RECORD OF PROCEEDINGS
         AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS


IN THE MATTER OF:                       DOCKET NUMBER:  BC-2001-00295
                                        INDEX CODE: 128.10
                                        COUNSEL: No

                                        HEARING DESIRED: Not Indicated

MANDATORY COMPLETION DATE:  23 APR 06

_________________________________________________________________

APPLICANT REQUESTS THAT:

Her debt in the amount of $63,299.69  for  sponsorship  in  the  Armed
Forces  Health  Professions  Scholarship  Program  (AFHPSP)   not   be
recouped.

_________________________________________________________________

APPLICANT CONTENDS THAT:

While she  was  being  processed  through  the  Disability  Evaluation
System, she was reassured that the Air Force would not recoup for  her
active  duty  service  commitment  (ADSC)  if   she   were   medically
discharged.  The contract she signed indicated that if she was  unable
“to commence” her ADSC, she would have to  pay  back  her  educational
expenses.  She completed her  medical  program  as  required  and  did
“commence” her ADSC period on 4 Sep 99. She has served for a total  of
2 years and 7 months since 12 Jun 98.  Since she was not involuntarily
separated for any kind of misconduct, she requests to be excused  from
her obligation.

The applicant’s complete submission is at Exhibit A.

_________________________________________________________________

STATEMENT OF FACTS:

The applicant signed her AFHPSP Financial Assistance  Contract  on  17
Feb 94 and was sponsored through  the  AFHPSP  program  at  Washington
University, St. Louis, MO, from 1994-1998, resulting in a 4-year ADSC.
 Scholarship funds expended  for  tuition,  books  and  supplies  were
$97,275.89.  (The  applicant’s  monthly  stipends   are   specifically
excluded from recoupment  by  10  USC  2005.  Statute  now  authorizes
recoupment of stipends from those students who entered AFHPSP after  1
Oct 96.)

She applied to the  1997  Joint  Service  Graduate  Medical  Education
Selection Board (JSGMESB) for a Transitional Year from 1 Jul 98-30 Jun
99. The board approved her training preference and her third  training
location at Malcolm Grow Medical Center (MGMC) at Andrews AFB, MD. She
entered training on 1 Jul 98.

The applicant began experiencing daily/migraine  headaches  and  post-
partum depression following the birth of her child on 13 Oct  98.  She
voluntarily sought psychiatric assistance  and,  on  17  Dec  98,  was
voluntarily  admitted  to  Walter  Reed  Army  Medical  Center  as   a
psychiatric inpatient.  She was discharged three days later  with  the
recommendation to restart clinical work but with regular hours and  no
call schedules initially.

On 24 Jan 99, the Transitional Year  program  director  requested  the
applicant’s internship be extended until 3 Sep 99 in order to complete
training. The extension was approved and her ADSC was adjusted  to  14
Aug 03.

On 4 Sep 99, she was assigned to the 11th Medical Group, Bolling  AFB,
DC, as a general medical officer.  On 7 Sep she applied  to  the  2000
JSGMESB for Dermatology; however, she was not selected.

On 14 Sep 00,  she  was  given  a  physical  profile  from  practicing
medicine because her ability to practice safely  and  effectively  was
impaired  by  severe  pain  from  migraine  headaches   and   sedating
medications.

A 2 Oct 00 MGMC Neurology Clinic Summary notes  the  applicant  had  a
history of intermittent headaches that  started  four  years  ago  and
increased after the birth of  her  child  to  daily  occurrences  with
migraine features. She  also  had  a  “significant  past  history”  of
depression.   Diagnosis  was   intractable   migraine   headache/daily
headache. She was found not worldwide qualified.

She was  profiled  again,  on  30 Oct  00,  for  intractable  migraine
headaches/chronic daily headache. She was allowed to practice when she
was headache free and not using sedating medications.

On 31 Oct 00, she was evaluated by a Medical  Evaluation  Board  (MEB)
and the Narrative Summary noted her history of migraine headaches  and
depression, as well as her feelings of anxiety and severe  guilt  over
separation  from  her  child.   She  was  diagnosed  with  intractable
migraine  headache/daily  headache  and  major  depressive   disorder,
recurrent, moderate with atypical features.

The case was  forwarded  to  an  Informal  Physical  Evaluation  Board
(IPEB), on 27 Nov 00, and she  was  found  unfit  due  to  intractable
migraine headaches associated with  major  depressive  disorder.   The
IPEB recommended placement on the Temporary Disability Retirement List
(TDRL) with a disability rating of 30%.  On 29 Nov 00,  the  applicant
concurred with the findings and recommendations.

On 3 Jan 01, HQ AFPC/DPAME informed the applicant that from 4  Sep  99
to 27 Jan 01, she fulfilled 510 days of her 4-year  ADSC,  paying  off
$33,976.20 of the  $97,275.89  total  funds  expended.   That  left  a
remaining debt of $63,299.69, for which recoupment  action  was  being
initiated.

In  accordance  with  the  IPEB’s  findings  and  recommendation,  the
applicant was placed on the TDRL in the grade of captain effective  26
Jan 01 with 1 year, 7 months and 13 days of active service.

_________________________________________________________________

AIR FORCE EVALUATION:

HQ  AFPC/DPMAF2  forwarded  an  advisory  from  the  Chief,  Physician
Education Branch, HQ AFPC/DPAME.  The Chief advised that recoupment is
based on Title 10, USC, Section 2005.  The applicant signed  her  HPSP
contract, thereby agreeing to the terms of the contract, and should be
required to reimburse the government.  Her commissioning  physical  in
Aug 93 and her accession physical in Nov 97 do not indicate disclosure
of  migraine  headaches.  The  Chief  does  not  dispute  her  medical
condition; however, the timing of her original symptoms and  diagnosis
are inconsistent with her commissioning date  and  entry  onto  active
duty.  Recommend disapproval.

A complete copy of the evaluation, with attachments, is at Exhibit C.

_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

The applicant takes  exception  to  the  facts  as  presented  in  the
evaluation.  She never requested separation from the  Air  Force.  She
explains that in 1993 she had never before  experienced  any  type  of
migraine headache and in 1997 she was  not  questioned  about  or  was
under  treatment  for  headaches.   In  1997  she  had  never   before
experienced a transformed migraine/chronic daily headache.  There  was
no  attempt  to  withhold  disclosure  of  the  common   migraine-like
headaches she experienced in medical school  at  any  time.   Further,
contrary to  the  advisory  opinion’s  assertion,  she  was  not  “de-
credentialed” on 14 Sep 00.  She was placed  on  a  temporary  medical
profile due to physical impairment (sedating  medication  for  chronic
pain). This did not revoke her credentials.  She again reiterates  her
contention that neither Title 10, USC, Section 2005,  nor  the  AFHPSP
contract call for  scholarship  recoupment  in  the  case  of  medical
discharge due to disability.  She possesses an  unrestricted  Virginia
state medical license; however, she lives in Illinois where  she  does
not have a license.  She is  unemployed  and  ineligible  for  medical
licensure in Illinois,  which  requires  two  years  of  post-graduate
medical training.

The applicant’s rebuttal, with attachments, is at Exhibit E.

_________________________________________________________________

ADDITIONAL AIR FORCE EVALUATION:

The Chief, General Law Division, HQ USAF/JAG, noted that Section  2005
provides for recoupment  if  a  member  fails  to  complete  the  ADSC
voluntarily or due to misconduct. It also provides for  recoupment  if
the member fails to fulfill such other terms  and  conditions  as  the
Secretary concerned may prescribe to  protect  the  interests  of  the
United States.  If a member becomes physically disqualified  to  serve
on active duty, the member shall reimburse the government the costs of
education as provided for in Section 2005.  Since 1982, the Air  Force
has routinely asserted its right to  recoup  the  costs  of  education
provided to medically disqualified individuals under the HPSP  program
when their medical condition does not preclude  them  from  practicing
their profession in civilian life.   However,  any  recoupment  action
against a member on the TDRL is premature. Placement on the TDRL is by
its very nature temporary.  It is possible that the applicant could be
found fit for duty, returned to active duty, and  complete  her  ADSC.
It would be inappropriate to begin recouping monies that might not  be
owed.  If in the  future  it  is  determined  that  the  applicant  is
permanently physically unfit to return to duty,  then  the  Air  Force
should assert its right to recoup the costs of her medical education.

A complete copy of the additional evaluation is at Exhibit F.

_________________________________________________________________

APPLICANT’S REVIEW OF ADDITIONAL EVALUATION:

The applicant noted that she did, in fact, “commence” her  ADSC  on  4
Sep 99. Therefore, there is no authority for recoupment of  the  costs
of her education according to the pertinent contract clause.  Further,
taxpayers  received  compensation  for  her  education   through   her
outstanding and dedicated performance during her service as an  intern
and general medical officer.  Finally, her medical condition makes  it
virtually impossible for her to earn a living in  a  civilian  medical
practice. She is unable to get a medical license  in  her  home  state
since she only has an internship, and residency training, both now and
in  the  future,  is  improbable  because  it  would  exacerbate   her
depression and migraines.

Her complete response is at Exhibit H.

_________________________________________________________________

ADDITIONAL STATEMENT OF FACTS:

On 23 Jul 01, based on the applicant being placed on the TDRL and  the
HQ USAF/JAG advisory (Exhibit F), the AFBCMR Staff requested that DFAS-
POCC/DE suspend debt collection temporarily until final disposition of
the applicant’s medical condition (Exhibit I).  On  26 Jul  01,  DFAS-
POCC/DE advised  that  the  recoupment  action  had  been  temporarily
suspended pending a final determination from the AFBCMR (Exhibit J).

On 14 Aug 01, DFAS-POCC/DE advised the applicant that,  based  on  her
placement on the TDRL, it was inappropriate at  this  time  to  recoup
monies which might not be owed if she were found fit and  returned  to
active duty to complete her ADSC.   She  was  also  advised  that  her
inability to complete her ADSC had  resulted  in  a  $63,299.69  debt.
Further, she had received a $15,000.00  medical  bonus  upon  entering
into a one-year contract effective 4 Sep 00.  However, since  she  had
only earned 143 days of the bonus, she owed $8,249.77 (Exhibit K).

On 23 Aug 01, the AFBCMR Staff advised  the  applicant  that,  pending
final determination of  her  medical  condition,  her  case  had  been
temporarily closed (Exhibit L).

A 1 Mar 02 TDRL reevaluation summary  disclosed  the  following:   The
applicant still experienced 12-15 migraines per month.  She  developed
post-partum depression in her final year of  medical  school  and  had
disappointing  results  with  antidepressant  medications.   She   was
currently unemployed and raising her three-year-old child.   Diagnoses
were medically-refractory  migraine  headaches  and  depression.   The
applicant was to continue to follow-up with her regular physician  for
migraine headache management.  Psychiatric evaluation diagnosed  major
depressive disorder, recurrent,  due  to  migraines,  by  history,  in
partial  remission.   Impairment  for  military  duty  was   moderate;
impairment for civilian social and industrial adaptability  was  mild.
The condition was determined to be in the line of duty,  with  service
aggravation.  Her depression appeared  to  be  improved;  however,  it
continued to be maintained by the recurrent migraines.  Recommendation
was  that  she  return  to  psychotherapy  for  additional  work  with
relaxation and to consider optimizing antidepressant  or  serotonergic
medications.

On 19 Mar 02, an Informal Physical Evaluation  Board  (IPEB)  convened
and concluded her medical condition had improved since being placed on
the TDRL and appeared to have stabilized.  She was  found  unfit,  and
discharge with severance pay with  a  disability  rating  of  10%  was
recommended.  On 11 Apr 02, the applicant did not concur and requested
a Formal PEB (FPEB).

The applicant presented a rebuttal statement for the FPEB,  contending
she should receive  a  50%  disability  rating.   She  also  submitted
statements from family members and friends which  indicated  how  much
they needed to help her.

A FPEB convened  on  22 May  02,  rendered  a  diagnosis  of  migraine
headaches associated with major depressive disorder, existed prior  to
service (EPTS) with service aggravation.  She was rated at 30%,  minus
20% for the EPTS factor, leaving a compensable  rating  of  10%.   The
recommendation was that the applicant be discharged with severance pay
at 10%.  The FPEB noted that, although the compensation was  the  same
as recommended by the IPEB, the FPEB  arrived  there  in  a  different
manner.  Based on the applicant’s subjective reported pain,  it  would
seem her migraines should be rated at 30%.  However,  the  FPEB  noted
the applicant had headaches prior to service and,  in  line  with  the
precedent set by the Department  of  Veterans  Affairs  (DVA)  in  her
recent evaluation, deduction for the EPTS factor was appropriate.  The
applicant requested another TDRL period; however, the FPEB opined that
sufficient time had been allowed.

On 23 May 02, the applicant did not concur with  the  FPEB’s  findings
and recommendation.  She submitted a rebuttal  statement,  along  with
statements from relatives and friends.

On 24 Jun 02,  the  Secretary  of  the  Air  Force  Personnel  Council
(SAF/MRBP) evaluated the applicant’s case and  noted  that  the  major
medical condition, which led to the applicant’s initial MEB  conducted
on 31 Oct 00, was major  depressive  disorder.   The  27 Nov  00  IPEB
decided to rate the applicant’s migraine headaches  as  the  principal
diagnosis and associated her depression condition.  The IPEB  did  not
take into consideration that her headache condition existed  prior  to
military service and was not  likely  permanently  aggravated  through
military service.  Further, the 1 Mar 02  narrative  summary  for  the
TDRL reevaluation  offered  a  final  diagnosis  of  major  depressive
disorder,  recurrent,  due  to  migraines,  by  history,  in   partial
remission, and offered a social and industrial adaptability  of  mild,
which corresponded with a 10% disability rating.  The SAF/MRBP  opined
the applicant’s major depressive disorder, as correctly identified  in
her original MEB, was in fact the principal diagnosis,  and  that  the
headache condition, which EPTS, contributed to the degree of  severity
of her depression.  The applicant should be removed from the TDRL  and
discharged with severance pay, at 10% for major  depressive  disorder,
associated with migraine  headaches.   The  SAF/MRBP  recommended  the
applicant explore her eligibility for  entitlement  care  through  the
DVA.

Effective 23 Jul 02, the applicant  was  removed  from  the  TDRL  and
discharged in the grade of captain by reason  of  physical  disability
with entitlement to severance pay.

She currently has a DVA disability rating totaling 70%  for  migraine,
major depressive disorder, degenerative arthritis,  and  gynecological
condition-general.

                               --------------

On 17 Jun 05, the applicant wrote the AFBCMR contending that, based on
the DFAS-POCC/DE letter, dated 14 Aug 01, and the AFBCMR letter, dated
23 Aug 01, her debt for $63,299.69 was cancelled  based  on  her  TDRL
status and her case was administratively closed.  [Note:  This is  not
what these letters, nor the 6 Jun 01 HQ USAF/JAG letter,  advise;  the
recoupment of her debt was merely temporarily suspended while  on  the
TDRL pending final resolution of her medical condition.]  She contests
the recoupment action as her contract did not provide  for  recoupment
based on a  discharge  for  disability.   She  contends  there  is  no
provision under Title 10, USC, Section 2005, for reimbursement due  to
separation based on physical disability.  She was never advised of any
reimbursement requirement during her initial  MEB  and  chose  not  to
contest their findings recommending separation.  She requests the debt
be cancelled.

The applicant’s complete submission, with attachments, is  at  Exhibit
M.

_________________________________________________________________

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. After a thorough  review  of  the
evidence  of  record  and  the  applicant’s  submission,  we  are  not
persuaded her debt, incurred as a result of sponsorship in the AFHPSP,
should not be recouped. The applicant’s contentions  are  duly  noted;
however, we do not  find  these  assertions,  in  and  by  themselves,
sufficiently persuasive to override the rationale provided by the  Air
Force.   The  applicant  appears  to  mistakenly  believe   that   her
$63,299.69 debt was permanently cancelled  in  Aug  01.   However,  as
recommended by HQ USAF/JAG and as indicated in  the  DFAS  and  AFBCMR
letters  to  her,  the  recoupment  action  of  her  debt  was  merely
temporarily suspended while she on the TDRL pending  final  resolution
of her medical condition.  If the applicant had  been  found  fit  and
returned to duty, presumably she would have been able to complete  her
four-year ADSC and  thereby  pay  off  her  debt.   Instead,  she  was
subsequently found unfit and discharged from the TDRL  on  23 Jul  03,
with severance pay at 10%, for major depressive  disorder,  associated
with  migraine  headaches.   HQ  USAF/JAG  addressed  the  applicant’s
contentions in their Jun 01 advisory and we agree with their  opinions
and recommendations. As  HQ  USAF/JAG  indicated,  Section  2005  also
provides for recoupment if a member fails to fulfill any or such other
terms and conditions as the Secretary concerned may prescribe; it does
not merely apply to failing to meet the ADSC  voluntarily  or  due  to
misconduct.  We also found interesting the attachments  to  Exhibit C,
which appear to indicate the applicant clearly wanted to separate from
the Air Force to be with her  child.   Further,  while  the  applicant
advises she does not have a medical license in Illinois, where she now
lives,  she  does  possess  an  unrestricted  Virginia  state  medical
license.  The applicant contends she is unable to  work,  but  we  are
unpersuaded that she is unable to  repay  the  costs  of  her  medical
education as required by Section 2005.  She receives compensation from
the DVA,  her  condition  has  shown  improvement  in  the  past  with
appropriate treatment, and she has failed  to  substantiate  that  she
could not at some future time resume her medical career.  The windfall
of a medical education without any reimbursement  to  the  government,
either through active service or recoupment, would not be in the  best
interests of the Air Force or the American  taxpayer.   The  applicant
was treated no differently than other participants  in  the  HPSP  who
have  been  required  to  reimburse  the  government   after   medical
disqualification from active service.  We  therefore  agree  with  the
recommendations of the Air Force and adopt the rationale expressed  as
the basis for our decision that the applicant has  not  sustained  her
burden of having suffered either an error or an injustice.  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 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  this  application  in
Executive Session on 17 August 2005, under the provisions of  AFI  36-
2603:

                 Mr. Joseph G. Diamond, Panel Chair
                 Mr. Wallace F. Beard, Jr., Member
                 Ms. LeLoy W. Cottrell, Member

The following documentary evidence pertaining to AFBCMR Docket  Number
BC-20BC-2001-00295 was considered:

   Exhibit A.  DD Form 149, dated 24 Jan 01, w/atchs.
   Exhibit B.  Applicant's Master Personnel Records.
   Exhibit C.  Letters, HQ AFPC/DPMAF2 & DPAME, dated 17 Apr 01,
                  w/atchs.
   Exhibit D.  Letter, SAF/MIBR, dated 4 May 01.
   Exhibit E.  Letter, Applicant, dated 4 May 01, w/atchs.
   Exhibit F.  Letter, HQ USAF/JAG, dated 6 Jun 01.
   Exhibit G.  Letter, AFBCMR, dated 11 Jun 01.
   Exhibit H.  Letter, Applicant, dated 3 Jul 01.
   Exhibit I.  Letter, AFBCMR, dated 23 Jul 01.
   Exhibit J.  Letter, DFAS-POCC/DE, dated 26 Jul 01.
   Exhibit K.  Letter, DFAS-POCC/DE, dated 14 Aug 01.
   Exhibit L.  Letter, AFBCMR, dated 23 Aug 01.
   Exhibit M.  Letter, Applicant, dated 17 Jun 05.



                                   JOSEPH G. DIAMOND
                                   Panel Chair