RECORD OF PROCEEDINGS
         AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS


IN THE MATTER OF:      DOCKET NUMBER:  02-03351
            INDEX CODE:  128.10
            COUNSEL:  NONE

            HEARING DESIRED:  NO

_________________________________________________________________

APPLICANT REQUESTS THAT:

He be released from recoupment of his  debt  for  sponsorship  in  the
Armed Forces Health Professions Scholarship Program (AFHPSP).

_________________________________________________________________

APPLICANT CONTENDS THAT:

He accepted the AFHPSP on  the  assumption  that  upon  completion  of
medical school he would be allowed to complete any  residency  of  his
choice and then serve the Air Force in that medical specialty for four
years.  Instead of being allowed to pursue his  medical  specialty  he
was forced to enter active duty as  a  general  medical  officer.   He
accepted his duty and began his first assignment at --- Air Force Base
and soon began to suffer terribly from what  in  retrospect  were  the
early  stages  of  depression,  isolation   and   obsessive-compulsive
disorder.  As his personal life deteriorated  he  petitioned  the  Air
Force to release him from active duty.  He suffered chastisement  from
his colleagues as a result of his attempts to separate  and  sought  a
new assignment at RAF Lakenheath,  UK.   His  situation  continued  to
deteriorate until he was in a  deep  major  depression  with  suicidal
ideation.  A psychiatrist treated him for seven months prior to  being
recommended for separation from the Air Force.  This major  depression
affected him physically, mentally, emotionally, and  spiritually,  but
never impaired his ability to practice medicine for the Air Force.  In
fact, he was used in the capacity of an unsupervised  general  medical
officer in the emergency department until his medical  separation  was
approved.

He is slowly beginning to pick up the pieces of  his  shattered  life.
He accepted the medical board’s finding  that  his  condition  existed
prior to service because all he wanted was to leave the military since
this was the cause  of  his  suffering.   No  mention  was  made  that
recoupment of scholarship money was going to be made at the  time  his
medical separation from the Air Force was approved.  If  anything,  he
should be compensated for the medical conditions that  resulted  as  a
direct effect of his military service.  He has tried  his  hardest  to
work in every possible way with the military to honorably complete his
term of service, but it did not  work  out.   He  requests  the  Board
review his Medical Board, medical records, OPRs and  specifically  the
letter he wrote while at --- AFB in an attempt to  separate  from  the
Air Force before his situation reached the point of desperation.

In support of his appeal,  applicant  submits  a  personal  statement,
copies of his Department of Defense Application for  Graduate  Medical
Education, copies of documents associated with his discharge,  a  copy
of AFIT/RPB expense summary report and associated documents.

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

_________________________________________________________________

STATEMENT OF FACTS:

Records indicate that the applicant was appointed a second lieutenant,
Reserve of the Air Force on 29 March 1995.   He  participated  in  the
HPSP program from 29 August 1995 – 27 March 1999.  On 27  March  1999,
applicant was appointed a captain Reserve of the  Air  Force  (Medical
Corps) and was voluntarily ordered to extended active duty on 10  July
2000 with assignment to ----.  In August 2001, he  was  reassigned  to
Lakenheath UK.  Applicant was discharged on 25 October  2002,  because
of disability, which existed prior to service.  He was  credited  with
2 years, 3 months and 16 days of total active duty service.

_________________________________________________________________

AIR FORCE EVALUATION:

AFPC/DPAME recommends the application be denied.   DPAME  states  that
the applicant had an existing active duty  service  obligation  of  10
July 2004.  DPAME reviewed the  HPSP  contract,  which  the  applicant
signed 29 August 1995, indicating, “I understand that, notwithstanding
any other provision of this contract, my failure to disclose any  fact
that might have a bearing on my acceptance into the AFHPSP may be used
as justification for recoupment of any, and/or all  scholarship  funds
expended on my behalf.  I further understand that recoupment can occur
under these circumstances even though I  have  successfully  completed
the program and have accepted an appointment  in  the  Medical  Corps.
(For example, failure to disclose any  portion  of  my  past  history,
medical  or  otherwise.)”   DPAME  states  that  the   applicant   was
discharged for a medical condition  that  existed  prior  to  entering
active duty.  Recoupment was requested  based  on  his  signed  AFHPSP
contract.  The applicant  signed  the  contract  on  29  August  1995,
thereby agreeing to the terms of the contract and should  be  required
to reimburse the government.  The AFPC/DPAME evaluation is at  Exhibit
C.

The BCMR Medical Consultant recommends the application be denied.  The
BCMR Medical Consultant states that  the  applicant  attended  medical
school on the HPSP which paid for his tuition and other expenses.   He
completed  medical  school  and  received  his  medical   degree   and
subsequently entered active duty to  serve  the  active  duty  service
commitment incurred as a result  of  his  participation  in  the  HPSP
program.  While the  applicant  was  on  active  duty  he  experienced
progressive symptoms of  depression,  obsessive/compulsive  behaviors,
and anxiety in the context of ongoing  conflict  with  the  Air  Force
regarding specialty training and assignments.  Although  his  symptoms
were severe, he maintained his ability to  perform  his  duties  as  a
physician.  Although  he  maintained  his  ability  to  perform  as  a
physician his psychiatrist recommended separation from the  Air  Force
because of concerns about deployability and  the  adverse  impact  his
condition was having on his  overall  quality  of  life.   Two  months
following his discharge from the Air  Force,  the  applicant  reported
progressive  improvement  in  his  symptoms  and  was  employed  as  a
practicing physician.  The BCMR Medical Consultant further states that
the only evidence as to when his mental health condition began is  the
June 27, 2002 psychiatry narrative summary and the December 2002 email
exchanges.  The narrative summary indicated that he presented for care
in November 2001 with a  2-year  history  of  intermittent  depressive
symptoms and over two years of fear of germs and  subsequent  cleaning
compulsions placing the onset of symptoms into 1999, prior to entering
active duty in July of 2000.  There is no evidence in  the  case  file
that there was a significant history of mental illness prior to August
1995 when the  applicant  signed  his  HPSP  contract.   He  was  also
diagnosed with  “Cluster  C  personality  traits”  not  of  sufficient
severity  to  warrant  a  diagnosis   of   a   personality   disorder.
Personality traits and disorders that are designated on Axis II of the
formal psychiatric diagnosis reflect the presence of lifelong patterns
of  maladjustment  in  the  individual’s  personality  structure  that
existed prior to entering active duty.  The  BCMR  Medical  Consultant
concurs with the conclusion the  Informal  Physical  Evaluation  Board
(IPEB) drew from the psychiatry narrative summary that the applicant’s
condition existed prior to entering active duty  in  July  2000.   The
IPEB did not imply by a finding of EPTS  that  the  condition  existed
prior to the signing of his HPSP contract.   Whether  the  applicant’s
symptoms in the months prior to entering  active  duty  were  of  such
character or severity that  would  have  warranted  reporting  by  the
applicant cannot be clearly determined from  the  available  evidence,
but  evidence  does  suggest  that  onset  of  clinically  significant
symptoms occurred following entry onto active  duty.   The  IPEB  also
concluded  that  his  condition  was  not  permanently  aggravated  by
military service  and  evidence  of  the  record  also  supports  that
conclusion.  The BCMR Medical Consultant evaluation is at Exhibit D.

_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATIONS:

Applicant requests that the Board review the attachments  he  provides
and, in particular, the highlighted areas of each document.  Upon this
review, the Board will find that absolutely no evidence of any  mental
health conditions existed prior  to  signing  the  AFHPSP  contact  on
August 29, 1995.  The mental health  conditions  under  which  he  was
discharged were the direct effect of his service in the United  States
Air Force.  He did not fail to disclose any fact regarding his  health
status  while  associated   with   the   United   States   Government.
Consequently, there is no breach of contract and no grounds upon which
the United States Government  can  demand  recoupment  of  $18,942.33.
Applicant’s complete submission, with attachments A-M is at Exhibit F.


In an additional submission,  the  applicant  contests  the  onset  of
symptoms timeline that the BCMR Medical Consultant  believes  to  have
occurred in 1999, prior to his entrance on active duty in  July  2000.
In retrospect, the applicant believes  that  he  began  to  experience
intermittent depressive symptoms after January 2000, which is one year
and ten months prior to November 2001.  He feels that the BCMR Medical
Consultant’s reference of his email to a friend stating  that  he  had
gained employment at an emergency department earning  double  his  Air
Force salary, was inappropriate, irrelevant  and  unprofessional.   He
feels it was inappropriate to cite a statement that was no more than a
casual factual remark made by him to a friend.  It  is  irrelevant  in
that his salary after leaving the Air Force has no bearing on his case
and it is unprofessional in that it has no business being stated in an
advisory opinion which was requested only to comment  on  whether  his
condition existed prior to his acceptance  and  signing  of  the  HPSP
contract in August 1995.  Applicant states that although he  separated
from the Air Force in October 2002, it was not until January 2003 that
he was able to find a position.  Lastly, the  applicant  disputes  the
BCMR  Medical  Consultant’s  statement  on  personality   traits   and
personality disorders and states  that  a  distinction  was  not  made
between the two.  His personality traits did  not  reach  a  level  of
severity under which they could be labeled a personality disorder  not
until the onset of clinically significant  depressive  and  obsessive-
compulsive symptoms arose while serving on active  duty  (See  Exhibit
G).

_________________________________________________________________

ADDITIONAL AIR FORCE EVALUATION:

HQ USAF/JAA recommends the application be denied.  JAA states that the
applicant’s medical records  establish  that  he  suffered  from  pre-
service, service disqualifying mental disorders or conditions.   These
disorders and/or conditions constituted conditions that the  applicant
was obliged to report to the Air Force under the terms and  conditions
of his  Health  Professions  Scholarship  Contract.   The  applicant’s
failure to do so was a material breach and recoupment  is  sustainable
on this basis alone.  Additionally, states  JAA,  recoupment  is  also
appropriate and warranted under HPSP Contract  para.  11  because  the
applicant’s retention was “not clearly consistent with the interest of
national security.”  HQ USAF/JAA review is at attachment H.

_________________________________________________________________
APPLICANT'S REVIEW OF THE ADDITIONAL AIR FORCE EVALUATION:

Applicant states that he has nothing  new  to  present  to  the  Board
regarding his case; however, his intent is to  only  provide  comments
and opinions on the USAF/JAA review.  He states he is fully aware that
the HPSP contract is iron-clad and that the United  States  government
may recoup money from him for any reason it sees  fit.   However,  the
condition for which he was discharged did not exist prior  to  signing
the HPSP contract or prior to entering active duty.  It was  a  direct
result of his  active  duty  service  that  impaired  his  ability  to
continue on active duty.  Applicant states that it was the Air Force’s
recommendation that he  be  separated;  therefore,  he  contends  that
reimbursement is inappropriate.  Applicant’s letter is at Exhibit J.

_________________________________________________________________

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 error  or  injustice  that  would  persuade  us  that
remission of the applicant's indebtedness  is  warranted.   The  Armed
Forces Health Professions  Scholarship  Program  (HPSP)  contract,  is
specific in which it states  that  if  a  member  fails  to  meet  the
applicable standards of the US Air Force, including physical  fitness,
the Air Force may, at its option, separate the member and  recoup  the
total cost of advanced education in lieu of  active  duty.   When  the
applicant entered into the HPSP contract, he  was  on  notice  of  the
requirement that he  must  meet,  and  continue  to  meet,  Air  Force
physical standards. The contract additionally placed the applicant  on
notice of  the  consequences  of  being  found  physically  unfit  for
service.  The Air  Force  made  the  determination  that  he  was  not
physically qualified for continued service, a determination he did not
dispute because he “wanted out of the military.”  We  also  note  that
prior to his disqualification for continued service, he had previously
made application to  resign  his  commission  indicating  he  was  not
comfortable with continuing to practice in a general  medical  officer
role and was fully aware that he was liable for  reimbursing  the  Air
Force for the cost of  his  medical  school.   While  the  applicant’s
disqualifying condition was not the result of misconduct or  voluntary
action, the condition did not arise through fault of  the  government.
The Board has routinely asserted its right  to  recoup  the  costs  of
education provided to medically  disqualified  individuals  under  the
HPSP  when  their  medical  condition  does  not  preclude  them  from
practicing  their  profession.   The  applicant   has   submitted   no
convincing  evidence  that  the  medical  processing  was  unduly   or
intentionally protracted, or that he was treated differently than  any
other HPSP recipient similarly situated.  In view  of  the  above  and
absent persuasive evidence to the  contrary,  we  find  no  compelling
basis to recommend granting the relief sought.

_________________________________________________________________

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 Docket Number 02-00856 in Executive
Session on 13 August 2003 and 6 January 2004, under the provisions  of
AFI 36-2603:


                 Ms. Brenda L. Romine, Panel Chair

                 Ms. Marcia J. Bachman, Member
                 Ms. B.J. White-Olson, Member

The following documentary evidence was considered:

      Exhibit A. DD Form 149, dated 17 Oct 02, w/atchs.
      Exhibit B. Applicant's Master Personnel Records.
      Exhibit C. Letter, AFBCMR Medical Consultant, dated
               25 Jun 03.
      Exhibit D. Letter, AFPC/DPAME, dated 26 Nov 02.
      Exhibit E. Letter, SAF/MRBR, dated 6 Dec 02.
      Exhibit F. Letter, Applicant, dated 1 Jan 03 w/atchs.
      Exhibit G. Letter, Applicant, dated 21 Jul 03.
      Exhibit H. Letter, USAF/JAA, dated 23 Sep 03.
      Exhibit I. Letter, AFBCMR, dated 1 Oct 03.
      Exhibit J. Letter, Applicant, dated 11 Oct 03.




      BRENDA L. ROMINE
      Panel Chair