RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS


IN THE MATTER OF: 			DOCKET NUMBER: BC-2014-01900

						COUNSEL:  NONE

						HEARING DESIRED:  NO 



APPLICANT REQUESTS THAT:

His voluntary retirement be changed to a medical retirement due 
medical illnesses and injuries that occurred while on active 
duty.  A medical board was not conducted prior to his voluntary 
retirement.  


APPLICANT CONTENDS THAT:

Prior to his retirement he was diagnosed and treated for 
“Chronic Post Traumatic Stress Disorder” after returning from a 
deployment to Iraq.  

In addition, he has other illnesses and injuries to include; 
depression, insomnia, dislocation of left knee, lumbago and 
degenerative and bulging disks in his lower back, and arthritis 
in both ankles.  

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


STATEMENT OF FACTS:

The applicant initially entered the Regular Air Force on 
22 Aug 89.

On 31 Oct 11, the applicant was retired from the Air Force, and 
was credited with 22 years, 2 months, and 9 days of active 
service.   

The remaining relevant facts pertaining to this application are 
contained in the memoranda prepared by the Air Force offices of 
primary responsibility (OPR), which are attached at Exhibits C 
and E.    





AIR FORCE EVALUATION:

AFBMCR Medical Consultant recommends denial indicating there is 
no evidence of an error or an injustice.  The applicant received 
evaluations and treatment for a number of acute injuries [some 
chronic] and illnesses during his military career.  Noteworthy 
is the applicant’s history of left knee pain, dating to CY 91, 
which presented as periodic dislocation of the patella; 
particularly when performing squats.  The applicant experienced 
acute exacerbations of knee pain in Mar 2003 and again in 
Jan, Feb, and Mar of 2011; the latter occurrence after 
performing a pivoting motion.  An MRI scan conducted back in 
Feb 2011 demonstrated “minor degenerative changes in posterior 
horn of medial meniscus, without definite tear.”  A small left 
knee joint effusion was also noted.  The applicant also 
experienced recurrent ankle sprains [92, 95, and Jun 2007; the 
latter for a suspected ankle fracture].  In each case, the 
applicant was issued short-term duty restrictions and was 
treated conservatively with physical therapy, rest, ice, 
elevation, crutches, a non-steroidal anti-inflammatories, and in 
the latter instance, Percocet for pain.   By 16 Aug 07, the 
applicants Jun 2007 ankle injury was better and he was fully 
functional.  

Additionally, the applicant received recurring treatment for 
chronic low back pain.  A Sep 2008 episode of care indicates 
that the applicant had experienced pain for the previous one 
year; but that he had also experienced recurrent back pain for 
“around eighteen years.”  An MRI scan was ordered in Oct 10, in 
preparation for an upcoming [“in two weeks”] PCS.   The 
applicant reported onset of back pain Sep 10 after moving 
furniture around.  The MRI demonstrated L4-L5 degenerative disc 
changes with bilateral moderate foraminal stenosis, more severe 
on the left, with mild L4-5 canal stenosis.  There was also L5-
S1 degenerative disc changes noted with moderate left foraminal 
stenosis.  He was placed on work restrictions from 25 Oct 10 to 
24 Nov 10.  He was instructed to follow-up with Physical Therapy 
at his gaining facility at Seymour-Johnson AFB upon PCS.
     
In regards to the applicant’s mental wellness, the record 
indicated he experienced an episode of Adjustment Disorder in 
Jan 2004.  He was also deployed twice; the last one to Iraq.  A 
Post-Deployment Questionnaire, dated 23 Dec 10, shows applicant 
characterized his overall health in the past month as “very 
good.”  When asked to compare/rate his current health with that 
before his most recent deployment, the applicant checked the 
response, “About the same as before I deployed.”  The applicant 
disclosed exposure to a blast or explosion and answered “yes” to 
the question asking if he was constantly on guard, watchful or 
easily startled.  The applicant responded “no” to the question 
asking if he had an experience so frightening, horrible, or 
upsetting that, in the past month he experienced nightmares, 
avoidance of thinking about it or avoidances of situations that 
remind him of it.  The provider assessment showed blackening of 
the circle indicating a “minor concern” regarding existence of 
PTSD symptoms.  The provider blackened the recommendation for 
mental health specialty care within seven days.  The applicant 
was seen in follow-up thereafter.   On 26 Jan 11, the evaluating 
provider assigned a “working diagnosis PTSD,” referred the 
applicant to mental health, but released him without 
limitations.  Among complaints, the applicant reported 
“sensitivity to loud noises since back from deployment in Iraq 
which was six months ago.

A 24 Feb 11, episode of care shows the applicant reported 
“sleeping issues” for the past three months, difficulty 
concentrating the last month, and a recent gastrointestinal 
disturbance that had resolved.  Among stressors, he disclosed 
that his wife had filed for divorce, that his nephew recently 
passed away, and the depression had “hit him in Jan after his 
kids left.”  The provider acknowledged the applicant’s insomnia; 
joint pain localized to knee, and assigned a diagnosis of 
Adjustment Disorder.  The entry shows that the applicant was 
“released without limitations.

6 Apr 11, the applicant restated his experiences to include a 
divorce from his second wife of thirteen years [finalized 
Jul 10], the sudden death of nephew in 2010, and his “PCS from 
Arkansas to North Carolina in Nov 2010.”  The applicant denied 
experiencing any one traumatic event or combat, but “felt 
constant stress related to his job due to not being unable to 
trust the Iraqi nationalist that he had to work very closely.  
He was given a diagnosis of Major Depression, recurrent, 
moderate.  In smaller print for the same episode of care appears 
the diagnosis “MDD, single episode, moderate; Anxiety Disorder, 
NOS [not otherwise specified].  The applicant was prescribed 
Zoloft 50 mg [starting at 25 mg], with titration of dosage to 
100 mg daily.  He was, again, released without limitations.
     
At follow-up on 7 Sep 11, the applicant disclosed fearing for 
his life and feeling helpless after being shot at from the 
ground while in a military helicopter.  The provider also noted 
the applicant’s report of “recurrent intrusive distressing 
recollections of the event with frequent thoughts and images as 
well as nightmares.”  Other symptoms included difficulty 
concentrating, an exaggerated startle response, hypervigilance, 
and avoiding thoughts, feelings, and conversations about the 
event.   The provider noted the applicant was “interested in 
PTSD treatment at this time.”  He concluded: “Not WWQ [worldwide 
qualified] from a mental health perspective.”  

At the point the applicant was granted the approved retirement 
date, he would have been presumed fit even if a Medical 
Evaluation Board (MEB) narrative summary was completed within 
the 12-month window of the approved retirement date.  
Specifically, under DoDI 1332.38, Physical Disability 
Evaluation, Enclosure 3, Paragraph E3.P3.5 and subparagraph 
E3.P3.5.2, in effect at the time of the applicant’s service 
addresses the presumptive period as, "Service members shall be 
considered to be pending retirement when the dictation of the 
member's MEB occurs after any of the circumstances designated in 
paragraph E3.P3.5.2.1 through E3.P3.45.2.4, which respectively 
read: (1) "When a member's request for voluntary retirement has 
been approved, revocation of voluntary retirement orders for 
purposes of referral into the Disability Evaluation System (DES) 
does not negate application of the presumption. (2) An officer 
has been approved for Selective Early Retirement (3) An officer 
is within twelve months of mandatory retirement due to age or 
length of service, and (4) An enlisted member is within twelve 
months of his or her retention control point (RCP) or expiration 
of active obligated service (EAOS), but will be eligible for 
retirement at his or her RCPIEAOS.  The presumption of fitness 
can be overcome, however, if one of the following applies: (1) 
Within the presumptive period an acute, grave illness or injury 
occurs that would prevent the member from performing further 
duty if he or she were not retiring, (2) Within the presumptive 
period a serious deterioration of a previously diagnosed 
condition, to include a chronic condition, occurs and the 
deterioration would preclude further duty if the member were not 
retiring, or (3) The condition for which the member is referred 
is a chronic condition and a preponderance of evidence 
establishes that the member was not performing duties befitting 
his or experience in the office, grade, rank, or rating before 
entering the presumptive period.  When there has been no serious 
deterioration within the presumptive period, the ability to 
perform duty in the future shall not be a consideration."

In regards to the applicant’s expressed desire for a medical 
retirement, the DES, established to maintain a fit and vital 
fighting force, can by law, under Title 10, United States Code 
(U.S.C.), only offers compensation for those service incurred 
diseases or injuries which specifically rendered a member unfit 
for continued active service and were the cause for career 
termination; and then only for the degree of impairment present 
at the time of separation and not based on post-service 
progression of illness or injury.  Department of Defense 
Instruction 1332.32, Physical Disability Evaluation, Enclosure 
3, Part 3, Standards For Determining Unfitness Due To Physical 
Disability Or Medical Disqualification, paragraph E3.P3.2.1, 
reads:” A Service member shall be considered unfit when the 
evidence establishes that the member, due to physical 
disability, is unable to reasonably perform the duties of his or 
her office, grade, rank, or rating (hereafter called duties) to 
include duties during a remaining period of Reserve obligation.”

The applicant is likely to be eligible for disability 
compensation for several medical conditions found service-
connected through the Department of Veterans Affairs (DVA).  
However, EXCEPT for the September 2011 entry, no service 
evidence is supplied that indicated that the applicant was 
restricted in performance of his duties of a sufficient level, 
e.g., “S4T” profile restrictions for a mental impairment or 
“L4T” for a lower extremity or spine ailment, and cumulative 
duration, e.g., 12 or more months [or sooner if not expected to 
return to normal functioning] that warranted MEB and Physical 
Evaluation Board processing.  

The Department of Defense (DoD) and the DVA operate under 
separate laws.  The DVA is authorized to offer compensation for 
any medical condition determined service incurred, without 
regard to [and independent of] its demonstrated or proven impact 
upon a service member’s fitness for continued service or 
narrative reason for release from military service.  With this 
in mind, Title 38, U.S.C., which governs the DVA compensation 
system, was written to allow awarding compensation ratings for 
all conditions with a nexus with military service; even those 
with no demonstrable functional impairment at the time of 
assessment.  This is the reason why an individual can be 
released from active military service for one reason and yet 
sometime thereafter receive compensation ratings from the DVA 
for conditions found service-connected, but which was not proven 
militarily unfitting during the period of service or the cause 
for career termination.  The DVA is also empowered to conduct 
periodic re-evaluations for the purpose of adjusting the 
disability rating awards (increase or decrease) as the level of 
impairment from a given service connected medical condition may 
vary (improve or worsen, affecting future employability) over 
the lifetime of the veteran.  

A complete copy of the AFBMCR Medical Consultant evaluation is 
at Exhibit C.

AFBMCR Clinical Psychology Consultant recommends denial 
indicating there is no evidence of an error or an injustice.  On 
26 Jan 11, applicant was evaluated in primary care and completed 
a PTSD screening form.  He was diagnosed with PTSD as a “working 
diagnosis only” and referred to mental health for further 
evaluation.  On 14 Feb 11, the applicant completed intake with a 
mental health social worker.  He was noted to be experiencing 
stress from returning from deployment in Jul 2010, a recent 
divorce, changes in leadership, mild financial issues, poor 
sleep, problems with children, and anxiety symptoms.  His 
diagnosis was deferred.  At follow up he was diagnosed with 
anxiety disorder not otherwise specified, insomnia, and 
adjustment disorder with depressed mood.  On 2 Mar 11, the 
applicant’s diagnosis was changed to recurrent major depression 
and anxiety disorder not otherwise specified.  He was listed as 
worldwide qualified (WWQ) and deployable.  These diagnoses and 
WWQ status were maintained over the next two sessions.  On 
6 Apr 11, he was evaluated by a psychiatrist.  His diagnosis was 
noted to be a single episode of moderate major depression with 
anxiety disorder not otherwise specified.  He was listed as not 
WWQ or deployable.  At follow up with the social worker 26 Apr 
11, his recurrent major depression diagnosis was retained.  On 
29 Apr 11, telephone contact between the applicant and his 
social worker stated, “This provider spoke to patient and 
advised that this provider can write a letter with the facts and 
will be unable to make recommendation for medical justification 
for retirement.  [Patient] verbalized understanding and agreed 
to this letter.”  He did not show for his next scheduled 
appointment because he was “stuck in a meeting.”  He was noted 
to be on leave and attending the Transition Assistance Program 
over the next few weeks.  At follow up with his psychiatrist on 
23 May 11, he reported he was pursuing permission to retire a 
year before completing the commitment he had incurred as the 
result of a permanent change of station.  Psychiatrist noted 
concern that the applicant was using mental health as a means of 
obtaining this permission and noted inconsistency in self-report 
of symptom severity between same-day appointments with the 
psychiatrist and social worker.  The social worker documented 
same concerns about the incongruity of the applicant’s symptom 
report between providers and after initially considering a 
diagnosis of PTSD she determined further evaluation was 
warranted.  The applicant had reported vicarious trauma from 
hearing an Iraqi soldier’s story of family-related traumatic 
events and memories of hearing this story were triggered by 
seeing “Middle Eastern” people on a plane and at his daughter’s 
graduation.  He was transferred to a new social worker and 
started therapy with her 24 Jun 11.  He was not WWQ.  

On 29 Jun 11, the applicant was seen in primary care for his 
retirement physical.  The primary care provider diagnosed PTSD 
and noted mental health had “changed” his diagnosis, although it 
is unclear why the primary care provider assumed there was a 
change.  The primary care provider’s note does not contain a 
rationale for diagnosing PTSD.  On 12 Jul 11, he was listed as 
WWQ and deployable by his psychiatrist.  His depression and 
anxiety diagnoses were maintained.  His next follow up was 
16 Aug 11.  At that time he reported being drugged and abducted 
the previous weekend and was in distress as a result.  He was 
listed as not WWQ.  He was hospitalized for three days due to 
expressing suicidal ideation during an interview with the Office 
of Special Investigations when inconsistencies in his retelling 
of abduction events were identified.  The applicant was cited as 
believing his alleged abduction had occurred but was unable to 
remember what happened.  By 23 Aug 11, he was reported to be 
very worried about his impending retirement and the transition 
to civilian life.  On 31 Aug 11, the applicant reported to his 
therapist that he had failed to report a previous traumatic 
event in which he allegedly took fire from the enemy while 
riding in a helicopter.  He reported the men he was riding with 
shot back and women and children were being shot at.  He cited 
fear about what it would do to his career as the reason for not 
reporting it earlier.  The therapist noted the applicant had 
recently been notified about the Wounded Warrior Program and 
that he would qualify for services if he was diagnosed with 
PTSD.  The social worker added a diagnosis of PTSD 7 Sep 11 
based on the applicant’s report of symptoms while also noting 
the account was unverified.  The applicant went on terminal 
leave for retirement and did not follow up for treatment.  

IAW DoDI 1332.38 (in effect at the time of the applicant’s 
discharge) in order for the applicant to have been entered into 
the disability evaluation system (DES) he must have met criteria 
for such a referral as listed in Enclosure 3 Part 2 of the 
regulation.  Specifically in this case, he must have suffered 
from a medical condition that was eligible at that time for 
referral and received optimal medical treatment benefits, or he 
must have been expected to be unable to return to full military 
duty within one year of diagnosis of his medical condition.  The 
applicant was profiled following initiation of psychotropic 
medication by his psychiatrist in Apr 2011 and the profile was 
lifted by the psychiatrist after he demonstrated 90 days of 
stability In accordance with (IAW) AFI 44-172.  Throughout his 
mental health record in 2011 it was noted that he did not 
require a medical evaluation board and the applicant has not 
supplied evidence to suggest his medical providers believed he 
was too impaired to perform military duty.  Diagnostic 
variability may occur in situations in which there are multiple 
medical providers administering care to a patient.  In this 
case, the social worker and the psychiatrist differed regarding 
whether the applicant’s major depressive disorder was recurrent 
(i.e., had experienced more than one episode in his lifetime) 
versus a single episode.  This diagnostic variability does 
create significant doubt that he was fit for military service 
when he retired as none of his medical providers deemed him 
appropriate for DES processing.  Thus, a diagnosis alone would 
not trigger DES processing in this case and a medical evaluation 
board is not simply “offered” to a Service member in lieu of 
years of service retirement.  

The Military Department operates under Title 10, United States 
Code (U.S.C.), and must base its actions upon evidence available 
at the “snap shot” in time of final military disposition.  The 
medical records reviewed for this case, which documented the 
applicant’s functioning during military service and at the time 
of discharge, do not support the presence of a mental health 
condition meeting criteria for initiating DES processing as 
listed in DoD Instruction 1332.38.  Even if the DVA rates the 
applicant for his various medical conditions this is no cause 
for a presumption that he was unfit at the time of his years of 
service retirement.  The DVA operates under a different set of 
laws (Title 38, U.S.C.), with a different purpose, and is 
authorized to offer service connection and compensation for any 
medical condition for which it has established a nexus with 
military service regardless of the narrative reason for 
separation or the length of time transpired since discharge.  
Therefore, post-service VA ratings would not equate to a 
Military Department conclusion that a Service member is no 
longer fit for continued military service.

A complete copy of the AFBMCR Clinical Psychology Consultant 
evaluation is at Exhibit E.



APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

Copies of the Air Force evaluations were forwarded to the 
applicant on 27 Jan 15 and 30 Jun 15, for review and comment 
within 30 days (Exhibits D and F).  As of this date, no response 
has been received by this office.


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 an error or injustice.  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 AFBMCR Medical and Clinical Psychology 
Consultants and adopt their rationale as the basis for our 
conclusion the applicant has not been the victim of an error of 
injustice.  Therefore, in the absence of evidence to the 
contrary, we find no basis to recommend granting the requested 
relief.


THE BOARD DETERMINES THAT:

The applicant be notified the evidence presented did not 
demonstrate the existence of material error or injustice; the 
application was denied without a personal appearance; and 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-2014-01900 in Executive Session on 11 Aug 15, under 
the provisions of AFI 36-2603:




The following documentary evidence pertaining to AFBCMR Docket 
Number BC-2014-01900 was considered:

	Exhibit A.  DD Form 149, dated 1 May 14, w/atchs.
	Exhibit B.  Applicant's Master Personnel Records.
	Exhibit C.  Memorandum, AFBMCR MED CONSLT, dated 22 Dec 14.
	Exhibit D.  Letter, SAF/MRBR, dated 27 Jan 15.
	Exhibit E.  Memorandum, AFBCMR, CLINICAL PSYCHOLOGY CONSLT,   
                    dated 15 Jun 15.
	Exhibit F.  Letter, SAF/MRBR, dated 30 Jun 15.