DEPARTMENT OF HOMELAND SECURITY 

BOARD FOR CORRECTION OF MILITARY RECORDS 

 
Application for the Correction of 
the Coast Guard Record of: 
 
                                                                                BCMR Docket No. 2011-214 
 
Xxxxxxxxxxxx 
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FINAL DECISION 

This is a proceeding under the provisions of section 1552 of title 10 and section 425 of 
title 14 of the United States Code.  The Chair docketed the case  after receiving  the  applicant’s 
completed  application  on  July  27,  2011,  and  assigned  the  case  to  staff  member  J.  Andrews  to 
prepare the decision for the Board as required by 33 C.F.R. § 52.61(c). 
 
 
appointed members who were designated to serve as the Board in this case. 
 

This  final  decision,  dated  April  19,  2012,  is  approved  and  signed  by  the  three  duly 

APPLICANT’S REQUEST AND ALLEGATIONS 

 
 
The  applicant  asked  the  Board  to  correct  a  Final  Mishap  Report  and  SF-600  medical 
record  to  show  that  she  did  not  refuse  medical  evaluation  or  treatment  when  she  was  injured 
aboard a cutter in September 2010 and to correct the date of injury shown on these records.  She 
alleged  that  she  never  refused  medical  evaluation  or  treatment  and  that  the  dates  earlier  than 
September 29, 2010, in those documents are erroneous because that was the date she was injured.  
In  support  of  her  allegations,  the  applicant  submitted  numerous  documents,  including  the 
following: 
 

  An  October  5,  2010,  hospital  report  shows  that  the  applicant  sought  treatment  for 
increased dizziness and disequilibrium on that date.  She told the doctor that on Septem-
ber  29,  2010,  she  had  fallen  against  a  bulkhead  and  hit  her  head  but  had  not  lost  con-
sciousness.    The  doctor  noted  that  the  applicant  had  visited  the  hospital  on  October  3, 
2010,  complaining  of  nausea,  sleepiness,  and  dizziness,  and  was  diagnosed  with  a  con-
cussion.   
 

  On  November  22,  2010,  the  applicant  sent  HS1  [X]  an  email  asking  for  a  copy  of  the 
mishap  report  of  her  injury.    Subsequent  emails  show  that  during  the  following  month, 
the applicant complained about the lack of a mishap report to HS1 [X’s] superiors.   
 

 

 

 

 

 

 

  Medical records show that the applicant continued to complain of dizziness following her 
concussion and began physical therapy for her imbalance.  Her military record shows that 
she was transferred off the cutter on November 29, 2010, just five months after her tour 
of duty began. 

  The disputed Final Mishap Report, which is undated, states that on September 24, 2010, 
the  applicant  was  seated  at  a  desk  on  the  mess  deck  while  the  cutter  was  transiting 
through  large  swells  near  Cape  Hatteras.    When  the  cutter  hit  a  particularly  high  swell, 
her chair slid 12 feet to port with her in it, hit a door frame, and toppled.  The applicant 
“landed on the deck of the serving line, then immediately complained of head, wrist, and 
shoulder  pain.    The  corpsman  was  called  to  the  scene  and  asked  the  member  if  [she] 
wanted to be evaluated, and the member declined evaluation.  Member was given a bag 
of ice for [her] head and sat on the mess deck.  Upon return to homeport approximately 
48 hours  after the incident,  member  went  to the  emergency room complaining of head-
aches  and vertigo.  After examination by  emergency  room personnel,  it  was discovered 
that member had a slight concussion.”  Reviewers noted that the chair should have been 
secured  because  of  the  rough  weather  and  that  “declining  medical  attention  is  never  a 
good  idea.    Initial  evaluation  and  treatment  may  have  identified  this  injury  sooner  and 
allowed appropriate steps to be taken to care for the member.” 
 

  Medical records dated in 2011 show that the applicant was diagnosed with and treated for 

traumatic brain injury (TBI). 
 

  Several emails show that in March 2011, the applicant discovered and reported that HS1 
[X]  had  never  made  any  note  in  her  medical  record  about  the  injuries  she  incurred  on 
September 29, 2010.  (Such medical notes are made on an SF-600.) 
 

  The disputed SF-600 entry in the applicant’s medical record is dated March 15, 2011, and 
is signed by both HS1 [X] and the cutter’s Executive Officer.  It states that the following: 

Addendum to previous  write  up dated 25 Sep 10 missing into  [sic]  member’s record.  On above 
date,  member  slipped  while  seated  upon  taking  a  role  [sic]  from  the  food  service  desk  to  the 
entrance in galley.  Member fell and hit her head against bulkhead.  Upon called to the seen [sic], I 
noticed member was alert and conscious.  I asked member if she needed medical attention and she 
refused treatment at that time.  No further treatment was given. 

  On March 17, 2011, the applicant  wrote an email  containing  a detailed statement  about 
her injury to the HSCS.  She said that on September 29, 2010, she sat down at a desk on 
the  mess  deck  because  her  end-of-the-month  report,  which  had  to  be  submitted  the 
following day, had “flown … all over the place” in the rough seas.  When the cutter took 
a deep pitch, her chair slid and flipped and her head hit  
 
the stainless steel serving line.  I remember [HS1  X] asking  me if I thought I  had been knocked 
unconscious and could I tell him what happened.  I told him what I remembered and that I wasn’t 
sure  but  my  head  was  pounding,  my  left  elbow  and  right  hand  were  really  hurting.    He  felt  my 
elbow and arm; didn’t say they were broken, just bruised maybe.  He checked my head; no cuts, 
just a couple goose eggs.  I remember seeing my XO standing over us asking if I was okay.  HS1 
told me just take a Motrin because I would probably be really sore the next day and try getting up.  

 

 

He helped me to the mess deck table and went back to playing cards.  After some time, he saw I 
was still sitting there, he said I would be more comfortable if I went to my rack and I said I don’t 
think I could do it myself. He says someone could help me.  I replied I just needed to sit a little 
longer because I was wobbly feeling and my head was still pounding and I would try to walk in a 
few minutes.  While sitting there I did take a 800 mg Motrin.  HS1 asked me if I needed any ice 
and I said no I was using my water bottle, which was cold; I had been holding it on my head the 
whole time I sat on the mess deck.  HS1 never asked me again how I was or any light duty status.   
 
The applicant described her subsequent symptoms and taking more Motrin.  She said that 
by  October  3rd,  she  was  much  worse.    She  was  speaking  with  a  slight  slur,  walking 
poorly,  and  feeling very  dizzy.  She spoke to the HS1  who told her that the base clinic 
was  closed  and  that  the  cutter  was  getting  underway  the  next  day.    She  told  him  she 
would find someone to take her to the emergency room and the HS1 walked away.  Later, 
a chief warrant officer told her she wasn’t herself and drove her to the hospital. 
 

  Physical therapy records show that on March 22, 2011, the applicant told a therapist that 
when she hit her head on September 29, 2010, she had an “instant headache, rating pain 
at 15/10 on pain scale; patient with immediate vertigo; medical corpsman was alerted to 
[patient’s] situation and saw [her] on the floor and advised [her] to take 800 mg of Motrin 
that [patient] already had; four days later patient with worsening of symptoms …” 
 

  On April 11, 2011, the applicant asked her supervisor in an email how to get a false SF-
600 removed from her  record.  She stated that there  “had  been a cover-up.”  She noted 
that the date of injury  was incorrect,  that it should be September 29, 2010, and that the 
HS1 had not written down anything about offering ice or telling her to lie down and take 
Motrin.    She  stated  that  she  never  refused  medical  treatment;  she  simply  refused  ice 
because she did not need it.  She said, “All I want is the truth in writing in my records.” 
 

  The  applicant’s  rebuttal  to  the  report  of  a  Medical  Board  convened  on  June  14,  2011, 

states the following: 
 
On Sept. 29, 2010, I received a concussion while underway aboard the [cutter].  I was seen on the 
floor by HS1 [X] who came to evaluate me.  He asked me if I knew the date, if I could remember 
what  happened, did I think I  was knocked out and  was I  hurt anywhere.  I told him I had a #10 
headache from hitting the stainless bulkhead.  I wasn’t sure about being out and my left elbow and 
right palm were really hurting.  He asked me if I could walk and I said I’d try.  He helped me to 
the mess deck table where I sat a while.  He went back to playing cards on the mess deck.  After 
some time had passed, he asked me if I  wanted some ice and I said no.  I had my  water bottle I 
was using for my goose egg on my head.  He also said I might want to go to my rack and lie down 
so I would be more comfortable.  He also offered to get someone to get me to my rack.  I told him 
when I felt a little less dizzy I would get someone to help. 
 
In October I inquired via email where my injury and incident report was.  I received no reply from 
the HS1.  I had HS1 [B] at the Clinic go through all my records several times and he found noth-
ing.  I also found another CG member’s medical records in my record and brought it to the atten-
tion  of  Chief  [S]  and  HSCS  [A].    I  also  requested  their  help  with  finding  out  where  my  SF-600 
entry was. 
 
On April 4, 2011, the SF-600 entry  was entered into my medical report and dated for March 15, 
2011.  The date of injury was written in by HS1 [X] on the SF-600 as happening on Sept. 25, 2010 
and states I refused medical treatment at that time.  My left elbow and my right palm were never 

 

 

entered in the SF-600.  HS1 [X] never wrote he had offered me ice or that he asked me did I think 
I had been knocked out or my reply. 
 
On  Oct.  26,  2010,  I  complained  again  about  my  elbow  and  Mr.  [S]  saw  it  was  swollen  and  had 
xrays done and found my bursa sac still swollen and gave me an ace bandage and some medicine 
called  Mobex  to  help  with  the  swelling.    My  medical  records  only  refer  to  the  xray;  the  finding 
isn’t in my records or the medicine prescribed for the swelling.  My head injury happened on Sept. 
29, 2010, not the date HS1 [X] put on the SF-600. … [At a meeting on April 4, 2011,] HS1 [X] 
started the meeting in his statement he said I had denied medical treatment.  I asked him directly 
how I had denied treatment.  His reply was, when he asked me if I needed “ice” and I said no and 
that  was  the  end  of  the  treatment  everyone  in  attendance  heard.    My  reply  was  really?    HSCS 
began to speak letting the HS1 know that he should have treated it as a serious head injury. … The 
question was asked why the entry  was never put into my records.  HS1 replied he had entered it 
but maybe Admin or the Portsmouth Naval Hospital had removed it. … 

VIEWS OF THE COAST GUARD 

 
 
On  October  28,  2011,  the  Judge  Advocate  General  submitted  an  advisory  opinion  in 
which he recommended that the Board deny relief in this case.  In so doing, he adopted the find-
ings and analysis provided in a memorandum prepared by the Personnel Service Center (PSC).   
 

PSC stated that in response to the applicant’s complaints, it has revised the SF-600 once 
and the Final Mishap Report twice.  Both documents now show that the injury occurred on Sep-
tember 29, 2010.  PSC stated that it informed the applicant of these corrections, but she remains 
dissatisfied because the documents continue to show that she refused medical treatment.   

 
PSC  recommended  that  no  further  relief  be  granted  but  noted  that  “[i]f  the  Board  finds 
that further correction(s) are warranted, the Coast guard will take appropriate action.  However, 
as  far  as  this  agency  is  concerned,  the  Coast  Guard  is  presumptively  correct,  and  the  applicant 
has  failed  to  substantiate  that  any  error  or  injustice  remains  in  her  record.”    In  support  of  this 
recommendation, PSC submitted the following documents: 
 

 

In an email to the PSC dated August 22, 2011, the applicant stated that during the meet-
ing on April 4, 2011, she asked HS1 X why he had written that she had refused medical 
treatment, and he “told everyone it was because when he asked me if I needed ice I said 
no, so that ended his treatment.” 

  A copy of the disputed SF-600 with a notation at the bottom dated September 23, 2011, 
states, “Addendum to previous write up dated 25 SEP 10.  Date of write up to be changed 
to 29 SEP 10 to reflect date of incident. [signature of HS1 X] Concur.  Date error likely 
due to loss of original SF-600s. [signature of physician’s assistant].” 

  A second version of the  Final Mishap Report has only the “date of mishap” changed to 

September 29, 2010. 

 

In an email dated September 26, 2011, the applicant complains that only the dates were 
changed  on  the  SF-600  and  Final  Mishap  Report  and  that  she  wants  the  claim  that  she 
refused treatment corrected because she only refused ice. 

 

 

 

 

 

  A  statement  signed  by  HS1  X,  stating  that  while  underway  on  September  29,  2010,  he 
was called to the galley and found the applicant “alert and conscious and seated against 
the  stainless  steel  bulkhead.    When  I  asked  the  member  what  had  happened,  she 
explained that … she had fallen and hit her head.  I asked the member if she required any 
further  medical  attention  or  if  she  would  have  liked  ice  to  apply  to  her  head  and  she 
refused treatment at that time and no further treatment was given to [her].” 

 

In an email dated October 13, 2011, the applicant stated that she had reviewed the third 
version of the Final Mishap Report (quoted below) and said that the report should show 
that she complained of a bad headache and was told to take Motrin and to lie down.  She 
stated that the report is also wrong in stating that she was not diagnosed with concussion/ 
TBI until after she had been transferred from the unit. 

  The  third  version  of  the  Final  Mishap  Report  contains  a  “narrative”  with  the  same  lan-
guage that was in the first and second versions, but “first level reviewer comments” that 
are  significantly  different  and  a  new  section  of  comments  from  the  Maintenance  and 
Logistics Command: 
 
NARRATIVE:  …  The  member  landed  on  the  deck  of  the  serving  line,  then  immediately  com-
plained  of  head,  wrist,  and  shoulder  pain.    The  corpsman  was  called  to  the  scene  and  asked  the 
member if they wanted to be evaluated, and the member declined evaluation.  Member was given 
a bag of ice for their head and sat on the mess deck.  Upon return to homeport approximately  48 
hours after the incident member went to the emergency room complaining of headaches and ver-
tigo. After examination by emergency room personnel, it was discovered that member had a slight 
concussion. 
 
FIRST LEVEL REVIEWER COMMENTS: … From discussions with HS1 [X] an additional dis-
crepancy was discovered with the investigator’s comments about calling the corpsman to the scene 
and  the  rendering  of  medical  treatment.    HS1  [X]  was  present  on  the  mess  deck  and  responded 
upon the member falling out of the chair.  The above investigation indicates the member was pro-
vided ice; however, I find that the member was offered a bag of ice and declined.  Member indi-
cated she would use her water bottle instead.  Further, witness accounts indicate the member was 
conscious and responsive and when asked if she was okay indicated that she wanted to sit on the 
deck  for  a  few  moments  before  getting  up  and  sitting  at  a  mess  deck  table.   The  log  for  official 
medical  treatment  (SF  600)  indicates  that  medical  treatment  was  refused  by  the  member.    This 
entry likely stems from the refusal of ice, lack of outward signs of injury, and indications by the 
member that she was okay without relaying actual symptoms.  I also reviewed additional informa-
tion that  was  not available during  the initial investigation.  Medical records indicate the member 
was diagnosed with traumatic brain injury.  This diagnosis came after the member was transferred 
from the unit. 
 
…  However,  from  my  discussions  with  those  that  were  present  during  the  incident,  at  no  time 
were any indicators present that this  was a serious incident.  The opinions expressed to me sum-
marized  that  the  member  gave  the  impression  of  being  okay  and  did  not  give  any  indications  of 
suffering any ill effects that prevented the member from returning to work nor was a request made 
for  further  medical  evaluation.    Member  was  on  the  bridge  the  following  day  in  the  presence  of 
command cadre and appeared to be able to fulfill her assigned duties.  No  further treatment  was 
sought out by the member to this unit.  Member sought treatment on 2 October 2010 at an emer-
gency  room,  two  days  after  the  unit  returned  to  port.    Diagnosis  at  the  ER  was  post  concussion 
syndrome. … 
 

 

 

 

 

 

 

MLC  COMMENTS/REMARKS: …  In  order  to  find  out  more  information  about  the  date  of  the 
mishap and the mishap response, I called the deputy [Executive Officer (XO)] of the [cutter], who 
was also the deputy at the time of the mishap.  He stated that he did not witness the mishap occur, 
but was on the mess deck during the time of the response. … 
 
When  asked  about  whether  the  applicant  received  a  “bag  of  ice”  for  her  injury,  [the  XO]  stated 
that she did not receive any ice.  He noted that she declined the ice because she already had a cold 
water bottle to apply to her head. (MOR (C))  When asked about whether he thought that declining 
a bag of ice constituted declining a  medical evaluation, he stated that they (he and the  SH1) did 
not think that it was a serious injury and did not see any reason to pursue further medical attention.  
He  did  not  indicate  that  the  HA1  asked  the  applicant  if  she  wanted  medical  attention;  he  only 
stated that the HS1 asked if she wanted ice.  However, he did state that the applicant never directly 
asked to be evaluated. (MOR (C))  I did not inquire as to why it was incorrectly noted on the E-
Mishap  Report  and  SF-600  that  she  explicitly  refused  a  medical  evaluation.    When  asked  about 
when the mishap occurred with relation to the time the ship came back to homeport, he confirmed 
that  the  mishap  occurred  the  day  before  the  ship  came  into  port,  placing  the  actual  day  of  the 
mishap as 29 SEP 2010.  Again, I did not inquire as to why the discrepancies of the dates existed 
on two official, signed documents. … 
 
Upon research of the date when the E-Mishap Report was submitted, I found the date to be some-
time  in  December  2010,  more  than  2  months  after  the  mishap  occurred.  …  The  Mishap  Report 
should have been filed within 21 days.  Likewise, the [disputed] “addendum to previous write-up 
dated 25 SEP 2010” SF-600 is dated 15 MAR 2011 and is signed by the HS1, who was the medi-
cal  person  on-site  at  the  time  of  the  mishap,  and  the  deputy.    The  deputy,  when  asked,  did  not 
know of any original SF-600 that was reportedly dated 25 SEP 2010, and was not sure if the one 
dated 15 MAR 2011 really was an addendum or was the only medical record drafted by the ship’s 
HS1.  (MOR  (C))    Given  that  neither  the  HS1  nor  the  command  felt  that  the  applicant  needed 
medical attention [at] the time of the mishap, I do not believe that the medical record (SF-600) of 
the mishap was made immediately after the applicant sustained the injury.  This is also supported 
by the fact that the initial SF-600 is now missing, and is also reportedly dated 25 SEP 2010, four 
days prior to the incident.  It is further supported by the fact that the HS1 only offered her ice for 
what  was  later  discovered  to  be  a  traumatic  head  injury,  treatment  that  would  not  require  such 
reporting.  I do not believe that the applicant refused treatment based on the discrepancies in the 
command’s  reports.    Additionally,  I  only  believe  that  she  was  offered  an  ice  bag  and  no  further 
medical evaluation.  Given that the official reports in question were not done in a timely manner 
and that no apparent effort was made to ensure that they were factual, I recommend that both the 
E-Mishap Report and the SF-600 be corrected with respect to the date of the mishap, the applica-
tion  of  ice  on  the  wound(s),  and  the  refusal  of  medical  attention.    There  are  no  supporting  facts 
from  the  Coast  Guard  to  presume  that  the  mishap  and  mishap  response  did  not  occur  exactly  as 
indicated by the applicant. … 
 
The  Coast  Guard  is  presumptively  correct,  and  the  applicant  has  substantiated  the  errors  and 
injustice with regards to her record. 

APPLICANT’S RESPONSE TO THE VIEWS OF THE COAST GUARD 

On  November  3,  2011,  the  Chair  sent  the  applicant  a  copy  of  the  views  of  the  Coast 

 
 
Guard and invited her to respond within 30 days.  No response was received.   
 

FINDINGS AND CONCLUSIONS 

The Board makes the following findings and conclusions on the basis of the applicant’s 

 
 
military record and submissions, the Coast Guard’s submissions, and applicable law: 
 

 

 

1. 

The Board has jurisdiction concerning this matter pursuant to  10 U.S.C. § 1552.  

The application was timely filed. 
 

2. 

The applicant requested an oral hearing before the Board.  The Chair, acting pur-
suant to 33 C.F.R. § 52.51, denied the request and recommended disposition of the case without 
a hearing.  The Board concurs in that recommendation.1   
 

3. 

The Coast Guard has already corrected the date of injury shown on the applicant’s 
SF-600  and  the  Final  Mishap  Report.    Therefore,  the  only  disputed  matters  remaining  in  the 
Final Mishap Report and the SF-600 are (a) the lack of a statement concerning HS1 X’s sugges-
tion  that  she  take  Motrin  and  lie  down;  (b)  the  statement  that  she  was  not  diagnosed  with  TBI 
until  after  she  left  the  cutter;  and  (c)  the  statements  that  she  declined  medical  evaluation  or 
treatment.  The Board begins its analysis in every case by presuming that the disputed informa-
tion  in  the  applicant’s  record  is  correct,  and  the  applicant  bears  the  burden  of  proving  by  a 
preponderance  of  the  evidence  that  the  disputed  information  is  erroneous  or  unjust.2    Absent 
evidence to  the contrary, the Board presumes that  Coast  Guard officials and other Government 
employees have carried out their duties “correctly, lawfully, and in good faith.”3 

  
4. 

Regarding  the  lack  of  a  statement  concerning  HS1  X’s  suggestion  that  she  take 
Motrin and lie down, the Board finds that adding such a statement is unnecessary and its absence 
does not make the records erroneous since not every detail of a situation can be included on an 
SF-600 or Final Mishap  Report.   Inserting  HS1  X’s advice to  take Motrin and lie down would 
not add significant information about the nature and treatment of her head injury to her medical 
record,  which  is  the  purpose  of  the  SF-600,4  or  help  others  avoid  similar injuries,  which  is  the 
purpose  of  a  mishap  report.5    Therefore,  the  Board  is  not  persuaded  that  the  SF-600  and  Final 
Mishap Report are erroneous or unjust because they lack this information. 

 
5. 

Regarding the statement in the Final Mishap Report that the applicant  was diag-
nosed after she transferred from the cutter, the Board finds that she has not proved by a prepon-
derance of the evidence that the statement, in context, is inaccurate.  The report states, “Medical 
records  indicate  the  member  was  diagnosed  with  traumatic  brain  injury.    This  diagnosis  came 
after the member was transferred from the unit.”  The applicant’s medical records show that she 
incurred her head injury on September 29, 2010, and was diagnosed with a concussion on Octo-
ber 3, 2010, before she transferred from the cutter.  However, not every concussion results in a 
long-term TBI symptoms,6 and the diagnosis of TBI does not appear in the medical records she 

                                                 
1 See Steen v. United States, No. 436-74, 1977 U.S. Ct. Cl. LEXIS 585, at *21 (Dec. 7, 1977) (holding that “whether 
to grant such a hearing is a decision entirely within the discretion of the Board”). 
2 33 C.F.R. § 52.24(b). 
3 Arens v. United States, 969 F.2d 1034, 1037 (Fed. Cir. 1992); Sanders v. United States, 594 F.2d 804, 813 (Ct. Cl. 
1979). 
4 Medical Manual, COMDTINST 6000. (2009), Chap. 4.B.14.a.(1). 
5 Safety and Environmental Health Manual, COMDTINST M5100.47 (2007), Chap. 1.A.2. and Encl. (2), para. 9. 
6  Eugene  Braunwald  et  al.,  eds.,  HARRISON’S  PRINCIPLES  OF  INTERNAL  MEDICINE,  15TH  EDITION  (McGraw-Hill, 
2001),  p.  2435,  2439  (stating  that  a  “single,  uncomplicated  head  injury  only  infrequently  produces  permanent 
neurobehavioral changes in patients” and that “[t]he patient who is fully alert and attentive after head injury but who 
has one or more symptoms of headache, faintness, nausea, a single episode of emesis, difficulty with concentration, 
or light blurring of vision has a good prognosis with little risk of subsequent deterioration”). 

 

 

has  submitted  until  2011.    Therefore,  the  Board  finds  that  in  the  context  of  the  Final  Mishap 
Report, the disputed statement is not erroneous or unjust. 

 
6. 

Regarding  the  statements  concerning  the  applicant’s  alleged  refusal  to  accept 
medical  evaluation  or treatment,  the Board  finds that the  applicant  has proved by  a preponder-
ance of the evidence that both statements are inaccurate.  Under the circumstances of this case, 
the  long  delay  in  the  preparation  of  both  the  SF-600  and  the  Final  Mishap  Report  makes  their 
reliability suspect.  Although delayed preparation per se does not prove that a medical or mishap 
report is erroneous, in this case, the reported incident was apparently not particularly significant 
or memorable to anyone except the applicant because the personnel who presumably would have 
documented it if they had thought it was significant failed to do so.  In addition, by the time the 
documents were prepared, the applicant had been complaining about their absence to her chain 
of command, which might have made the personnel responsible for responding to her injury and 
preparing the reports interpret and report the circumstances of her injury more defensively than 
accurately.  Moreover, the investigation conducted by the Maintenance and Logistics Command 
after the applicant filed her BCMR application shows that she was not offered a medical evalua-
tion  on  September  29,  2010—other  than  to  be  asked  if  she  was  “okay”—and  so  she  did  not 
refuse a medical evaluation.  In addition, the investigation shows that the only medical treatment 
offered was ice.  The Board finds that saying one will use an available, cold water bottle, in lieu 
of ice, to soothe a head injury does not constitute refusing medical treatment unless the medical 
personnel on hand advise the member that the application of ice is important medical treatment 
for which a cold water bottle is not an acceptable substitute.   

 
7. 

Because  the  applicant  did  not  refuse  medical  evaluation  or  treatment,  the  Board 
must determine what corrections should be made to the disputed documents.  The third version 
of the Final Mishap Report states in the Narrative section that “[t]he corpsman was called to the 
scene and asked the member if they wanted to be evaluated, and the member declined evaluation.  
Member was given a bag of ice for their head and sat on the mess deck.”  None of this appears to 
be  accurate,  as  explained  in  the  First  Level  Reviewer  Comments  and  the  MLC  Comments/Re-
marks.  These latter sections for reviewers’ comments show that the findings of the investigator 
as reported in the Narrative are erroneous, which is one of the purposes of requiring reviews and 
allowing reviewers’ comments.7  However, if the Narrative were corrected by removing the erro-
neous  material,  the  First  Level  Reviewer  Comments  and  the  MLC  Comments/Remarks  would 
appear  nonsensical.    Therefore,  even  though  the  Narrative  section  of  the  Final  Mishap  Report 
contains errors, the Board finds that the Final Mishap Report as a whole is correct  because the 
errors  in  the  Narrative  are  properly  pointed  out  and  corrected  in  the  reviewers’  comment  sec-
tions.  Because the errors in the Narrative section of the Final Mishap Report are adequately cor-
rected  by  the  reviewers’  comments,  the  Board  will  not  order  any  additional  corrections  of  this 
report. 

 
 8. 

The  SF-600,  however,  is  erroneous  because  both  entries  indicate  that  they  are 
addenda to an entry that apparently never existed; because the HS1 was not called to the scene 
but was already present  in the room when the accident occurred; and because the applicant did 
not  refuse  medical  treatment.    Only  this  last  error  is  potentially  prejudicial  to  her,  however.  
Because  expunging  the  entire  SF-600  would  not  be  in  her  interest  and  removing  one  sentence 
                                                 
7 Safety and Environmental Health Manual, COMDTINST M5100.47 (2007), Encl. (2), para. 9. 

 

 

from  the  first  addendum  might  raise  undue  questions,  the  Board  finds  that  another  addendum, 
signed by an appropriate authority, should be added to the SF-600 stating, “Further inquiry has 
shown that member did not refuse medical treatment when her head was injured on 29 SEP 10.”   

 
9. 

Accordingly, partial relief should be granted by ordering the Coast Guard to add 
another  addendum  to  the  disputed  SF-600,  to  be  signed  by  an  appropriate  authority,  stating  in 
pertinent  part,  “Further  inquiry  has  shown  that  member  did  not  refuse  medical  treatment  when 
her head was injured on 29 SEP 10.”   

[ORDER AND SIGNATURES APPEAR ON NEXT PAGE] 

 

 
 

 
 
 
 
 

 

 
 
 

 

 

The application of xxxxxxxxxxxxxxxxxx, USCG, for correction of her military record is 

granted in part as follows: 

ORDER 

 

 
The  Coast  Guard  shall  add  another  addendum  to  the  SF-600  documenting  her  head 
injury.    This  new  addendum  shall  be  signed  by  an  appropriate  authority  and  shall  state  in 
pertinent  part,  “Further  inquiry  has  shown  that  member  did  not  refuse  medical  treatment  when 
her head was injured on 29 SEP 10.”   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 Anthony C. DeFelice 

 
 Patrick B. Kernan 

 
 

 

 
 Megan Gemunder