RECORD OF PROCEEDINGS
             AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:      DOCKET NUMBER:  BC-2008-00220
            INDEX CODE:  108.07
            COUNSEL:
            HEARING DESIRED:  NO

_________________________________________________________________

APPLICANT REQUESTS THAT:

His service-connected  medical  condition,  post-traumatic  stress  disorder
(PTSD), be assessed as a direct result of armed conflict, or was  caused  by
an instrumentality of war, and incurred in the line of duty during a  period
of war.

_________________________________________________________________

APPLICANT CONTENDS THAT:

His disability was the direct result of armed conflict or was caused  by  an
instrumentality of war, and that it was incurred in the line of duty  during
a period of war.

In support of his request,  applicant  provides  a  personal  statement  and
documentation  associated  with  his  Combat  Related  Special  Compensation
(CRSC) application.

His complete submission, with attachments, is at Exhibit A.

_________________________________________________________________

STATEMENT OF FACTS:

Applicant contracted his initial enlistment in the Air National Guard  on  1
Mar 83, and served  as  an  A10  Aircraft  Flight  Line  Mechanic.   He  was
progressively promoted to the grade of master sergeant, having assumed  that
grade effective and with a date of rank of 1 Sep 01.

He was permanently disability retired from the Air National Guard on  2  Nov
06, for physical disability with a compensable percentage of 30 percent.

His available  Department  of  Veterans  Affairs  (DVA)  records  reflect  a
combined compensable rating of 100 percent for his unfitting conditions.

His CRSC application was disapproved on 10 Mar 04, based upon the fact  that
his service-connected medical conditions were determined not to  be  combat-
related.

He served a total of 20 years and 13 days military service.

_________________________________________________________________

AIR FORCE EVALUATION:

The BCMR Medical Consultant recommends denial  of  the  applicant’s  request
for granting establishment of the designation that his PTSD was  the  direct
result of armed conflict or caused by an instrumentality of  war,  during  a
period of war.

The Medical Consultant states that despite the arguments put forth  for  and
against the applicant’s diagnosis of PTSD, the bottom-line is  that  he  has
been granted a medical retirement for PTSD.  The  question  confronting  the
Board  is  to  determine  whether  the  applicant  should  be  granted   the
designations he desires.  To assist the Board in its decision the  following
definitions are provided.

First, DoDI 1332.38 defines an instrumentality of war as a vehicle,  vessel,
or device designed primarily for military service and intended  for  use  in
such service at the time of the occurrence of the injury.  It may also be  a
vehicle, vessel or device not designed for military service, if  use  of  or
occurrence  involving  such  a  vehicle,  vessel,  or  device  subjects  the
individual to a hazard peculiar to military service.  The use or  occurrence
differs from the use or occurrence under similar circumstances  in  civilian
pursuits.  There must be a direct causal relationship  between  the  use  of
the instrumentality of war and the disability, and the  disability  must  be
incurred incident to a hazard or risk of the service.

A further clarification of the definition is offered in the  same  document,
under Enclosure 3  Paragraph  5.2.2.4,  which  reads,  incurrence  during  a
period of war is not required.  A favorable determination  is  made  if  the
disability was incurred during any period of service as  a  result  of  such
diverse causes as wounds caused by a military weapon, accidents involving  a
military combat vehicle, injury or  sickness  caused  by  fumes,  gases,  or
explosion of military  ordnance,  vehicles,  or  material.   However,  there
again must be a direct causal relationship between  the  instrumentality  of
war and the disability.

For example, an injury resulting from a service member falling off the  deck
of a ship while participating in a sports activity  would  not  be  normally
considered an injury caused by an instrumentality of war  (the  ship)  since
the sports activity and not the ship caused the fall.  The exception  occurs
if the operation of the ship caused the fall.

The BCMR Medical Consultant offers the following additional key  definitions
that  may  prove  helpful  in  adjudicating  the  applicant’s  case.   Armed
conflict is defined in  DoDI  1332.38,  as  the  physical  disability  if  a
disease or injury incurred in the line of duty as a direct result  of  armed
conflict.

The fact that a member may have incurred a disability  during  a  period  of
war or in an area  of  armed  conflict  or  while  participating  in  combat
operations, is not sufficient to support this  finding.   There  must  be  a
definite causal relationship between the armed conflict  and  the  resulting
unfitting  disability.   The  definition  of  combat-related  encompasses  a
broader, inclusive range of factors which includes: (1) as a  direct  result
of armed conflict, as defined above (2) while engaged in hazardous  service,
e.g. aerial flight  duty,  parachute  duty,  demolition  duty,  experimental
stress duty, and diving duty and (3) under conditions  simulating  war.   In
general, this covers disabilities resulting from military training, such  as
war  games,  practice  alerts,  tactical  exercises,  airborne   operations,
grenade and live  fire  weapons  practice,  bayonet  training,  hand-to-hand
combat  training,  repelling,  and  negotiation  of  combat  confidence  and
obstacle courses.

Addressing  the  medical  condition  for  which   the   applicant   received
disability compensation (PTSD), the  BCMR  Consultant  finds  no  reason  to
further  challenge  the  accuracy  or  appropriateness  of  his   diagnosis.
However, when collectively  considering  the  applicant’s  co-morbid  mental
diagnoses of record, Bipolar Disorder,  Panic  Disorder,  Anxiety  Disorder,
and his baseline  personality  profile  (Obsessive-Compulsive  traits),  and
their impact upon his overall psyche at  a  given  time,  the  BCMR  Medical
Consultant finds no clear direct causal relationship between his  PTSD,  and
duties requiring him  to  load  ordinance  onto  a  military  aircraft  (the
instrumentality of war) or the observations he made at  an  airfield,  while
not under enemy fire; nor either performing  qualifying  hazardous  duty  or
under the imminent threat of injury or death,  of  the  flag-draped  coffins
and wounded warriors enroute to the continental United States.

On the other hand, the  BCMR  Medical  Consultant  finds  it  reasonable  to
conclude that repeated exposures to air raid sirens could result in  a  fear
of an imminent danger.  However, in the  case  under  review,  there  is  no
evidence that the applicant was ever exposed to an actual  incoming  warhead
of the detonation of an explosive device.  Consequently,  the  BCMR  Medical
Consultant finds that the applicant’s reported symptoms  following  exposure
to the execution of high  levels  of  alert  (e.g.,  DEFCON  4)  by  command
officials (while participating in combat  operations)  an  insufficient  in-
dependent basis for  establishing  instrumentality  of  war  or  the  direct
result of armed conflict, symptoms which in  this  case,  more  likely  than
not,  could  be  better  explained  by  the  applicant’s  co-morbid  anxiety
disorder, panic  disorder,  and  baseline  personality  profile  (Obsessive-
Compulsive  traits);  the  latter  factor  which  the  evaluating   military
psychiatrist found, on 15 Sep 06, to be the main contributing factor to  his
impairment.

The complete Medical Consultant Evaluation is at Exhibit B.

_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

The applicant, through his service representative  states  that  while  they
agree with the BCMR Medical  Consultants  assessment  that  the  applicant’s
psychiatric illnesses variously  diagnosed  cannot  be  separated  from  the
stressors of his military service they disagree  with  the  conclusion  that
his condition is not the direct result of armed conflict.  “It  appears  the
Medical Consultant has equated the phrase direct result of  armed  conflict”
to  the  elements  required  in  a  stressor  imminent  danger,  etc,   when
determining whether the applicant’s psychiatric illness  is  the  result  of
armed conflict.

The fact is the applicant  was  engaged  in  support  activities  for  armed
conflict.  He was loading bombs that did result in the death  of  enemy  and
quite potentially civilians.  The aircraft, which he loaded the  bombs  were
vessels or vehicles designed primarily for military service.

This realization and his participating role had significant  impact  on  his
mental health.  His psychiatric impairment can be directly  associated  with
his required duties and the stress of loading these bombs during the  combat
support activities.  It is not required that  the  service  member  to  have
been exposed to enemy forces or suffered an injury from enemy.

Although there are elements of  other  psychiatric  factors  with  different
etiologies, the BCMR  Medical  Consultant  and  other  psychiatric  evidence
absolutely establishes that components of his psychiatric  disease  are  the
direct  result  of  his  duties  in  the  military  during  combat   support
activities.  The finding that other etiologies are  considered  to  be  main
contributing  factors  to  his  various  psychiatric  illnesses  erroneously
negates the fact that a direct relationship still exists.

The applicant’s duties during a  war  effort  directly  contributed  to  his
psychiatric impairment.   Therefore,  they  are  of  the  opinion  that  his
psychiatric condition was the direct result of armed conflict or  caused  by
an instrumentality of war.

He strongly disagrees with  the  BCMR  Medical  Consultant’s  recommendation
that he be denied correction of his military records.   There  are  numerous
errors in the report that need to be addressed.

He was in a wartime environment at  a  classified  location  and  that  they
donned their flak jackets and were armed with M-16  rifles,  as  there  were
reports the base would be under possible attack.  He feared for his life  on
those nights and still has recurring thoughts about it.   He  felt  that  he
was in imminent danger.

He was in Kuwait during the 11 Sep 01 attack when the threat was  heightened
to DEFCON 4, and he continues to have recurring thoughts and visions of  the
emergency procedures  enacted,  subsequent  to  the  attack  on  the  United
States.  He believes this establishes the criteria  for  instrumentality  of
war.

The report also states that he has been under the care of a civilian  family
therapist.  The report fails to take  into  account  that  it  was  the  Air
National Guard  that  sent  him  to  the  contracted  therapist,  after  his
commander noticed he was having mental issues in Nov 05.

In regards to the report that he deliberately attempted to endorse  as  many
items  as  possible  on  his  personality  questionnaire,  he   finds   this
insulting, especially having PTSD.  He took the test  to  the  best  of  his
knowledge. The advisory is largely  incorrect  and  his  records  should  be
changed to reflect the truth.

In further support of his appeal, applicant provides a  statement  from  his
service representative, two personal statements,  two  statements  from  his
wife, and a statement from his physician.

The applicant’s complete response, with attachments, is at Exhibit D.

_________________________________________________________________

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.  After a thorough review of  the  available
evidence of record, it is our opinion  that  the  service-connected  medical
conditions the applicant believes are combat-related were  not  incurred  as
the direct result of armed conflict, while engaged in hazardous service,  in
the performance of duty under  conditions  simulating  war,  or  through  an
instrumentality of war.  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.  In  the  absence  of  evidence  to  the  contrary,  we  find  no
compelling  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 AFBCMR Docket Number  BC-2008-
00220 in Executive Session on 4 Dec 08, under  the  provisions  of  AFI  36-
2603:

                 Mr. Thomas S. Markiewicz, Chair
                 Mr. Mark J. Novitski, Member
                 Ms. Michelle M. Rachie, Member

The following documentary evidence was considered under  Docket  Number  BC-
2008-00220:

    Exhibit A.  DD Form 149, dated 3 Jan 08, w/atchs.
    Exhibit B.  Letter, BCMR Medical Consultant, dated 11 Jun 08.
    Exhibit C.  Letter, SAF/MRBR, dated 13 Jun 08.
    Exhibit D.  Letter, Disabled American Veterans.
       dated 23 Jun 08, w/atchs.





                                   THOMAS S. MARKIEWICZ
                                   Chair