RECORD OF PROCEEDINGS
             AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS


IN THE MATTER OF:      DOCKET NUMBER:  BC-2005-02390
            INDEX CODE:  110.00
            COUNSEL:  DAV


            HEARING DESIRED:  YES

MANDATORY CASE COMPLETION DATE:  1 FEB 07

_________________________________________________________________

APPLICANT REQUESTS THAT:

Her honorable discharge be changed to a disability retirement.

_________________________________________________________________

APPLICANT CONTENDS THAT:

The Air Force Physical  Evaluation  Board  (PEB)  determined  that  she  had
conditions  which  rendered  her  unfit  for  military  duty  (upper  airway
resistance, hypothyroidism, and major depression  in  remission).   The  Air
Force assigned a combined compensable disability percentage of 20%  and  she
was honorably discharged.   She  states  that  the  Department  of  Veterans
Affairs (DVA) rated her differently  for  service  connection  compensation.
The Air Force improperly pyramided  three  conditions  together  for  rating
purposes.

In support of her request, the applicant provided a personal  statement  and
documents extracted from her military personnel record.

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

_________________________________________________________________

STATEMENT OF FACTS:

The applicant entered active duty on 3 May  1990,  and  served  as  a  judge
advocate.

A Medical Evaluation Board (MEB) convened on 2 May  2002  and  referred  her
case to an Informal Physical  Evaluation  Board  (IPEB)  with  diagnoses  of
upper airway resistance, chronic fatigue syndrome, vocal chord  dysfunction,
angioedema, HSV-2, hypothyroidism, tempromandubular joint syndrome,  chronic
sinusitis,  trichotillomania,  endometriosis,  urinary   tract   infections,
history of  spontaneous  pneumothorax,  fibrocystic  breast  disease,  major
depressive disorder recurrent – moderate, in partial remission.  On  15  May
2002, the IPEB found  her  unfit  for  further  military  service  based  on
diagnoses of Category I - unfitting conditions  which  are  compensable  and
ratable: chronic fatigue associated with multiple  medical  problems:  upper
airway resistance, hypothyroidism, and major depression  in  remission;  and
Category II – conditions  that  can  be  unfitting  but  are  not  currently
compensable  or  ratable:   vocal  cord  dysfunction,  angioedema,  seasonal
allergic rhinitis.   The  IPEB  recommended  that  she  be  discharged  with
severance pay with a disability rating of 20%.  The  applicant  agreed  with
the findings and recommended disposition of the IPEB.  On 21 May  2002,  The
Office of the Secretary of the Air Force directed  that  she  be  discharged
effective 12 June 2002.  She served 12 years, 1 month, and 9 days on  active
duty.

_________________________________________________________________

AIR FORCE EVALUATION:

The BCMR Medical Consultant recommends denial.  The BCMR Medical  Consultant
states the applicant was discharged with severance pay for  chronic  fatigue
of multi-factorial origin, sleep disorder,  depression  and  hypothyroidism.
She  asserts  that  the  PEB  improperly  pyramided  when   adjudicating   a
disability rating  for  her  unfitting  fatigue  by  associating  her  sleep
disorder, depression and hypothyroidism together under the  single  category
of fatigue, and rating her unfitting symptom  of  fatigue  using  the  VASRD
code for chronic fatigue syndrome as a guide.  Pyramiding is the  assignment
of separate  ratings  for  unique  and  separate  diagnoses  that  each  are
producing or  contributing  to  the  same  impairment  and  is  specifically
prohibited by VA Schedule of Rating Disabilities (VASRD) rating guidance  as
well as DoD policy.

The purpose of  disability  rating  is  to  rate  disability,  not  distinct
diagnoses.  There can be multiple distinct  diagnoses  contributing  to  the
same impairment, and separately rating each diagnosis by applying  the  same
impairment to the rating of different diagnoses, and combining them  into  a
total combined rating is the same as rating  the  same  impairment  multiple
times and is called pyramiding.   Distinct  diagnoses  contributing  to  the
same impairment are rated together under one code that rates the  impairment
resulting from the combined effects of  the  multiple  conditions.   In  the
case of the applicant, the PEB determined her fatigue was unfitting.   Based
on evidence of record, the fatigue was  caused  by  contributions  from  her
sleep disorder, hypothyroidism and major depression  in  partial  remission.
Each of the conditions individually did not explain all of her  fatigue  and
her  hypothyroidism  and  depression  were  not  separately  unfitting  (her
hypothyroidism is easily treated with replacement  therapy;  her  depression
was in partial remission and psychiatrists concluded there was  no  military
impairment from her depression).

DVA adjudicators rated her depression 10% because she was taking  medication
and similarly rated hypothyroidism  10%  also  merely  because  she  was  on
medication.  Merely taking medication for depression or hypothyroidism  does
not render an individual unfit for military service or warrant a  disability
rating and compensation under the rules of the military DES.   At  the  time
the applicant was being evaluated in the  Air  Force  disability  evaluation
system, her depression and hypothyroidism were not separately unfitting  and
did not warrant a separate rating from the rating for fatigue.

If the PEB had instead separately rated her sleep  disorder,  hypothyroidism
and depression each based the common impairment of fatigue;  the  PEB  would
have pyramided in violation of DoD and VASRD  rating  policy  and  guidance.
Her symptom of fatigue was unfitting, had multiple contributing factors  and
was properly rated by analogy  under  the  VASRD  Code  of  Chronic  Fatigue
syndrome even though she did not meet the  strict  diagnostic  criteria  for
chronic fatigue syndrome due to the presence of other conditions  productive
of the symptoms of fatigue.   The  PEB  did  not  conclude  her  vocal  cord
dysfunction and angioederna were  unfitting  and  evidence  of  the  records
indicates that these conditions had  existed  unchanged  for  years  without
impairment of military duties.

The Air Force PEB  did  not  pyramid  and  properly  rated  the  applicant’s
unfitting fatigue by associating conditions  that  together  contributed  to
her fatigue.  Action and disposition in this case are proper  and  equitable
reflecting compliance with Air Force directives that implement the law.

The BCMR Medical Consultant’s complete evaluation is at Exhibit C.

_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

On 21 September 2006, the evaluation was  forwarded  to  the  applicant  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 an error or injustice warranting the applicant’s  discharge  be
changed to  a  disability  retirement.   After  a  thorough  review  of  the
evidence of record, the discharge appears  to  be  in  compliance  with  the
governing AF instruction which implements the law.  We find no  evidence  of
error in this case and after thoroughly reviewing the  evidence  of  record,
we do not believe she has  suffered  from  an  injustice.   It  appears  the
Disability Evaluation System properly evaluated and rated the applicant  and
she has not provided any evidence which would lead us to believe  otherwise.
 In view of the above, we agree with the opinion and recommendation  of  the
BCMR Medical Consultant and  adopt  his  rationale  as  the  basis  for  our
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 compelling basis to recommend granting the relief sought.

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 issue involved.  Therefore, the request  for
a hearing is not favorably considered.

_________________________________________________________________

THE BOARD DETERMINES THAT:

The applicant be notified the evidence presented  did  not  demonstrate  the
existence of an error or an injustice; the application was denied without  a
personal appearance; and 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 AFBCMR Docket Number  BC-2005-
02390 in Executive Session on 10 January 2007, under the provisions  of  AFI
36-2603:

                 Mr. James W. Russell III, Panel Chair
                 Ms. Barbara R. Murray, Member
                 Mr. Reginald P. Howard, Member

The following  documentary  evidence  pertaining  to  this  application  was
considered:

   Exhibit A.  DD Form 149, dated 30 May 05, w/atchs.
   Exhibit B.  Applicant's Master Personnel Records.
   Exhibit C.  Letter, BCMR Medical Consultant, dated 19 Sep 06.
   Exhibit D.  Letter, SAF/MRBR, dated 21 Sep 06.




                       JAMES W. RUSSELL III
                       Panel Chair