RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:	DOCKET NUMBER:  BC-2014-00978
		COUNSEL:  NONE
		HEARING DESIRED:  NO


APPLICANT REQUESTS THAT:

Her narrative reason for separation of Disability, Existed 
Prior to Service (EPTS), Physical Evaluation Board (PEB) be 
changed to a service connected disability.


APPLICANT CONTENDS THAT:

Her pre-entry physical indicates that she had no knee issues but 
her Medical Evaluation Board (MEB) and outpatient physical states 
her injury occurred in the Line of Duty (LOD).

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


STATEMENT OF FACTS:

According to the applicant’s DD Form 214, Certificate of Release 
or Discharge from Active Duty, on 5 Feb 02, she entered the 
Regular Air Force.

On 9 May 03, a MEB diagnosed the applicant with bilateral knee 
pain that was found in the LOD and recommended referral to an 
Informal Physical Evaluation Board (IPEB).

On 15 May 03, an IPEB found the applicant unfit and recommended 
she be discharged under provisions other than 10 USC 61.  The 
IPEB indicated the applicant’s condition EPTS, had not been 
permanently aggravated through military service, and is 
incompatible with the rigors of military service.

On 20 May 03, the applicant agreed with the findings and 
recommendation of the IPEB and waived her right to a Formal PEB 
(FPEB).

On 21 May 03, the Secretary of the Air Force directed the 
applicant be separated from active service for physical 
disability due to a condition that EPTS under the provisions of 
10 USC 61.

On 2 Aug 03, the applicant was honorably discharged with a 
narrative reason for separation of “Disability, Existed Prior to 
Service, PEB.”  She was credited with 1 year, 6 months, and 
27 days of total active service.

On 26 Mar 14, the Department of Veterans Affairs evaluated the 
applicant’s diagnosis of patellofemoral syndrome of the right and 
left knees and determined them to be service connected.  The DVA 
assigned a 20 percent combined disability rating, effective 16 
Aug 13.


AIR FORCE EVALUATION:

AFPC/DPFD recommends denial indicating the preponderance of 
evidence reflects no error or injustice occurred during the 
disability process.  The IPEB found the applicant unfit and 
recommended discharge noting the applicant’s medical condition, 
EPTS and had not been permanently aggravated through military 
service, is incompatible with the rigors of military service.  
The board also noted the applicant had knee pains within weeks of 
entering active duty, despite no specific injury/trauma which 
indicates natural progression of a pre-existing 
condition/weakness.  The board opined that the 180 day rule 
(DODI) 1332.38, E3.P4.5.4.1) applied.  The board also noted that 
the applicant did not use her two appeal rights through the FPEB 
and the Secretary of the Air Force Personnel Council.

The complete DPFD evaluation is at Exhibit C.

The BCMR Medical Consultant recommends approval indicating that 
under today’s standard of clear and unmistakable evidence, there 
remains a reasonable uncertainty in the applicant’s favor.

The applicant remained symptomatic one year following the onset 
of pain.  The anatomic relationship between the applicant’s 
femur, patella, quadriceps tendon, and patellar tendons 
[bilaterally], which predated her entry to military service, 
predisposed her to developing the clinical condition referred to 
as patellofemoral syndrome with her increased activity in Basic 
Military Training (BMT) and technical school training.  In Jun 
02, she had a normal Magnetic Resonance Imaging (MRI) scan of the 
knees and in Apr 03, a bone scan failed to show evidence of worn 
or torn cartilaginous or bone structures, but showed a preserved 
joint space, suggesting that no detectable permanent anatomic 
damage or new defect was present at either point in time.

Although it was over a decade after the applicant’s discharge, 
the DVA concluded that her condition is considered permanent 
service aggravation.  This conclusion was reached at a time the 
applicant was also apparently asymptomatic at the Mar 
13 Compensation and Pension examination.

The presumption that a disease is incurred or aggravated in the 
line of duty may only be overcome by competent medical evidence 
establishing by a preponderance of evidence that the disease was 
clearly neither incurred nor aggravated while serving on active 
duty or authorized training.

Due to the significant passage of time and the likelihood that 
the applicant’s medical condition may have worsened over the ten 
years since her discharge, a definitive conclusion cannot be made 
that at the time of discharge, her knee ailment had already been 
permanently worsened.  However, with the absence of symptoms or a 
history of the disorder prior to entering the military service, 
the preponderance of evidence policy rests in the applicant’s 
favor.

The complete BCMR Medical Consultant evaluation is at Exhibit D.


APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

Copies of the Air Force evaluations were forwarded to the 
applicant on 27 Oct 14 for review and comment within 30 days.  As 
of this date, no response has been received by this office 
(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 an error or injustice warranting 
relief.  We note the Air Force office of primary responsibility 
recommends denial stating that the preponderance of evidence 
reflects no error or injustice in the disability process. 
However, after carefully reviewing this application, we agree 
with the opinion and 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 
records be corrected as set forth below.


THE BOARD RECOMMENDS THAT:

The pertinent military records of the Department of the Air 
Force relating to the APPLICANT, be corrected to reflect that 
she was found unfit to perform the duties of her office, rank, 
grade, or rating by reason of physical disability for her 
diagnosis of bilateral patellofemoral syndrome, that the 
condition was permanently aggravated through military service, 
that the condition was rated 20 percent under VASRD code 5003-
5299, and that she was discharged with entitlement to severance 
pay, effective 2 Aug 03.


The following members of the Board considered AFBCMR Docket 
Number BC-2014-00978 in Executive Session on 14 Jan 15, 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 Mar 14, w/atchs.
	Exhibit B.  Applicant's Available Master Personnel Records.
	Exhibit C.  Letter, AFPC/DPFD, dated 9 Apr 14.
	Exhibit D.  Letter, BCMR Medical Advisor, 6 Oct 14, w/atch.
      Exhibit E.  Letter, SAF/MRBR, dated 27 Oct 14.
						 
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