RECORD OF PROCEEDINGS


	IN THE CASE OF:	  


	BOARD DATE:	  27 February 2007
	DOCKET NUMBER:  AR20060011003 


	I certify that hereinafter is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in the case of the above-named individual.  


Mr. Gerard W. Schwartz

Acting Director

Mr. G. E. Vandenberg

Analyst


The following members, a quorum, were present:


Mr. Ted S. Kanamine 

Chairperson

Mr. Larry C. Bergquist

Member

Ms. LaVerne M. Douglas

Member

	The Board considered the following evidence: 

	Exhibit A - Application for correction of military records.

	Exhibit B - Military Personnel Records (including advisory opinion, if any).


THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE:

1.  The applicant requests that the findings of her Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) be amended to include the diagnosis of Upper Airway Resistance Syndrome (UARS) (sleep apnea).

2.  The applicant states, in effect, that due to errors in getting a referral processed and diagnostic testing completed the condition of UARS or sleep apnea was not diagnosed until after her discharge.  She was first evaluated for sleep apnea in mid-2005 but the initial request for a referral for sleep studies was lost.  After her separation she inquired about the referral and was advised that it appeared the referral had been lost and a second referral was made.  She believes it is an injustice that this condition was not included on her MEB/PEB.  She asks that her medical discharge be reevaluated to include the diagnosis of sleep apnea and her disability percentage adjusted.

3.  The applicant provides copies of a 21 April 2006 polysomnography report (sleep readings) and a 5 May 2006 CPAP (continuous positive airway pressure) Titration Report. 

CONSIDERATION OF EVIDENCE:

1.  The internet site for the National Heart, Lung, and Blood Institute (NHLBI), a part of the U.S. Department of Health and Human Services, National Institutes of Health, describes sleep apnea as a disorder affecting about 18 million Americans that has the potential for serious and even fatal complications.  Symptoms of sleep apnea include heavy snoring, frequent interrupted sleep, unrefreshing sleep, morning headaches, excessive daytime sleepiness, frequent accidents, irritability, decreased productivity at work, decreased attentiveness at home, and poor memory.  Untreated or improperly treated sleep apnea can cause heart attacks, strokes, weight gain, impotency, high blood pressure and other cardiovascular disease, memory problems, and sudden death.  

2.  There are two types of sleep apnea, central sleep apnea (CSA) (without respiratory movements) and obstructive sleep apnea (OSA) (caused by upper-airway blockage).  CSA occurs when the brain does not send a signal to the respiratory muscles to take a breath, and there is no muscular effort to take a breath.  OSA occurs when the brain sends the signal to the muscles and the muscles make an effort to take a breath, but they are unsuccessful because the airway becomes obstructed and prevents the flow of air.  Blockage of the airway 
is usually caused when excess tissues of the soft palate, in the rear of the throat, collapse and close the airway during sleep.  The third type of sleep apnea, mixed sleep apnea, occurs when there are components of both CSA and OSA.

3.  In simple terms, apnea occurs when a person stops breathing completely or the patient takes less than 25% of a normal breath for a period that lasts 10 seconds or more.  Another determination of apnea is when there is at least a 4% drop in the saturation of oxygen in the blood which is a direct result of the reduction in the transfer of oxygen into the blood when breathing stops.  The diagnosis of sleep apnea is made when a patient, without medical problems that may be related to the sleep apnea, experiences at least 15 episodes of apnea per hour.  In patients with high blood pressure, stroke, daytime sleepiness, ischemic heart disease (low flow of blood to the heart), insomnia, or mood disorders (all of which can be caused or worsened by sleep apnea) sleep apnea is determined by at least 5 apnea episodes per hour.  This stricter definition is because these patients may be already experiencing the negative medical effects of sleep apnea, and it may be important to begin treatment at a lower apnea index.  

4.  The NHLBI website also describes continuous positive airway pressure (CPAP) as an effective treatment for obstructive sleep apnea in the case of sleep-disordered breathing (SDB) and obstructive sleep apnea.  CPAP delivers a pressurized airflow through a mask that covers a patient's nose during sleep, prevents pauses in breathing and restores oxygen levels.  

5.  The records show the applicant entered active duty on 18 May 2001, completed training, and was awarded the military occupation specialty (MOS) 91T1O (Animal Care Specialist).

6.  A DA Form 705 (Army Physical Fitness Test (APFT) Scorecard) indicates the applicant failed the weight-in portion of the APFT on 5 December 2003, 20 March 2004, and 5 October 2004.

7.  The available service medical records show the applicant underwent a total of five surgical procedures for repair of her left knee condition.  In 2004, following her third knee surgery, her command determined that her knee condition was negatively impacting her ability to perform her assigned duties and recommended she be referred to an MEB.

8.  A DD Form 2807-1 (Report of Medical History), dated 18 October 2004, lists the applicant's complaints as right shoulder, chest, low back, and bilateral hip pain; continued problems of instability, locking and pain in her left knee; 
significant short term weight gain (10-12 pounds in one month); several anxiety attacks; consistent stress headaches; sleep disturbances; and a reduction in memory capacity. 

9.  On the DD Form 2807-1, the applicant reported a history of bilateral eustachian drainage tubes in 1983, hospitalization for bronchitis in 1987, adenoid removal in 1988, left ear tympanoplasty in 1996 and a broken nose with a septoplastiy (1998).

10.  On 18 May 2005, the applicant was referred to a MEB for evaluation of a left knee osteochondral, low back pain, right shoulder acromioclavicular sprain, chronic headaches, labile hypertension, and bilateral hip pain.  

11.  A 30 August 2005 DA Form 3947 (Medical Evaluation Board Proceedings) indicates the board found all six conditions to have been incurred while on active duty.  The last three conditions were determined to be medically acceptable and the MEB recommended referral to a PEB.

12.  The applicant concurred with MEB findings on 14 September 2005.

13.  The PEB found the applicant physically unfit by reason of left knee osteochondral which interfered with her ability to perform her duties.  It also determined that the other five conditions were not medically unfitting.  The PEB recommended that the applicant's condition be rated 10 percent disabling and that she be separated from the service with entitlement to severance pay.  The PEB recommendation was subsequently approved for the Secretary of the Army.

14.  On 5 October 2005 the applicant concurred with the PEB findings and waived her rights to a formal hearing.

15.  The applicant was honorably discharged on 10 November 2005 due to physical disability with severance pay ($15, 021.60).  

16.  A 25 April 2006 polysomnography report shows that the applicant underwent testing of UARS.  The test results indicate a moderate degree of sleep fragmentation at an average of 27 incidents per hour, although the majority of the sleep arousals were not secondary to sleep disorder breathing resulting in a sleep apnea/hypopnea index of 3.5 incidents per hour.  The applicant's lowest oxygen saturation was 94 percent with no electrocardiograph (EKG) (heart related) or electroencephalographic (EEG) (brain wave) abnormalities.  It was recommended that the applicant be advised of the different treatment options including the use of a CPAP device.
17.  A 5 May 2006 CPAP Titration Report indicates that the applicant's snoring was controlled at a pressure of 5 centimeters of water and her SDB appeared to be controlled at that level.  Again no EKG or EEG abnormalities were noted.

18.  Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation), provides at:

a.  paragraph 3-1 that the mere presence of an impairment does not, of itself, justify a finding of unfitness because of physical disability.  In each case, it is necessary to compare the nature and degree of physical disability present with the requirements of the duties the member reasonably may be expected to perform because of his or her office, rank, grade or rating; and 

b.  paragraph 3-2b(1) that disability compensation is not an entitlement acquired by reason of service-incurred illness or injury; rather, it is provided to Soldiers whose service is interrupted and they can no longer continue to reasonably perform because of a physical disability incurred or aggravated in service.

DISCUSSION AND CONCLUSIONS:

1.  The only in-service documentation of sleep related problems are notations on a DD Form 2807-1, dated 18 October 2004.

2.  The applicant concurred with the findings of both the MEB and PEB and did not raise the issue of sleep or breathing problems during the processing of either of these boards. 

3.  A MEB/PEB can address only those diagnosed medical conditions that are made a matter of record at the time the board meets.  Sleep apnea was not an issue addressed as part of the applicant’s medical record at the time of the MEB or PEB.  The available medical records show the applicant followed up on this concern after she was discharged.  

4.  While the applicant did raise the issue of several of the symptoms that might be related to sleep apnea prior to her MEB/PEB, no diagnosis of this condition was made while she was on active duty, and none of the documentation related to the physical limitations that rendered her unfit for duty were related to sleep apnea.  



5.  There is no available evidence that sleep apnea interrupted the applicant's service or interfered with her ability to perform the duties of her office, rank, grade, or rating.  The available evidence is insufficient to grant the applicant’s request.

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

__LMD__  __LCB__   _TSK____  DENY APPLICATION


BOARD DETERMINATION/RECOMMENDATION:

The evidence presented does not demonstrate the existence of a probable error or injustice.  Therefore, the Board determined that the overall merits of this case are insufficient as a basis for correction of the records of the individual concerned.




__     Ted S. Kanamine____
          CHAIRPERSON


INDEX

CASE ID
AR20060011003
SUFFIX

RECON
 
DATE BOARDED
20070227 
TYPE OF DISCHARGE

DATE OF DISCHARGE
 
DISCHARGE AUTHORITY
 . . . . .  
DISCHARGE REASON

BOARD DECISION
DENY
REVIEW AUTHORITY

ISSUES         1.
100
2.

3.

4.

5.

6.