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

IN THE MATTER OF:      DOCKET NUMBER:  BC-2003-02287
            INDEX NUMBER:  108.00
      XXXXXXX    COUNSEL:  Joseph W. Kastl

      XXXXXXX    HEARING DESIRED:  Yes

_________________________________________________________________

APPLICANT REQUESTS THAT:

He be medically retired.

_________________________________________________________________

RESUME OF CASE:

On 21 Jan 04, the Board considered and denied the applicant’s request
(Exhibit F).  After his case had  been  decided  by  the  Board,  the
applicant submitted in an undated letter a copy of  his  most  recent
cardiac nuclear imaging study for the Board’s reconsideration of  his
request (Exhibit  G).   Based  on  this  additional  information,  an
additional evaluation of  the  applicant’s  case  was  requested  and
received from the BCMR Medical  Consultant  (Exhibit  H).   The  BCMR
Medical Consultant  again  recommended  the  applicant’s  request  be
denied.  After receipt of the new  evaluation  by  the  BCMR  Medical
Consultant,  the  applicant  requested  his   case   be   temporarily
withdrawn.  In a new DD Form 149 (Exhibit L), dated 25  Nov  04,  the
applicant, represented by counsel, again requests medical retirement.
 In the new  DD  Form  149,  applicant’s  counsel  asserts  that  the
applicant should be medically retired at a rating of 60% with pay and
benefits retroactive to his separation from active duty  30  Apr  03.
In support of the applicant’s case, counsel provides an  overview  of
the applicant’s case,  a  discussion  of  the  methods  of  measuring
ejection fraction and responds to the additional evaluation  prepared
by the BCMR Medical Consultant.  Counsel also discusses the pertinent
Department  of  Veterans  Affairs  Schedule  of  Rating  Disabilities
(VASRD) codes used to determine level of disability and  submits  new
evidence he asserts proves that the  applicant  should  be  medically
retired.  Based on the new  submission  of  evidence  by  applicant’s
counsel,  a  second  additional  evaluation  (Exhibit   N)   of   the
applicant’s case was requested from the BCMR Medical Consultant.

_________________________________________________________________

ADDITIONAL AIR FORCE EVALUATION:

Pursuant to the Board’s request, the BCMR Medical Consultant provided
an additional evaluation of the applicant’s case,  dated  2  Feb  04.
The BCMR Medical Consultant  recommends  denial  of  the  applicant’s
request.

The  applicant’s  Jun  03  stress  test  demonstrates  very  good  to
excellent exercise capacity at the same level as prior tests  in  Jun
02 and Dec 02 (approximately 17 METS).  The applicant is correct that
the sooner definitive treatment is  begun  for  an  acute  myocardial
infarction, the better the outcome.  Thrombolytic therapy  within  70
minutes or intervention with balloon angioplasty within two to  three
hours is considered optimal (clinical benefit for the former  extends
to four hours).  The applicant received thrombolytic therapy followed
by angioplasty with stent placement in a timeframe remarkable  for  a
deployed location and not uncommon  for  individuals  in  the  United
States.

The applicant cites the reported ejection fraction from the  thallium
stress test as evidence that he was not fit  for  continued  military
service.  However, the ejection fraction calculated by  the  computer
from the thallium  images  does  not  correlate  with  the  excellent
exercise capacity demonstrated by the applicant on the  stress  test.
An individual with an actual left ventricular ejection fraction of 31
percent would typically not be able to exercise much more than  three
minutes on a Bruce protocol  stress  test.   In  this  instance,  the
nuclear scan underestimates  his  actual  left  ventricular  ejection
fraction, which based on his stable, very good exercise  capacity  on
three tests over one year, has  also  remained  stable  from  earlier
studies.  Individuals able to exercise 14 minutes on a Bruce protocol
stress test after myocardial infarction possess good left ventricular
function.

The complete evaluation is at Exhibit H.

_________________________________________________________________

APPLICANT'S REVIEW OF ADDITIONAL AIR FORCE EVALUATION:

Applicant’s counsel responded to the additional Air Force  evaluation
in the evidence submitted with his new DD Form 149.  He  opines  that
the Board has used one extremely questionable exercise stress test to
deny the applicant benefits.  The applicant’s retained medical expert
has written an extensive  analysis  challenging  the  decision.   His
expert proves that exercise tolerance is a very weak measure of merit
and that the test was an  aberration.   He  is  also  presenting  new
medical evidence showing consistent ejection fractions at 45%  and  a
Department of Veterans Affairs  (DVA)  rating  of  60%.   Applicant’s
counsel summarizes his arguments  in  support  of  the  applicant  as
follows:

        a.  The VASRD codes are clear regarding the disability rating
assigned for a heart attack such as that suffered by the applicant.

         b.  Exercise  tolerance  is  not  the  sole   criterion   in
determining  disability  and  exercise  tolerance  is   variable   as
evidenced by literature on  the  subject  and  the  applicant’s  last
stress test.

        c. All military boards  are  required  to  follow  the  VASRD
codes.

        d.  Although not relevant to these Board  proceedings,  there
are findings from the applicant’s last  echocardiogram  that  may  be
harbingers  of  difficulties  to  come  in  myocardial  and  valvular
function as he has described in his response.

Counsel’s complete response, with attachments, is at Exhibit L.

_________________________________________________________________

SECOND ADDITIONAL AIR FORCE EVALUATION:

Pursuant to the Board’s request, the BCMR Medical Consultant provided
a second additional evaluation.  The BCMR Medical Consultant provides
an in depth analysis of the  applicant’s  case.   However,  he  still
finds that based on the preponderance of evidence at the time of  the
applicant’s physical evaluation board (PEB),  his  medical  condition
satisfied standards for a finding  of  fit  for  duty.   Following  a
return to duty, the applicant voluntarily retired from the Air  Force
Reserves.  The BCMR Medical Consultant notes the  difference  between
Title 10, which the DoD operates under and Title 38,  which  the  DVA
operates under.

The complete evaluation is at Exhibit N.

_________________________________________________________________

APPLICANT’S RESPONSE TO SECOND ADDITIONAL AIR FORCE EVALUATION:

In a letter dated 15 Sep 05, the applicant asked for additional  time
to respond to the second additional evaluation (Exhibit O).   He  was
advised in a letter dated 26 Sep 05 that  because  of  the  statutory
mandate regarding the processing of cases, additional time could  not
be extended but he could request that his  case  be  administratively
withdrawn until such time as he was prepared to proceed (Exhibit  P).
The applicant was  given  a  30  day  period  in  which  to  respond.
However, to date a response has not been received.

_________________________________________________________________

THE BOARD CONCLUDES THAT:

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

2.  The application was timely filed.

3.  After again reviewing the complete evidence of  record,  the  new
arguments  made  by  applicant’s  counsel,  and  the  new  advisories
prepared by the  BCMR  Medical  Consultant,  we  still  do  not  find
evidence of an error or injustice that would warrant  a  reversal  of
our previous decision in this case.  In our view, the  applicant  has
not provided sufficient evidence to support his contention he  should
have been medically retired and that the  Physical  Evaluation  Board
made an erroneous decision in his case.   As  previously  noted,  the
decision to end his military career was a  voluntary  action  on  his
part.  While cross training into a different Air Force  specialty  or
accepting a restricted level of service may not have been preferable,
the applicant could  have  still  served.   And,  if  over  time  his
condition continued to deteriorate, he  may  have  subsequently  been
medically retired.  However, the Physical Evaluation Board based  its
recommendation solely on the applicant’s condition at the time of his
evaluation, which is the normal  process  and  how  anyone  similarly
situated would be evaluated.  Therefore, in the absence  of  evidence
to the contrary, we 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   issues   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  BC-2003-
02287 in Executive Session on 23 December 2005, under the  provisions
of AFI 36-2603:

      Ms. Kathleen Graham, Panel Chair
      Mr. James A. Wolffe, Member
      Ms. Rita A. Maldonado, Member

The following documentary evidence was considered:

    Exhibit F.  ROP, dated 29 Jan 04, w/atchs.
    Exhibit G.  Letter, Applicant, undated, w/atch.
    Exhibit H.  Memorandum, BCMR Medical Consultant,
                dated 2 Feb 04.
    Exhibit I.  Letter, SAF/MRBR, dated 10 Feb 04.
    Exhibit J.  Letter, Applicant, dated 3 Mar 04.
    Exhibit K.  Letter, AFBCMR, dated 4 Mar 04.
    Exhibit L.  DD Form 149, dated 25 Nov 04, w/atchs.
    Exhibit M.  Letter, Applicant, dated 16 Aug 05.
    Exhibit N.  Memorandum, BCMR Medical Consultant,
                dated 30 Aug 05.
    Exhibit O.  Letter, Applicant, dated 15 Sep 05.
    Exhibit P.  Letter, AFBCMR, dated 26 Sep 05.




                                   KATHLEEN GRAHAM
                                   Panel Chair