RECORD OF PROCEEDINGS
         AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:	DOCKET NUMBER:  BC-2013-05416
		COUNSEL:  NONE
		HEARING DESIRED: NO



APPLICANT REQUESTS THAT:

His record be corrected to reflect that he was medically retired 
through a Medical Evaluation Board (MEB).  


APPLICANT CONTENDS THAT:

He received injuries while serving in Afghanistan to his back 
and neck.  He should have met a MEB and retired as a result of 
his injuries.

His Primary Care Manager (PCM) would not order a Magnetic 
Resonance Imaging (MRI) until two other medical physicians 
determined that the problem was with his back and neck.

He has shooting pain in his left leg and back each time he takes 
a step which causes him to limp in pain.

He was placed on a permanent medical profile by an Army 
physician.  

He requested a MEB; however, his PCM dragged his feet.  
Consequently, on 31 May 13, he was separated under the Date of 
Separation (DOS) Rollback Program.

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


STATEMENT OF FACTS:

On 31 May 13, the applicant was honorably discharged with a 
reason for separation of non-retention on active duty under the 
DOS Rollback program.  He was credited with 10 years, 5 months, 
and 28 days of active duty service.


AIR FORCE EVALUATION:

The BCMR Medical Consultant recommends approval.  A review of 
the applicant’s medical records indicates, as early as Feb 09, 
he experienced difficulties with his lower back, sleeping 
difficulties and was “starting to have dreams of this deployment 
with multiple scenes involving fire fights.”  He was given a 
diagnosis of Post-Traumatic Stress Disorder (PTSD), which was 
subsequently changed to Adjustment Disorder with Anxiety, on 
12 Mar 09 and remained the primary diagnosis through 5 May 09.  

Aside from the applicant’s medical clearance for another 
apparent deployment in Jan 11, his service treatment 
documentation is indicative of an acceleration of episodes of 
care during Calendar Year 2012 (CY12), which continued until his 
release from military service in May 13.  The level of detail 
and frequency of the episodes of care are presented to 
illustrate the scope and variable severity of the applicant’s 
medical conditions, which, at some point, appeared to warrant 
consideration for MEB processing.  However, according to the 
applicant, upon review of his case by a Deployment Availability 
Working Group (DAWG), no further MEB processing was recommended.  
The applicant alleges this was the result of “foot dragging” on 
the part of his PCM, who reportedly apologized to him for being 
a “bad physician.”

The applicant clearly experienced chronic recurring pain 
involving the neck and lower back since 2011, with subsequent 
reported worsening following physical therapy in 2012.  His 
condition failed to achieve a durable resolution throughout 
CY12 such that his referral physician recommended placing him on 
a permanent profile and subsequent referral for MEB/PEB 
processing.  The Medical Consultant does not have access to the 
rationale of the DAWG to forego conducting an official MEB.  
However, the applicant's changing dates of separation [a 
foreshortened separation date] and the time and effort required 
to reestablish profile restrictions utilizing Air Force 
paperwork, although already permanently established at the 
referring US Army medical center, may have influenced this 
decision.  

Individuals may be retained on active duty with profile 
restrictions under an Assignment Limitation Code.  However, the 
applicant was assigned "menial tasks, while awaiting his 
discharge," the applicant was unable to reasonably perform the 
duties of his office, grade, rank, and rating.  A more 
appropriate action would have been to place the applicant on a 
medical hold for proper processing through the Disability 
Evaluation System (DES) which would likely have occurred, but 
not for his projected "roll-back" from military service.  This 
recommendation is not intended to usurp the authority of the 
DAWG or to invalidate its decision, but to put on the table the 
likely reasons a complete MEB was not conducted, which would 
have required narrative summaries from the applicant's 
psychiatrist, his pain management physicians, and likely an 
orthopedic surgeon or neurologist, with too little time left for 
completing the effort.  In the case under review, the applicant 
had already achieved maximum medical benefit with the multiple 
failed treatment modalities he had received for his chronic 
medical conditions and for which he would not have been expected 
to return to unrestricted duty.

Based upon the preponderance of evidence, had an MEB been 
conducted and referral was made for PEB review, the applicant's 
cervicalgia and his chronic low back pain and associated left 
lower extremity radiculopathy would have, more likely than not, 
been found unfitting, noting their distinctly separate 
etiologies, as opposed to falling under a unifying diagnosis 
such as fibromyalgia or generalized myofascial pain syndrome.  
Under the Integrated DES, the PEB would have applied the ratings 
assigned by the DVA only to the unfitting conditions; that is 
20 percent for cervical spine, 10 percent for low back 
condition, and 10 percent for lumbar radiculopathy, left leg; 
resulting in a combined disability rating of 40 percent.

Although diagnosed with PTSD, the evidence was insufficient to 
demonstrate that this condition, at or about the time of the 
applicant's release from service, would have been found 
individually unfitting as noted by the "S1" [worldwide 
qualified] designation on the same profile document utilized to 
depict his physical impairments, e.g., "L3" profile 
restrictions.  It should also be noted that a large contribution 
of the applicant's emotional distress appears to have been 
related to his post-service occupational concerns and ability to 
provide for his family due to his physical impairments.  

Unlike the Military Department, which operates under Title 10, 
United States Code (U.S.C.), the Department of Veterans Affairs 
is authorized, under Title 38, U.S.C., to offer compensation for 
any medical condition determined service incurred, without 
regard to its impact upon an individual's retainability, fitness 
to serve, or narrative reason for release from military service.

Recommend the record be changed to reflect that he underwent a 
MEB and was found unfit by the Physical Evaluation Board 
(PEB), with the assignment of a combined disability rating of 
40 percent and permanent retirement, effective 31 May 13.

The complete BCMR Medical Consultant evaluation is at Exhibit C.


APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

Through his Member of Congress, the applicant acknowledged 
receipt of the advisory opinion (Exhibit E).



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 error or injustice warranting 
corrective action.  Having carefully reviewed this application, 
we agree with the recommendation of the BCMR Medical Consultant 
and adopt the rationale expressed as the basis for our decision 
that the applicant has been the victim of either an error or an 
injustice.  Therefore, we recommend the applicant’s record be 
corrected as 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 30 May 13, he was found unfit to perform the duties 
of his office, rank, grade, or rating by reason of physical 
disability, incurred while he was entitled to receive basic pay; 
the diagnosis in his case was degenerative disc disease, 
cervical spine, rated at 20 percent under hyphenated VASRD code 
5010-5237; low back pain [low back condition], rated at 
10 percent under VASRD code 5242; left lower extremity 
radiculopathy [lumbar radiculopathy], rated at 10 percent under 
VASRD code 8520, with a combined disability rating of 
40 percent; the degree of impairment was permanent; the 
disability was not due to intentional misconduct or willful 
neglect; 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 31 May 13, he was honorably discharged from active 
duty and on 1 Jun 13, his name was placed on the Permanent 
Disability Retired List (PDRL).

	c.  His election of the Survivor Benefit Plan option will 
be corrected in accordance with his expressed preferences and/or 
as otherwise provided for by law or the Code of Federal 
Regulations.


The following members of the Board considered AFBCMR Docket 
Number BC-2013-05416 in Executive Session on 18 Sep 14, 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 11 Oct 13, w/atchs.
    Exhibit B.  Excerpts from the Applicant’s Military Records.
    Exhibit C.  Letter, BCMR Medical Consultant, dated 6 Jun 14.
    Exhibit D.  Letter, SAF/MRBR, dated 28 Jun 14.
    Exhibit E.  Electronic Mail, Congressman, dated 18 Aug 14.