RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:	DOCKET NUMBER:  01-01032
		INDEX CODE:  128.02
		COUNSEL:  NONE

		HEARING DESIRED:  NO

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APPLICANT REQUESTS THAT:

She be reimbursed for temporary duty (TDY) travel expenses in the amount of $1,590.96.

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APPLICANT CONTENDS THAT:

In 1993, while stationed at Dover AFB, DE, she had an elective surgery procedure that was performed at the Malcolm Grow Medical Center (MGMC) at Andrews AFB, MD.  Although the procedure was elective, she was placed on TDY orders and reimbursed for her travel expenses.  She is currently stationed at Altus AFB, OK.  In January 2001, she noticed a problem resulting from the surgical procedure that was performed in 1993.  Dr. XXXXX a military physician at Altus AFB, advised her that the complication was major and that referral to the Wilford Hall Medical Center (WHMC) or to a civilian specialist was necessary.  She was later advised that service at WHMC was not immediately available.  Therefore, she was put on a waiting list and told that it could take several months before she could be seen.  Dr. XXXXX provided her a referral sheet so that TRICARE personnel could arrange for treatment at another military installation or with a civilian specialist.  She was advised by Ms. XXXXX of the TRICARE office, that the only available solution was referral to a general surgeon instead of a specialist.  

She contacted Dr. XXXXX, the physician at Andrews AFB that performed the surgery in 1993, and he advised her that a general surgeon most likely would not be able to perform the surgery and that he would make arrangements to perform the procedure within the following two months.  She contacted Ms. XXXXX to make travel arrangements and was advised that they would not pay for travel or per diem because it was out of their region.  She inquired about shuttle arrangements from Altus AFB to Andrews AFB and was told by Ms. XXXXX that she could be flown to WHMC but as far as she knew, there was no shuttle from WHMC to Andrews AFB.  It was recommended by SrA XXXXX, of Dr. XXXXX's office, that her husband should accompany her because after the surgery she would not be able to drive or lift objects weighing more than 5 or 6 pounds.  

She purchased her tickets through the Scheduled Airline Ticket Office (SATO) at the military rate for unofficial travel.  She arrived at MGMC on 9 Feb 01.  She spoke to the TRICARE office at Andrews AFB and was told that her travel should have been at no cost to her and that there was a daily shuttle that departs from WHMC to Andrews AFB.  She departed Andrews AFB on 15 Feb 01, after her surgical procedure, and contacted the Chief of Hospital Operations at Altus AFB, Dr. XXXXX and informed her of the situation.  Dr. XXXXX agreed that she had been misinformed and that she would have approved her TDY travel costs.  She told her that Lt. XXXXX of the TRICARE office would contact her and accomplish amendments to her orders.  However, Lt XXXXX did not agree that she was authorized reimbursement for the elective surgery travel expenses and only allowed reimbursement for her actual travel, reduced proportional rate per diem, and for her billeting costs.  

Her original procedure was elective, it was done at a Military Treatment Facility (MTF), and funded by the Air Force.  The most recent surgery was required as it was corrective surgery, not elective.  She and her husband spent well over $1,600 and were reimbursed only $582.

In support of her request applicant provided, documents associated with her 1993 TDY for surgery, documents associated with her 2001 TDY for surgery, MGMC preoperative admission instructions, lodging receipts, airline travel receipts, her rental car receipt, and medical invoices.  Her complete submission is at Exhibit A.

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STATEMENT OF FACTS:

Applicant contracted her initial enlistment in the Regular Air Force on 10 Dec 86.  She has continually served on active duty, entering her last enlistment on 30 Jun 98, when she reenlisted for a period of 4 years.  She has been progressively promoted to the grade of technical sergeant, having assumed that grade effective and with a date of rank of 1 May 99.  

Additional relevant facts pertaining to this application, extracted from the applicant’s military records, are contained in the letter prepared by the appropriate office of the Air Force.  Accordingly, there is no need to recite these facts in this Record of Proceedings.

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AIR FORCE EVALUATION:

The Chief, Compensation and Entitlement Policy, USAF/DPRCC, reviewed applicant's request and recommended the application be evaluated by the medical community and states that TDY entitlements for her spouse should be a separate application (see Exhibit C).

The BCMR Medical Consultant, reviewed applicant's request and states that she underwent a breast augmentation procedure in 1990 and had replacement of inserts performed in 1991 and 1993.  In 2001, when one of the inserts became asymmetric compared to the other, she sought another revision.  Her TDY orders initially indicated she was to pay for all expenses but were later revised to allow $400 for travel and $182.50 for per diem expenses.  Review of her records determined that she felt she could not wait until this elective procedure could be arranged more locally and took it upon herself to seek other avenues for a quicker resolution.  It appears some misinformation was relayed in use of the aeromedical evacuation system that worked detrimentally against her.  It is debatable whether or not her husband should have been named as a non-medical attendant (NMA), which increased the costs of travel by virtue of his being active duty military.  Much of the expense could have been avoided had she simply waited until service was available at WHMC (see Exhibit D).

The Assistant Surgeon General, Medical Programs and Resources, USAF/SGMA, reviewed applicant's request and concurs that her records should be corrected to reflect that the TDY to Andrews was authorized as medically indicated and that a request for a NMA was approved by an authorized representative of the Air Force.  The care she received was medically indicated.  She did require an NMA.  The unfortunate misinformation she received about her TRICARE benefits and about her ability to access the aeromedical evacuation system prevented her from using the most cost-effective means of transportation (see Exhibit E).

The Legal Advisor to the Surgeon General, USAF/SGJ, reviewed applicant's request and states that she is not entitled to reimbursement for travel related to elective care.  Neither she nor her husband should have been placed on TDY orders, or reimbursed even partially for travel expenses.  Other options were made available to her, yet she chose to travel for her care.  The fact that her care was "authorized" does not affect her travel status.

She is precluded from recovery by the Federal Tort Claims Act by the Feres Doctrine for allegations of tort against the Air Force.  Any relief, if appropriate would have to be found administratively.  There were no statements to support or contradict her contentions concerning what she was told or led to believe.  If given the benefit of the doubt, however, there would still be no justification for travel reimbursement for this care, nor is there any justification for any reimbursement for her husband (who should be a separate party from this action).  The Air Force medical system is not one in which beneficiaries can pick and choose an "ideal" facility they would like to be treated in and then expect the government to reimburse them for the expenses of travel, especially in the case of elective care and sequelae of that care.

However, if the Medical Treatment Facility (MTF) at Altus AFB, were to make a declaration that the care she received was urgently needed, that care could only be provided by a sub-specialist not locally available, that such sub-specialist used was the most reasonably expedient one under the circumstances, and that military transport was not readily available; then it may be appropriate to consider travel funding consistent with normal TDY reimbursement (see Exhibit G).

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APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

Copies of the Air Force evaluations were forwarded to the applicant on 24 Aug 01 and the USAF/SGJ evaluation was forwarded to her on 3 Oct 01, for review and response within 30 days.  As of this date, this office has received no response.

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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 a probable injustice.  Given the circumstances of this case, it appears that she was properly compensated for her travel expenses.  Nonetheless, in light of the Air Force advisory opinions that opined differing assessments of her entitlements and the conflicting information that was provided to the applicant, the Board majority believes that an injustice may exist; and accordingly, it would be in the best interest of the Air Force and the applicant to favorably consider her request.  We note that the applicant seeks reimbursement for expenses her military spouse incurred as a non-medical attendant.  However, without a formal application from her military spouse, we are unable to act upon that portion of her request.  Therefore, it is the Board majority's opinion that in order to provide her fair and equitable relief her records should be corrected as indicated below. 

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THE BOARD RECOMMENDS THAT:

The pertinent military records of the Department of the Air Force relating to APPLICANT be corrected to show that competent authority determined that the medical treatment she received at Andrews AFB, MD, during the period of 9 February 2001 through 15 February 2001, was urgently needed, care could only be provided by a sub-specialist that was not locally available, care at the Andrews AFB Medical Treatment Facility (MTF) was the most reasonably expedient means under the circumstances; and, that military transport was not readily available.

It is further recommended that she be entitled to full reimbursement of travel expenses that she incurred which are normally authorized for TDY travel related to non-elective medical care.

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The following members of the Board considered this application in Executive Session on 27 Nov 01, under the provisions of AFI 36‑2603:

Panel Chair
     Member
Member

The Board majority voted to correct the record, as recommended.  Mr. Baxter voted to deny the applicant’s request but elected not to submit a minority report.  The following documentary evidence was considered:

     Exhibit A.  DD Form 149, dated 4 Apr 01, w/atchs
     Exhibit B.  Applicant's Master Personnel Records
     Exhibit C.  Letter, USAF/DPRCC, dated 18 May 01
     Exhibit D.  Letter, BCMR Medical Consultant, dated 26 Jun 01
     Exhibit E.  Letter, USAF/SGMA, dated 17 Aug 01
     Exhibit F.  Letter, SAF/MRBR, dated 24 Aug 01
     Exhibit G.  Letter, USAF/SGJ, dated 27 Sep 01
     Exhibit H.  Letter, SAF/MRBC, dated 3 Oct 01

                                  
                                  Acting Panel Chair

AFBCMR 01-01032

MEMORANDUM FOR THE CHIEF OF STAFF

	Having received and considered the recommendation of the Air Force Board for Correction of Military Records and under the authority of Section 1552, Title 10, United States Code (70A Stat 116), it is directed that:

	The pertinent military records of the Department of the Air Force relating to APPLICANT, be corrected to show that competent authority determined that the medical treatment she received at Andrews AFB, MD, during the period of 9 February 2001 through 15 February 2001, was urgently needed, care could only be provided by a sub-specialist that was not locally available, care at the Andrews AFB Medical Treatment Facility (MTF) was the most reasonably expedient means under the circumstances; and, that military transport was not readily available.

	It is further directed that she be entitled to full reimbursement of travel expenses incurred which are normally authorized for TDY travel related to non-elective medical care.

							
							Director
							Air Force Review Boards Agency