RECORD OF PROCEEDINGS

IN THE MATTER OF:	DOCKET NUMBER: BC-2019-04560

XXXXXXXX	COUNSEL: NONE
	
	HEARING REQUESTED: NO

APPLICANT’S REQUEST

He be placed on Medical Continuation (MEDCON) orders for the period 6 Jun 16 thru 5 Jun 17.

By amendment at Exhibit E, he be placed on MEDCON orders for the period 9 Nov 16 thru 5 May 17.

APPLICANT’S CONTENTIONS

MEDCON orders were not made available for a line of duty (LOD) condition, which led to financial hardship.  In Mar 16, he was treated in the deployed location, and on 5 May 16, the LOD condition was reported to Guard Medical Unit (GMU), within 72 hours of return to home station.  The LOD Program Manager received the signed LOD from the medical provider on 16 Jun 16; but, failed to track the progress until Apr 17.  The finalized approved LOD was not signed until 26 Apr 17, which led to the delay in care.    

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

STATEMENT OF FACTS

The applicant is a technical sergeant (E-6) in the Air National Guard.

For more information, see the excerpt of the applicant’s record at Exhibit B and the advisory at Exhibit C.

AIR FORCE EVALUATION

AFPC/DPFA, recommends denying the application.  At no time during the time requested by the applicant did he meet all MEDCON eligibility criteria.  This is largely based upon the fact the LOD was not finalized until 26 Apr 17.  By this time, the medical plan of care provided by the applicant did not extend beyond 30 days and was therefore not MEDCON eligible.  The applicant states he reported the LOD condition to his GMU on 5 May 16, as was required after treatment in a deployed location in Mar 16.  He states the LOD program manager received the signed LOD from the medical provider on 16 Jun 16 and failed to track the progress of the AF Form 348 until Apr 17, when it was signed by the immediate commander.  Ultimately the LOD was finalized In the Line of Duty (ILOD) on 26 Apr 17.

The applicant would have to meet the specified criteria in accordance with AFI 36-2910, Line of Duty (LOD) Determination, Medical Continuation (MEDCON) and Incapacitation (INCAP) Pay:

1.  A copy of the Airman’s orders covering the period during which the injury, illness, or disease was incurred or aggravated – MET.  It should also be noted the applicant was on orders seven separate times during the requested time period.

2.  An interim or finalized LOD (AF Form 348, Line of Duty Determination, or DD Form 261, Report of Investigation Line of Duty and Misconduct Status) - Partially Met.  The LOD was interim on 17 Apr 17 and final on 26 Apr 17.  Due to the break in orders, the applicant required a finalized LOD to apply for MEDCON.  It should be noted the LOD was initiated on 5 May 16 while he was on MPA orders.

3.  A completed AF Form 469, Duty Limiting Condition Report - Partially Met.  The applicant was profiled (with mobility restriction) for plantar fascial fibromatosis on 9 Nov 16 and remained on this profile until returned to duty (RTD) with Assignment Limitation Code (ALC) C2 as of 1 Nov 17.

4.  A medical evaluation conducted by a credentialed military provider within the last 30 days that describes why the Airman is unable to meet retention or mobility standards, citing a specific paragraph from AFI 48-123, Medical Examinations and Standards, Chapter 5 or 13 - Partially Met.  The applicant submitted follow-up documentation that referred to a surgical procedure for the LOD condition in Oct 16 with continuous rehab through 5 May 17.  No documentation was provided describing the care leading up until that timeframe.  Coupled with the repeated sets of orders during this timeframe, the applicant’s medical condition is not clear.

5.  An individual treatment plan approved by a credentialed military provider based on occupational medicine guidelines and peer-reviewed recovery timelines that includes the expected duration of the impairment - Partially Met (see paragraph 4).

The applicant was seen for heel pain and a diagnosis of plantar fasciitis and pes cavus in May and Jul 17 respectively.  He was then given a corticosteroid injection in the left heel and was also recommended to perform plantar fascial stretching exercises while using heat and ice therapy.  The applicant had a follow-up appointment on 19 Sep 16 for the same condition reporting little improvement with the prescribed therapy.  A repeat corticosteroid injection was performed and he was again counseled on appropriate stretching exercises, icing, contrast therapies and the need for appropriate arch support.  If there was again no improvement, then a pneumatic Cam Walker would be placed and magnetic resonance imaging (MRI) would be recommended.  If he failed conservative management, the plan would be for endoscopic release.  In Oct 16, the applicant underwent a left foot endoscopic plantar fasciotomy.  He experienced relief for about 8 weeks (Dec 16 timeframe) before pain returned and physical therapy (PT) was recommended.

A physician note dated 4 Jan 17 was provided and stated, at that time, he was post 18 weeks endoscopic plantar fasciotomy of his left foot.  He was continuing PT, but was still experiencing pain.  A corticosteroid injection was performed at this visit and continued PT was recommended with a follow-up planned in 4-6 weeks.  A PT re-evaluation note provided dated 7 Mar 17 and recommended skilled physical therapy in conjunction with a home exercise program and overall rehab potential was good.  A physician note provided for a 27 Mar 17 appointment stated the applicant was seen and prescribed a cam walker boot and an estimated return to “physical education” on 17 Apr 17.  A PT progress note submitted from 28 Mar 17 where the applicant reported obtaining an MRI during the previous week (about 21 Mar 17) and found out there were no fractures.  PT re-evaluation was again performed on 7 Apr 17 recommending continued rehab with 2 visits a week for 4 additional weeks (through 5 May 17).

The applicant applied for MEDCON on 13 Apr 17, but his package was declined by the resources branch of Air Reserve Component (ARC) Case Management Division (CMD) as it was administratively incomplete.  Additionally, since there was a break in orders, the LOD needed to be finalized as ILOD.  The LOD was then finalized on 26 Apr 17 and the package was resubmitted and accepted as administratively complete on 26 Apr 17.  The initial MEDCON application was then reviewed by the medical branch on 28 Apr 17 and was unable to validate the case due to a lack of a treatment plan.  The plan of care only went through early May 17 and therefore was not MEDCON eligible (treatment plan must be at least 30 days from MEDCON start date).  It was additionally noted the applicant’s AF Form 469 diagnosis did not match his LOD condition.  The LOD condition represented an acute condition (Plantar Fasciitis), while the profiled condition was Congenital Pes Cavus and Plantar Fascial Fibromatosis, which are chronic conditions.  Finally, the expected recovery timeframe following a plantar fascial release is typically 84 days, while the applicant was approximately 7 months post-op at the time he was applying for MEDCON.  While it was recognized the LOD condition did affect mobility and potentially retention, the medical documentation provided supported it as a chronic condition that is stable and therefore did not meet criteria for MEDCON.  The MEDCON case was disapproved on 1 May 17 and a notification was sent to the applicant.  The applicant was encouraged to reapply should the condition or treatment plan change, but no appeal or new case was submitted in response to the decision.

It should be noted that the LOD was initiated while the applicant was on qualifying orders (5 May 16) and took almost a year to be signed by the immediate commander.  If the Board considers this delay in LOD processing an error or injustice, then the applicant would have met all other MEDCON eligibility criteria from the time he had a mobility restricting profile, 9 Nov 16, through the end of his provided plan of care on 5 May 17.

The complete advisory opinion is at Exhibit C.

APPLICANT’S REVIEW OF AIR FORCE EVALUATION

The Board sent a copy of the advisory opinion to the applicant on 5 May 20 for comment (Exhibit D), and the applicant replied on 2 Jun 20.  In his response, the applicant request his record be corrected to reflect MEDCON orders for the period 9 Nov 16 thru 5 May 17, due to a delay in LOD processing.  In support of his request, the applicant provided email correspondence with the LOD Program Manager, and Commander, confirming the delay in processing was the fault of the Program Manager.  This correspondence further reflects that when the Commander edited the form his original signature date of 22 Jun 16 was changed.  

The applicant’s complete response is at Exhibit E.

FINDINGS AND CONCLUSION

1.  The application was timely filed.

2.  The applicant exhausted all available non-judicial relief before applying to the Board.

3.  After reviewing all Exhibits, the Board concludes the applicant is not the victim of an error or injustice.  The Board concurs with the rationale and recommendation of AFPC/DPFA and finds a preponderance of the evidence does not substantiate the applicant’s contentions.  At no time during the time requested by the applicant did he meet all MEDCON eligibility criteria.  Therefore, the Board recommends against correcting the applicant’s records.

RECOMMENDATION

The Board recommends informing the applicant the evidence did not demonstrate material error or injustice, and the Board will reconsider the application only upon receipt of relevant evidence not already presented.

CERTIFICATION

The following quorum of the Board, as defined in Air Force Instruction (AFI) 36-2603, Air Force Board for Correction of Military Records (AFBCMR), paragraph 1.5, considered Docket Number BC-2019-04560 in Executive Session on 15 Jul 20:

, Panel Chair
, Panel Member
, Panel Member

All members voted against correcting the record.  The panel considered the following:

Exhibit A:	Application, DD Form 149, w/atchs, dated 2 Jul 19.
Exhibit B:	Documentary evidence, including relevant excerpts from official records.
Exhibit C:	Advisory opinion, AFPC/DPFA, dated 4 May 20.
Exhibit D:	Notification of advisory, SAF/MRBC to applicant, dated 5 May 20.
Exhibit E:	Applicant’s response, w/atchs, dated 2 Jun 20.

Taken together with all Exhibits, this document constitutes the true and complete Record of Proceedings regarding AFBCMR Docket Number BC-2019-04560, as required by AFI 36-2603, paragraph 4.11.9.