "in the line of duty." 

The BCMR Medical Consultant opines that applicant should have been 
presented  to  a  Medical  Evaluation  Board  with  referral  to  the 
Informal  Physical  Evaluation  Board  and  the  determination  should 
have  been  Idiopathic  Cardimyopathy,  severe,  compensable  at  60% 
disability  (VASRD Code 7099- 7000)  for a medi"ea1  retirement. 
The complete evaluation is at Exhibit G. 

APPLICANT'S REVIEW OF ADDITIONAL AIR FORCE EVALUATION: 

Applicant  concurred  with  the  recommendation  contained  in  the 
additional  evaluation  provided  by  the  BCMR  Medical  Consultant. 
(Exhibit I) 

. 

I. 

5 

AFBCMR  96- 01176 

THE BOARD CON 
1.  The applicant has  exhausted  all  remedies provided by  existing 
law or regulations. 

AT: - 

. 

2.  The application was timely filed. 

I. 

3.  Sufficient relevant evidence has been presented  to demonstrate 
the  existence  of  probable  injustice warranting  corrective action. 
In  this  respect,  we  note  the  findings  of  the  BCMR  Medical 
Consultant  (Exhibit G) that the applicant was diagnosed with severe 
cardiac  disease  when  he  was  evaluated  at  Wilford  Hall  Medical 
He  was  subsequently  found  medically 
Center  in  October  1 9 9 4 .  
disqualified  for  worldwide  duty  and  continued  service  in  the  Air 
Force Reserve; however, he  was  never  referred to or  considered by 
the Air  Force  Disability System.  We  agree with  the BCMR  Medical 
Consultant that it is rather arbitrary to conclude that applicant’s 
condition existed prior  to a period  of  active duty and  to exclude 
him  from  consideration  under  the  disability  evaluation  system. 
While  it  is  not  certain when  his  condition began,  it  is  just  as 
likely to have occurred while he was on a period of active duty as 
not.  Therefore, we believe  any doubt  should be  resolved in favor 
of  the  applicant.  Accordingly,  we  recommend  that  the  records be 
corrected as indicated below. 
4 .   Applicant’s 
contentions  regarding  inaccuracies  on  the 
Chronological  Record  of  Medical  Care  and  Summary Translation  are 
duly  noted.  However, we  agree with  the  opinion expressed by  the 
BCMR Medical  Consultant  (Exhibit C) that the  changes requested by 
the applicant are not germane to arriving at the correct diagnosis 
or  establishing  a  basis  for a  disability.  Therefore, we  find  no 
compelling basis to disturb these documents. 

THE BOARD RECOMMENDS THAT: 

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

a.  He  was  not  relieved  from  his  Reserve  assignment  on 
21 April  1 9 9 5   and  transferred  to  the  Retired  Reserve  Section 
awaiting  pay  under  the  provisions  of  AFR  35- 7  but,  on  20  April 
1995,  he was found unfit to perform the duties of his office, rank, 
grade, or  rating by  reason of physical  disability, incurred while 
he  was  entitled  to  receive  basic  pay;  that  the  diagnosis  in  his 
case  was  Idiopathic  Cardiomyopathy,  severe;  VA  Diagnostic  Code 
7099- 7000,  rated at  60%;  that the compensable rating was  60%;  and 
that the disability was permanent. 

b.  On  21  April  1995,  he  was  relieved  from  his  Reserve 
assignment  and  was  permanently  retired  by  reason  of  physical 
disability under the provisions of AFI  36-3212, effective 22 April 
1 9 9 5 .  

6, 

AFBCMR 96- 01176 

The  following members of  the Board  considered  this application in 
Executive  Session  on  21  July  1998,  under  the  provisions  of  AFI 
36-2603: 

~. 

Mr. David W. Mulgrew, Panel Chair 
Mr. Joseph G. Diamond, Member 
Mr. Terry A. Yonkers, Member 

All  members  voted  to  correct  the  records,  as  recommended.  The 
following documentary evidence was considered: 

Exhibit 
Exhibit 
Exhibit 
Exhibit 
Exhibit 
Exhibit 
Exhibit 
Exhibit 
Exhibit 

A.  DD Form 149, dated 18 Apr 96, w/atchs. 
B.  Applicant's Master Personnel Records. 
C.  Letter, BCMR Medical Consultant, undated. 
D.  Letter, AFPC/DPPD, dated 9 Dec 96. 
E.  Letter, SAF/MIBR, dated 23 Dec 96. 
F.  Letter, Applicant, dated 21 Feb 97, w/atchs. 
G.  Letter, BCMR Medical Consultant, dated 2 Jul 97. 
H.  Letter, AFBCMR, dated 8 Jul 97. 
I.  Letter, Applicant, dated 16 Jul 97. 

9- 

DAVID W.  MULG EW 
Panel Chair 

7, 

AFBCMR 96-01176