DEPARTMENT OF THE NAVY

BOARD FOR CORRECTION OF NAVAL RECORD

S

2 NAVY ANNE

X

WASHINGTON DC 20370-510

0

JRE
Docket No:  
6 September 2002

7425-01

This is in reference to your application for correction of your naval record pursuant to the
provisions of title 10 of the United States Code, section 1552.

A three-member panel of the Board for Correction of Naval Records, sitting in executive
session, considered your application on 29 August 2002.
Your allegations of error and
injustice were reviewed in  
applicable to the proceedings of this Board.
consisted of your application, together with all material submitted in support thereof, your
naval record and applicable statutes, regulations and policies. In addition, the Board
considered the advisory opinion furnished by the Specialty Leader for Nephrology dated 1
July 2002, a copy of which is attached.

accordance’iyith administrative regulations and procedures

Documentary material considered by the Board

After careful and conscientious consideration of the entire record, the Board found that the
evidence submitted was insufficient to establish the existence of probable material error or
injustice. In this connection, the Board substantially concurred with the comments contained
in the advisory opinion. Accordingly, your application has been denied. The names and
votes of the members of the panel will be furnished upon request.

It is regretted that the circumstances of your case are such that favorable action cannot be
taken. You are entitled to have the Board reconsider its decision upon submission of new and
material evidence or other matter not previously considered by the Board.
important to keep in mind that a presumption of regularity attaches to all official records.

In this regard, it is

Consequently, when applying for a correction of an official naval record, the burden is on the
applicant to demonstrate the existence of probable material error or injustice.

Sincerely,

W. DEAN PFEIFFER
Executive Director

Enclosure

NEPHROLOGY DIVISION

 
’
NAVAL MEDICAL CENTER SAN DIEGO

Suite 308, 34800  Bob Wilson Drive
San Diego, California 92 134-l 308
Tel: 619-532-8840 Fax: 6 19-532-8856

.

Docket No. 0742501
1 July 2002

From: CAPT

MC, USN

Navy SG Specialty Leader  for Nephrology
Chairman, Board for Correction of Naval Records

To:

Subj: COMMENTS AND RECOMMENDATION IN THE CASE OF

FORMER:

Ref:

(a) BCNR letter JRE:jdh Docket No. 07425-01 of 12 June 2002

1. I have reviewed 

forme

medical file
rrection of Naval Record. I have also review
letter to the Board, dated 13 August 200 1.

ided by the

a. end stage renal disease, for which he first received peritoneal

dialysis and later (1996) a cadaveric renal transplant. Based on lab data and
his weight as recorded in the record, in late summer-early fall 2001 his
creatinine clearance was about 50-60 ml/minute, which is about one 
normal. By itself, this level of kidney functioning should not cause
symptoms. However, the medicines he has to take to keep his kidney can
have significant side effects, as noted below.

half.of

b. hypertension which was definitively diagnosed after he left the

Navy. As side effects of his therapy, he has some mild leg edema or
swelling (described as 
4-t).

“l+” in the record on a scale that can go as high as

c. gingival hyperplasia (swollen and enlarged gum tissue)  
(Norvasc) and

a known side effect of his therapy with amlodipine 
cyclosporine. Those drugs were prescribed for his hypertension and kidney
transplant, respectively.

, which is

d. diabetes mellitus type 

7 which is a known side effect of his
_,

cyclosporine 

?md prednisone therapy, which are needed to keep his kidney.

evaluation of his hypertension and the protein noted on his urinalysis. He appears to state that
such an evaluation would have included referral to a nephrologist.  In turn, that referral would
have led to a medical discharge and institution of preventive therapy which could have saved
his kidneys and prevented significant suffering.

4. I disagree with

mg/dl, which
is actually normal for an African-American male (African-Americans on average have higher
creatinine levels than Caucasians).

a. First, transient or intermittent proteinuria which is not associated with a significant

kidney disease is fairly common.
mostly while evaluating him for infections. Some showed protein, but the majority did not. The
final value in his record, 40 
Of note, a urinalysis in October 1992, more than a year after his separation, was negative for
protein. If his Navy doctor had been really suspicious of a kidney disease, he would have
obtained a serum creatinine level. In October 1992, his serum creatinine was 1.3 

did not meet criteria for a diagnosis of hypertension while he
an cause a temporary rise in blood pressure.

b. Second
was on active dut
hypertension requires multiple consecutive high blood pressure readings. While
had a few borderline measurements recorded in his chart, most were completely normal. Some
of the higher readings were taken during visits in which he complained of pain, which can raise
blood pressure temporarily. His blood pressure at his separation physical was perfect at 120172.
It would have been wrong to say that he had hypertension at that time.

c. Third, it is highly unlikely that a reputable nephrologist would have recommended a

kidney biopsy or specific treatment if presented with the history available in
chart: low-grade, intermittent proteinuria, a bland urinary sediment and normal blood pressure.

d. Fourth, there was no preventive treatment available for kidney diseases in 199 1.  The

fact that treatment with an angiotensin-converting enzyme (ACE) inhibitor can sometimes slow
down worsening of kidney diseases was not proven until several years after Mr. Thompson ’s
separation from the Navy.

‘5. It is probable, but not at all certain, that
at the time of his separation from the Navy. 
award him a disability rating for his hypertension and his renal failure as they became apparent
from 1992-l 996.

I believe that it was reasonable for the VA to

ad the beginnings of kidney disease

6. In summary, 
received while he was on 
negligent. 

I do not find any significant problems with the medical care that

acaive duty. I do not find evidence that his military physicians were
I do not believe that his kidney failure could have been predicted. I do not believe

that he should have been placed on medical hold or referred to a nephrologists before being
separated. I believe that documentation of the low-grade proteinuria on his SF 88 was the
only action that needed to be taken at the time of his separation-physical. Thus I do not
support Mr. Thompson’s claim for extraordinary benefits beyond those he already receives.