RECORD OF PROCEEDINGS
         AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:	DOCKET NUMBER:  BC-2012-04338

		COUNSEL:  NONE

		HEARING DESIRED: NO

________________________________________________________________

APPLICANT REQUESTS THAT:

She be given a full military medical retirement back dated to 
her release from the Air Force on 2 December 2006.  

________________________________________________________________

APPLICANT CONTENDS THAT:

An injustice occurred with her military service, specifically 
with her medical evaluation board (MEB) status and lack of any 
results, ratings, or proper submittal of records before her 
release from active duty.  She was released from the Air Force 
without a final rating decision or MEB documentation even after 
she requested a review of her MEB status several months before 
being released.  The MEB paperwork was created for problems with 
her heart and lungs which should have resulted with the proper 
military retirement but no rating was ever given prior to her 
release.  She was not placed on the Temporary Disability Retired 
List (TDRL), nor was she provided any guidance on steps to take 
to complete the MEB process.  

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

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STATEMENT OF FACTS:

According to copies of documents submitted by the applicant, she 
is a former member of the Regular Air Force who enlisted on 
3 December 2002, and was released from active duty on 
2 December 2006, with an honorable characterization of service, 
a separation code of “MBK” and a narrative reason for separation 
of “Completion of Required Active Service.”  She was credited 
with 4 years of active duty service.  

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AIR FORCE EVALUATION:

1.  The AFBCMR Medical Consultant recommends denial of the 
applicant's petition to supplant her established reason for 
separation with a medical retirement.  The Medical Consultant 
states the applicant's medical case file strongly suggests she 
should have been placed on medical hold for either completion of 
a formal Medical Evaluation Board (MEB) or, as a minimum, 
receive a review in lieu of an MEB for either clearance of 
return to duty or referral to a Physical Evaluation Board.  It 
is otherwise not clear why the applicant's MEB was never 
conducted as this was the documented plan of action over the 
course of two years.  The Medical Consultant opines, that 
despite the characterization of the applicant's mitral valve 
prolapse and mitral insufficiency as “mild,” the fact that her 
alertness could be unpredictable, albeit for brief periods, 
should have prompted completion of the MEB, referral to a 
Physical Evaluation Board, and career termination.  

2.  Addressing the applicant's petition for a medical 
retirement, had she been found unfit by a Physical Evaluation 
Board, a disability rating would be applied utilizing the 
Veterans Administration Schedule for Rating Disabilities (VASRD) 
under the applicable rating code.  The Medical Consultant is of 
the opinion that the applicant would not have qualified for a 
medical retirement based upon a preponderance of medical 
evidence at or about the time of her release from military 
service because the VASRD code utilized for syncope of vasovagal 
or neurogenic origin would likely have been analogized under 
VASRD Code 8210-8299, and likely assigned a 10 percent 
disability rating, for incomplete, moderate impairment.  
Alternatively, if the applicant was rated under Valvular Heart 
Disease (including rheumatic heart disease), VASRD code 7000, 
the evidence does not reflect an impairment of cardiac valvular 
function that would reach the minimum threshold for a 30 percent 
disability rating due to her mild mitral valve prolapse and mild 
mitral insufficiency; which also does not reflect an impairment 
of heart muscle contractility, e.g., ejection fraction, nor a 
rhythm disturbance that restricted the applicant's workload to 
greater than 5 metabolic equivalents (METs), but not greater 
than 7 METs, and resulting in dyspnea, fatigue, angina, 
dizziness, or syncope.  

3.  Although the applicant "became tired" after 8 minutes of 
treadmill testing, the Consultant opines, this was not the 
result of her mild valvulopathy impairment and should not be 
considered in the disability rating decision.  Nevertheless, 
some might consider analogizing some causes of altered alertness 
under the neurological code for petit mal seizures, as in 
psychomotor or absence seizures.  However, the supplied evidence 
does not support rating the applicant's condition utilizing this 
neurological code.  Additionally, although there has been some 
discussion of asthma and a possible trial of treatment for the 
same, prior to entering military service, the supplied evidence 
fails to validate the existence of reversible airway hyper-
responsiveness disorder (asthma), exercise-induced or otherwise, 
which occurred or was permanently aggravated during the 
applicant's military service, interfered with her military 
service, or which has required ongoing treatment with a 
bronchodilator, a leukotriene antagonist, mast cell stabilizer, 
or corticosteroid for control or prevention.  

4.  Operating under Title 10, United States Code (U.S.C.), 
Military Departments, by law, only assign disability ratings for 
the condition(s) that cause career termination; and then only to 
the degree of severity present at the "snap-shot" in time of 
final military disposition and not based upon future 
occurrences.  On the other hand and operating under a different 
set of laws, (Title 38, U.S.C.), the DVA is authorized to 
conduct periodic evaluations for the purpose of adjusting 
(increase or decrease) the disability ratings, as the severity 
or level of impairment caused by a given medical condition may 
vary (worsen or improve) over the lifetime of the veteran.  
Moreover, the DVA also assigns compensation for any medical 
condition determined service-incurred, without regard to its 
demonstrated impact upon a service member's retainability, 
fitness to serve, or narrative reason for release from service.

5.  The BCMR Medical Consultant concludes the applicant should 
have received an MEB and that her mitral valve prolapse and mild 
mitral insufficiency should have been the cause for career 
termination; but that she would have been assigned a disability 
rating of no greater than 10 percent, resulting in discharge 
with severance pay.  Therefore, while the Medical Consultant 
does find error in the failure to conduct the applicant's MEB 
and referral to a Physical Evaluation Board, the evidence does 
not support the final outcome of a medical retirement.  

The complete AFBCMR Medical Consultant evaluation is at 
Exhibit C. 

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APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

A copy of the Air Force evaluation was forwarded to the 
applicant on 25 February 2013 for review and comment within 
30 days (Exhibit D). To date, a response has not been received.  

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THE BOARD CONCLUDES THAT:

1.  The applicant has exhausted all remedies provided by 
existing law or regulations.

2.  The application was not timely filed; however, it is in the 
interest of justice to excuse the failure to timely file.  

3.  Insufficient relevant evidence of an error or injustice has 
been presented regarding the applicant’s request to be granted a 
full medical retirement.  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 the rationale as the basis for our 
conclusion that the applicant would not have qualified for a 
medical retirement based upon a preponderance of medical 
evidence at or about the time of her release from military 
service.  Accordingly, the applicant’s request for a medical 
retirement is not favorably considered.  

4.  Notwithstanding our findings above, we believe sufficient 
evidence has been presented to warrant partial relief.  In this 
regard, we note the BCMR Medical Consultant concludes the 
applicant should have received an MEB and that her mitral valve 
prolapse and mild mitral insufficiency should have been the 
cause for career termination; but that she would have been 
assigned a disability rating of no greater than 10 percent in 
accordance with the Veterans Administration Schedule for Rating 
Disabilities (VASRD) guidelines, resulting in discharge with 
severance pay.  As such, we believe the applicant's medical 
condition may not have been rated properly at the time of her 
separation. Therefore, we accept the BCMR Medical Consultant's 
assessment and in the interest of equity and justice, recommend 
the applicant’s records 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 1 December 2006, 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 mitral valve 
prolapse and mild mitral insufficiency (valvular heart disease) 
VASRD code 7000, rated at 10%; that the compensable percentage 
was 10%; that the degree of impairment was incomplete, moderate; 
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 2 December 2006, she was separated by reason of 
physical disability, with entitlement to severance pay with a 
disability rating of 10 percent.   

________________________________________________________________

The following members of the Board considered this application 
in Executive Session on 18 June 2013, under the provisions of 
AFI 36-2603:
			, Panel Chair
      , Member
			, Member

The following documentary evidence was considered in AFBCMR 
Docket Number BC-2012-04338:

    Exhibit A.  DD Form 149, dated 17 September 2012, w/atchs.
    Exhibit B.  Applicant's Master Personnel Records.
    Exhibit C.  Letter, AFBCMR Medical Consultant, dated 
25 February 2013.
    Exhibit D.  Letter, SAF/MRBC, dated 25 February 2013.




                                   
                                   Panel Chair