RECORD OF PROCEEDINGS
             AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:      DOCKET NUMBER:  BC-2005-00236
            INDEX CODE:  108.02

            COUNSEL:  NONE

            HEARING DESIRED:  NO

MANDATORY CASE COMPLETION DATE: 22 JUL 06

________________________________________________________________

APPLICANT REQUESTS THAT:

Her discharge with  severance  pay  be  changed  to  reflect  that  she  was
medically retired.

________________________________________________________________

APPLICANT CONTENDS THAT:

The Air Force failed to properly diagnose and treat her condition.  She  was
medically discharged for a condition she does not have.   The  AF  Form  356
shows evidence was found  of  right  ulnar  neuropathy,  and  then  suspects
psychological factors.  However, no psychological or medical evaluation  was
ever performed.  She was allowed to meet with the Physical Evaluation  Board
(PEB) for only 20 minutes.  The PEB failed to  review  her  medical  records
from the Department of  Veterans  Affairs  (DVA)  and  her  pain  management
doctor.  The Medical Evaluation Board (MEB) just sent her to  Neurology  for
a test for right ulnar neuropathy, they found  nothing,  and  recommended  a
discharge.  The neurologist stated the  condition  was  psychological.   She
has had a spinal cord stimulator implanted but the DVA does  not  work  with
spinal cord stimulators.

In support of her request, applicant provided documentation associated  with
her disability evaluation  system  processing  and  documentation  extracted
from her medical records.  Her complete submission, with attachments, is  at
Exhibit A.

________________________________________________________________

STATEMENT OF FACTS:

Applicant contracted her initial enlistment in the Regular Air  Force  on  5
Jul 00 and was progressively promoted to the grade of senior airman.

An MEB was convened on 21  Jun  01  and  referred  applicant's  case  to  an
Informal PEB (IPEB) with a diagnosis of right ulnar neuropathy.   On  7  Aug
01, the IPEB found her unfit for further military  service  and  recommended
that she be placed on the Temporary Disability Retired List  (TDRL)  with  a
combined compensable rating of 30 percent.  The applicant  agreed  with  the
findings and recommended disposition of the IPEB and was placed on the  TDRL
effective 6 Nov 01.  A TDRL reevaluation was conducted on 26 Mar 03.   On  2
May 03, the Air Force PEB recommended that she be discharged with  severance
pay, based on a diagnosis of right  ulnar  neuropathy,  with  a  compensable
disability rating of 10 percent.  The  applicant  did  not  agree  with  the
recommendation of the IPEB and  her  case  was  referred  to  a  Formal  PEB
(FPEB).  On 22 Jul 03, an FPEB considered her case and  recommended  she  be
discharged with severance pay with a compensable percentage of  10  percent.
On 21 Sep 01, she was removed from the TDRL and  retired  in  the  grade  of
senior airman with a compensable rating of 10 percent.  She served  1  year,
2 months, and 17 days on active duty

________________________________________________________________

AIR FORCE EVALUATION:

The BCMR Medical  Consultant  recommends  denial.   The  Medical  Consultant
states she struck her right elbow and right ulnar nerve at the  elbow  while
performing military duties in July 2000.  Although there was  no  detectable
permanent  damage,  she  experienced  persistent  neuralgic  pain   in   the
distribution  of  the  right  ulnar  nerve  variously  diagnosed  as   ulnar
neuralgia, causalgia, reflex  sympathetic  dystrophy  and  complex  regional
pain syndrome.  Treatment did not relieve her pain and  she  was  placed  on
the TDRL.  While on the TDRL a spinal cord stimulator was implanted  by  her
civilian pain  specialist  and  subsequent  pain  clinic  entries  indicated
significant relief of pain.  At  the  time  of  her  TDRL  reevaluation  she
reported the stimulator did not relieve her pain.   The  PEB  concluded  her
condition had improved and rated her pain syndrome under the VASRD code  for
ulnar neuralgia at 10 percent.  The applicant is correct in  asserting  that
the diagnosis of ulnar  neuropathy  inaccurately  describes  her  condition.
She has a pain syndrome limited to  the  distribution  of  the  right  ulnar
nerve that has been classified as  causalgia/reflex  sympathetic  dystrophy,
which is a  pain  syndrome  currently  classified  under  the  term  Complex
Regional Pain Syndrome (CRPS).  Although her pain syndrome is classified  as
CRPS affecting the distribution of  the  ulnar  nerve,  in  the  absence  of
demonstrable ulnar  neuropathy,  the  PEB  rated  her  condition  under  the
appropriate VASRD code, the code for neuralgia of the  ulnar  nerve.   There
is no dedicated VASRD code for rating reflex sympathetic dystrophy  or  CRPS
and this group of pain syndromes is rated by analogy  to  neuralgia  of  the
affected peripheral nerve distribution.  Her records show her pain  syndrome
was restricted to the distribution of  the  originally  injured  nerve,  the
right ulnar nerve.  Whether diagnosed as neuralgia of the ulnar nerve or  as
CRPS in the ulnar nerve distribution, the  conditions  are  rated  the  same
using the same VASRD code for neuralgia  of  the  ulnar  nerve.   The  VASRD
guidance for rating ulnar nerve conditions shows the rating  for  incomplete
mild paralysis  is  10  percent  and  the  rating  for  moderate  incomplete
paralysis of the dominant ulnar nerve is  30  percent.   Disability  ratings
are based on loss of function.  Her complaint is one  of  pain,  from  which
her functional impairment follows.  All the exams available  for  review  in
her military and DVA records attribute her  muscular  weakness  to  loss  of
volitional movement of the  right  upper  extremity  due  to  pain  and  the
anticipation of  pain  with  use.   Pain  is  a  subjective  sensation,  not
amenable to objective measurement.  While there is no dispute  her  pain  is
real, the quantification of  her  symptoms  is  dependent  entirely  on  her
reporting.  Evidence of record  shows  her  condition  was  limited  to  the
distribution of the ulnar nerve and that secondary manifestations that  were
previously present were mild and were subsequently  no  longer  observed  on
examinations after September 2002.  Despite the presence  of  chronic  pain,
examination  objectively  showed  the  absence  of  effects  that  would  be
expected from long term decreased use of the  extremity.   Findings  at  the
time of her TDRL reexamination are consistent with the  rating.   The  IPEB,
FPEB, and  Personnel  Council's  recommendations  are  consistent  with  the
available medical information and her disability rating  of  10  percent  is
supported by the preponderance  of  the  evidence  of  record.   Situational
exacerbation of depression during administrative proceedings/action  is  not
considered a basis for disability.

The DVA granted her a higher rating based  on  a  compensation  and  pension
examination prior to placement of the spinal cord stimulator.  The FPEB  had
the DVA rating and rationale for their review.  Military disability  systems
operate  under  different  laws  with  a  different  purpose.    Independent
decisions made by the DoD and the DVA are not binding  on  the  other.   The
mere fact that the DVA may grant compensation ratings at one level does  not
establish eligibility for similar action from the Air  Force.   The  DoD  is
required to use the VASRD as a  guideline  to  rate  disabilities  that  are
unfitting for continued military service.  The intent is to rate the  degree
of civilian occupational  disability.   It  is  not  intended  to  rate  for
limitations  for  a  specific  occupational  specialty  or  in  recreational
activities.  Rating guidance in DoD Instruction  1332.39  states  "When  the
circumstances of a case are such that two percentage  evaluations  could  be
applied, the  higher  percentage  will  be  assigned  only  if  the  Service
member's disability more nearly approximates the criteria for  that  rating.
Otherwise, the lower rating will be assigned".   The  preponderance  of  the
evidence does  not  support  a  higher  rating  at  the  time  of  permanent
disposition.  Her case was  properly  evaluated,  appropriately  rated,  and
received full consideration under the provisions of AFI 36-3212.

The Medical Consultant's evaluation is at Exhibit C.

________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

A copy of the Air Force evaluation was forwarded to the applicant on 16  Feb
06 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  error  or  injustice.   We  took  notice  of  the  applicant's
complete submission in judging the merits of the  case;  however,  we  agree
with the opinion and recommendation  of  the  BCMR  Medical  Consultant  and
adopt his rationale as the basis for the conclusion that the  applicant  has
not been the victim of an error or injustice.  Therefore, in the absence  of
evidence to the contrary, we find no basis to recommend granting the  relief
sought in this application.

_________________________________________________________________

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 9 May 2006, under the provisions of AFI 36-2603:

                 Mr. James W. Russell III, Panel Chair
                 Ms. Mary C. Puckett, Member
                 Mr. Steven A. Cantrell, Member








The following documentary evidence pertaining to AFBCMR  Docket  Number  BC-
2005-00236 was considered:

      Exhibit A. DD Form 149, dated 5 Jan 05, w/atchs.
      Exhibit B. Applicant's Master Personnel Records.
      Exhibit C. Letter, BCMR Medical Consultant, dated 9 Feb 06.
      Exhibit D. Letter, SAF/MRBR, dated 16 Feb 06.




                             JAMES W. RUSSELL III
                             Panel Chair