IN THE CASE OF: BOARD DATE: 20 April 2022 DOCKET NUMBER: AR20220003444 THE BOARD CONSIDERED THE FOLLOWING EVIDENCE: 1. Application for correction of military records and the following evidence submitted by the applicant: * NGB Form 22 (National Guard Report of Separation and Record of Service) for the period ending 30 April 2014 * NGB Form 23A (Army National Guard Current Annual Statement) dated 5 May 2014 * Service Treatment Records * Memorandum for U.S. Army Human Resources Command (AHRC), dated 7 May 2019, subject: Unqualified Resignation for [Applicant] * Memorandum for AHRC, dated 7 May 2019, subject: Unqualified Resignation for [Applicant] endorsed by battalion commander * Memorandum for AHRC, dated 7 May 2019, subject: Unqualified Resignation for [Applicant] endorsed by brigade commander * Memorandum from AHRC, dated 27 June 2019, subject: Separation – Unqualified Resignation * DA Form 1506 (Statement of Service – For Computation of Length of Service for Pay Purposes * Officer Record Brief dated 29 September 2019 * Orders Number 274-2202 dated 1 October 2019 * DD Form 214 (Certificate of Release or Discharge from Active Duty) for the period ending 1 October 2019 * DD Form 215 (Correction to DD Form 215 – Certificate of Release or Discharge from Active Duty) * Civilian Medical Treatment Records * Department of Veterans Affairs (DVA) Rating Decision dated 23 December 2021 2. The applicant states, in effect, prior to his discharge from the Regular Army he experienced abdominal pain and sought medical treatment on or about 13 June 2018. He was seen multiple times by medical providers at his military installation. He was discharged from the Regular Army effective 1 October 2019 after submitting his request for an unqualified resignation through his chain of command. Post service he was diagnosed with stage IV colon cancer. The DVA in their rating decision on 23 December 2021 stated, "Colon cancer onset during active duty, based on in-service symptoms of stomach pain; therefore, service connection is established on a direct basis.” He is currently rated 100 percent disabled by the DVA. He states, in effect, he suffers from an injustice because medical providers within the Defense Health Agency failed to properly diagnosis his colon cancer. He believes he suffers from a gross medical error due to the failure of the military health system. His metastatic colon cancer clearly developed while he was on active duty and that it existed at the time of his discharge. He opines he prepared his request for discharge under the premise he was fit to leave active service. Based on his diagnosis shortly after he was discharged and the subsequent DVA rating wherein DVA stated his colon cancer was directly related to his service, he requests correction to his record to show he was placed on the PDRL with a disabling rating of 100 and entitlement to retroactive medical retired pay. He states, The error in my military discharge has prevented me from receiving retired pay, denied proper access to TRICARE medical coverage, and prevented SBP [Survivor Benefit Plan] coverage for my spouse and young son. Not only is this injustice ongoing, but correcting my discharge expeditiously is of critical importance given the terminal nature of my diagnosis and life expectancy averaging less than 33 months. 3. With prior service in the United States Marine Corps and the Army National Guard of the United States (ARNGUS), the applicant accepted an appointment in the Regular Army in the Medical Service Corps. Prior to his discharge from the Minnesota Army National Guard, he received NGB Form 23a (ARNG Current Annual Statement) dated 5 May 2014 showing he had 17 years of creditable service for non-regular retired pay. 4. In reviewing his personnel record he deployed to Afghanistan, Iraq and Kuwait. He is the recipient of the Combat Action Badge and two Air Medals. He served as an aviation operations specialist and helicopter pilot. 5. On 29 April 2014 AHRC issued him Orders Number A-04-404097 ordering him to active duty in the rank of second lieutenant (2LT)/pay grade O-2. He was ordered to report to Fort Sam Houston, Texas on 13 June 2014 for a period of 44 days. After completing the Medical Services Corps Basic Officer Leader Course, he was to report to Uniformed Services University of the Health Sciences (USUHS) to attend medical school no later than 1 August 2014. 6. Upon his arrival at Fort Sam Houston, Texas, he and a witness completed DA Form 71 (Oath of Office – Military Personnel) on 13 June 2014. He was commissioned into the Regular Army in the Medical Service Corps as a 2LT. Concurrently, he also was counselled and completed USAREC Form 1223 (Department of the Army Service Agreement F. Edward Herbert Armed Forces Uniformed Services University of Health Sciences). Within this agreement, he agreed to: * Incurring an active duty service obligation (ADSO) of not less than 7 years upon graduation from USUHS, unless sooner released * Understanding under no condition would he be released from active duty until he had served a minimum of 2 years following completion of any period of graduate professional education except when his release is determined by the Army to be in the best interest of the Government * Understanding that his prior active duty service and any period of time spent as a military intern or residency training was not creditable for satisfying his USUHS program obligation * That, if he failed to complete the education requirements specified in his agreement, he would serve on active duty for the period specified in this agreement 7. As directed, he reported to the USUSH and began his first year of medical school on or about 25 August 2014. His personnel record contains two DA Forms 1059 (Service School Academic Evaluation Report) documenting his successful completion of 2 years of medical school. His third DA Form 1059 shows he started his third year of medical school and that he was achieving course standards when he submitted his resignation to the Dean of the School of Medicine. On 14 September 2016 he was officially disenrolled from USUHS while in good academic standing. 8. On 16 December 2016 he received permanent change of station orders directing his reassignment to Camp Humphrey, Korea with a reporting date of 1 March 2017. He was directed to attend a specified course on medical evacuation doctrine prior to reporting to Korea. Within this order it states he would incur an ADSO for a period of 1 year based on accepting an overseas tour. 9. Upon completion of his tour of duty in Korea, he was reassigned to Fort Benning, Georgia with a projected reporting date of 11 January 2018. His orders, Orders Number 326-3301, further state he would incur a 1 year ADSO for moving to a continental United States location. 10. Accordingly, he reported to Fort Benning, Georgia and was assigned as a helicopter pilot to a medical evacuation company. 11. On or about 24 July 2019 he and a Department of the Army Civilian nurse practitioner completed DD Form 2697 (Report of Medical Assessment). He stated that compared to his last medical assessment/physical examination that his health was the same. In pertinent part, * Block 11 – he did not have any illness or injury that caused him to miss duty longer than 3 days * Block 12 – since his last medical assessment/physical examination he had not been seen or treated by a health care provider, admitted to the hospital or had surgery * Block 14 – he was not taking any medications * Block 15 – he did not have any conditions limiting his ability to work in his primary military specialty or that required geographic or assignment limitations * Block 17 – he did not have any questions or concerns about his health * Block 18 – he did not intend to seek DVA disability [compensation] * Block 21 – the nurse practitioner did not refer the applicant for further medical evaluation 12. He also completed DD Form 2807-1 (Report of Medical History) indicating he did have frequent indigestion or heartburn involving his stomach, liver, intestines or a possible ulcer. He further indicated he felt he was in good health except he had trouble sleeping. A nurse practitioner recorded that fact stating he was treated with proton pump inhibitors [reducing the production of acid in his stomach] and underwent a scope of his stomach which did not reveal ulcers. 13. After reviewing the applicant’s medical history, the nurse practitioner conducted a medical examination completing DD Form 2808 (Report of Medical Examination). She indicated he did have problems with his lower extremities. His left knee had decreased range of motion. For his upper extremities, his left hand, third and fourth fingers also had a decreased range of motion. No abdominal abnormalities were identified. The nurse practitioner found him qualified for continued service or separation under Army Regulation 40-501 (Standards of Medical Fitness). 14. On 8 July 2019, Headquarters, U.S. Army Garrison, Fort Benning, Georgia issued him Orders Number 189- reassigning him to the separation transfer point and subsequently discharging him from the Regular Army effective 1 October 2019. 15. On 1 September 2019 he was promoted to captain (CPT)/pay grade O-3. 16. Orders Number 189- were revoked and new orders were published on 1 October 2019. His new order, Orders Number 274-2202, shows his standard name line with his new rank. 17. As ordered on 1 October 2019 he was honorably discharged from the Regular Army. During this period of active service, he served 5 years, 3 months, and 19 days. His DD Form 214 shows his prior active service was 9 years, 3 months and 8 days with 7 years, 10 months and 27 days of inactive service. The authority for his separation is shown as Army Regulation 600-8-24 (Officer Transfers and Discharges), paragraph 3-5 (Rules for processing unqualified resignation) and his narrative reason was for miscellaneous/general reasons. 18. The applicant provides the following evidence that has not been previously discussed within this record of proceedings. a. Service treatment records showing he sought medical care for abdominal pain on numerous occasions starting on or about 13 June 2018. He described having a sense of discomfort in the epigastric area. A medical doctor’s diagnosis was gastro-esophageal reflux disease without esophagitis. He was prescribed medication to relieve the discomfort. During a 22 August 2018 medical appointment he stated he continued to have abdominal discomfort which interfered with his ability to run. His medical provider referred him to gastroenterology clinic for follow-up assessment and treatment. b. During his gastroenterology clinic appointment, he described his general stomach pains with onset on or about June 2018. He saw some improvement with proton pump inhibitors medication. Upon examination the medical doctor recorded, "No mass was palpated in the abdomen." The medical doctor ordered an esophagogastroduodenoscopy (EGD) to examine the lining of the applicant’s esophagus, stomach, and duodenum. c. On 11 October 2018 he underwent a Class 2 Short Flight Physical with no disqualifying defects discovered though he was pending an EGD on or about 7 November 2018. He was given a temporary physical profile but it did not affect his flight duties. (There is no evidence he was issued a permanent physical profile for his abdominal pain.) d. On 7 November 2018 he had the EGD. The medical doctor stated the esophagus, stomach and duodenum were examined and no abnormalities were seen. A biopsy was taken and the results showed he had gastritis, a benign inflammation of his stomach, and there was no evidence of infection with Helicobacter pylori. The pathology report stated his biopsy sample was negative for metaplasia, dysplasia, or malignancy. f. On 7 May 2019 he submitted his written request to tender an unqualified resignation from the Army under Army Regulation 600-8-24, chapter 3, section II with a projected discharge date of 1 October 2019. He stated he had fulfilled his ADOS and he was tendering his resignation to pursue a civilian career. He had completed his military service obligation and he did not desire an appointment in the U.S. Army Reserve. His battalion commander and brigade commander favorably endorsed his request to tender his unqualified resignation. g. On 27 June 2019 AHRC approved his request and issued separation instructions stating he would be honorably separated under Army Regulation 600-8-24, chapter 3, section II and his separation program designator code was FND. In conjunction with this personnel action, a DA Form 1506 was prepared showing he had 22 years, 5 months and 24 days of creditable service for pay purposes. h. He continued seeking medical treatment for his abdominal pain up until his date of separation providing service treatment records to support his contentions. i. He provides his civilian treatment records and hospital records showing he had abdominal surgery on or about 14 October 2021 to remove a perforated cecal mass. The pathology report shows he has invasive colon adenocarcinoma with 26 lymph nodes showing they were negative for cancer. Of note, the tumor had invaded through the bowel wall, small bowel, appendix and omentum. The mass measured approximately 13.5 centimeters. He started chemotherapy treatments. j. On 23 December 2021 the DVA issued him their rating decision informing him his colon cancer status post hemicolectomy with metastasis to peritoneum, small bowel, appendix and omentum was granted with an evaluation of 100 percent effective 21 October 2021. He also was entitled to special monthly compensation. 19. As the applicant is requesting entry into the disability evaluation system with a subsequent finding of medical retirement for colon cancer, his application and its supporting evidence were reviewed by the Army Review Boards Agency medical officers. The medical doctors are clinically licensed and authorized to practice medicine with the Department of the Army/Defense Health Agency. After their review, they prepared an advisory for the Board’s review. See "MEDICAL REVIEW." 20. Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation) prescribes the Army Disability Evaluation System and sets forth policies, responsibilities, and procedures that apply in determining whether a Soldier is unfit because of physical disability to reasonably perform the duties of his office, grade, rank, or rating. Unless reserved for higher authority, the U.S. Army Physical Disability Agency approves disability cases for the Secretary of the Army and issues disposition instructions for Soldiers separated or retired for physical disability. (This includes cases referred into the disability evaluation system by the ABCMR.) 21. The Army rates only conditions determined to be physically unfitting at the time of discharge, which disqualify the Soldier from further military service. The Army disability rating is to compensate the individual for the loss of a military career. The VA does not have authority or responsibility for determining physical fitness for military service. The VA may compensate the individual for loss of civilian employability. 22. Title 38, USC, Sections 1110 and 1131, permit the VA to award compensation for disabilities which were incurred in or aggravated by active military service. However, an award of a VA rating does not establish an error or injustice on the part of the Army. 23. Title 38, Code of Federal Regulation, Part IV is the VA’s schedule for rating disabilities. The VA awards disability ratings to veterans for service-connected conditions, including those conditions detected after discharge. As a result, the VA, operating under different policies, may award a disability rating where the Army did not find the member to be unfit to perform his duties. Unlike the Army, the VA can evaluate a veteran throughout his or her lifetime, adjusting the percentage of disability based upon that agency's examinations and findings MEDICAL REVIEW: 1. The Army Review Boards Agency (ARBA) Medical Advisor was asked to review this case. Documentation reviewed included the applicant’s ABCMR application and accompanying documentation, the military electronic medical record (AHLTA), the VA electronic medical record (JLV), the electronic Physical Evaluation Board (ePEB), the Medical Electronic Data Care History and Readiness Tracking (MEDCHART) application, and the Interactive Personnel Electronic Records Management System (iPERMS). The ARBA Medical Advisor made the following findings and recommendations: a. The applicant is applying to the ABCMR requesting referral to the Disability Evaluation System so that he may receive a permanent retirement for physical disability. He states: I am requesting a retroactive medical disability retirement from the U.S. Army Active Component and placement on the Permanent Disability Retirement List (PDRL) due to the failure of the Military Health System to properly diagnose stage IV (4), metastatic colon cancer that clearly existed at the time of my discharge. As a result of this gross medical oversight, I was discharged without medically necessary MEB or PEB proceedings and under the erroneous assumption that I was 'completely physically fit and qualified for release from active duty.' b. This Record of Proceedings outlines the applicant’s military service and the circumstances of his case. The applicant’s DD 214 for the period of service under consideration shows he entered the regular Army on 13 June 2014 and was honorably discharged on 1 October 2019 under the separation authority provided by paragraph 3-5 of AR 600-8-24 (Officer Transfers and Discharges: Unqualified Resignations). c. A former aeromedical evacuation officer, he voluntarily requested to resign his commission in a 7 May 2019 memorandum to the commander of the U.S. Army Human Resourced Command (AHRC): I, (Applicant), 1LT, MS, xxx-xx-xxxx, tender my unqualified resignation from the Army under the provisions of AR 600-8-24, Chapter 3, section II to be effective 1 October 2019 or as soon as practicable thereafter. d. His chain of command supported his request and it was approved by the AHRC on 27 June 2019. He was discharged as requested on 1 October 2019. e. The applicant underwent a complete pre-separation medical evaluation on 29 July 2019. The Report of Medical History (DD Form 2807) and Report of Medical Examination (DD Form 2808) show the applicant was in good health and without any significant medical conditions other than a decrease in the range of motion of his left knee and the 3rd and 4th fingers of his left hand. f. Documentation shows the applicant underwent evaluation for epigastric pain in 2018. From a 27 September 2018 gastroenterology AHLTA encounter: (1) 38-year-old male here for evaluation of new onset epigastric abdominal pain. He describes the pain as gnawing in character and better with eating. No melena or hematochezia, no nausea or vomiting. No unintentional weight loss. History of heavy non-steroidal anti-inflammatory drugs (NSAID) use but none for several months prior to onset of pain. Pain has occurred over the last 3-4 months and after a 90-day course of proton pump inhibitor (PPI), pain is about 60-70 percent improved. He is avoiding NSAIDs. No hematemesis. (2) Epigastric pain: 38-year-old male with new onset epigastric abdominal pain better with food concerning for peptic ulcer disease. Initial improvement with PPI but persistent pain. Therefore, recommend EGD to rule out ulcer, gastritis, Helicobacter pylori (H. pylori). g. The endoscopy, performed on 7 November 2018, was normal. The applicant was not seen again for this or other abdominal related complaints prior to discharge. h. There is no evidence the applicant had any medical condition which would have failed the medical retention standards of chapter 3, Army Regulation 40-501 prior to his discharge. Thus, there was no cause for referral to the Disability Evaluation System. Furthermore, there is no evidence that any medical condition prevented the applicant from being able to reasonably perform the duties of his office, grade, rank, or rating prior to his discharge. i. The DES compensates disabilities when they cause or contribute to career termination. Paragraph 3-2b of Army Regulation 635-40 dated 20 March 2012 states: 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. j. Review of his records in JLV shows he was awarded multiple VA service connected disability ratings, including one for malignancy. However, the DES compensates an individual only for service incurred medical condition(s) which have been determined to disqualify him or her from further military service. The DES has neither the role nor the authority to compensate Servicemembers for anticipated future severity or potential complications of conditions which were incurred or permanently aggravated during their military service; or which did not cause or contribute to the termination of their military career. These roles and authorities are granted by Congress to the Department of Veterans Affairs and executed under a different set of laws. k. It is the opinion of the Agency Medical Advisor that a referral of his case to the DES not is warranted. CONSIDERATION OF ADDITIONAL EVIDENCE: 24. On 13 April 2022 new information was received from the applicant’s spouse in regard to the decision of the ABCMR in Docket Number AR2022000, dated 21 March 2022. 25. The applicant’s spouse stated the applicant remains in the hospital and that he is now available by telephone to discuss his application. [He requested a personal appearance hearing before the Board within his initial application identified as AR2022000.] She submitted new medical evidence requesting its incorporation into his case file. As his initial application was finalized, yet not mailed, the Director, ABCMR requested preparation of a supplemental Record of Proceedings. 26. The evidence submitted consists of a surgical pathology report prepared on 11 April 2022. This pathology report states the applicant has adenocarcinoma (colon cancer) with extensive extracellular marcin pools (a surrogate marker of response to treatment and down staging) in, near or around the following organs: spleen with retroperitoneal mass, splenectomy; soft tissue, retroperitoneal nodule, excision; soft tissue, sigmoid colon nodule, excision with extensive extracellular mucin pools; peritoneum, over bladder, excision; peritoneum, right iliac, excision; soft tissue, sigmoid colon nodule Number 2, excision; soft tissue, small bowel nodule, excision; soft tissue, sigmoid colon epiploic nodule, excision; sigmoid colon, resection; and, peritoneum, right lower quadrant nodule, excision. 27. Based upon the nature of the additional evidence submitted, the ARBA medical staff provided an additional medical review for the Board members. See ?SUPPLEMENTAL MEDICAL REVIEW? section. SUPPLEMENTAL MEDICAL REVIEW: 1. The ARBA Medical Advisor was asked to review this case. Documentation reviewed included the applicant’s ABCMR application and accompanying documentation, the military electronic medical record (AHLTA), the VA electronic medical record (JLV), the electronic Physical Evaluation Board (ePEB), the Medical Electronic Data Care History and Readiness Tracking (MEDCHART) application, and/or the Interactive Personnel Electronic Records Management System (iPERMS). The ARBA Medical Advisor made the following findings and recommendations: a. The applicant is requesting the ABCMR reconsider their prior denial of his request for referral to the Disability Evaluation System so that he may receive a permanent retirement for physical disability. He stated in the initial application: I am requesting a retroactive medical disability retirement from the U.S. Army Active Component and placement on the Permanent Disability Retirement List (PDRL) due to the failure of the Military Health System to properly diagnose stage IV (4), metastatic colon cancer that clearly existed at the time of my discharge. As a result of this gross medical oversight, I was discharged without medically necessary MEB or PEB proceedings and under the erroneous assumption that I was “completely physically fit and qualified for release from active duty.” The Record of Proceedings and prior denial (11 April 2022; AR2022000) outline the applicant’s military service and the circumstances of the case. The applicant’s DD 214 for the period of Service under consideration shows he entered the regular Army on 13 June 2014 and was honorably discharged on 1 October 2019 under the separation authority provided by paragraph 3-5 of AR 600-8-24, Officer Transfers and Discharges: Unqualified Resignations. b. A former Armor Officer, he voluntarily requested to resign his commission in a 7 May 2019 memorandum to the Commander of the U.S. Army Human Resourced Command (USA HRC): “I, [applicant], 1LT, MS, xxx-xx-xxxx, tender my unqualified resignation from the Army under the provisions of AR 600-8-24, Chapter 3, section II to be effective 1 OCTOBER 2019 or as soon as practicable thereafter.” c. His chain of command supported his request and it was approved by the USA HRC on 27 June 2019. The former Officer was discharged as requested on 1 October 2019. d. The applicant was first seen for epigastric discomfort on 13 June 2018. The upper part of your abdomen, which sits below your rib cage, is known as the epigastrium. Following his examination, the flight physician (aka flight surgeon) opined: Gastro-esophageal reflux disease without esophagitis: Epigastric discomfort possibly consistent with peptic acid disease. I have given him Aciphex to take daily. We discussed other measures to limit symptoms. I have done a lab for Helicobacter pylori and will contact him if it's positive. He will follow-up in one week if symptoms have not resolved. Aciphex, like Prilosec, is a proton pump inhibitor. These drugs decrease the amount of acid in your stomach by inhibiting a chemical system called the hydrogen-potassium adenosine triphosphatase enzyme system (otherwise known as the 'proton pump'). This chemical system is found in the cells in the stomach lining that make stomach acid. e. At his follow-up appointment with his flight surgeon on 13 July 2018: “Patient states that since he started taking the PPI 4 weeks ago, his epigastric discomfort has dramatically improved. He has no symptoms during the day. He says when he first wakes up in the morning he occasionally gets some epigastric discomfort until he eats.” That the applicant’s symptoms had markedly improved from use of a medication which lowers the amount of stomach acid, and were improved with food (which dilutes and possibly buffers the acid in the stomach) suggested the applicant may have had ulcer disease. These findings would not be consistent with a bowel tumor. f. He was seen for persistent mild symptoms on 22 August 2018: “Patient is in for follow-up on epigastric discomfort and suspected ulcer. He continues to take the PPI. He says he is better overall but symptoms just will not go away. He has a continued epigastric discomfort.” His flight surgeon ordered multiple laboratory studies and referred the applicant to gastroenterology. g. The results of the blood based laboratory studies are not in AHLTA. The applicant did submit three stool samples, all of which were negative for occult blood. These tests for occult fecal blood are the most common screening test for cancer of the large intestine, and typically done in sets of three to increase sensitivity of the test. h. The applicant was seen by gastroenterology on 27 September 2018. From that AHLTA encounter: 38-year-old male here for evaluation of new onset epigastric abdominal pain. He describes the pain as gnawing in character and better with eating. No melena or hematochezia [blood in one’s stool], no nausea or vomiting. No unintentional weight loss. History of heavy NSAID [nonsteroidal anti-inflammatory drug, e.g. ibuprofen and naproxen] use but none for several months prior to onset of pain. Pain has occurred over the last 3-4 months and after a 90-day course of PPI [proton pump inhibitor], pain is about 60-70% improved. He has been avoiding NSAIDs. No hematemesis. Epigastric pain: 38-year-old male with new onset epigastric abdominal pain better with food concerning for peptic ulcer disease. Initial improvement with PPI but persistent pain. Therefore, recommend EGD [esophagogastroduodenoscopy] to rule out ulcer, gastritis, H. pylori. i. The endoscopy, performed 7 November 2018, was normal. Biopsies obtained during the endoscopy revealed mild chronic inactive gastritis. They were negative for metaplasia, dysplasia, or malignancy. No helicobacter pylori, an infectious bacterium associated with ulcers, were identified. The applicant was not seen again for epigastric symptoms or other abdominal related complaints prior to discharge in October 2019. j. The applicant underwent a complete pre-separation medical evaluation on 29 July 2019. On his Report of Medical History (DD Form 2807-1), the applicant marked “Yes” to the question “Have you ever had or do you now have stomach, liver, intestinal trouble, or ulcer?” He wrote “Was treated with PPI and had a scope which did not reveal ulcers.” The provider commented “Pt [patient] reports symptoms is {sic} still lingering.” While he may have been taking over the counter medication at his own cost, AHLTA shows he last filled prescriptions for ranitidine (Zantac) and omeprazole (Prilosec) on 13 October 2018. Prilosec is a PPI. k. The accompanying Report of Medical Examination (DD Form 2808) showed the applicant to be in good health and without any significant medical conditions other than a decrease in the range of motion of his left knee and the 3rd and 4th fingers of his left hand. Examination of his abdomen and viscera, and of his anus and rectum, were noted as normal. His urinalysis was normal. Blood based laboratory studies were negative for hepatitis C and revealed a normal lipid panel and fasting glucose. His hemogram with automatic differential was normal except for a mildly decreased hematocrit of 41.5% (normal 42-52). His hemoglobin, the second study of red blood cell quantity, was normal. Studies of the quality of his red blood cells were also normal. The applicant was found qualified for separation l. On 14 October 2021, the applicant presented to an emergency room for an acute onset of abdominal pain. The applicant underwent an emergent exploratory laparotomy at which time he was found to have a perforated cecal mass in the right lower abdominal quadrant with a pelvic abscess, and abnormal tissues implanted in the linings of his abdomen. The applicant subsequently underwent a right hemicolectomy, drainage of the pelvic abscess, and resection of some omental implants. Pathological evaluation of the resected right hemicolon and omental implants revealed invasive colonic adenocarcinoma with a tumor which had invaded through and perforated the bowel wall, and metastatic spread in the abdominal cavity. m. The pathology report for 16 surgical specimens obtained on 7 April 2022 again showed metastatic adenocarcinoma in the abdomen. n. There is no evidence the applicant had any medical condition which would have failed the medical retention standards of chapter 3, AR 40-501, Standards of Medical Fitness (27 June 2019), prior to his voluntary discharge. Thus, there was no cause for referral to the Disability Evaluation System. Furthermore, there is no evidence that any medical condition prevented the applicant from being able to reasonably perform the duties of his office, grade, rank, or rating prior to his discharge. o. While there is no probative evidence the applicant had colon cancer prior his discharge, for completeness, paragraph 3-34 of AR 40-501 states that malignant neoplasms are a cause for referral to the DES only when they “are unresponsive to therapy or when therapy is such as to require prolonged, intensive medical supervision, or when the residuals of treatment themselves meet the definition of a disqualifying medical condition or physical defect.” p. Paragraph 5a in appendix 2 to enclosure 3 of Department of Defense Instruction 1332.18 SUBJECT: Disability Evaluation System (DES), 5 August 2014 states “The DES compensates disabilities when they cause or contribute to career termination. Service members who are pending retirement at the time they are referred for disability evaluation are presumed fit for military service.” q. This concept is incorporated in paragraph 4-1c(2) of AR 635-40, Physical Evaluation for Retention, Retirement, or Separation (19 January 2017). It states that one of the objectives of the DES is to “Provide benefits for eligible Soldiers whose military Service is terminated because of a disability incurred in the LOD (line of duty).” r. Review of his records in JLV shows he has been awarded multiple VA service connected disability ratings, including one for malignancy. However, the DES compensates an individual only for service incurred medical condition(s) which have been determined to disqualify him or her from further military service. The DES has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions which were incurred or permanently aggravated during their military service; or which did not cause or contribute to the termination of their military career. These roles and authorities are granted by Congress to the Department of Veterans Affairs and executed under a different set of laws. 2. It is the opinion of the Agency Medical Advisor that a referral of his case to the DES remains unwarranted. ADDITIONAL DISCUSSION AND CONCLUSIONS: 1. After reviewing the application and all supporting documents, the Board found that relief was not warranted. The Board carefully considered the applicant's record of service, documents submitted in support of the petition and executed a comprehensive and standard review based on law, policy and regulation. After a subsequent Board review of the applicant’s application, his medical records, personnel records, DVA records and new evidence submitted by his spouse on 13 April 2022, the Board concurred with the ARBA Medical Advisor and found the applicant does not meet the regulatory criteria for referral to the DES. 2. The applicant voluntarily submitted his request to resign his officer commission after serving as an aeromedical evacuation pilot. His voluntary request was approved by AHRC. Prior to his voluntary discharge, he underwent the pre-separation medical evaluation on 29 July 2019. He did indicate he had undergone treatment for stomach, liver, intestinal trouble or ulcers. He was prescribed medication. The last date he requested medication refills for various proton pump inhibitors that reduce the acid in the stomach was 13 October 2018. A flight surgeon (medical doctor) diagnosed the applicant with gastro-esophageal reflux disease without esophagitis. 3. He underwent a medical examination prior to his discharge. A medical provider found the applicant to be in good health and without any significant medical conditions that would warrant entry into the DES. He was found qualified for separation or retention in the Army under Army Regulation 40-501. The medical advisory provides sufficient details showing an examination of his abdomen and viscera, and his anus and rectum were all normal. His urinalysis was normal and his blood based laboratory studies were normal though he had a mildly decreased hematocrit. His red blood cells were also normal. He also had stool samples analyzed and the laboratory reports show he had no blood in his stool. As noted by the ARBA Medical Advisor, “These tests for occult fecal blood are the most common screening test for cancer of the large intestine, and typically done in sets of three to increase sensitivity of the test. 4. The intent of the DES is to provide benefits to eligible Soldiers whose military service is terminated because of a disability that is incurred in the line of duty. There is no evidence showing the applicant was not able to perform his military occupational duties or the duties of a Soldier in his rank or grade. He continued serving as an aeromedical evacuation pilot meeting the stringent flight physical fitness standards until he submitted a voluntary request requested to resign his commission. 5. As he met medical retention standards of Army Regulation 40-501, he was allowed to administratively separate from the Army on 1 October 2019. Having completed his statutory military service obligation, he was voluntarily discharged under Army Regulation 600-8-24. 6. The applicant provided no evidence supporting his contention the Army medical staff committed an error by not entering him into the DES after undergoing his separation medical examination. Nearly 2 years after his separation, he sought emergency medical treatment for acute onset of abdominal pain. During his course of treatment in October 2021, he received a diagnosis of invasive colonic adenocarcinoma with a tumor that had perforated the bowel wall, and metastatic spread in his abdominal cavity. The surgical pathological reports dated 7 April 2022 continues to show metastatic adenocarcinoma of his abdomen. This new evidence does not demonstrate the Army medical staff committed an error during his separation medical examination in 2019. 7. There is no evidence the applicant had any medical condition which would have failed the medical retention standards of chapter 3, AR 40-501, Standards of Medical Fitness (27 June 2019), at the time of his voluntary discharge. Therefore, there was no cause for referral to the Disability Evaluation System. Furthermore, there is no evidence that any medical condition prevented the applicant from being able to reasonably perform the duties of his office, grade, rank, or rating prior to his discharge. 8. Army Regulation 40-501 states that malignant neoplasms are a cause for referral into the DES only when they are nonresponsive to therapy or when therapy requires prolonged, intensive medical supervision, or when the residuals of treatment themselves meet the definition of a disqualifying medical condition or physical defect. A medical diagnosis of cancer does not require immediate entry into the DES. Based on this, the Board determined relief was not warranted and denied relief to reverse the previous ABCMR decision. 9. The Board acknowledges the applicant’s request to have a personal hearing before the Board. In reviewing his evidence and medical records available to the Army Review Boards Agency medical advisors who are medical doctors, there is sufficient evidence for the Board to make a recommendation to the Secretary of the Army or his designee without a personal appearance hearing. BOARD VOTE: ________ ________ ________ GRANT FULL RELIEF ________ ________ ________ GRANT PARTIAL RELIEF ________ ________ ________ GRANT FORMAL HEARING X X X DENY APPLICATION BOARD DETERMINATION/RECOMMENDATION: The Board determined that the evidence presented was insufficient to warrant amendment of the decision of the Army Board for Correction of Military Records set forth in Docket Number AR2022000 dated 11 April 2022, to show applicant met the regulatory criteria for referral to the Disability Evaluation System (DES). I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case. ABCMR Supplemental Record of Proceedings (cont) AR20220003444 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1