RECORD OF PROCEEDINGS
             AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS


IN THE MATTER OF:      DOCKET NUMBER:  BC-2007-04028
            INDEX CODE:  108.00
            COUNSEL:  NONE
            HEARING DESIRED:  NO

_________________________________________________________________

APPLICANT REQUESTS THAT:

Her disability rating be increased from 10%  to  70%-80%  with  a  permanent
disability retirement.

_________________________________________________________________

APPLICANT CONTENDS THAT:

An artificially low disability rating was reached as her condition  was  not
fully characterized and full treatment benefits had not been obtained.   Had
the board process been handled appropriately these errors  would  have  been
addressed.  She is now confined to a wheelchair.  This is  a  direct  result
of the surgery performed and the aftercare provided by the Air  Force.   Her
retirement should be processed under Reflex Sympathetic Dystrophy  (RSD)  or
Neuralgia or the Femoral, Peronal and Tibial Nerves (final  diagnosis  while
in the Air Force) at a total rating of 70%  -  80%.   Private  practitioners
discovered  the  symptoms  had  spread  to  both  legs   and   both   hands.
Additionally,  she  experiences  myoclonus  (8104)  as  a  result   of   the
neurological problems.

Once the Medical Evaluation  Board  (MEB)  progressed  there  were  multiple
points at which the packet should have been  returned.   A  packet  must  be
recalled  for  clarification,   updating,   deficient   information/evidence
missing, change in status,  errors,  omissions,  inconsistencies,  and  non-
compliance with the regulations governing the Disability  Evaluation  System
(DES)  process.   Individuals  responsible  for  this  action  include   the
preparing physician, the board president  reviewing  officer,  the  hospital
commander,  AFPC/DPPD,  the  Informal  Physical  Evaluation   Board   (IPEB)
president, the Formal Physical Evaluation Board (FPEB)  president,  and  the
Secretary of the Air  Force  Personnel  Council  (SAF/PC).   None  of  these
individuals  acted  to  recall  the  packet   despite   multiple   problems.
Therefore, the MEB and PEB could  not  carry  out  their  primary  roles  to
confirm the medical diagnosis  and  to  determine  the  nature,  origin  and
degree of the disability.

The narrative serves as the summary of all of  the  information  the  boards
receive.  Therefore, this document  is  very  important  to  any  disability
case.  The narrative, in this case; however,  was  missing  information  and
contained inaccurate information.  Both oversights  are  violations  of  the
regulations governing the narrative's preparation.

Whether she left the Air Force through force shaping or through the MEB,  it
is clear that her career was cut short by this disability.  Dramatic  though
it may sound, she was scared for her life.  A plethora of  medications  were
prescribed, some  of  which  were  wholly  inappropriate.   Care  was  often
unacceptably delayed or denied.   She  attempted  to  remedy  the  situation
through  a  number  of  channels  and  unfortunately,  all   remedies   were
unsuitable.  She was ultimately forced to request to leave the Air Force  in
order to protect her health and to pursue medical treatment elsewhere.

In support of her request, the applicant provided a personal  statement  and
documentation extracted from her medical records.

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

_________________________________________________________________

STATEMENT OF FACTS:

The applicant entered active duty on 17 June 2002 in  the  grade  of  second
lieutenant.   She  was  progressively  promoted  to  the  grade   of   first
lieutenant having assumed that grade effective and with a date  of  rank  of
29 May 2004.

An MEB convened on 12 April 2005 and referred her case to  an  IPEB  with  a
diagnosis of chronic regional pain syndrome,  mild,  after  injury  to  left
anterior cruciate ligament.  On 11 May 2005, the IPEB found  her  unfit  for
further military service.  The IPEB recommended discharge  with  a  combined
compensable rating of 10%.  The applicant disagreed with  the  findings  and
recommended disposition of the IPEB and  requested  an  FPEB.   On  29  June
2005, the FPEB found her unfit for  further  military  service  based  on  a
compensable diagnosis of chronic regional pain syndrome.  The  FPEB  further
recommended discharge with severance pay with a disability  rating  of  10%.
She appealed the  FPEB  decision  to  SAF/PC.   SAF/PC  concurred  with  the
findings  and  recommendation  of  the  FPEB  and  directed  discharge  with
severance pay effective 11 October 2005.  She served 3 years, 3 months,  and
25 days on active duty.

_________________________________________________________________

AIR FORCE EVALUATION:

AFPC/DPSD recommends denial.  DPSD states the applicant  was  released  from
active service on 11 October 2005 for diagnoses  of  chronic  regional  pain
syndrome  (Reflex  Sympathetic  Dystrophy),  mild,  after  injury  to   left
anterior cruciate ligament.  The IPEB reviewed her case on 11 May  2005  and
recommended discharge with severance pay at  a  disability  rating  of  10%.
She requested a hearing with the FPEB and appeared with counsel  before  the
FPEB on 29 June 2005.  The FPEB  examined  the  evidence  presented  at  the
hearing and also recommended discharge with severance pay with a  disability
rating of 10%.  The FPEB noted the applicant had  received  a  diagnosis  of
chronic regional pain syndrome and agreed that  a  change  in  the  Veterans
Administration Schedule for Rating  Disabilities  (VASRD)  code  to  reflect
sympathetic dystrophy was  appropriate.   The  FPEB  noted  she  had  missed
minimal duty time and was  able  to  perform  her  military  duties  without
significant impairment or modifications of her duty environment.  They  also
noted the imaging study of  18  June  2004  showed  no  evidence  of  reflex
sympathetic dystrophy, her anterior cruciate  ligament  reconstruction  with
graft had healed, and she had no mechanical  limitations  to  her  rehab  or
activities.  The FPEB also recommended discharge with  severance  pay  at  a
disability rating of 10%.  In the applicant's  rebuttal  she  requested  her
disability rating be increased to 50%.  On 29 August 2005,  SAF/PC  reviewed
the entire case file with applicant's additional documentation.   The  board
found  no  compelling  evidence  to  justify  overturning   previous   board
decisions.   They  noted  that  during  a  follow-up   clinical   assessment
conducted on 7 July 2005, the applicant demonstrated no impairment  of  gait
and  had  essentially  normal  strength   in   the   involved   left   knee.
Electrodiagnostic studies of the applicant's lower extremities  also  failed
to demonstrate the presence of a peripheral neuropathy or  radiculopathy  to
explain  her  symptoms.   SAF/PC  found  no  errors  with  the  adjudication
procedure of her case and concurred with the  dispositions  of  both  boards
upholding  the  recommendation  of  discharge  with  severance  pay  with  a
disability rating of 10%.

Per AFI 36-3212, section 2.61, if major change in  the  diagnosis  or  in  a
member's condition is discovered, the referring MTF  commander  must  recall
the case for further medical evaluation and new medical  board  or  addendum
as appropriate.  The commander sends a report of circumstances  and  request
for recall to HQ AFPC/DPSD.  At no time was a request  for  recall  received
by their office.  Any  new  medical  documentation  regarding  the  member's
condition was submitted with each new appeal of her case.

The preponderance of evidence reflects that no error or  injustice  occurred
during the disability process.

The complete DPSD evaluation is at Exhibit C.

_________________________________________________________________





APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

On 1 February 2008, the  evaluation  was  forwarded  to  the  applicant  for
review and comment within 30 days  (Exhibit  D).   As  of  this  date,  this
office has received no response.

_________________________________________________________________

ADDITIONAL AIR FORCE EVALUATION:

The AFBCMR Medical Consultant recommends changing the record to reflect  the
applicant was retired from military service with a  40%  disability  rating,
due to her "moderately severe" Complex Regional Pain Syndrome (CRPS).

The  AFBCMR  Medical  Consultant  states  the  applicant  was  given  a  10%
disability  rating  for  her  condition.   The  record   reflects   numerous
evaluations by different physician specialists (sports medicine,  neurology,
and orthopedics) some finding  inconclusive  evidence  of  CRPS  and  others
confirming the diagnosis.  In assessing  the  severity  of  the  applicant's
medical condition, the Medical Consultant noted that the  rationale  of  the
FPEB for awarding a 10% disability rating was based  collectively  upon  the
applicant's use of "non-narcotic medications and her ability to perform  her
military duties without significant impairment or modifications of her  duty
environment."  The  FPEB  also  noted  that  the  applicant  had  reportedly
"missed minimal duty time" and that she "[had] no limitations in  activities
of daily living."  The applicant's  commanding  officer  also  provided  the
following description of the applicant's duty performance in a letter  dated
23 February 2005, which  reads:  "Lt  L's  supervisor  says  that  her  duty
performance  has  not  diminished  significantly  and  suggested  that   her
standards are perhaps much higher than  most  people's.   Although  she  has
missed several days of work for medical appointments, [her supervisor]  does
not deem them excessive.  He also has seen no  significant  negative  impact
from her condition to his work center or the unit's overall mission."

Additionally, electrodiagnostic studies (EMG and nerve conduction  velocity)
of the applicant's lower extremities failed to  demonstrate  a  quantifiable
neurological  deficit.   Nonetheless,  the  applicant  had  been  under   an
extended treatment plan utilizing a broad range of pain modulating  measures
both during military service and following her discharge, to include  lumbar
sympathetic blocks,  a  saphenous  nerve  block,  use  of  a  transcutaneous
electrical  nerve  stimulation  (TENS)  device,  and  a  variety   of   oral
medications; none of which eliminated the applicant's symptoms.

Although  the  applicant's  medical  condition  may  have  progressed  since
leaving  military  service,  to  the  extent  that  she  is  now  reportedly
wheelchair-dependent, the Military Disability Evaluation System  (MDES)  can
only rate her medical condition based upon its  level  of  severity  at  the
"snap-shot" in time in which the final case disposition  was  reached.   The
AFBCMR Medical Consultant acknowledges the applicant's concerns that  a  10%
disability  rating  does  not  accurately  reflect  the  actual   level   of
functional impairment she experiences on  a  given  day,  particularly  when
taking into account her reported daily fatigue and the  adverse  effects  of
her medications.  Therefore,  in  justifying  a  recommended  Board  action,
attention is directed to special rating guidelines for Neuralgia,  or  pain,
as  provided  under  the  Veterans  Administration   Schedule   for   Rating
Disabilities  (VASRD).   Neuralgia,  cranial  or  peripheral,  characterized
usually by a dull and intermittent pain, of typical distribution  so  as  to
identify the nerve, is to be rated on the same scale, with a  maximum  equal
to moderate incomplete paralysis.

Noting that the applicant's functional  impairment  has  been  predominantly
due to pain, strict adherence to the  aforementioned  VASRD  guidelines  for
rating Neuralgia, would result in a  disability  rating  not  exceeding  20%
under  this  scheme.   However,  noting  that   the   applicant   has   also
demonstrated  additional  physical  signs  and  symptoms,  characterized  by
organic  changes  related  to  her  disorder,  to  include  muscle  atrophy,
tremors, myochlonus, in addition to an  altered  tactile  sensory  response,
the AFBCMR Medical Consultant finds justification  for  rating  her  medical
condition, utilizing the same overarching  disability  rating  scheme  under
the analogous code for the Sciatic Nerve code (8799-8720), but  applying  it
to the more accurate rating criteria for  Neuritis,  instead,  which  reads:
Neuritis, cranial or peripheral, characterized by loss of  reflexes,  muscle
atrophy, sensory disturbances, and constant pain, at times excruciating,  is
to be rated on the scale provided for injury of the nerve involved,  with  a
maximum equal to severe, incomplete paralysis.   The  maximum  rating  which
may be assigned for neuritis not characterized by organic  changes  referred
to in this section  will  be  that  for  moderate,  or  with  sciatic  nerve
involvement, for moderately severe, incomplete paralysis.

Considering  the  applicant's   self-reported   and   witnessed   functional
impairment,  the  medical  records  documentation,  and   the   demonstrable
"sciatic nerve involvement" of her  disease  process,  a  consideration  for
rating her condition as moderately severe, as above,  at  the  time  of  her
discharge is a reasonable course of action.  Nonetheless, operating under  a
different set of laws (Title 38, United  States  Code),  the  Department  of
Veterans Affairs is authorized to offer the applicant  a  higher  disability
rating based upon her  current  level  of  impairment  and  may  adjust  her
disability rating due to any fluctuations in her condition  that  may  occur
over time.  Therefore, the two systems  represent  a  continuum  of  medical
care and disability compensation that starts with entry on  to  active  duty
and extends for the life of the veteran.


The complete AFBCMR Medical Consultant's evaluation is at Exhibit E.

_________________________________________________________________

APPLICANT'S REVIEW OF ADDITIONAL AIR FORCE EVALUATION:

On 24 March 2008, the AFBCMR Medical Consultant's evaluation  was  forwarded
to the applicant for review and comment within 30 days (Exhibit F).   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.  Sufficient relevant evidence  has  been  presented  to  demonstrate  the
existence of  an  injustice  warranting  partial  relief.   After  carefully
reviewing  the  evidence  of  record,  we  agree  with  the  AFBCMR  Medical
Consultant that it  appears  the  applicant’s  condition  was  not  properly
adjudicated according to  standards  in  place  during  the  contested  time
period.  Therefore, we believe that a change in her records is warranted  to
reflect a 40% disability rating at the time  of  final  disposition  of  her
case.  We considered her request that her condition  be  rated  at  70%-80%;
however, other than her  own  assertions,  insufficient  evidence  has  been
provided showing that at the time of final  disposition  her  condition  had
reached the level of severity warranting a 70%-80% rating.  Accordingly,  we
recommend her records be corrected to the extent indicated below.

_________________________________________________________________

THE BOARD DETERMINES THAT:

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

      a.  On 10 October 2005, she was found unfit to perform the  duties  of
her office, rank,  grade,  or  rating  by  reason  of  physical  disability,
incurred while she was entitled to receive basic pay; that the diagnosis  in
her case was Complex Regional Pain Syndrome, VASRD code 8799-8720, rated  at
40%; 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.  On 11  October  2005,  she  was  retired  by  reason  of  physical
disability under the provisions of AFI 36-3212.

_________________________________________________________________

The following members of the Board considered AFBCMR Docket Number  BC-2007-
04028 in Executive Session on 6 August 2008, under the provisions of AFI 36-
2603:

                 Mr. Thomas S. Markiewicz, Panel Chair
                 Ms. Josephine D. Davis, Member
                 Mr. Kurt R. LaFrance, Member

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

   Exhibit A.  DD Form 149, dated 30 November 2007, w/atchs.
   Exhibit B.  Applicant's Master Personnel Records.
   Exhibit C.  Letter, AFPC/DPSD, dated 28 January 2008.
   Exhibit D.  Letter, SAF/MRBR, dated 1 February 2008.
   Exhibit E.  Letter, BCMR Medical Consultant, dated 19 March 2008.
   Exhibit F.  Letter, SAF/MRBR, dated 24 March 2008.





                       THOMAS S. MARKIEWICZ
                       Chair





AFBCMR BC-2007-04028




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 XXX, be corrected to show that:

            a.  On 10 October 2005, she  was  found  unfit  to  perform  the
duties of  her  office,  rank,  grade,  or  rating  by  reason  of  physical
disability, incurred while she was entitled to receive basic pay;  that  the
diagnosis in her case was Complex Regional Pain Syndrome, VASRD  code  8799-
8720, rated at 40%; 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.  On 11 October 2005, she was retired by  reason  of  physical
disability under the provisions of AFI 36-3212.





      JOE G. LINEBERGER
      Director
      Air Force Review Boards Agency