RECORD OF PROCEEDINGS
             AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:      DOCKET NUMBER:  02-01063
            INDEX CODE:  100.03
            COUNSEL:  NONE
            HEARING DESIRED:  NO

_________________________________________________________________

APPLICANT REQUESTS THAT:

The assignment limitation code “C” restricting her from  worldwide  duty  or
mobility be removed.

_________________________________________________________________

APPLICANT CONTENDS THAT:

The Medical Evaluation Board (MEB) treated her  unfairly.   Before  arriving
at Incirlik AB, Turkey, she was selected for follow-on assignment to  Aviano
AB, Italy.  She had been previously cleared for her assignment to Turkey  as
well as being declared worldwide qualified 4 months prior during her  annual
Physical Health Assessment (PHA) performed  by  the  Incirlik  clinic.   The
physical exam section refused to sign off  on  her  letter  due  to  a  pre-
existing  condition  of  Ocular  Myasthenia  Gravis.   She  was   originally
diagnosed with this  condition  in  the  fall  of  1997  at  Landstuhl  Army
Hospital, while stationed at Ramstein AB, Germany.   She  has  seen  several
neurologists over the years and  all  agree  that  her  condition  does  not
restrict her from performing her duties as a personnel  technician  or  from
being worldwide qualified.  A Medical Evaluation Board (MEB)  was  initiated
in October 2000 which would determine her worldwide eligibility and  if  she
was qualified to remain overseas and retain her  assignment  to  Aviano  AB.
Because the process was taking long, she contacted the base IG at  Incirlik.
 The Inspector General (IG) felt she had a justifiable complaint,  not  only
on the length of time that the MEB was taking,  but  also  because  the  MEB
should not have been initiated  since  the  Air  Force  had  already  set  a
precedent  by  authorizing  her  worldwide  qualification  to  complete  two
previous tours in overseas areas since  her  diagnosis  in  1997.   The  MEB
returned a decision that she was to be returned to duty,  but  she  was  not
worldwide qualified.  She was devastated with the  decision.   The  decision
was based on the fact that she needed to be in an area to receive  necessary
medical treatment.  She currently does not  receive  any  medical  treatment
for  ocular  myasthenia  gravis.   She  was  issued  a  prescription  called
Mestinon, which is taken  as  needed  and  is  available  at  all  the  base
pharmacies and at her previous overseas bases.  Her only  other  requirement
in the form of care is an annual visit to a  neurologist,  which  she  would
have been able to complete more accessibly from her follow-on assignment  in
Italy.

Upon her arrival at Peterson AFB, CO she was  encouraged  by  her  chain  of
command to try for a new MEB.  The neurologist  at  the  Air  Force  Academy
hospital proposed submitting a narrative summary in  lieu  of  initiating  a
new MEB  and  supported  her  request  to  have  the  restriction  code  for
worldwide duty revoked.   On  November  14,  2001,  she  was  notified  that
despite another specialist recommending that she is fit for worldwide  duty,
the decision to restrict her from worldwide duty stood.   She  was  told  by
Headquarters Air Force Personnel Center that the reason for her  restriction
was based on the guidance  in  Air  Force  Instructions  and  not  what  the
neurologists recommended.

She is qualified on the M-16, has participated  in  mobility  exercises  (to
include the wear of chemical warfare gear) and received firewall  5  ratings
on all of the  Enlisted  Performance  Reports  written  on  her  during  her
overseas tours after her medical diagnosis.  She has received no  exclusions
from completing the annual fitness test as a result of her  condition.   She
is very active in  base  sports,  successfully  completed  her  last  annual
fitness test and works out on a regular basis.  She feels there  is  nothing
about her  physical  health  that  should  preclude  her  qualification  for
worldwide duty.

Despite the AFI stating that cases are evaluated on  a  case-by-case  basis,
it  seems  to  be  generalized.   Ocular  Myasthenia  Gravis  is  not   life
threatening nor does it prevent her from performing her duties.   She  feels
that the recommendation of Neurologists with  first-hand  knowledge  of  her
condition, were ignored and the case-by-case  consideration  was  not  taken
into account.  This decision seemed to be based on  the  AFI  that  was  not
specific for a case-by-case basis or less serious types  of  this  disorder.
The logic that she is restricted to a CONUS assignment, or  to  an  overseas
assignment listed in the  AFI,  to  receive  proper  medical  care,  is  not
justified.

She has devoted over 14 years of her life to the Air Force  and  feels  that
her ability to serve in the military is being limited with  the  removal  of
her worldwide qualification.  She feels that she is medically qualified  for
overseas deployments and tours and is willing to volunteer  for  both.   The
Air Force MEB refused to take her specific  case  into  consideration.   She
believes the MEB threw  her  into  a  general  category  and  didn’t  really
consider the inputs and recommendations  of  her  doctors  as  well  as  her
supervisors and commanders.  She would like the opportunity  to  finish  her
Air Force career without restriction or limitation of service.

In  support  of  her  request,  applicant  provides  a  personal  statement,
associated medical documents tabbed from letters A-K,  and  copies  of  EPRs
for the periods ending 30 November 1997, 8 July 1998  and  2  January  2001.
The applicant’s complete submission, with attachments, is at Exhibit A.

_________________________________________________________________
STATEMENT OF FACTS:

Applicant contracted her initial enlistment in the Regular Air  Force  on  7
December 1987.  She is currently serving on  a  26-month  extension  of  her
enlistment she entered on 2 April 1996 giving her a new ETS date of  1  July
2004.  She has  been  progressively  promoted  to  the  grade  of  technical
sergeant, having assumed that grade effective and with a  date  of  rank  of
1 February 2002.  Applicant is currently assigned as  an  NCOIC,  Class  and
Retraining at Peterson AFB, CO.

The remaining relevant facts pertaining to this application  extracted  from
the applicant’s military medical  records,  are  contained  in  the  letters
prepared by the appropriate offices of the Air Force at Exhibits C-F.

_________________________________________________________________

AIR FORCE EVALUATION:

The BCMR Medical Consultant recommends the application be denied.  The  BCMR
Medical Consultant states that the applicant has  ocular  myasthenia  gravis
which was diagnosed in 1997, that has been  mild  and  has  remained  stable
without any evidence of progression in the nearly 5 years  since  diagnosis.
Myasthenia Gravis is an  autoimmune  disease  in  which  antibodies  against
neurotransmitter receptors interferes  with  normal  neuromuscular  function
typically manifesting as muscle weakness that  becomes  progressively  worse
with effort and improves somewhat with  rest.   It  often  starts  with  eye
involvement causing blurring and double vision.   Many  patients  experience
progression to generalized weakness that can be fatal over the subsequent  1
to 5 years.  Approximately 10 to 15 percent of  myasthenia  gravis  patients
will  not  progress  to  have  generalized  weakness.   These  patients  are
considered to have “ocular  myasthenia.”   Ocular  Myasthenia  Gravis  is  a
subtype of myasthenia gravis that causes  relatively  mild  disability,  but
may progress to severe generalized muscle weakness.

The BCMR Medical Consultant states that  myasthenia  gravis  is  an  unusual
condition and most  primary  care  physicians  are  not  familiar  with  the
diagnosis and  management  of  this  disease.   Referral  to  neurology  for
ongoing management is the usual practice.   In  overseas  settings,  medical
resources are limited and resourced  to  care  for  a  healthy  active  duty
population.  Military Treatment Facility commanders are reluctant to  accept
active duty members with  chronic  medical  illnesses  however  stable  they
appear to be, as their experience has been too often to  the  contrary,  and
their limited resources become quickly strained  by  patients  with  unusual
diseases or requirements.  The applicant’s mild and  stable  course  over  5
years seems to predict an excellent prognosis, and would  suggest  that  she
is unlikely to develop problems inappropriate  to  an  overseas  assignment.
This, however, is not an absolute guarantee, and there is no clear  data  to
give a  more  specific  quantification  of  risk.   Medically  clearing  the
applicant for overseas assignments is a calculated risk.  Taking this  risk,
however small, is unnecessary to meet the  needs  of  the  Air  Force.   The
assignment of a Code C limitation in this case is conservative  and  prudent
and retains the applicant  on  active  duty  without  exposing  her  to  any
additional risk related to  her  condition.   The  BCMR  Medical  Consultant
states that the action and disposition of this case is proper and  equitable
reflecting compliance with Air Force directives that implement the law.

The BCMR Medical Consultant evaluation is at Exhibit C.

The Chief Medical Standards Branch  reviewed  the  application  and  concurs
with the conclusions and the recommendation of the BCMR Medical  Consultant.
 A consultation between the Chief  Medical  Standards  Branch  and  the  Air
Force  consultant  in  Neurology  determined  that  patients   with   Ocular
Myasthenia Gravis should  not  be  assigned  overseas.   The  Chief  Medical
Standards Branch evaluation is at Exhibit D.

AFPC/DPPD reviewed  the  application  and  concurs  with  the  BCMR  Medical
Consultant’s recommendation.   DPPD  states  that  the  applicant  underwent
processing through the Air Force Disability Evaluation System (DES) and  the
results were forwarded to the Informal Physical Evaluation Board (IPEB)  for
adjudication of her case.  The IPEB determined  her  medical  condition  for
Ocular Myasthenia Gravis did not prevent her from reasonably performing  her
duties and found her physically fit.   Subsequently,  the  IPEB  recommended
that she be returned to duty for  further  care  and  treatment.   The  DPPD
evaluation is at Exhibit E.

AFPC/DPMAF2 reviewed the application and concurs with  the  conclusions  and
recommendation of the BCMR Medical Consultant.  The DPMAF2 evaluation is  at
Exhibit F.

________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

Applicant advises that there is nothing specific listed  for  her  condition
of ocular myasthenia gravis.  She hopes that her  condition,  despite  being
categorized  as  myasthenia,  would  be  considered  for  its  less   severe
symptoms.  Applicant refutes the BCMR Medical Consultant’s reference to  her
having Myasthenia Gravis.  She states  she  has  Ocular  Myasthenia  Gravis,
which is a less severe, milder condition and  does  not  affect  her  ocular
muscles and does not have an effect on  her  respiratory  system.   She  has
taken into consideration that there is the possibility  that  her  condition
could deteriorate, but all the neurologists she has spoken to have told  her
that deterioration would likely occur within 3-5 years  of  diagnosis.   She
is on her 5th year.  Applicant states that the  precedent  of  her  previous
tours after being diagnosed should show that she is capable of  serving  the
Air Force anywhere.   Applicant  states  that  with  the  exception  of  her
prescription for Mestonin, and annual visits to the neurologist, no  medical
facility is required for her condition.

Applicant states that removing her “C” code may be unnecessary to  meet  the
needs of the Air Force; however, no consideration  is  being  given  to  the
emotional and mental needs of the active duty member in  a  situation  where
physical evidence cannot be provided to warrant  such  a  restriction.   She
understands the Air Force reluctance to remove the code based  on  the  fear
that something may happen in the future; however, she is confident that  her
health meets worldwide qualifications.

Applicant  attaches  a  current  examination  and  narrative  opinions  from
Optometry, Opthamology and Neurology.   The  applicant’s  complete  rebuttal
with Tabs 1-8 are at Exhibit H.

_________________________________________________________________

ADDITIONAL AIR FORCE ADVISORY:

The BCMR Medical Consultant reviewed the current examination  and  narrative
opinions  the  applicant  provided  in  her  rebuttal.   The  BCMR   Medical
Consultant states the  recent  neurology  consultation  dated  September  7,
2001, reports that she has  continued  to  do  very  well  only  taking  her
medication (pyridostigmine also called Mestinon) as  needed  once  or  twice
per month.  The BCMR Medical Consultant also noted the neurologist  and  the
neuro-ophthalmologist recommendation that she  is  worldwide  qualified  for
duty.  The BCMR Consultant states  that  the  risk  of  progression  to  the
generalized form is lower in patients such as  the  applicant,  however  the
actual risk  in  an  individual  cannot  be  specifically  quantified.   The
applicant states that the medical standards  for  the  generalized  form  of
myasthenia gravis were  unfairly  applied  to  her.   They  were  not.   The
applicant’s condition is unusual, and she has been retained on  active  duty
with the conservative  placement  of  a  Code  “C”  restriction.   The  BCMR
Medical Consultant’s discussion with the Neurology  consultant  to  the  Air
Force Surgeon General confirms the opinion that the risk for progression  in
this case is present, but unknown.  However, reconsideration of her  request
can be done based  on  a  re-evaluation  by  the  Neuromuscular  and  Neuro-
ophthalmology  department  at  Wilford  Hall   Medical   Center,   and   the
recommendation of the Neurology Consultant to the Air Force Surgeon  General
to the Air Force Medical Standards Branch.

The BCMR Medical Consultant evaluation is at Exhibit I.

_________________________________________________________________

APPLICANT'S REVIEW OF ADDITIONAL AIR FORCE EVALUATION:

Applicant states she fails to see how consulting with  more  specialists  in
the Neurological field will benefit her case when all the  specialists  have
had the same conclusion.  Since she  has  previously  accomplished  all  the
recommendations  the  BCMR  Medical  Consultant  stated  in  his  additional
advisory, she does not see any reason to spend government  funds  to  go  to
Wilford Hall to again obtain documentation that is already in  her  records.
Applicant states she fails to see what the difference would be  whether  she
was stationed overseas  or  CONUS  if  her  condition  worsened,  which  she
doesn’t believe it will after five years and a great period of remission.

The applicant is in the process of applying for retraining  and  would  like
to go into the Contracting career field.   However,  the  contracting  field
has numerous deployments to overseas locations.  Because of  her  limitation
code, this may come into play during the  review  of  her  package  and  her
retraining may be denied.  She asks that her individual  case  be  based  on
the results of examinations of her current condition, and  past  history  of
her disorder, not on what might be or  what  is  considered  a  more  severe
condition of general Myasthenia Gravis.

The applicant’s rebuttal Tabbed 1-3 is at Exhibit K.

_________________________________________________________________

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  provided  to  demonstrate  the
existence  of  injustice  that  warrants  the  removal  of  the   Assignment
Limitation Code (ALC) “C.”  After a review of the  facts  and  circumstances
of this case, we have reached a conclusion  different  from  the  Air  Force
offices of primary responsibility  in  this  matter.   We  are  sufficiently
persuaded that the applicant has  provided  the  necessary  and  appropriate
documentation to sustain her burden that she  has  been  the  victim  of  an
injustice and that she should be found qualified for “world-wide” duty.   It
appears to us that the physicians who actually  evaluated  and  treated  the
applicant’s condition are in unanimous agreement that she has  a  very  mild
symptom of ocular myasthenia gravis, which does not impair  her  ability  to
perform her tasks, is readily treatable  and  she  is  world-wide  qualified
despite her diagnosis.  We note that at the time of her  initial  diagnosis,
she was stationed  overseas,  a  tour  she  completed  with  no  significant
problems, returned to CONUS and served on another overseas  assignment,  all
for which she was cleared for  world-wide  duty.    In  a  recent  neurology
consultation dated 26 June 2002, the Chief, Neurology Service, reports  that
her ocular myasthenia gravis, is distinct from generalized MG  and  the  two
conditions should not be grouped together.  This  physician  further  stated
that since  it  has  been  over  5  years  since  her  diagnosis  of  ocular
myasthenia gravis, the risk  of  progression  is  extremely  low,  that  the
applicant appears to  be  world-wide  qualified  and  her  request  for  the
removal of the ALC “C” should be reviewed.  In view of the  strong  opinions
of the physicians who actually treated the applicant and the fact  that  she
was able to successfully  function  in  an  overseas  assignment  after  the
diagnosis was made, we do not believe the applicant should  be  barred  from
securing career opportunities that would be beneficial to the Air Force  and
the individual.  Therefore, as an exception to  policy,  we  recommend  that
her records be corrected to the extent indicated below.

_________________________________________________________________

THE BOARD RECOMMENDS THAT:

The pertinent military records of the Department of the Air  Force  relating
to APPLICANT be corrected to show that on 26 June 2002, competent  authority
determined that the Assignment Limitation Code “C”  should  be  removed  and
that she is medically qualified for world-wide duty.

_________________________________________________________________

The following members  of  the  Board  considered  this  application  AFBCMR
Docket Number 02-01063 in Executive Session on 5 February  2003,  under  the
provisions of AFI 36-2603:

      Mr. Roscoe Hinton, Jr, Panel Chair
      Mr. Thomas J. Topolski, Jr, Member
      Mr. Steven Shaw, Member

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

    Exhibit A.  DD Form 149, dated 19 March 2003, w/atchs.
    Exhibit B.  Applicant's Master Personnel Records.
    Exhibit C.  Letter, BCMR Medical Consultant, dated 8 May 02.
    Exhibit D.  Letter, Chief Medical Standards Branch,
                dated 6 Jun 02.
    Exhibit E.  Letter, AFPC/DPPD, dated 29 May 02.
    Exhibit F.  Letter, AFPC/DPMAF2, dated 7 Jun 02.
    Exhibit G.  Letter, SAF/MRBR, dated 14 Jun 02.
    Exhibit H.  Letter, Applicant, undated w/atchs.
    Exhibit I.  Letter, BCMR Medical Consultant, dated 9 Aug 02.
    Exhibit J.  Letter, AFBCMR, dated 12 Aug 02.
    Exhibit K.  Letter, Applicant, undated, w/atchs.





                                   ROSCOE HINTON JR
                                   Panel Chair


AFBCMR 02-01063




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 xxxxxxxxx, be corrected to show that on 26 June 2002, competent
authority determined the Assignment Limitation Code “C” should be removed
and that she is medically qualified for world-wide duty.






  JOE G. LINEBERGER

  Director

        Air Force Review Boards Agency