RECORD OF PROCEEDINGS
             AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:      DOCKET NUMBER:  01-03671
            INDEX CODE:  108.01
            COUNSEL:  Mr. John F. Legris

            HEARING DESIRED:  YES

_________________________________________________________________

APPLICANT REQUESTS THAT:

Her records be corrected to  show  that  she  was  found  to  be  unfit  for
military duty and that she was assigned a minimum  rating  of  20%  or  more
appropriately that her name was placed on the Temporary  Disability  Retired
List (TDRL) with a 40% rating under VASRD  Diagnostic  codes  8599-8515  for
her Reflex Sympathetic Dystrophy (RSD).

_________________________________________________________________

APPLICANT CONTENDS THAT:

While on duty in the Surgical Intensive Care Unit she injured her left  hand
while attempting to lift a patient.  The nature and  extent  of  her  injury
was listed as "left index finger sagittal band rupture" and her  injury  was
determined to be in-line-of-duty by the appropriate  authority.   On  8  Sep
99, she underwent a surgical procedure that consisted of partial release  of
her ulnar sagittal  band  with  repair  of  the  radial  sagittal  band  and
realignment of her extensor mechanism over her index finger.  When her  cast
was removed on 30 Sep 99, she experienced severe hypersensitivity  over  her
incision and along the dorsal forearm as  well  as  pain.   There  was  poor
metacarpal motion, wrist motion and elbow motion.  She  could  not  tolerate
even a slight touch to her  left  hand  all  the  way  to  her  elbow.   Her
physician suspected  RSD  and  referred  her  to  the  occupational  therapy
clinic.

On 4 Oct 99, her therapy began which included desensitization, scar  massage
and, passive and active range of motion exercises.   The  therapy  was  very
painful, especially when she attempted to extend her finger.  During follow-
up, on 14 Oct 99, it was noted that she  was  experiencing  numbness,  pain,
and tingling along the right side of the left index  finger.   Beginning  15
Oct 99, she was seen twice a day, five days a week in  occupational  therapy
for desensitization and active range of motion exercises.  During a  follow-
up visit on 21 Oct 99, she reported some progress with desensitization,  but
the numbness and tingling sensation along the left  index  finger  continued
and the pain remained the same.  On 18 Nov 99, she reported pain  along  the
side of the left finger while doing active range  of  motion  exercises  and
informed the therapist that if she did not  exercise  the  finger  within  3
hours it would become very stiff.  Occupational  therapy  was  decreased  to
once per day to decrease the pain.
On 22 Nov 99, she reported that she had developed hard and  painful  nodules
on the left index finger.  The pain was excruciating with  flexion  and  the
skin had become very red.  It was determined that she was experiencing  some
synovitis and was provided with a figure eight splint.  By 16  Dec  99,  her
numbness and tingling was unchanged yet her finger was stiffer as  a  result
of being placed in the splint.  She requested tests to determine whether  or
not  she  had  suffered  nerve  damage  or  injury.   She  asked  for  nerve
conduction velocity tests  to  be  performed  as  well  as  tests  for  bone
density.  Since her physician did not see the  need  for  these  tests,  she
sought a second opinion.  During her second opinion examination  a  decrease
in flexion was noted.  The physician  suspected  that  the  dysesthesia  was
mild and declined to recommend surgery at least for a period  of  one  year.
On 31 Jan 00, in a follow-up appointment, she reported improvement  in  pain
during flexion and after fluid therapy.  However,  the  physician  did  note
continued mild swelling, redness and nodules.  No changes  in  therapy  were
made.  During the month of February 2000, it was noted that her therapy  had
plateaued.  Her left index finger  remained  stiff  and  difficult  to  bend
beyond a certain point.  Her numbness and tingling were  unchanged  and  her
left hand was weaker than the right.  On 6 Mar 00, she was  discharged  from
occupational therapy.  Since that time she continued to experience pain  and
stiffness.  On 13 Mar 00, she was told that her  finger  might  not  improve
much more, if at all and that she would not be able to do  patient  care  as
she had done before, but as a nurse had other options.

A Medical Evaluation Board (MEB)  convened  on  6  Apr  00  and  recommended
return to duty.  On 12 Apr 00, she submitted her letter of exception to  the
MEB results.  Her case was  referred  to  an  Informal  Physical  Evaluation
Board (IPEB) which met on 21 Apr 00.  The IPEB determined that there was  no
category I unfitting condition which was compensable and ratable.   However,
the IPEB did find that she suffered from a category II condition that  could
be unfitting but was not currently compensable or  ratable,  namely  chronic
pain in the left second digit.  The VA diagnostic code utilized by the  IPEB
was 8715, which is designated as neuralgia of the median  curve.   The  IPEB
stated that her medical condition did not prevent her from  performing  less
strenuous duties.  The IPEB found  her  fit  and  recommended  that  she  be
returned to duty.

What the IPEB overlooked in this case is that her condition  is  not  simply
"chronic pain in the left second digit (index finger)" but rather a  serious
neurological condition known as Reflex Sympathetic  Dystrophy  (RSD).   This
condition is an excruciatingly painful condition, which  is  both  extremely
debilitating and has  one  of  the  highest  rates  for  suicide  among  the
afflicted of any known medical condition.  Subsequent to  her  release  from
active duty she was evaluated by the Department of Veterans  Affairs  (DVA).
A rating decision was issued to her which assigned her  20%  disability  for
her left index finger radial sagittal rupture.   The  decision  stated  that
"Service records and other evidence shows hospitalization  for  a  prolonged
period of treatment of wound, with record of consistent  complaint  of  loss
of power, weakness, lowered threshold of fatigue,  fatigue-pain,  impairment
of coordination, and uncertainty of movement, and if  present,  evidence  of
inability to keep up with work requirements.  The DVA found  her  disability
to be "moderately severe".  The DVA assigned its percentage  for  moderately
severe muscle disability whereas the IPEB  chose  to  focus  more  upon  the
damage to the nerves, utilizing VA diagnostic code  8715  for  neuralgia  of
the median nerve.  Based on the verbiage of the VA  rating  decision  it  is
obvious that the DVA evaluated her  on  the  basis  of  the  impairment  she
experienced in the muscles of the hand.  It is a well-established  principle
that the Air Force need not rate an evaluee in the same manner as  the  DVA.
Nevertheless, it is well known to practitioners before the  Formal  Physical
Evaluation Board (FPEB) that,  upon  TDRL  re-evaluation,  the  FPEB  always
inquires as to the evaluee's rating with the DVA and the rationale for  that
rating.  The FPEB in particular is always concerned as  to  whether  or  not
the DVA rating decision was based upon only  a  records  review  or  upon  a
medical examination.   Although  not  binding  on  the  FPEB  or  IPEB,  DVA
determinations often carry great weight with these boards.  In her case  the
DVA rating decision is definitely relevant to  a  determination  of  whether
the Air Force  disability  system  made  the  appropriate  determination  in
finding her fit for duty.  The DVA by contrast considered her  condition  to
be that of  a  moderately  severe  muscle  disability.   The  DVA  gave  her
condition the careful, thoughtful consideration it deserved.   However,  the
more pertinent of the two evaluations would be to rate  her  RSD  under  the
appropriate code for incomplete paralysis of the median nerve  as  at  least
"moderate" for the non-dominant hand at 20%.  An argument could be made  for
rating her condition as incomplete paralysis of the median nerve  as  severe
as 40%.  Such a rating would of course direct a determination  that  she  be
placed on the TDRL.  A rating of  20%  would  at  a  minimum  recognize  her
medical condition as not only service connected but as  one  which  rendered
her,  in  fact,  unfit  for  military  service  and  which   constituted   a
debilitating condition much greater than merely "chronic pain."

In support of  her  request,  applicant  provided  her  counsel's  brief,  a
personal  statement,  documents  associated  with  her  Line-of-Duty   (LOD)
determination, extracts from her medical records, documents associated  with
her Disability Evaluation  System  (DES)  processing,  documents  associated
with her DVA claim processing and rating decision,  a  magazine  article,  a
local  newspaper  article,  and  medical  journal  excerpts.   Her  complete
submission, with attachments, is at Exhibit A.

_________________________________________________________________

STATEMENT OF FACTS:

Applicant, a prior service Army Reserve officer, was  appointed  a  captain,
Reserve of the Air Force, on 3 Sep  96.   She  was  voluntarily  ordered  to
extended active duty on 12 Nov 96.  While working as a critical  care  nurse
the applicant injured her left hand on 22 May 99 while moving a  very  heavy
patient.  She was  subsequently  referred  to  orthopedic  surgery  and  was
diagnosed with partial rupture of the stabilizing radial  sagittal  band  of
the left index finger metacarpal phalangeal joint.  She  underwent  surgical
repair on 8 Sep 99.  Upon removal of her cast on 30 Sep 99 she was found  to
have hypersensitivity that  generalized  to  the  forearm.   The  orthopedic
surgeon referred her to occupational therapy using the  RSD  protocol.   She
was subsequently seen by occupational therapy 68 times.   In  December  1999
and January 2000 orthopedics reported  her  RSD  symptoms  and  symptoms  of
dysesthesias improving.  In February 2000, she reported decreased  pain  and
improved range of motion.

An MEB was convened on 6 Apr 00 and returned the  applicant  to  duty.   The
applicant did not concur with  the  findings  of  the  MEB.   Her  case  was
consequently referred to  an  IPEB  which  determined  her  injury  did  not
prevent her from performing less  strenuous  duties  commensurate  with  her
office, rank, grade, or rating, or  from  completing  her  current  tour  of
duty, and returned her to  duty.   Her  request  for  extension  of  service
(Specified Period of Time Contract) was denied based  on  her  ineligibility
for military retirement due  to  her  age.   On  26 Apr  99,  she  requested
separation from the Air Force.  On 30 Jun 00, she was released  from  active
duty and transferred to the Ready Reserve.  She served 3  years,  7  months,
and 19 days on active duty.

On 24 Feb 01, the DVA rated her medical condition for the left index  finger
radial sagittal rupture, as 20 percent disabling.

_________________________________________________________________

AIR FORCE EVALUATION:

The BCMR Medical  Consultant  recommends  denial.   The  Medical  Consultant
states that the applicant contends that  her  disability  should  have  been
based on a diagnosis  of  RSD  using  VASRD  Code  8713,  neuralgia  of  all
ridiculer groups (i.e. the entire arm)  rather  than  a  diagnosis  of  pain
limited to the index finger using VASRD Code 8715, neuralgia of  the  median
nerve (localized portion of the hand innervated by  the  median  nerve  that
includes the thumb, index, middle and ring  fingers).   Her  DVA  disability
rating is based on loss  of  muscle  function  using  VASRD  5307,  loss  of
flexion of the hand and wrist, at a moderately severe level, rather than  on
the basis of pain neuralgia.

A diagnosis of RSD was suspected based on her abnormal painful  response  to
her surgery.  RSD is a pain syndrome that affects an  entire  extremity  and
often occurs as an abnormal response to an injury of surgery affecting  only
a part of that extremity.  Although she initially showed some symptoms  that
were concerning to  her  orthopedic  surgeon  for  RSD,  that  of  pain  and
hyperesthesia that generalized to  the  forearm,  the  generalized  symptoms
appeared to  resolve  quickly  with  therapy  and  her  subsequent  problems
affected only the left (non-dominant) index finger.  Using  the  VASRD  code
for neuralgia that affects the entire extremity as claimed by the  applicant
is not appropriate since her disability at the time of separation  from  the
Air Force was limited to the left index  finger.   Using  the  median  nerve
code  for  neuralgia  or  the  muscle  disability  codes,  both   of   which
characterize the disability to the region affected, are more appropriate  in
this case.  The Medical Consultant evaluation is at Exhibit C.

AFPC/DPPD reviewed applicant's request and recommends denial.   DPPD  states
that IPEB decisions that result in return to duty  recommendations  are  not
given rebuttal rights to the individual.  This  decision  is  determined  on
the  condition  that  fit  for  duty  findings  do  not  cause   involuntary
separation for  physical  disability.   One  question  comes  to  mind  when
evaluating this case is that it has been 21 months since  she  was  released
from active  duty;  however,  nothing  in  her  military  records  medically
disqualifies her from her Ready Reserve status,  a  strong  indication  that
she is still qualified for military service.  The main purpose for  the  MEB
was to determine the status of her injured left index finger.  Although  the
MEB medical narrative summary  states  that  she  was  started  on  the  RSD
protocol, a final diagnosis was not determined during this  timeframe.   The
DVA rating decision rates her medical condition for the  left  index  finger
sagittal rupture and does not evaluate  her  for  RSD.   The  applicant  was
treated fairly during the DES process  and  she  was  properly  rated  under
federal disability guidelines based on her condition  at  the  time  of  her
assessment.  The DPPD evaluation is at Exhibit D.

_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

Applicant responded and states that the Air Force evaluations  neglected  to
mention that her duties that she was returned to were  as  a  "gofer."   She
was not able to return to her duties as a Critical Care  Nurse  as  she  had
done for the previous 15 years.  She  is  left  with  pain,  discomfort  and
hypersensitivity on her left hand and not only her  left  finger  as  is  so
frequently stated in the evaluation.   She has been forced to make a  career
change that has left her with a salary a lot lower than she  would  earn  if
she were able to work in Critical Care Units.

Counsel states that her contention continues to be  that  the  IPEB  ignored
relevant  and  competent  evidence  of  the  applicant's  diagnosed  medical
condition, RSD, now renamed Complex Regional  Pain  Syndrome  I,  and  as  a
result mischaracterized her medical condition as  simply  "chronic  pain  of
the left second digit (index finger)."  As a  result,  the  IPEB  failed  to
find her medical condition unfitting  for  further  military  service.   Her
physician immediately started her on an RSD protocol.   Thus,  as  early  as
this first post-operative visit, Air Force physicians  recognized  that  she
was suffering from RSD and not just a sagittal band rupture.
In the medical advisory the Medical  Consultant  acknowledges  the  possible
existence of RSD as a diagnosis in the applicant's case.  He noted  that  on
30 Sep 99 upon removal of her cast, she was found to  have  hypersensitivity
over the surgical incision and the dorsal forearm  and  had  poor  range  of
motion  of  the  elbow,  wrist,  and  index  finger  joints.   The   Medical
Consultant also noted that her RSD-like symptoms improved from October  1999
to March 2000.  He also observed that as of 15 Jun 00 a  hand  surgery  note
indicated "resolving RDS..."  Thus he located many of the  same  entries  in
the applicant's medical records that counsel had noticed, which referred  to
RSD as possibly the appropriate diagnosis in her case.   The  applicant  was
obviously suffering from something more significant than  chronic  pain  and
the IPEB should have been  more  precise  in  its  characterization  of  her
medical condition.  It is apparent that the Medical Consultant is  skeptical
of this diagnosis, since he says that her problem affected  "only  the  left
(non-dominant) index finger."  He has reluctantly admitted that RSD  may  be
appropriately diagnosed in one affected upper  or  lower  extremity.   There
are many cases in the medical literature provided  which  reflect  diagnoses
of RSD in a leg, an arm, a  hand,  or  a  foot.   The  medical  Consultant's
statement to the effect that  "RSD  is  a  pain  syndrome  currently  termed
Complex Regional Pain Syndrome that affects an entire extremity..."  is  not
exactly correct.  RSD need not affect the entire extremity, but  may  affect
some portion of the extremity i.e. the  fingers  of  a  hand.   The  Medical
Consultant inaccurately states the applicant's position with regard  to  the
appropriate VASRD code to be applied and misquotes  the  Brief  of  Counsel.
He is incorrect stating that "The applicant  contends  that  her  disability
should have been rated based on a diagnosis of RSD using the VASRD  code  of
8713, neuralgia of all radicular groups (i.e. the entire arm),  rather  that
a diagnosis of pain limited to the  index  finger  using  VASRD  code  8715,
neuralgia of the median nerve..."  Counsel  contends  that  the  appropriate
code to be  utilized  for  her  RSD  was  VASRD  code  8515  for  incomplete
paralysis of the median nerve.

The applicant recognizes that 8713 is in fact a  VASRD  code  for  neuralgia
for all radicular groups.  She was  merely  suggesting  the  analogous  code
8799-8713 as a possibility.  By misquoting the Counsel's Brief, the  Medical
Consultant  would  imply  to  the  Board  that  the  applicant  is   somehow
requesting more than is appropriate for her medical condition.  She  is  not
claiming  that  she  suffers  neuralgia  in  all  radicular  groups  of  the
peripheral nerves; she is not claiming that she suffers RSD  in  her  entire
forearm or arm' she is merely claiming that the appropriate  code  would  be
VASRD 8515, incomplete paralysis of the median nerve and  that  this  should
be rated at least 20% "moderate" for the non-dominant hand.  The VASRD  does
not go into detail such that dysfunctions of the digital  nerves  are  rated
separately from the larger nerves (such  and  the  median)  which  intervate
them.

The Medical Consultant states that "Her subsequent VA Disability  rating  of
20% is based on loss of muscle function using VASRD 5307,  loss  of  flexion
of the hand and wrist as a moderately  severe  level,  rather  than  on  the
basis  of  pain  (neuralgia)."   He  is  only  partially  correct  in   this
assertion.  The VA's  rating  was  on  the  impairment  of  the  applicant's
muscles to flex and/or extend the left finger rather than the entire  wrist.
 VASRD code 5307 refers to group VII of the muscles of the forearm  and  the
hand, the specific functions of which are flexion of the wrist and  fingers.
 VASRD code 5308 refers to group Viii of the  muscles  of  the  forearm  and
hand, the functions of which are extension of the wrist and fingers.  It  is
clear from the VA medical examination that  range  of  motion  was  measured
with regard to the fingers  of  the  left  hand,  i.e.  the  interphalangeal
joints, not the radiocarpal joint which is responsible for  flexion  of  the
wrist.  Te approach used of analyzing the condition of a  muscle  disability
is certainly  an  acceptable  method  of  rating  the  applicant's  physical
disability.  Her contention is that the preferable method  is  to  rate  her
condition as RSD, under VASRD code 8515.

In additional support of  her  request,  applicant  provided  her  counsel's
brief, a personal statement, and  extracts  from  her  post-service  medical
records.  Her complete response, with attachments is at Exhibit F.

_________________________________________________________________

APPLICANT'S ADDITIONAL REVIEW OF AIR FORCE EVALUATION:

Counsel states that  as  early  as  her  initial  post-operative  visit  she
complained of burning in the radial aspect of the left index finger and  her
physician immediately started  her  on  an  RSD  protocol.   The  Air  Force
physician recognized that  she  was  suffering  from  RSD  and  not  just  a
sagittal band rupture.  The IPEB rated her condition under VASRD code  8715,
which is designated as neuralgia of the median nerve.  Neuralgia  is  simply
a synonym for pain. The IPEB should have rated  her  RSD  under  appropriate
code for incomplete paralysis of the median nerve, VASRD  code  8515  as  at
least moderate for the non-dominant hand at 20 percent.  An  argument  could
be made for rating her as "severe" at 40 percent.   The  Medical  Consultant
acknowledges the possible existence of RSD as a diagnosis of her  case.   He
noted that upon removal of her cast, she was found to have  hypersensitivity
over the surgical incision and the dorsal forearm  and  had  poor  range  of
motion of the elbow, wrist, and index finger joints.   He  also  notes  that
her RSD like symptoms improved from October 1999  through  March  2000.   He
also observed a hand surgery note  indicates  "resolving  RSD..."   Thus  he
located many of the same entries as counsel noted  which  referred  to  RSD.
The applicant was obviously suffering from something more  significant  that
chronic pain.

In his diagnosis he has reluctantly admitted that RSD may  be  appropriately
diagnosed in one affected upper or lower extremity.  There  are  many  cases
in medical literature which reflect diagnoses of RSD in a  leg,  an  arm,  a
hand, or a foot.  His statement to the effect that RSD is  a  pain  syndrome
currently termed Complex Regional  Pain  Syndrome  that  affects  an  entire
extremity,  is  not  exactly  correct.   RSD  need  not  affect  an   entire
extremity, but may affect some portion of the extremity,  i.e.  the  fingers
of a hand.  The Medical Consultant inaccurately states her position  stating
that she contends that her disability should have  been  rated  using  VASRD
code 8713 when in actuality she contends that  it  should  have  been  8715.
She was merely suggesting the analogous code 8713 as a possibility.  She  is
not claiming that she suffers neuralgia  in  all  radicular  groups  of  the
peripheral nerves; she is not claiming that she suffers RSD  in  her  entire
forearm of arm; she is merely claiming that the appropriate  code  would  be
VASRD 8515.

The Consultant comments that a note reflected "a digital nerve  dysfunction,
not a median nerve dysfunction."  The VASRD does not  go  into  detail  such
that dysfunctions of the  digital  nerves  are  rated  separately  from  the
larger nerves (such as the median) which intervate them.   Counsel  believes
that the consultant is only partially correct in his assertion that her  DVA
disability rating is based loss of muscle function using  VASRD  5307,  loss
of flexion of the hand and wrist at a moderately severe level,  rather  that
on the basis of pain.  It is  true  that  the  DVA  rating  was  focused  on
impairment of the muscles rather than on  pain;  however,  counsel  believes
the DVA rating was on the impairment of her muscles to  flex  and/or  extend
the left finger rather than the entire wrist.  VASRD  code  5307  refers  to
group VII of the muscles of the forearm and hand, the specific functions  of
which are flexion of the wrist and  fingers.   VASRD  code  5308  refers  to
group VIII of the muscles of the forearm and hand, the  functions  of  which
are extension of the wrist and fingers.  It is not clear which of these  two
VASRD codes the DVA used.  It is clear that range  of  motion  was  measured
with regard to the fingers of the left hand.

DPPD acknowledges that the applicant was started  on  the  RSD  protocol  as
well.  The  DPPD  advisory  fails  to  effectively  refute  the  applicant's
contention as set forth in  counsel's  brief  in  the  fact  that  the  only
diagnosis commented on frequently in the medical  records,  other  than  the
sagittal band rupture, is RSD.

This is not a case where the Board is asked to second-guess a percentage  of
disability which was assigned by  the  PEB.   Rather,  this  is  a  case  of
fundamental issues.  The first  is  the  nature  of  the  medical  condition
itself and the second is whether or not the applicant was fit or unfit as  a
result of the medical condition.  The applicant's complete submission is  at
Exhibit G.

_________________________________________________________________

ADDITIONAL AIR FORCE ADVISORY:

The BCMR Medical Consultant  states  that  the  nature  of  the  applicant's
condition, that of pain of neurologic origin is  not  at  issue.   There  is
evidence to support that her pain was more than that expected from a  normal
post-operative course for the type of surgery that  had  undergone  and  was
considered to be RSD.  She was treated with improvement  but  with  residual
discomfort documented to have been limited to the left index finger  (radial
side).  At the time of her MEB there was no weakness or instability  of  the
finger.  She did have variable limitation of  motion  related  to  pain  and
attendant stiffness that was overcome with  stretching  and  use.  Within  a
year  following  separation,  the  DVA  evaluation   documented   pain   and
limitation of motion and rated her at 20 percent.  At issue is  whether  she
was unfit for continued duty.  The  orthopedic  surgeon  did  not  find  any
"mechanical deficit in her hand that would necessitate  her  to  be  removed
from clinical care," yet she contends that her  painful  left  index  finger
completely disabled her from working as a  nurse  in  any  capacity.   Thus,
there was  no  objective  finding  that  her  condition  was  unfitting  for
continued service but her pain limited her ability to perform her duties  as
a critical care nurse.  The index finger in unique in function to  the  hand
as a whole and that impairments involving the index finger alone  do  affect
function of the hand as a whole requiring therapy  to  compensate.   At  the
time of her separation, she had not returned to clinical care nursing.   The
consultant concurs with the opinion of the orthopedic surgeon and  the  IPEB
that her condition at that time was not unfitting as defined by the  ability
to perform as a clinical nurse in a more  generic  way.   Had  her  contract
been extended she could have continued to function effectively, albeit in  a
different capacity.  If the IPEB had instead  reached  the  conclusion  that
her finger pain was unfitting and  compensable,  then  the  VASRD  code  for
neuralgia of the median nerve (8715) is the  most  appropriate.   Since  the
nature of her condition is predominantly pain of  a  neurogenic  basis,  the
neuralgia code is the most appropriate.  The reason she  could  be  fit  for
duty despite the presence of a medical problem and later granted a  service-
connected disability by  the  DVA  lies  in  understanding  the  differences
between Title 10 U.S.C., and Title 38, U.S.C.  Title 10 charges the  service
Secretaries with maintaining a fit and vital force.  For  an  individual  to
be considered unfit for service there must be a medical condition so  severe
that if prevents the performance of any  work  commensurate  with  rank  and
experience.  In  this  instance,  her  condition  did  not  appear  to  have
rendered her unfit for continued military service  and  she  proceeded  with
planned separation from the Air Force.  Title  38,  which  governs  the  DVA
compensation system was written to allow awarding compensation  ratings  for
conditions that are not unfitting for military service.  This is the  reason
why an individual can be found fit  for  service  and  yet  soon  thereafter
receive  compensation  rating  from  the  DVA.    The   Medical   Consultant
evaluation is at Exhibit H.

_________________________________________________________________

APPLICANT'S REVIEW OF ADDITIONAL AIR FORCE EVALUATION:

A copy  of  the  additional  Air  Force  evaluation  was  forwarded  to  the
applicant on 20 Dec 02 for review and comment within 30 days.   As  of  this
date, this office has received no response.

_________________________________________________________________

THE BOARD CONCLUDES THAT:

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

2.  The application was timely filed.

3.  Insufficient relevant evidence has been  presented  to  demonstrate  the
existence of an  error  or  injustice.   After  a  thorough  review  of  the
evidence of record  and  the  documentation  submitted  in  support  of  her
appeal, we are not persuaded that  she  was  unfit  for  continued  military
service at the time of  her  separation  from  the  military.   Her  records
indicate that she suffered a  partial  rupture  of  the  stabilizing  radial
sagittal band of the left index  finger  while  lifting  a  patient  in  the
performance of her  military  duties.   During  her  treatment  process,  it
appears that her  symptoms  led  the  attending  physician  to  suspect  the
existence  of  RSD  and  she  was  referred  to  a  specialist  for  further
evaluation and treatment.  Further review  of  her  medical  record  reveals
that those particular symptoms  of  RSD  apparently  improved  and  resolved
after therapeutic treatments.  Contrary  to  her  contentions,  we  are  not
persuaded that the decision of the IPEB was inappropriate  at  the  time  it
was considered nor has evidence been provided that would lead us to  believe
that the IPEB decision was  made  without  taking  all  of  the  appropriate
factors into consideration.  Evidence has not  been  presented  which  would
lead us to believe that her condition  prevented  her  from  completing  her
tour of duty with the Air Force or that her condition  rendered  her  unable
to perform other military duties commensurate with her grade  and  position.
The Air Force is required to rate an individual's disability at the time  of
evaluation.  The DVA  operates  under  a  totally  separate  system  with  a
different statutory basis.  In this respect, we believe that the  Air  Force
appropriately considered the applicant's condition and whether  or  not  the
condition rendered her unfit to perform the duties of her office  and  grade
at that time.  The DVA rates for any and all  service  connected  conditions
to the degree in which they interfere  with  future  employability,  without
consideration of fitness.   Therefore,  in  the  absence  of  evidence  that
convincingly refutes the opinions  and  recommendations  of  the  Air  Force
offices of primary responsibility, we are  compelled  to  agree  with  their
recommendation and adopt their rationale as the  basis  for  our  conclusion
that she has not been the victim of  an  error  of  injustice  and  find  no
compelling  basis  to  recommend  granting  the  relief   sought   in   this
application.

4.  The applicant's case is adequately documented and it has not been  shown
that a personal appearance with or without counsel will  materially  add  to
our understanding of the issue  involved.   Therefore,  the  request  for  a
hearing is not favorably considered.

_________________________________________________________________



THE BOARD DETERMINES THAT:

The applicant be notified that the evidence presented  did  not  demonstrate
the existence of 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  Docket  Number  01-03671  in
Executive Session on 12 Mar 03, under the provisions of AFI 36-2603:

      Mr. Michael K. Gallogly, Panel Chair
      Mr. Gregory A. Parker, Member
      Ms. Brenda L. Romine, Member

The following documentary evidence was considered:

    Exhibit A.  DD Form 149, dated 10 Dec 01, w/atchs.
    Exhibit B.  Applicant's Master Personnel Records.
    Exhibit C.  Letter, BCMR Medical Consultant, dated 4 Mar 02.
    Exhibit D.  Letter, AFPC/DPPD, dated 18 Apr 02.
    Exhibit E.  Letter, SAF/MRBR, dated 26 Apr 02.
    Exhibit F.  Letter, Applicant, dated 19 May 02.
    Exhibit G.  Letter, Applicant's Counsel, dated 23 Aug 02.
    Exhibit H.  Letter, BCMR Medical Consultant, dated 6 Dec 02.
    Exhibit I.  Letter, SAF/MRBC, dated 20 Dec 02.




                                             MICHAEL K. GALLOGLY.
                                             Panel Chair