RECORD OF PROCEEDINGS
             AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS


IN THE MATTER OF:      DOCKET NUMBER:  98-02446
            INDEX CODE 108.01/108.10/108.04
                        (Deceased)      COUNSEL:  None

                       HEARING DESIRED:  No

_________________________________________________________________

APPLICANT REQUESTS THAT:

Her late husband’s retirement for length of service be  changed  to  a
medical retirement.

_________________________________________________________________

APPLICANT CONTENDS THAT:

Upon reviewing her husband’s military medical records,  she  found  at
least 19 instances of her husband seeking medial care, and  she  truly
believes the care, or lack of care, her husband received  was  grossly
negligent.  She realizes that it was eight years  from  her  husband’s
retirement to his first known “heart attack.” Had she  been  aware  of
the many visits her husband made to the doctors  and  emergency  room,
she would have had a red flag letting her know there  was  a  problem.
She  asserts  that  had  someone  been  doing  their   job   properly,
consultations on her husband’s continuous  problems  would  have  been
done.  They should have been told that her husband  was  at  risk  for
heart disease and they could have alerted their family doctor so  that
they could have been looking for  symptoms  of  heart  disease.   This
would have been especially true if it had been  known  how  often  her
husband went in for chest pains.  No where in his records does she see
any discussion or recommendations regarding  coronary  artery  disease
(CAD), smoking, diet, exercise or cholesterol medication.   She  wants
copies of the missing medical records.  In September 1992 her  husband
complained to their family doctor of the same symptoms  for  which  he
went to the Air Force emergency room and was immediately referred to a
cardiologist and hospitalized.

In support, she includes a  chronological  summary  of  her  husband’s
medical visits and the reasons he went for treatment as well as copies
of his medical records. Copies of her complete submission, as well  as
subsequent letters written to the Secretaries of Defense and  the  Air
Force, are at Exhibit A.

_________________________________________________________________

STATEMENT OF FACTS:

The decedent’s military medical records pertaining  to  the  issue  at
hand contain only the same military medical entries  provided  by  the
applicant, with a few exceptions. First, the only additional  military
medical entries that had the remotest reference or  relevance  to  the
decedent’s heart condition were two  Dental  Patient  Medical  History
Forms, dated 12 May 1983 and 7 February 1984 reflecting BPs of  144/88
and 138/80, respectively.  On  both  forms,  the  applicant’s  husband
indicated “No” to a history of  frequent  chest  pains,  high  BP,  or
shortness of breath. Second, the  military  medical  records  had  the
complete copy of SF 88, Report of Medical Examination,  regarding  his
retirement exam on 13 February 1984 at  Castle  AFB,  CA.  The  Report
refers to “Neck pain with stiffness to left side in 1974, treated with
moist heat. Pain recurs whenever  patient  puts  strain  on  it,  last
episode in  SEP  83,  treated  with  medicines,  NCNS”  and  “Frequent
indigestion for unknown number of years, treated with baking soda with
good results, NCNS.” There is a recommendation for follow-up  on  high
cholesterol.  The decedent’s sitting BP that day was 118/80.  The  EKG
was within normal limits. Third, on the accompanying SF 93, Report  of
Medical History, which the decedent himself filled out on 13  February
1984, he indicated he was taking no medications and  checked  “No”  to
having problems with shortness of breath, pain or pressure  in  chest,
palpitation or pounding heart, heart trouble, and high or low  BP.  He
indicated  “Yes”  only  to  swollen  or   painful   joints,   frequent
indigestion, broken bones, and recurrent back pain.

The decedent was retired in the grade of master sergeant  on  1 August
1984 with 20 years and 19  months  of  active  service.   His  primary
professional  specialty  was  as  a  tactical   aircraft   maintenance
technician/superintendent. His evaluation reports reflect the  highest
ratings.

In September 1992, the decedent suffered a heart attack and  underwent
quadruple coronary bypass surgery. In 1995, he suffered a second heart
attack.

According to the Death Certificate provided by the  applicant,  on  26
December 1996, the applicant’s late husband died of  acute  myocardial
infarction due to CAD and hypercholesterolemia, with hypertension as a
contributing factor.

On 30 January 1997, the applicant filed a claim with the Department of
Veterans Affairs  (DVA)  for  service-connected  cause  of  death  and
Dependency and Indemnity Compensation (DIC). The DVA denied her  claim
in May 1997, indicating that “Service medical records show no evidence
of manifestations of hypertension  or  coronary  artery  disease.  The
veteran had some complaints of chest
pain in April 1981 and June 1972, but heart  disease  was  ruled  out.
Retirement examination of 2-13-84  noted  blood  pressure  reading  of
118/80, normal EKG, and no history of or complaints of hypertension or
heart disease.” She appealed and on 4 June 1998,  the  DVA  determined
the decedent’s death was due to a  service-connected  disability.  The
DVA stated that “Review of the service medical records show a total of
eight instances of elevated BP readings, the first on 06-01-72 with  a
reading of 140/90 and the last on 10-17-83 with a reading of  144/106.
BP on separation  exam  was  normal,  EKG  was  normal,  but  elevated
cholesterol levels were shown.”  Based on the death certificate and “.
. . the elevated BP readings shown in service, doubt  is  resolved  in
favor of [the applicant] and service connection for cause of death  is
established.”

On 20 July 1999, the AFBCMR Staff requested SAF/MIBR  at  Randolph  to
perform a final search for any additional  medical  records  that  may
have been compiled at Mather and Castle AFBs.  Both bases  are  closed
and  SAF/MIBR’s  search  for  additional  medical   documents   proved
fruitless.

_________________________________________________________________

AIR FORCE EVALUATION:

The AFBCMR Medical Consultant indicates that the length of time  since
the decedent  retired  and  the  application  was  filed  have  likely
contributed to the incomplete records available  for  review  in  this
case. The decedent was seen on several visits for pain  and  stiffness
of his neck with some radiation of pain into his arm and  numbness  of
the upper extremities, particularly the  left  upper  arm.  Evaluation
with x-rays showed some early degenerative arthritic changes. Frequent
EKGs performed in regard to these complaints were normal.  There  were
instances of high BP recorded in his clinic visits along with  reports
of elevated cholesterol and tryglycerides. Both  of  these  conditions
can contribute to the development of  arterial  atherosclerosis  which
may well have had its onset during  the  decedent’s  military  career.
There is no evidence found that  shows  unequivocal  evidence  of  the
existence of CAD prior to the decedent’s retirement. On the  contrary,
the normal EKG and BP recorded at his retirement  physical  exam  were
evidence against such a disorder, at least to any significant  degree.
He was seen for his first verified heart attack in  1992,  some  eight
years following his retirement. It must be pointed out that  the  mere
presence of a disease or defect does not necessarily cause one  to  be
considered unfit for duty and to come under the auspices  of  the  Air
Force Disability Evaluation System (DES). While  the  DVA  is  charged
with  compensating  former  military  members  for   service-connected
disease, these same diseases may  not  have  rendered  the  individual
unfit, as was clearly  seen  in  this  particular  review.  While  the
applicant claims that, had
appropriate attention been paid to her husband’s conditions they would
have brought this to the attention of the civilian physician following
retirement, the decedent was retired for eight years before  suffering
his first cardiac event, time enough for interventions  to  have  been
initiated by their civilian practitioners had  the  need  arisen.  The
Consultant recommends denial.

A complete copy of the evaluation is at Exhibit C.

The  Chief,  Special  Actions/BCMR  Advisories,  HQ  AFPC/DPPD,   also
reviewed the appeal and asserts that the  decedent’s  records  clearly
show he was able to perform the duties of his office, grade,  rank  or
rating right up until the time of his  retirement  from  active  duty.
This is reflected in his  retirement  exam  which  qualified  him  for
worldwide duty and his outstanding performance  reports.   The  author
verifies that the decedent was never referred to or considered by  the
DES under the provisions of AFR 35-4.  Although  he  was  treated  for
various medical conditions while on active  duty,  none  were  serious
enough to make him unfit for continued military service.  The  request
for a military disability retirement is without legal basis and denial
is recommended.

A complete copy of the evaluation is at Exhibit D.
_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

The applicant responded to the evaluations in letters to  the  AFBCMR,
the President, her Senator, and the Office of the Secretary of the Air
Force (Legislative  Liaison).   She  disagrees  with  the  evaluations
contending that, with an incomplete record,  accurate  recommendations
cannot be made. She questions why the military medical records do  not
contain discussions, follow-ups, recommendations, test  results,  etc.
She also asks how can the Medical Consultant indicate that  the  EKGs,
etc., were normal when no record exists of the test results. The onset
of her husband’s disease occurred in 1972 while he was  still  in  the
Air Force.  After he retired, he was prescribed nicorette gum to  help
him stop smoking; the doctor would not have prescribed this gum had he
known of her husband’s prior medical history. She asserts  this  is  a
case of malpractice.  Without the proper documentation to prove  tests
were done and recommendations for follow-ups completed, how  can  [the
advisory writers] in good faith recommend anything.  She contends  the
missing documents are not missing---they are nonexistent.  The doctors
did  a  careless  job  and  her  husband  was  the  victim  of   their
carelessness. At the time both of them were so young  and  naïve  they
thought this was an acceptable way to be treated. The Board’s decision
should be in her favor.

Complete copies of applicant’s rebuttal letters, with attachments, are
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 to warrant  changing  the
decedent’s length of service retirement to a medical  retirement.  The
applicant’s grievance appears driven by a two-pronged contention:  her
husband’s heart disease should have been diagnosed and  treated  while
he was on active duty with retirement for medical disability  and,  if
he had been diagnosed and treated for CAD while  on  active  duty,  he
would have lived longer.

4.    Outside of the exceptions noted in the Statement of  Facts,  the
decedent’s military records  contain  no  further  information  beyond
those same medical entries provided by the applicant. We do  not  know
if the decedent consulted “Dr. Brown” as recommended on the  14  April
1981 emergency visit or if this doctor was a cardiologist. We  do  not
know what additional visits, tests, treatment, discussions, etc.,  may
or may not have occurred between the  decedent  and  military  medical
personnel. Neither does the applicant. She indicates that had she been
aware of her husband’s emergency room and  doctor  visits,  she  would
have had a “red flag” letting her know there was a  problem.   She  is
undoubtedly aware that for privacy reasons the medical staff could not
discuss her husband’s  medical  history  with  her,  or  anyone  else,
without his permission. The applicant’s  husband  apparently  did  not
tell her about his symptoms and medical visits because  she  indicates
she did not know about them until  after  his  death.  Since  she  was
neither the patient nor privy to her husband’s  medical  history,  she
was not in a position to take any action herself. The base closures of
Mather and Castle may have contributed to the loss of  any  additional
records the medical facilities there maintained. While  these  records
could have supplied additional pertinent information for this Board to
review and may have  provided  answers  to  some  of  the  applicant’s
questions, in our opinion her husband in all  likelihood  would  still
have been retired  for  length  of  service  rather  than  disability.
Regardless of what the records now say or may have said years ago, the
decedent was considered fit  to  perform  his  duties  throughout  his
exemplary career up to the date of his  retirement.  Although  he  was
seen for various conditions, the treating  facilities  apparently  did
not consider any of them unfitting enough to enter him  into  the  Air
Force disability system for consideration and processing. A  diagnosis
of CAD does not automatically make a member unfit for continued active
duty.  Therefore, even if the decedent had been  diagnosed  with  CAD,
the available evidence does not demonstrate that he should  have  been
retired for medical disability rather than for length of service.

5.    With regard to the applicant’s assertion that  her  husband  was
the victim  of  neglect  and/or  malpractice,  what  documentation  is
available in her submission  and  in  the  military  record  does  not
support this contention. While neck pain, left arm numbness and  chest
pain/pressure can be signs of heart disease as the applicant  contends
(and they may have been in this case), they can also be symptomatic of
physical  injury  or  strain,  and  arthritic   and   gastrointestinal
problems.  The available documents  indicate  her  husband  fit  these
scenarios also and received treatment  in  these  arenas  as  well  as
cardiac evaluation. It is impossible at this date  to  determine  with
any  certainty  what  discussions  may  have  transpired  between  the
applicant’s husband  and  his  care  providers  regarding  his  BP  or
triglycerides.  He was aware of his symptoms and brought them  to  his
medical providers’ attention, yet on other occasions he  indicated  he
did not have a history of high BP or chest pain or pressure.  This was
not true.  Given the fact that the applicant’s husband had  his  first
heart  attack  eight  years  after   retirement   and   his   civilian
practitioners had ample time to intervene had the need arisen, we fail
to see how the Air Force can be held culpable for his death in 1996.

6.    We do sympathize with  the  applicant’s  loss,  and  having  her
husband collapse in her arms as she described must have been extremely
traumatic.  Nevertheless, for the reasons discussed above,  we  cannot
find a reasonable basis to recommend favorable  consideration  of  her
appeal.

_________________________________________________________________

THE BOARD DETERMINES THAT:

The  applicant  be  notified  that  the  evidence  presented  did  not
demonstrate the existence of probable  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 September 1999 under the provisions of AFI 36-
2603:


                 Mr. Richard A. Peterson, Panel Chair
                 Mr. Patrick R. Wheeler, Member
                 Ms. Rita J. Maldonado, Member

The following documentary evidence was considered:

      Exhibit A. DD Form 149, dated 20 Aug 98, w/atchs; Letters
                 dated 22 May, 31 Aug, 10 Oct and 14 Dec 98,
                 and 15 Jan 99 w/atchs.
      Exhibit B. Applicant's Master Personnel Records.
      Exhibit C. Letter, AFBCMR Medical Consultant, dated 7 Dec 98.
      Exhibit D. Letter, HQ AFPC/DPPD, dated 10 Feb 99.
      Exhibit E. Letters, AFBCMR, dated 26 Jun, 22 Sep and
                 23 Oct 98, and 7 Jan, 5 Feb, 1 Mar and 11 Aug 99.
      Exhibit F. Letters, Applicant, dated 23 Apr (3), 18 & 26 May,
                 26 Jul and 24 Aug 99 w/atchs.




                                   RICHARD A. PETERSON
                                   Panel Chair