RECORD OF PROCEEDINGS
         AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS


IN THE MATTER OF:      DOCKET NUMBER:  02-01473
            INDEX CODE:  100.06

            COUNSEL:  NONE

            HEARING DESIRED:  NO


_________________________________________________________________

APPLICANT REQUESTS THAT:

His reenlistment eligibility (RE) code of 2Q be changed.

_________________________________________________________________

APPLICANT CONTENDS THAT:

While  in  basic  training,  he  was  diagnosed  with  pneumonia   and
rhabdomyolysis.  He was not discharged for the pneumonia but  for  the
rhabdomyolysis.  The diagnosis was not supported by a doctor’s opinion
or lab results.  While at the Wilford  Hall  Medical  Center,  he  was
informed that rhabdomyolysis causes kidney and liver problems, as well
as muscle breakdown in the urine.  He had absolutely no problems  with
either his kidneys or his liver, both were in perfect  working  order.
They did find muscle breakdown in his urine.  It was explained to  him
that it may have been caused by the large bruises and cuts on both  of
his knees and elbows, and the fact that the pneumonia would not  allow
his muscles to receive the proper amount of oxygen.  The  bruises  and
cuts were caused by warrior week and the  low  crawls  over  sand  and
rocks.

Since his discharge, he has remained very physically  active,  and  he
religiously runs three to five miles a day at least four times a week.
 He has had no problems with his body or his lungs.  On 16 Jan 02,  he
underwent a complete physical at  a  Department  of  Veterans  Affairs
(DVA) Medical Center in Chicago.  It was the opinion  of  the  medical
doctor that he be returned to active duty as soon as he wants.

In  support  of  his  appeal,  the  applicant  provided  an   expanded
statement, the results of a examination from the  DVA  Chicago  Health
Care System, and a copy of his DD Form  214,  Certificate  of  Release
from Active Duty.

Applicant’s complete submission, with attachments, is at Exhibit A.

_________________________________________________________________

STATEMENT OF FACTS:

Applicant enlisted in the Regular Air Force on 24 Jul 01 for a  period
of six years.

On 19 Sep 01, while in basic training, the Emergency Medical  Services
(EMS) was called to  a  training  field  after  the  applicant  became
fatigued and confused.  The EMS found the applicant to be  hypoxic  at
84 percent and transported him to the Wilford  Hall  Medical  Center’s
Emergency Department.  He was found to have multilobar  pneumonia  and
rhabdomyolysis and was  admitted.   He  was  released  on  24  Sep  01
assigned to light duty for one week.

On 16  Oct  01,  an  MEB  convened  and  established  a  diagnosis  of
multilobar  pneumonia  with   rhabdomyolysis,   resolved.    The   MEB
recommended that the applicant’s  case  be  referred  to  an  Informal
Physical Evaluation Board (IPEB).  It also indicated that  nonmilitary
hospitalization was required.

On 26 Oct  01,  an  IPEB  convened  and  established  a  diagnosis  of
rhabdomyolysis.  The IPEB found that the applicant was  unfit  because
of physical disability, that the disability  was  incurred  while  the
applicant was entitled to receive basic pay, that the  disability  was
incurred in the line of duty, that the disability was ratable under VA
Diagnostic Codes 5021-5033 at 10 percent, and that the disability  was
permanent.  The IPEB recommended that the applicant be discharged with
severance pay.

On 1 Nov 01, the applicant agreed with the  findings  and  recommended
disposition of the IPEB.

On 5 Nov 01,  the  Secretary  of  the  Air  Force  directed  that  the
applicant  be  separated  from  active  duty  service   for   physical
disability under the provisions of 10 USC 1203, with severance pay.

On 8 Nov 01, the applicant received an entry  level  separation  under
the  provisions  of  AFI  36-3212  (Disability,  Severance  Pay),  and
assigned an RE code of 2Q.  He was credited with 3 months and 11  days
of active duty service.

_________________________________________________________________

AIR FORCE EVALUATION:

The Medical Consultant noted that the applicant developed  an  episode
of rhabdomyolysis while in  basic  training.   Rhabdomyolysis  is  the
abnormal breakdown of muscle cells releasing muscle enzymes  into  the
blood stream, in  particular  myoglobin,  that  can  result  in  renal
failure and other complications.  Rhabdomyolysis can occur  due  to  a
variety  of  causes  including  high  levels  of   exertion,   trauma,
infections, drugs, and underlying muscle disease (including metabolic,
degenerative, and inflammatory disease processes).  Heavy exertion  in
hot climatic conditions that also results in dehydration and  possibly
electrolyte depletion can cause this  condition  in  otherwise  normal
individuals as well as in those with  predisposing  underlying  muscle
disease.  A 1976 study of Marine Corps recruits found that  nearly  40
percent had  “substantial”  elevations  of  muscle  enzymes  including
myoglobin, but remained asymptomatic during training.   A  variety  of
underlying diseases of  the  muscle  including  genetic  disorders  of
muscle  metabolism,  muscle  function,  or  inflammatory  disease  can
predispose to this condition, and an episode of rhabdomyolysis such as
this may be the only manifestation of an otherwise asymptomatic  case.
It is the underlying muscle disease manifesting as rhabdomyolysis that
is the disqualifying condition.  A single  episode  of  rhabdomyolysis
due to causes not reflective of  underlying  muscle  abnormalities  or
disease may not necessarily  be  considered  unfitting  for  continued
military service.

According  to  the  Medical  Consultant,   the   applicant   developed
rhabdomyolysis  in  the  setting  of  four  significant   contributing
factors:  exertion, heat, a serious infection (pneumonia), and hypoxia
(low blood oxygen) due to the pneumonia.  If  the  applicant  did  not
have the pneumonia and related hypoxia, it is quite possible  that  he
would not have developed rhabdomyolysis.  The fact that he reported he
was asymptomatic with vigorous exercise, both  now  and  during  basic
training, suggests he is less likely to  have  an  underlying  genetic
disorder of muscle metabolism (or other abnormality) which predisposed
him  to  his  episode  of   rhabdomyolysis.    Had   the   applicant’s
rhabdomyolysis occurred only as a result of exertion in the heat,  the
Medical Consultant indicated that he would  have  concurred  with  the
decision of the IPEB.  However, in  his  opinion,  the  pneumonia  and
related hypoxia were significant additional physiologic stressors that
resulted in rhabdomyolysis.  In addition, the rhabdomyolysis  appeared
to be mild in severity when considered in light of the severity of the
physiologic stressors, suggesting that the applicant is less likely to
possess an underlying metabolic muscle disease that  would  predispose
him to recurrent problems with exertion in the heat.  It  is  possible
that he could  suffer  recurrent  episodes  of  rhabdomyolysis  if  an
unrecognized disorder of muscle exists.

The Medical Consultant  stated  that  Air  Force  Instruction  48-123,
Attachment 2, Medical Standards for Continued Military  Service,  does
not list rhabdomyolysis alone as disqualifying for continued  service,
however Attachment 3, Medical Standards for  Appointment,  Enlistment,
and Induction, specifically lists rhabdomyolysis, or a history thereof
as disqualifying for enlistment.  Thus, the applicant  is  potentially
caught in a “catch 22” where, if his request is granted to change  his
RE code, he would still be disqualified from enlisting  based  on  his
medical history.  According to the Medical Consultant,  it  was  under
the unusual circumstances of the added stress of  the  pneumonia  with
hypoxia that triggered the  rhabdomyolysis,  and  that  the  applicant
could  have  been  kept  on  active  duty.   Recurrent   episodes   of
rhabdomyolysis following that initial  episode  would  certainly  have
been cause for MEB processing.

The Medical Consultant is of the opinion that the preponderance of the
current  evidence  suggests  that  the  applicant  did  not  have   an
underlying disorder of muscle that disqualifies him  from  reenlisting
and that his request  to  change  his  RE  code  should  be  favorably
considered.   He  recommended  that  the  applicant  be  evaluated  by
Neurology at Wilford Hall Medical  Center  (WHMC)  to  assess  for  an
underlying muscle disease to determine whether the applicant’s history
of a single episode of rhabdomyolysis associated with pneumonia in Sep
01 can be waived for enlistment.

A complete copy of the Medical Consultant’s evaluation is  at  Exhibit
C.

AFPC/DPPAE conducted  a  review  of  the  applicant’s  case  file  and
determined that the RE code of  2Q  (Personnel  medically  retired  or
discharged) was correct.

A complete copy of the AFPC/DPPAE evaluation is at Exhibit D.

_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

In his response, the applicant indicated that his past was  summed  up
by the Medical Consultant’s advisory opinion.  Since his discharge, he
has been attending college courses full time and  working  part  time.
He exercises religiously and has not  once  experienced  any  problems
with his lungs or muscles.  He is advising the Board  of  these  facts
because he wants and needs to show the Board that he does not quit.

Applicant’s complete response is at Exhibit E.

_________________________________________________________________

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 presented to demonstrate the
existence of error or injustice  warranting  corrective  action.   The
evidence of record indicates that, while  undergoing  basic  training,
the applicant was found unfit for  continued  military  service  after
being diagnosed with rhabdomyolysis and was separated by reason  of  a
physical disability.  The applicant now requests that his RE  code  of
2Q be changed, indicating that he has not had any recurring  problems.
The Medical Consultant has indicated that he does not believe that the
applicant’s episode of rhabdomyolysis was the result of an  underlying
muscle abnormality or disease, but rather  was  the  result  of  other
contributing factors; i.e., exertion, heat, pneumonia, and  low  blood
oxygen due to the pneumonia.  Furthermore, it appeared to him that the
applicant’s condition was mild in its severity,  suggesting  that  the
applicant is less likely to possess a condition that would  predispose
him to recurrent problems.  Notwithstanding this, rhabdomyolysis is  a
disqualifying  condition  for  enlistment.   Therefore,  the   Medical
Consultant recommended that the applicant be  medically  evaluated  at
WHMC to assess for an underlying muscle disease to  determine  whether
the  applicant’s  history  of  a  single  episode  of   rhabdomyolysis
associated with pneumonia can  be  waived  for  enlistment.   Since  a
determination cannot at this time  be  made  whether  the  applicant’s
present condition is unfitting, we are not  inclined  to  recommend  a
change in the applicant’s RE code.  However, after a  thorough  review
of the facts and circumstances of this case, we agree with the Medical
Consultant’s assessment and  his  recommendation  that  the  applicant
should  be  medically  evaluated  at  WHMC  to  determine  whether  an
underlying muscle disorder exists that would preclude his reentry into
military service.  In our view, this  is  the  appropriate  course  of
action at this point.  In view of the foregoing, we recommend that the
applicant’s records be corrected to the extent set forth below.

_________________________________________________________________

THE BOARD RECOMMENDS THAT:

The pertinent military records of the  Department  of  the  Air  Force
relating to APPLICANT, be corrected to show that  invitational  orders
to Wilford Hall Medical Center were issued by competent authority  for
the purpose of his undergoing a physical examination to determine  his
medical fitness for reentry into military service; that the results be
forwarded to the Air Force Board for Correction of Military Records at
the earliest practicable date so that all  necessary  and  appropriate
actions may be completed; and,  that  all  charges  for  the  physical
examination be, and hereby are, waived.

_________________________________________________________________

The following members of the Board considered AFBCMR Docket Number 02-
01473 in Executive Session on 14 Jan 03, under the provisions  of  AFI
36-2603:

      Mr. Charles E. Bennett, Panel Chair
      Mr. Jay H. Jordan, Member
      Mr. George Franklin, Member

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

     Exhibit A.  DD Form 149, dated 24 Apr 02, w/atchs.
     Exhibit B.  Applicant's Master Personnel Records.
     Exhibit C.  Letter, Medical Consultant, dated 15 Jul 02.
     Exhibit D.  Letter, AFPC/DPPAE, dated 31 Oct 02.
     Exhibit E.  Letter, SAF/MRBR, dated 8 Nov 02.
     Exhibit F.  Letter, applicant, undated.




                                   CHARLES E. BENNETT
                                   Panel Chair










AFBCMR 02-01473




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 , be corrected to show that invitational orders to
Wilford Hall Medical Center were issued by competent authority for the
purpose of his undergoing a physical examination to determine his
medical fitness for reentry into military service; that the results be
forwarded to the Air Force Board for Correction of Military Records at
the earliest practicable date so that all necessary and appropriate
actions may be completed; and, that all charges for the physical
examination be, and hereby are, waived.







    JOE G. LINEBERGER

    Director

    Air Force Review Boards Agency