RECORD OF PROCEEDINGS
         AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:      DOCKET NUMBER:  BC-2005-02389
            INDEX NUMBER:  108.00
      XXXXXXXXXXXXXXX  COUNSEL:  None

      XXXXXXX    HEARING DESIRED:  Yes


MANDATORY CASE COMPLETION DATE:  28 Jan 07


_________________________________________________________________

APPLICANT REQUESTS THAT:

He be medically retired.

_________________________________________________________________

APPLICANT CONTENDS THAT:

Failure of Air Force medical personnel to follow AFI 48-123,  “Medical
Examinations and Standards,” AFI 44-157,  “Medical  Evaluation  Boards
and Continued Military Service, and AFI 41-210, Patient Administration
Functions,  Procedures  cut  short  his  military  career  and  caused
irreparable shoulder and knee damage.

He suffered two injustices while receiving medical  treatment  at  the
78th Medical Group, Robins AFB, GA:

        A.  Established guidelines prescribed in pertinent  Air  Force
Instructions were violated by  backdating  his  physical  profiles  to
avoid Medical Evaluation Board (MEB) processing.  The  MEB  processing
timeline was not met.   Consequently,  he  did  not  receive  adequate
recuperation time for his knee to heal.  Although the problem with his
knee started with surgery in 2001, an MEB was not initiated until 2005
and immediately cleared with no action.  The applicant states that the
MEB never carried out its function to review his records  and  make  a
determination as to whether or not the medical condition was such that
it would interfere with his military  duties.   The  applicant  opines
that “many” regulations were violated in his treatment and  care.   He
specifically references the failure of the physicians treating him  to
coordinate with AFPC/DPAMM to place him on medical hold.

        B.  There was a lack  of  procedures  in  his  receiving  care
between the medical treatment facility (MTF) at Robins AFB and the MTF
at Fort Gordon.  Applicant states he did not  receive  urgent,  timely
treatment and medical care to correct  his  right  shoulder  and  neck
condition.  Applicant opines his Primary  Care  Manager  (PCM)  should
have immediately referred him to an orthopedic specialist.   Applicant
notes that after continued problems with his shoulder, he was  finally
referred by his PCM for an MRI and to see a specialist.  The applicant
states he encountered long delays and  problems  in  coordination  and
communication between Robins AFB and Fort Gordon.

The applicant states he should have been placed  on  medical  hold  or
given a medical discharge due to his medical conditions.  He  believes
that the problems between Robins AFB and  Fort  Gordon  prevented  his
preexisting medical conditions from being resolved.

Due to his frustration with the medical care he  received  and  before
discovering  he  needed  shoulder  surgery,  applicant  submitted  his
request for retirement.

In support of his appeal, applicant provides a  copy  of  his  medical
records.

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

_________________________________________________________________

STATEMENT OF FACTS:

The applicant entered active duty in the Air Force on 16 Jul 84.  On 9
Sep 04, the applicant requested an extension of his current enlistment
for the purpose of retirement  and  also  submitted  his  request  for
voluntary retirement to be effective  31  May  05.   During  his  last
several years of service, the applicant experienced recurring problems
with his right knee and right shoulder.  Additional facts pertinent to
this  application  are  contained  in  the  BCMR  Medical   Consultant
evaluation at Exhibit C.

A resume of the applicant’s last 10 enlisted performance report  (EPR)
overall ratings follows:

      Closeout Date                     Overall Rating

       2 Mar 96                         5
       2 Mar 97                         5
       5 Dec 97                         5
       8 Sep 98                         5
       8 Sep 99                         5
       8 Sep 00                         5
       1 Mar 01                         5
       1 Mar 02                         5
       1 Mar 03                         5
       1 Mar 04                         5

The applicant was separated on 31  May  05  for  retirement  based  on
sufficient length of service.

_________________________________________________________________

AIR FORCE EVALUATION:

The BCMR Medical Consultant  recommends  the  applicant’s  request  be
denied.  The applicant’s contention he was not qualified for worldwide
duty and continuously L4 profiled from his Sep 01 knee  surgery  until
Mar 05 is not supported by  the  medical  record.   Neither  is  there
evidence  he  was  inappropriately  medically  managed  following  the
initial knee surgery.

The applicant correctly asserts that numerous delays were  encountered
in the care of his recurrent right shoulder complaints, many  of  then
caused by the challenges imposed  by  the  Tricare  referral  process.
However, there is nothing in the medical record that suggests that the
delays caused a worsening of his medical condition or that the  delays
were out of the ordinary for the elective nature  of  the  applicant’s
problems.

The  applicant  is  also  correct  that   the   timeliness   standards
established for identification and administrative referral for an  MEB
were exceeded.  Based on the circumstances of the applicant’s case, an
MEB should have been initiated 1 Apr 04.  It appears  that  Air  Force
medical personnel were aware of this requirement  and  declared  their
intent to perform an MEB in  Jul  04.   For  reasons  that  cannot  be
determined from the record, the narrative summary  was  not  completed
until Feb 05.  If the applicant’s MEB had been performed significantly
before he had reached the minimum years for  retirement,  one  of  two
outcomes would have resulted:

        a.  A finding of fit for duty.   If  the  applicant  had  been
found fit, he would have been returned to duty.  Based on his  Sep  04
request for voluntary retirement, it is reasonable to believe he would
have still retired in a similar manner.

        b.  A finding of unfit for duty.  If the  applicant  had  been
found unfit, he would have been given a compensable rating.  Based  on
the evidence of record, it is likely he would have been rated no  more
than 10 percent.  If the MEB had been initiated on 1  Apr  04,  it  is
unlikely the applicant would have been separated  with  severance  pay
since he was within a few months of sufficient service for  a  lengthy
service retirement.  Rather, he would have been retained until he  was
able to retire and then retired with a 10 percent disability.

When the MEB  for  his  knee  condition  was  finally  submitted,  the
applicant was returned to active duty on 8 Mar 05 by AFPC/DPAMM  under
a presumption of fitness.  The  applicant  has  raised  the  issue  of
medical hold in reference to his chronic shoulder  condition.   Active
duty members who develop medical problems during the final  12  months
of their active duty service (i.e., have a scheduled  retirement)  are
presumed fit for continued active  duty  unless  there  is  clear  and
convincing evidence to the contrary.  Medical hold is not approved for
the purpose of evaluating or treating chronic  conditions,  performing
diagnostic studies,  elective  surgery  or  its  convalescence,  other
elective treatment of remedial defects, or for conditions that do  not
otherwise warrant termination of active duty  through  the  Disability
Evaluation  System.   As  reviewed  by  AFPC/DPAMM,  the   applicant’s
shoulder difficulties were chronic and the proposed surgery  elective,
and the use of medical hold clearly not appropriate.  The  applicant’s
retirement did not exclude him from continued medical care.

The complete evaluation is at Exhibit C.

_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

In his response to the Air Force evaluation, the applicant  states  he
has discovered errors in the BCMR Medical Consultant’s  assessment  of
the facts and is providing additional  documentation  to  support  his
request.

The applicant states he did not reinjure his right knee.  He  provides
the details that led to his surgery in Nov  01.   He  states  that  he
encountered problems receiving AF Form 422,  Physical  Profiles.   The
applicant discusses  his  treatment,  handling  of  his  profiles  and
performance of duties and how his knee condition was aggravated.   The
applicant notes that he received a profile on 9 Oct 03, which  stated,
“pending MEB” in the restrictions area.  On  2  Nov  03,  his  medical
records were annotated by  a  flight  surgeon  to  indicate  that  “if
condition persists 1 yr, MEB required.”  Applicant states the 1 Apr 03
date indicated for initiation of  profile  is  incorrect  due  to  his
continuous treatment for the same condition.  The applicant notes that
his medical records are annotated on 3 Feb 04 with the  comment,  “see
memorandum dated 30 Jan regarding 4T review.”  He states he has  never
seen this memorandum, it is  not  in  his  medical  records,  and  the
memorandum is never mentioned in the BCMR Medical Consultant’s report.

The applicant discusses the circumstances  of  his  delayed  MEB.   He
questions why the MEB summary, dated 19 Feb 05, did not cover  all  of
his restrictions and the truth of  his  condition  as  stated  by  the
Orthopedist that treated him.  He became frustrated on 24 Feb 05  when
he received an e-mail stating he needed to complete a questionnaire to
start MEB processing.  The email stated MEBs normally  take  90  days.
He was advised that if his retirement date was within 90 days  of  the
date his MEB package would be sent to Lackland, he would be placed  on
medical hold.  By 2 Mar 05, he had less than 90 days  left  on  active
duty and had not received any information on his MEB.  He considers it
ironic he was never called to review his package or given a  briefing.
His MEB was expedited  without  procedures  being  followed.   He  was
advised of the results on 8 Mar 05.

The applicant states he would not have requested retirement if the MEB
action and medical assistance had  been  processed  according  to  Air
Force procedures.  He states he could no longer endure the pain he was
encountering  and  maintain  Air  Force  standards.    The   applicant
indicates he disagrees with the BCMR  Medical  consultant’s  assertion
his shoulder condition flared up  in  the  final  six  months  of  his
service.  It became more severe in the final nine months  even  though
he sought treatment 15 months before retirement.  He believes  if  his
care providers had followed proper procedures, his shoulder  condition
would have been diagnosed, treated and included in his MEB package.

In support of his appeal, applicant submits 70 attachments designed to
show the course of his medical treatment and correct errors  reflected
in the BCMR Medical  Consultant’s  evaluation  and  also  submits  two
letters from his former rating chain.

The applicant’s complete response, 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.  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  primary  basis  for
our conclusion that the applicant has not been the victim of an  error
or injustice.  We note the disagreements the applicant  has  with  the
BCMR medical Consultant’s evaluation.   However,  we  do  not  find  a
sufficient basis to grant him  a  medical  retirement.   Although  the
applicant feels he  was  coerced  into  a  voluntary  retirement,  the
decision was his and resulted in his coming under the  presumption  of
fitness standard during his last 12 months of service.   Additionally,
although the applicant indicates  he  spoke  with  the  Medical  Group
commander regarding his case and worked with patient affairs regarding
his  medical  appointments,  he  has  not  provided  any  evidence  he
exhausted all administrative remedies such as the involvement  of  his
unit commander or filing a complaint  through  the  inspector  general
system.  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-2005-
02389 in Executive Session on 22 March 2006, under the  provisions  of
AFI 36-2603:

      Mr. Michael K. Gallogly, Panel Chair
      MS. Rita J. Maldonado, Member
      Ms. Glenda H. Scheiner, Member

The following documentary evidence was considered:

    Exhibit A.  DD Form 149, dated 15 Jul 05, w/atchs.
    Exhibit B.  Applicant's Master Personnel Records.
    Exhibit C.  Memorandum, BCMR Medical Consultant,
                dated 6 Feb 06.
    Exhibit D.  Letter, SAF/MRBR, dated 7 Feb 06.
    Exhibit E.  Letter, Applicant, dated 22 Feb 06.




                                   MICHAEL K. GALLOGLY
                                   Panel Chair