ADDENDUM TO
                            RECORD OF PROCEEDINGS
             AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS


IN THE MATTER OF:      DOCKET NUMBER:  01-01184
            INDEX CODE:  108.00
            COUNSEL:  NONE

            HEARING DESIRED:  Yes

______________________________________________________________

APPLICANT REQUESTS THAT:

The disability rating at the time of her discharge in February 1999  for  be
increased from 20 percent to 30 percent in order to qualify her for  medical
retirement.

______________________________________________________________

STATEMENT OF FACTS:

Applicant,  a  prior  service  enlisted  member,  was  appointed  a   second
lieutenant, Reserve of the Air Force  on  25  Aug  96  and  was  voluntarily
ordered to extended active duty on that same date.  She was promoted to  the
grade of first lieutenant, having assumed that grade effective  and  with  a
date of rank of 25 Aug 98.

An MEB was convened on 28 Jul 98  and  referred  her  case  to  an  Informal
Physical Evaluation Board (IPEB) with a diagnosis  of  postpartum  herniated
disk with debilitating pain syndrome and peripheral neuropathy of left  leg,
mitral valve  prolapse,  first  degree  atrio-ventricular  (AV)  block,  and
intraventricular heart conductive disease.  On 24 Sep  98,  the  IPEB  found
her unfit for further military service based on a diagnosis of chronic  back
pain  and  first  degree  AV  block.   The  IPEB  recommended  that  she  be
discharged with  a  combined  compensable  rating  of  20%.   The  applicant
disagreed with the findings and recommended  disposition  of  the  IPEB  and
requested a formal PEB (FPEB).  On 22 Oct 98, the FPEB found her  unfit  for
further military service based on a compensable diagnosis  of  chronic  back
pain at 20 percent; and  a  noncompensable  diagnosis  of  first  degree  AV
block, mitral valve prolapse, and intraventricular heart conduction  disease
possibly related to an existing prior to  service  (EPTS)  first  degree  AV
block.  The FPEB further recommended that she be discharged  with  severance
pay.  She appealed the FPEB decision to the Air Force Personnel Board.   The
Personnel Board concurred with the findings and recommendation of  the  FPEB
and the Office of the Secretary of  the  Air  Force  directed  that  she  be
discharged with severance pay effective 18 Feb 99.  She served  4  years,  7
months, and 8 days on active duty.

On 4 Oct 99, the DVA granted the applicant service connection for  AV  block
with intermittent second degree AV block and mitral valve prolapse  with  an
evaluation of 60 percent, service connection  for  degenerative  disk  joint
disease of the lumbar spine with fibrosis with an evaluation of 60  percent,
and service connection for restrictive airway disease with an evaluation  of
zero percent.

A similar appeal was considered and denied by the Board on 27 Nov  01.   For
an accounting of the rationale of the earlier decision  by  the  Board,  see
the Record of Proceedings at Exhibit F.

On 2 Jan 02, the applicant submitted a  request  for  reconsideration.   She
states that it was stated numerous times that her back and  heart  condition
did not interfere with her work attendance  which  is  just  not  the  case.
From the start of her back problems through her surgery  she  did  not  work
full time.  After months of  convalescent  leave,  she  only  worked  4-hour
days.  Subsequent to her discharge the Department of Veterans Affairs  noted
that the ruling of the Air Force regarding her condition  was  out  of  line
with the contents of her  medical  examinations.   Therefore,  she  believes
that the gravity of  her  heart  and  back  condition  were  not  given  the
appropriate diagnoses based on the guidelines  and  the  examinations.   She
has been under constant medical care since her  discharge.   In  support  of
her request, applicant  provided  a  personal  statement,  a  chronology  of
events, extracts from her military medical records, and  extracts  from  her
DVA medical records.  Her  complete  submission,  with  attachments,  is  at
Exhibit G.

______________________________________________________________

AIR FORCE EVALUATION:

The BCMR Medical Consultant recommends denial.  The  consultant  states  the
applicant entered active duty while pregnant, a condition disqualifying  for
entry.  There no evidence that she concealed this fact  or  whether  it  was
waived.  At the time  of  delivery,  she  developed  lower  back  pain,  was
diagnosed with a slipped  disc,  and  underwent  surgery  in  January  1998.
After  her  surgery,  she  had  continued  pain  with   minimal   neurologic
abnormalities interfering with  duty  and  underwent  disability  evaluation
processing.  The PEB noted that she was able  to  lift  her  child  and  had
infrequent  medical  visits  with  no  ongoing  physical  therapy   and   no
requirement for braces or  canes.   She  had  an  abnormal  electromyography
study and reported some right-sided symptoms that correlated  with  the  MIR
progression.  She appeared to have  back  pain  out  of  proportion  to  the
objective  findings  and  other  than  mild   weaknesses.    Mild   residual
weaknesses of her left ankle and foot and the  reported  sensory  change  in
the left lower leg would not alone interfere with duty.  It was  her  report
of pain that interfered with duty.  Post-operative MRIs revealed  successful
discectomy without recurrence at the site of the  surgery,  but  did  reveal
the formation of scar tissue that would explain pain into the left  leg  and
foot, but not necessarily her back pain.  It  is  likely  that  her  chronic
back pain is related to multiple factors.  Rating her  disability  form  her
back pain is solely based on  her  report  of  the  severity  of  the  pain.
Review of her DVA records finds no evidence of progression  of  symptoms  or
findings and as of 1 Oct 01, a  DVA  clinic  note  indicated  her  pain  was
controlled and overshadowed by other medical concerns.  It would  seem  that
her rating was reasonable and the differentiation between  the  DVA  ratings
for intervertebal disc syndrome at 20 percent, and  the  40  percent  severe
recurring attacks  with  intermittent  relief  is  open  to  interpretation.
Since her disc was removed  and  a  post  operative  MRI  showed  successful
removal of the disc but scar tissue formation around the nerve root, use  of
the VASRD code for neuralgia of the sciatic nerve would be an  option.   The
maximum rating in this instance would be 20 percent.

At the time of her MEB/PEB  and  discharge  she  had  other  medical  issues
including an EPTS first degree heart block, recurrent  syncope/near  syncope
felt related to apparent  progression  of  the  EPTS  heart  condition,  and
mitral valve prolapse.  These conditions may be  unfitting  and  compensable
but did not appear to interfere with the performance of her  duty  and  were
not related.  The  VASRD  rating  for  atrio-ventricular  block  at  the  10
percent level requires limiting symptoms at an  exercise  workload  of  less
than 10 METS or continuous medication or pacemaker.  She achieved  12  METS,
did not require a pacemaker or medication at that time.

Following her discharge she had a pacemaker  placed  that  did  not  provide
symptomatic benefit indicating that heart beat conduction block was not  the
cause of her symptoms.  Following the failure of the  pacemaker  to  correct
her symptoms, she was ultimately diagnosed with  a  condition  that  results
from abnormal congenital bands of heart tissue, which results in  abnormally
rapid heart rates that can cause syncope.  Active  duty  members  with  this
condition remain  on  active  duty  following  successful  correction.   She
alludes to being treated for polymyositis  with  elevated  cryoglobulins  at
the time of her January 2002 letter.  There is no evidence  that  while  she
was on active duty that there were signs of polymyositis.  A  February  2002
rheumatology evaluation makes no mention of polymysitis.

Although she experienced ongoing and progressive medical problems  following
her discharge, once an individual has been declared unfit, the condition  is
rated based  upon  the  degree  of  disability  at  the  time  of  permanent
disposition and not on future events.   Her  rating  appears  to  have  been
appropriate.  Her duty related problem was related to  her  herniated  disc.
Her cardiac condition was not duty  limiting.   She  has  properly  received
health care and disability benefits form the DVA.   The  Medical  Consultant
evaluation is at Exhibit H.

______________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

Applicant states that the Medical Consultant relied  on  the  words  of  the
doctor instead of the specialist that saw her all of the time.   The  doctor
in his notes did not include all of the tests that he ordered  because  they
negated his own exam.  She  was  a  healthy  34-year-old  female  until  the
disastrous labor and birth of  her  child,  which  was  the  result  of  the
substandard and negligent care she received.  The physicians  who  delivered
her baby were young and inexperienced.  She was  over  anesthetized  to  the
point of not  being  able  to  feel  or  use  her  muscles.   Prior  to  her
separation, she reported an incident to the Office of Special  Investigation
of a male nurse obtaining injectable steroids  illegally  from  Tijuana  and
injecting himself with insulin and was making  significant  patient  errors.
She was told not to report the  incident,  but  did  so  because  it  was  a
reportable incident under the code of conduct.  A senior Air  Force  officer
told her he would ruin her.  She subsequently was  given  the  stress  tests
and was told by her cardiology consultants that it would be more prudent  to
put her on the Temporary Disability Retired List (TDRL) and re-evaluated  in
a year.  Instead she was kicked  out  with  an  active  herniated  disc,  an
unresolved and unexamined paradoxical hypotension, and a heart  problem  all
developing and progressing.  The Medical Consultant noted that  a  pacemaker
was not needed for a year after her separation.  The DVA  lost  her  medical
record and the DVA cardiologist disagreed with the findings of the  previous
cardiologists.  She did not have extra tracts,  cells,  or  tissue  removed,
but  the  actual  node  was  removed  and  she  is  still  taking   numerous
medications.  She is not pacemaker assisted but dependent on  it  for  life.
Her syncopal episodes are related to a combination  of  the  heart  problems
and the severe changes in her blood pressure.   The  only  time  she  really
feels normal and her blood pressure is at its best when she is  at  rest  in
supine position.  She can no longer do the things that she used to  be  able
to do.  She takes medication to control her pain, wears a girdle tight  back
support to help her spasms, and receives anesthesia spinal injections.   All
of her medical conditions  developed  during  her  last  tour  of  duty  and
progressed rapidly.  The doctor that delivered her baby received  permission
to have her child off base citing high risk  but  in  truth  she  just  knew
there was nobody experienced enough to deliver  her  child.   She  is  aware
that two other members with herniated discs were sent out  for  surgery  but
she was required to wait and live a year in pain.

In support of her request, applicant provided  extracts  from  her  military
and DVA medical records.  Her complete submission, with attachments,  is  at
Exhibit J.

______________________________________________________________

ADDITIONAL AIR FORCE EVALUATION:

The  BCMR  Medical  Consultant  recommends  consideration  for  rating   her
neurocardiogenic syncope based on the severity of the condition at the  time
of her  discharge.   The  Medical  Consultant  states  that  the  additional
medical documentation  provided  by  the  applicant  from  her  DVA  medical
records shows that an exercise stress test performed  in  March  2002  after
her AV nodal ablation reveals poor exercise tolerance and a hypotensive  and
bradycardic response.  The progress notes reflect that at the time  she  had
stopped taking the medication intended to improve  retention  of  fluid  and
started an over the counter diuretic, both changes that would  significantly
aggravate her neurocardiogenic syncope.  Neurocardiogenic  syncope  was  not
specifically considered by the MEB or PEB.  The  MEB  and  PEB  related  her
syncope to her EPTS first-degree heart block and intermittent  second-degree
heart block.  Evaluation subsequent to her discharge definitively  diagnosed
neurocardiogenic syncope.  Active duty documentation is not specific  as  to
whether her  syncope  interfered  with  duty,  however  she  did  experience
syncopal episodes and was evaluated in March 1998 for syncope  and  referred
for civilian cardiology evaluation.  Her  service  medical  records  has  no
other entries other than  an  18  Mar  98  clinic  note  regarding  problems
related to her cardiac history.  There is no mention  in  the  MEB  and  PEB
summaries of work disabilities or other limitations related to  her  cardiac
condition.  Thus, the PEB reasonably concluded that this condition  was  not
unfitting.  Her subsequent evaluations have  diagnosed  this  condition  and
cardiology evaluations have provided no evidence to  link  it  to  her  EPTS
first-degree heart block.  Had the diagnosis been made while on active  duty
and included as an additional unfitting diagnosis in her  evaluation  board,
it is possible that the PEB would have determined it  to  be  unfitting  and
rated it for  compensation.   At  the  time,  the  mild  degree  would  have
resulted in a rating of 10 percent according to VASRD code 8210.   Following
discharge she developed rheumatic symptoms  and  cryoglubins.   The  service
medical record finds no evidence of these symptoms  while  on  active  duty.
The rating of  her  back  condition  at  that  time  appears  to  have  been
appropriate.  Her duty-limiting  problem  was  pain.   Her  neurocardiogenic
syncope  was  not  clearly  diagnosed  while  still  on  active   duty   and
documentation is insufficient to clearly judge the degree to  which  it  may
have been unfitting since  it  was  overshadowed  by  her  back  pain.   The
Medical Consultant evaluation is at Exhibit K.

______________________________________________________________

APPLICANT'S REVIEW OF ADDITIONAL AIR FORCE EVALUATION:

Applicant states that her initial board should have had a totally  different
focus than the pain issue.  The herniated discs can be easily explained  but
the question all along should have been how a healthy female ended  up  with
a heart condition  and  subsequent  medical  problems.   She  had  untreated
pregnancy-induced hypertension and thus  her  current  heart  condition  and
problems are merely the normal sequelae that follow and the result  of  poor
judgment and treatment by novice family practice  physicians.   A  pathology
report noted a mature placenta, pinkish gray,  not  the  healthy  red,  with
multiple infarcts.  She had a small infant that  stopped  growing  prior  to
delivery and was in great distress from the time of labor to  delivery.   At
the beginning of the 6th month there was an 8-pound weight gain  and  a  20-
point rise in blood pressure.  The untrained physician  was  looking  for  a
blood pressure of 140/90 instead of realizing that she normally ran  a  very
low pressure.  The  physician  noted  she  had  no  edema  even  though  she
complained of it.  She was allowed to work  8-hour  shifts  instead  of  12.
For several months her weight gain continued at a steady pace and her  blood
pressure continued to stay high.  That  stress  on  her  heart  and  vessels
caused the permanent damage that she now lives with.   She  would  not  have
any of thee problems today had the physician been more experienced.

In further support of her request, applicant  provided  additional  extracts
from her medical records.  Her complete submission, with attachments, is  at
Exhibit M.

______________________________________________________________

THE BOARD CONCLUDES THAT:

After again reviewing the evidence of  record,  along  with  the  additional
evidence provided, we believe that sufficient  relevant  evidence  has  been
presented to demonstrate the existence of  error  or  injustice  that  would
warrant corrective action.  In this regard, we note that  the  BCMR  Medical
Consultant believes that had her diagnosis of neorocardiogenic syncope  been
made definitively while  on  active  duty  and  included  as  an  additional
unfitting diagnosis, that condition may have been  determined  as  unfitting
and rated for compensation.  We agree.  It appears that  during  the  course
of her  physical  evaluation  process,  her  condition  of  neurocardiogenic
syncope was not given consideration since it was believed that her  symptoms
were related to her EPTS first degree heart  block.   However,  the  syncope
condition  was  definitively  diagnosed  subsequent  to  her  discharge  and
determined not to be associated with her EPTS heart condition.  In  view  of
the foregoing, we believe that the benefit  of  any  doubt  in  this  matter
should be resolved in  the  applicant's  favor  and  the  fairest  and  most
equitable resolution would be to recommend that she be granted  a  permanent
disability retirement with a combined disability rating of 30  percent.   In
determining the rating that  should  be  assigned  we  noted  that  the  PEB
diagnosed her compensable unfitting conditions as chronic back  pain  at  20
percent.  At the time of her disposition, it appears that  the  mild  degree
of syncope she suffered would have resulted in a compensable  rating  of  10
percent, resulting in a combined rating  of  30  percent.   Accordingly,  we
recommend 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:

      a.  On 17 February 1999, she was unfit to perform the  duties  of  her
office, rank, grade or rating by  reason  of  physical  disability  incurred
while entitled to receive basic pay; that the diagnosis  in  her  case  were
Chronic Back Pain, disability rating 20 percent, VASRD  Code  5299  -  5293;
and Neurocardiogenic Syncope,  disability  rating  10  percent,  VASRD  Code
8210; with  a  combined  rating  of  30  percent;  that  the  disability  is
permanent; that the disability was not  due  to  intentional  misconduct  or
willful neglect; that the disability was not incurred  during  a  period  of
unauthorized absence; that the disability was not received in line  of  duty
as a direct result of armed conflict.

      b.  She was not discharged with severance pay  on  18  February  1999,
but on that date her name was placed on  the  Permanent  Disability  Retired
List.


_________________________________________________________________

The following members of the Board  considered  Docket  Number  01-01184  in
Executive Session on 15 Apr 03, under the provisions of AFI 36-2603:

      Mr. James W. Russell III, Panel Chair
      Mr. Billy C. Baxter, Member
      Ms. Martha Maust, Member

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

    Exhibit F.  Record of Proceedings, dated 27 Nov 02, w/atchs.
    Exhibit G.  Letter, Applicant, dated 2 Jan 02, w/atchs.
    Exhibit H.  Letter, BCMR Medical Consultant, dated 17 Jul 02.
    Exhibit I.  Letter, SAF/MRBC, dated 25 Jul 02.
    Exhibit J.  Letter, Applicant, dated 28 Oct 02.
    Exhibit K.  Letter, BCMR Medical Consultant, dated 12 Dec 02.
    Exhibit L.  Letter, SAF/MRBC, dated 20 Dec 02.
    Exhibit M.  Letter, Applicant, dated 26 Feb 03, w/atchs.




                             JAMES W. RUSSELL III
                                             Acting Panel Chair

AFBCMR BC-2001-01184




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:

            a.  On 17 February 1999, she was unfit to perform the duties of
her office, rank, grade or rating by reason of physical disability incurred
while entitled to receive basic pay; that the diagnosis in her case were
Chronic Back Pain, disability rating 20 percent, VASRD Code 5299 - 5293;
and Neurocardiogenic Syncope, disability rating 10 percent, VASRD Code
8210; with a combined rating of 30 percent; that the disability is
permanent; that the disability was not due to intentional misconduct or
willful neglect; that the disability was not incurred during a period of
unauthorized absence; that the disability was not received in line of duty
as a direct result of armed conflict.

            b.  She was not discharged with severance pay on 18 February
1999, but on that date her name was placed on the Permanent Disability
Retired List.







  JOE G. LINEBERGER

  Director

  Air Force Review Boards Agency