RECORD OF PROCEEDINGS
         AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:      DOCKET NUMBER:  BC-2005-02220
            INDEX NUMBER:  108.00
      XXXXXXX    COUNSEL:  None

      XXXXXXX    HEARING DESIRED:  No


MANDATORY CASE COMPLETION DATE:  12 Jan 07


_________________________________________________________________

APPLICANT REQUESTS THAT:

His disability discharge with severance pay rated at 20 percent  under
the Department of Veterans Affairs  Schedule  of  Rating  Disabilities
(VASRD) code 5312 be changed to VASRD  code  8720  with  a  disability
rating of 40 percent.

Additionally as  stated  in  his  rebuttal  at  Exhibit  E,  applicant
requests that his overall disability rating be increased by rating his
chronic back pain as well as his right lower leg.

_________________________________________________________________

APPLICANT CONTENDS THAT:

He was clearly diagnosed on 1 Jul  04  as  having  Reflex  Sympathetic
Dystrophy (RSD), also known as Complex Regional Pain Syndrome (CRPS).

In support of his appeal, applicant provides ten  attachments  related
to his medical care and discharge.

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

_________________________________________________________________

STATEMENT OF FACTS:

The applicant entered active duty in the Air Force in Aug 89  and  was
promoted up to the grade of technical sergeant (TSgt)  (E-6).   On  26
Jan 05, he met a Medical Evaluation Board (MEB) for chronic left lower
extremity pain  and  swelling.   The  applicant  was  referred  to  an
Informal Physical Evaluation Board (IPEB).  On   24 Mar 05,  the  IPEB
found the applicant unfit due to  chronic  left  lower  leg  pain  and
swelling and recommended he be discharged  with  disability  severance
pay with a compensable rating of 20 percent.  The applicant  indicated
his disagreement with the recommendation on the AF IMT  1180,  “Action
on Physical Evaluation Board Findings  and  Recommended  Disposition,”
and requested a Formal PEB (FPEB).  On 26 Apr 05, the FPEB upheld  the
recommendation of the IPEB  that  the  applicant  be  discharged  with
disability severance pay rated at 20 percent.  The applicant  did  not
agree with their recommendation and exercised his right  to  submit  a
rebuttal, requesting he be retained or granted a  medical  retirement.
On  22 Jun 05, the  Secretary  of  the  Air  Force  Personnel  Council
(SAFPC) directed the applicant be discharged with severance pay  rated
at  20  percent.   In  rendering  their  decision,  SAFPC  noted   the
applicant’s high motivation to continue and serve and his  commander’s
strong support for retention.   However,  SAFPC  indicated  that  they
found the applicant’s  persistent  symptoms,  chronic  utilization  of
medical resources, and the  expected  continuation  of  duty  limiting
profiles in order to sustain his employment, to be  incompatible  with
the rigors of military service and found no objective basis upon which
to justify overturning the previous board  decisions.   The  applicant
was discharged with disability severance pay on  26  Aug  05  with  16
years and 11 days on active duty.

Additional relevant facts pertinent to the applicant’s application are
found in the BCMR Medical Consultant’s evaluation at Exhibit C.

_________________________________________________________________

AIR FORCE EVALUATION:

The BCMR Medical Consultant  recommends  the  applicant  be  rated  an
additional 10 percent for the condition of his right leg resulting  in
an overall combined rating of 30 percent, qualifying him for permanent
disability retirement.

The applicant was disability discharged with severance pay for chronic
left lower leg pain and swelling status-post  fasciotomy  for  chronic
exertional  compartment  syndrome.   On  18  Nov  03,  the   applicant
underwent corrective surgery to regain function and preserve  his  Air
Force career,  but  experienced  persisting  pain  and  swelling  that
prevented him from meeting fitness standards and rendered  him  unable
to  wear  standard  or  military  footwear.   There  were  conflicting
diagnoses as to the cause  of  the  applicant’s  pain.   However,  the
Physical Evaluation Boards noted this and determined  the  applicant’s
condition warranted a 20 percent rating using the VASRD code 5312  for
muscle impairment  of  the  lower  leg  region  corresponding  to  the
anatomic region of the applicant’s impairment.

The applicant requests an increase in  his  disability  rating  to  40
percent, asserting that VASRD code 8720 for sciatic nerve neuralgia is
the more appropriate code for rating complex regional pain syndrome of
the lower extremity.  There is no  dedicated  VASRD  code  for  rating
reflex sympathetic dystrophy or complex  regional  pain  syndrome  and
this group of pain syndromes is  rated  by  the  PEBs  by  analogy  to
neuralgia of the  peripheral  nerve  distribution  that  most  closely
correlates with the affected  anatomic  region.   In  the  applicant’s
case, the PEBs noted the apparent conflict in  opinion  regarding  the
cause of his left ankle, foot pain and swelling and opted to rate  his
disability using the VASRD guidance of impairment of  muscle  function
of the lower leg, although examinations showed no impairment of muscle
function other than limitation due to pain and swelling.  In  view  of
the objective clinical and occupational evidence of  the  record,  the
maximum rating when using the sciatic nerve code is not supported

Although the focus of attention was on the left leg  post-operatively,
the applicant also had exertional compartment syndrome of the opposite
(right) leg, which, based on evidence of record, was limiting for duty
and would have likely resulted in a finding of unfit had  he  declined
surgery and undergone evaluation in the Disability  Evaluation  System
(DES) for his bilateral leg condition.   The  existence  of  bilateral
unfitting leg conditions  was  not  considered  at  the  time  he  was
evaluated in the DES.  The BCMR Medical Consultant is of  the  opinion
the applicant’s exertional  compartment  syndrome  of  the  right  leg
warranted consideration by the PEBs and  would  have  resulted  in  no
greater than a 10 percent rating.  When combined with the rating of 20
percent for the left leg, a combined  total  of  30  percent  results,
which would make the  applicant  eligible  for  disability  retirement
benefits.

The complete evaluation is at Exhibit C.

_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

The applicant responded to the BCMR Medical Consultant’s evaluation by
reiterating his request to the  Board.   He  states  that  if  he  had
received   proper   medical   care   for   his   Reflex    Sympathetic
Dystrophy/Complex Regional Pain Syndrome (RSD/CRPS), he might still be
serving in the Air Force today.  He notes he is still waiting for  the
proper medical care and has not received the appropriate intervention.

The applicant points out he would like to appear before the  Board  to
give the full details on his  medical  conditions.   Specifically,  he
would like to present the unknowns of his medical  care  history.   He
further notes that if his memo to the Board were to contain  the  full
details of his case, it would  be  overwhelming  to  read.   Applicant
indicates he wants the Board to  know  that  the  Physical  Evaluation
Boards (PEBs) and the Secretary of the Air Force  (SecAF)  made  their
decisions based on inaccurate medical information. He was assigned  to
four different medical care providers over an  18  month  period.   He
also had three orthopedic surgeons and two pain management  physicians
involved in his case.  Ultimately, he  sought  the  care  of  civilian
providers when he was discharged.

The applicant states the  BCMR  Medical  Consultant  is  incorrect  in
stating that the applicant could not meet Air Force fitness  standards
by the  fall  of  2003.   The  applicant  states  he  could  pass  the
ergometry/bike (ergo) test, even with his leg  condition,  before  the
surgery.  He notes that AFI 10-248, dated 7 Jul 05 allows  AF  members
that are medically exempted from running  to  be  ergo  tested  versus
running. Just because a member cannot run doesn’t require them  to  be
discharged.  The applicant discusses the sequence of events leading to
his decision to have surgery.  One of his care providers suspected  he
had exertional compartment syndrome  (ECS)  and  referred  him  for  a
further evaluation, which subsequently confirmed  his  condition.   He
was offered two options for his  ECS,  a  permanent  profile  for  not
running or fasciotomy surgery.  Because the Air Force was starting  to
require a medical evaluation board (MEB) for anyone with  a  permanent
profile lasting more than 12 months, he elected to have the surgery.

The applicant discusses the problems that occurred after the  surgery.
He notes his disagreement with the BCMR Medical Consultant’s statement
that  “on  December  8,  2003,  three  weeks  post  operatively,   his
orthopedic  surgeon  was  concerned  the  applicant  had  developed  a
neurologically based pain condition that occasionally occurs following
trauma or surgery….”  The applicant states the orthopedic surgeon  was
attempting to control his leg pain, numbness,  tingling,  and  chronic
swelling via a “medication module.”  He was never  initially  referred
to physical therapy during the first five weeks following his surgery.
 He states the orthopedic surgeon did not know  he  was  developing  a
classic case of RSD/CRPS until advised by the primary  care  provider.
The applicant discusses the rigorous physical therapy plan  instituted
by his primary care provider.  Although the orthopedic surgeon  agreed
with the primary care provider regarding the diagnosis of RSD/CRPS, he
did not refer him for intervention until Apr 04.

The applicant notes the regimen of care he went through up to Dec  04,
noting that he was initially seen in the Pain Management clinic in Dec
04.  By  Jan  05,  he  was  being  processed  through  the  Disability
Evaluation System (DES),  which  recommended  he  be  discharged  with
disability severance pay.  While at  the  Formal  Physical  Evaluation
Board (FPEB), he asked to have his leg evaluated again  to  receive  a
definitive diagnosis for his leg, but  the  FPEB  upheld  the  earlier
recommendations  for  disability  discharge.   He  continued,  without
success, to get a definitive diagnosis on his leg.

Ultimately, he submitted  his  appeal  the  SecAF  noting  the  impact
improper medical care had on  his  career.   On  22  Jun  05,  he  was
notified of the decision that he would be disability  discharged  with
severance pay in Aug 05.  He still had the same swollen,  painful  leg
with open sores that never healed from surgery.   At  this  point,  he
opted to pay for medical care out of his own pocket.  He  notes  that,
unfortunately, the information he gained, which  may  have  aided  his
case, was two months after his Informal PEB and FPEB.   He  states  he
should have had a neurological consultation within the first  4  to  6
months of his surgical complications, which did not occur.

The  applicant  notes  his  disagreement   with   the   BCMR   Medical
Consultant’s assertion he would not have been able to meet  Air  Force
fitness standards because of his right leg.  He states he did not have
surgery on his right leg because of the problems he had with his  left
leg.   He  believes  if  he  had  received   definitive   neurological
treatment, he may have completely healed  and  been  willing  to  have
surgery on his right leg.

He asks the Board to rate his disability at 40% for his lower left leg
and then to increase  it  based  on  ratings  for  his  right  leg  as
recommended by the BCMR Medical Consultant  as  well  as  his  chronic
lower back pain, which was omitted by the FPEB.  This will  allow  him
to have a medical retirement and to receive the medical care  for  his
condition.

In support of his appeal, applicant provides ten  attachments  related
to his medical care.

The applicant’s complete submission, with attachments, 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  a  degree  of  relief.   In
coming to our  determination  we  reviewed  the  complete  evidence  of
record, in particular, the memorandum prepared by the Physical  Therapy
Element Chief who recommends approval of the  applicant’s  requests  to
change the VASRD code his disability was rated under from 5312 to  8720
and to increase his disability rating to 40 percent.   However,  we  do
not find the evidence presented sufficiently compelling to overcome the
rationale and recommendation provided by the BCMR  Medical  Consultant.
We accept the BCMR Medical Consultant’s determination  that  the  error
made in the applicant’s case was not that he was rated under the  wrong
VASRD code, but, rather, that his right  leg  condition  was  not  also
rated.  We find the rationale put forth by the BCMR Medical  Consultant
the more persuasive on this issue and adopt his rationale as the  basis
for our determination  of  the  error  or  injustice  suffered  by  the
applicant.   Therefore,  we  recommend  the  applicant’s   records   be
corrected as indicated below.

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 RECOMMENDS THAT:

The pertinent military records of  the  Department  of  the  Air  Force
relating to APPLICANT be corrected to show that:

      a. On 24 August 2005, he was found unfit to perform the duties of
his office, rank, grade, or rating by reason of physical disability,
incurred while he was entitled to receive basic pay; that the diagnosis
in his case was chronic left lower leg pain and swelling status post
fasciotomy for compartment syndrome, DVA diagnostic code 5312, rated at
20%; and exertional compartment syndrome of the right leg, DVA diagnostic
code 5312, rated at 10%; that the combined compensable percentage was
30%; that the degree of impairment was permanent; that the disability was
not due to intentional misconduct or willful neglect; that the disability
was not incurred during a period of unauthorized absence; and that the
disability was not received in the line of duty as a direct result of
armed conflict or caused by an instrumentality of war.

      b. He was not honorably discharged on 25 August  2005  under  the
provisions of AFI  36-3208  by  reason  of  physical  disability,  with
entitlement to disability severance pay,  but  on  that  date,  he  was
honorably discharged from active duty and effective    26 August  2005,
his name was placed on the Permanent Disability Retired List.

_______________________________________________________________

The following members of the Board considered  Docket  Number  BC-2005-
02220 in Executive Session on 4 April 2006, under the provisions of AFI
36-2603:

      Mr. Thomas S. Markiewicz, Chair
      Ms. Mary C. Puckett, Member
      Ms. Janet I. Hassan, Member

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

     Exhibit A.  DD Form 149, dated 8 Jul 05, w/atchs.
     Exhibit B.  Applicant's Master Personnel Records.
     Exhibit C.  Memorandum, BCMR Medical Consultant,
                 dated 27 Feb 06.
     Exhibit D.  Letter, SAF/MRBR, dated 28 Feb 06.
     Exhibit E.  Memorandum, Applicant, dated 5 Mar 06,
                 w/atchs.




                                   THOMAS S. MARKIEWICZ
                                   Chair


AFBCMR BC-2005-02220


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 XXXXXXX, XXXXXXX, be corrected to show that:

            a. On 24 August 2005, he was found unfit to perform the
duties of his office, rank, grade, or rating by reason of physical
disability, incurred while he was entitled to receive basic pay; that the
diagnosis in his case was chronic left lower leg pain and swelling status
post fasciotomy for compartment syndrome, DVA diagnostic code 5312, rated
at 20%; and exertional compartment syndrome of the right leg, DVA
diagnostic code 5312, rated at 10%; that the combined compensable
percentage was 30%; that the degree of impairment was permanent; that the
disability was not due to intentional misconduct or willful neglect; that
the disability was not incurred during a period of unauthorized absence;
and that the disability was not received in the line of duty as a direct
result of armed conflict or caused by an instrumentality of war.

            b. He was not honorably discharged on 25 August 2005 under
the provisions of AFI 36-3208 by reason of physical disability, with
entitlement to disability severance pay, but on that date, he was
honorably discharged from active duty and effective 26 August 2005, his
name was placed on the Permanent Disability Retired List.




            JOE G. LINEBERGER
            Director
            Air Force Review Boards Agency