RECORD OF PROCEEDINGS
             AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:      DOCKET NUMBER: BC-2010-00545

            COUNSEL: NONE

            HEARING DESIRED:  YES

_________________________________________________________________

APPLICANT REQUESTS THAT:

The 40 percent disability retirement rating she received be increased.

_________________________________________________________________

APPLICANT CONTENDS THAT:

She was poorly advised  by  her  lawyer  when  she  accepted  the  permanent
retirement with a 40 percent disability rating.  She feels she  should  have
been retired with a higher disability rating than 40 percent.

She further contends that the following medical conditions should have  been
considered during the disability processing:

- Chronic pain syndrome.

- Neuropathy, radiculopathy, and a pinched nerve behind her knee.

- Migraines headaches with nausea and photobia.

- Ovarian cysts.

She also has taken issue with the appropriateness of a  surgical  procedure,
contending that her glutei muscles should not have been wrapped  around  her
sacrum, resulting her being unable to sit  or  stand  for  periods  of  time
without fatigue or pain in the gluteal area.

In support of her application, the applicant  provides  documents  extracted
from her military personnel and medical records.

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

_________________________________________________________________

STATEMENT OF FACTS:

On 21 Jul 98, the applicant contracted her  enlistment  in  the  Air  Force.
She was progressively promoted to the grade of captain  having  assumed  the
grade effective and with a date of rank of 21 Jun 02.

In 2003, the applicant underwent elective  surgery  for  sacral  prominence.
On 27 Jul 05, she underwent a Medical Evaluation Board (MEB) for  a  history
of coccygeal pain, sacroplasty and a coccygectomy.   The  MEB  referred  her
case to the Informal Physical Evaluation Board (IPEB).  On 15  Aug  05,  the
IPEB found her unfit and recommended discharge with severance pay with a  10
percent disability rating.  The IPEB also determined her  condition  existed
prior  to  service  and  was  aggravated  through  military  service.    She
nonconcurred with the IPEB and requested an appeal with the Formal  Physical
Evaluation Board (FPEB).  The FPEB, on  27 Sep 05,  reviewed  the  case  and
recommended placement on the Temporary Disability Retired List  (TDRL)  with
a 40 percent disability rating.  The applicant concurred with  the  findings
of the FPEB.  On 15 Nov 05, the applicant was placed on the TDRL with  a  40
percent disability rating.  The applicant underwent a TDRL re-evaluation  on
1 May 06 by the IPEB.  The IPEB determined  the  applicant’s  condition  had
stabilized and found her fit and recommended removal from the  TDRL.   On  2
May 06, the applicant concurred with the findings  of  the  IPEB.   The  MEB
narrative summary dated 28 Jun 07 addressed the applicant’s coccygeal  pain.
 Her treatment history reflected her pain was not controlled  after  several
trials of multiple injections, neurolytic blocks,  radiofrequency  ablation,
neurontin, oxycodone and celebrex.  The applicant underwent a repeat MEB  on
11 Jul 07 for coccydynia and chronic pain syndrome.  The  MEB  referred  her
case to the IPEB.  On 14 Aug 07, the IPEB  found  the  applicant  unfit  and
recommended separation with severance  pay  with  a  10  percent  disability
rating.  On 20 Aug 07, the applicant nonconcurred with the findings  of  the
IPEB and requested a hearing before the FPEB.  The FPEB on 2 Oct  07,  found
the applicant unfit and recommended permanent retirement with a  40  percent
disability rating.  The applicant concurred with the finding of the FPEB  on
3 Oct 07.  The applicant  was  permanently  disability  retired  with  a  40
percent disability rating on 12 Oct 07.

_________________________________________________________________

AIR FORCE EVALUATION:

The AFBCMR Medical Consultant recommends the record be  changed  to  reflect
the applicant was permanently retired with a combined disability  rating  of
50 percent, effective her existing retirement date of  record.   He  further
recommends changing  the  record  to  reflect  she  received  a  40  percent
disability rating for "chronic pain syndrome due to coccydynia,  status-post
coccygectomy  and  sacroplasty,"  but  that  her  10  percent   rating   for
coccygectomy and 10 percent rating for Migraine Headaches remain  unchanged.
When the aforementioned  disability  ratings  are  combined  at  50  percent
disability rating is achieved. Should the
Board find the applicant should receive a 30 percent disability  rating  for
her migraine headaches; a combined rating of 60 percent  is  achieved.   She
contends that she was poorly advised by her  appointed  legal  counsel  when
she accepted the permanent retirement with a 40 percent  disability  rating.
She  also  contends  that  she  "should  be  compensated  for  chronic  pain
syndrome," noting that it is documented by several doctors in  her  military
service records.  She was diagnosed with neuropathy and radiculopathy.   She
also suffered from a pinched nerve behind her knee which required  emergency
treatment.  She also has taken issue with the appropriateness of a  surgical
procedure, contending that her glutei muscles should not have been  "wrapped
around her sacrum."  As a result she is unable  to  support  her  core  body
with standing (or sitting) for periods of time without fatigue  or  pain  in
the gluteal area.  She experiences migraine  headaches  3  to  5  times  per
month with nausea and photophobia.  She also has ovarian cysts,  which  have
caused pain to reach a level as high as 9.  She experiences a recurrence  of
the cysts on a monthly basis, which were treated with birth  control  pills,
but this regimen triggered her migraine headaches.   The  applicant  elected
not to pursue a surgical option, due to her youthful  reproductive  age  and
early onset of menopause.  She feels she should have  been  retired  with  a
higher disability rating  than  40  percent.   Addressing  the  quality  and
appropriateness of the surgical procedure carried out  by  a  Navy  surgeon,
the Medical Consultant advises the AFBCMR is  not  the  venue  to  challenge
whether the standard of care was met or violated in this  case  and  directs
the applicant to the Navy Surgeon General Bureau of  Medicine  (BUMED),  the
Office of the Navy Inspector General, or the medical facility  commander  to
address the issue of care quality.  The applicant has experienced  what  can
be characterized as intractable pain, on sitting or standing, for  which  no
durable relief or resolution has been achieved; despite a  full  regimen  of
measures undertaken.  While the FPEB preferentially rated this condition  as
"moderate," the Medical Consultant opines the intractable  and  debilitating
nature of her condition warrants consideration for re-characterizing  it  as
"moderately severe", resulting in a change  of  disability  rating  from  20
percent to 40 percent.  The Medical Consultant  also  acknowledges,  as  did
the FPEB, the applicant's degenerative disc  disease  and  disc  protrusions
noted on MRI scans  of  2005  and  2008.   However,  there  is  insufficient
evidence these findings represented or were the cause  for  a  corresponding
duty-limiting functional impairment that contributed to  cutting  short  the
applicant's  military  career.   The  Medical  Consultant  acknowledges  the
electrodiagnostic testing performed at Tri-City Neurology Associates,  which
reportedly  revealed  a  peroneal  nerve  neuropathy;  however,   there   is
insufficient evidence this contributed  to  or  cut  short  the  applicant's
career.  There is little attention (and no  profile  restrictions)  directed
toward any lower extremity impairment during the applicant's final  term  of
service. In addressing the applicant's headaches, the criteria
currently established by  the  DVA  for  migraine  headaches  are  open  for
interpretation; noting that a 30 percent rating may be  applied  when  there
are "characteristic prostrating attacks  occurring  on  an  average  once  a
month over the last several months versus a 10  percent  rating  when  there
are "characteristic prostrating attacks averaging one in 2 months over  last
several months.  The known difficulty in adjudicating migraine headaches  is
distinguishing which headaches should be considered  prostrating  and  which
should not.  The applicant's record, in 2005, reflects  her  headaches  were
"controlled." Although  the  applicant  now  reports  that  she  experiences
headaches "3 to 5 times"  per  month,  there  is  insufficient  evidence  to
determine which, if any, should be characterized as  prostrating.  There  is
insufficient  evidence,  that  not  only  the  condition  was   individually
unfitting.  The only medical condition  which  appears  to  have  interfered
with the applicant's military service is her coccyx and  sacral  pain.   The
applicant  has  not  supplied  disability  rating  documentation  from   the
Department of Veterans Affairs, as this information would be considered  for
its  probative  value  in  determining  the  her  final  disability   rating
determination.

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

_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

In support of her appeal, the  applicant  has  provided  additional  medical
documentation.  The applicant’s sister provides a statement  in  support  of
the applicant’s request.

The complete additional medical documentation and sister’s statement  is  at
Exhibits E and F.

_________________________________________________________________

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 error or injustice. After a careful review of  the  evidence
of record, we are of the opinion a  change  in  the  applicant's  disability
rating is warranted.  While  the  applicant's  condition  has  progressively
worsened since her retirement, the critical issue before this Board  is  the
degree of disability at the time of her retirement.  The BCMR Medical
Consultant has thoroughly reviewed the evidence of record  and  provides  an
extensive evaluation  in  which  he  ultimately  recommends  increasing  the
applicant’s disability rating.  In view  of  this  and  since  the  evidence
before us  supports  assigning  a  30  percent  disability  rating  for  her
migraine headaches, we recommend her disability rating be  increased  to  60
percent.  In view  of  the  foregoing,  and  in  an  effort  to  offset  any
possibility of an injustice, we believe her records should be  corrected  to
the extent indicated below.

_________________________________________________________________

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 12 October 2007, she was found unfit to perform the  duties  of
her office, rank,  grade,  or  rating  by  reason  of  physical  disability,
incurred when she was entitled to received basic pay; that the diagnoses  in
her case were Chronic Pain  Syndrome,  VASRD  5315,  rated  at  20  percent;
Coccygectomy, VASRD 5298, rated at 10 percent; and  Migraines,  VASRD  8100,
rated at 30 percent; that the total combined comprehensible  percentage  was
60 percent;  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.  She was released from active duty on 14 Nov 07 and was permanently
retired by reason of physical  disability,  with  a  60 percent  compensable
disability rating, effective 15 Nov 07.

_________________________________________________________________

The following members of the Board considered AFBCMR Docket Number  BC-2010-
00545 in Executive Session on 10 Mar 11, under the  provisions  of  AFI  36-
2603:

       , Panel Chair
       , Member
       , Member

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

      Exhibit A. DD Form 149, dated 4 Feb 10, w/atchs.
      Exhibit B. Applicant's Military Personnel Records.
      Exhibit C. Letter, AFBCMR Medical Consultant, dated 19 Oct 10.
      Exhibit D. Letter, SAF/MRBR, dated 26 Oct 10.
      Exhibit E. Applicant, Additional Documentation, undated.
      Exhibit F. Letter, Character Reference, dated 3 Nov 10.





                             Panel Chair