Opinion ID: 800991
Heading Depth: 2
Heading Rank: 3

Heading: Coburn's MEB Claims

Text: Army Regulation 635-40 establishes the Army Physical Disability Evaluation System. Army Reg. 635-40 ¶ 1-1. The regulation sets forth a specific process governing how the Army determines a soldier's medical qualification for continued service. First, [t]he MTF [Medical Treatment Facility] commander having primary medical care responsibility will conduct an examination of a Soldier referred for evaluation. Id. ¶ 4-9. Second, [i]f it appears the Soldier is not medically qualified to perform duty, the MTF commander will refer the Soldier to a MEB, id., a group composed of two or more physician members, Army Reg. 40-400 ¶ 7-3 (2011). Third, if a soldier is referred to a MEB, a MEB is then convened to document a Soldier's medical status and duty limitations insofar as duty is affected by the Soldier's status, and [a] decision is made as to the Soldier's medical qualification for retention. Army Reg. 635-40 ¶ 4-10; see also Army Reg. 40-400 ¶ 7-1. Under the applicable regulatory process, a MEB referral follows a medical examination; in other words, medical examination and referral to a MEB appear to be distinct steps. It also appears that the doctor who completes the medical examination to determine whether to refer a case to a MEB is not one of the doctors who serves as a member of the MEB. Once a MEB has been initiated, the MEB process generally takes precedence over separation under the QMP: Except in separate actions under Chapter 10 [Discharge in Lieu of Trial by Court-Martial] and as provided in para. 1-33 b, disposition through medical channels takes precedence over administrative separation processing. Army Reg. 635-200 ¶ 1-33(a). When the MTF commander or attending medical officer determines that a Soldier being processed for administrative separation under chapters 7 [Defective Enlistments/Reenlistments and Extensions] (see sec IV) [Fraudulent Entry], or 14 [Separation for Misconduct], does not meet the medical fitness standards for retention . . ., he/she will refer the Soldier to a Medical Evaluation Board (MEB). . . . The administrative separation proceedings will continue, but final action by the separation authority will not be taken, pending the results of MEB. Id. ¶ 1-33(b). The QMP is governed by Chapter 19 of the same regulation. See id. ¶ 19-1. The parties here do not disagree that Coburn could not have been separated pursuant to the QMP if he was involved with a MEB in a matter that was still pending disposition. The Secretary contends that while Dr. Caycedo initiated the MEB, Appellee's Br. at 19, Coburn was never actually referred to the Medical Evaluation Board itself, id. at 58. And during oral argument before this court, counsel for the Secretary argued that while there was no question that the evidence in the record says `MEB initiated,' this was simply loose language to mean the medical disability processing started, not the MEB was referred. Oral Argument at 30:59, 31:30. Under the Secretary's theory of the case, [t]here is no evidence in this record that the Medical Treatment Facility Commander ever referred anything to a Medical Evaluation Board. Id. at 25:48. Instead, the Secretary contends that it was the medical examination that precedes the MEB referral process that was terminated here, not the MEB itself. Id. at 25:01. Coburn, in contrast, claims both that a MEB was initiated and that he was referred to a MEB. Appellant's Br. at 10, 17. Coburn also appears to equate MEB initiation with a referr[al] to the Army Physical Disability Evaluation System. Id. at 9 (citation omitted). As indicated by the facts recounted in the Background section of this opinion, Appellant makes a compelling case in suggesting that he was referred to a MEB. In any event, it is clear that the parties disagree over whether Dr. Caycedo terminated Coburn's medical processing before or after he was referred to a MEB. The resolution of this issue influences the analysis of Appellant's claim that his MEB processing was improperly terminated. The parties agree that the MEB was initiated. And, as noted above, the record clearly supports this conclusion and, in some instances, suggests Coburn was referred to a MEB. The relevant evidence, some of which is outlined in the Background section of the opinion, is fairly extensive. First, the record indicates that Dr. Caycedo requested that MEB action on SFC Coburn be terminate[d], clearly implying that Coburn's case had come to involve the MEB process in some form. Caycedo Letter, J.A. 109. Second, the record also contains an Individual Sick Slip from Dr. Caycedo, dated June 3, 2002, on which is written MEB initiated. Individual Sick Slip, June 3, 2002, J.A. 244. Third, two official responses to Coburn's allegations that the Army was attempting to separate him while his MEB continued also demonstrate that a MEB had at least been initiated. In July 2002, the Army wrote to a member of Congress, apparently to respond to Coburn's prior complaints to the member that the Army was attempting to unlawfully separate him. The response explains, Sergeant Coburn's allegation that his unit was trying to separate him from the Army while he was undergoing a medical evaluation board (MEB) board [sic] is unsubstantiated. Storm Letter, J.A. 112. It further states that it was determined that Sergeant Coburn did not meet medical retention standards. . .; therefore, he was eligible for processing through the Physical Disability System. On July 2, 2002, he was referred to process through the MEB. . . . Id. (emphasis added). The letter concludes that Coburn was being afforded every legal and medical recourse as he processes through the MEB channels. Id., J.A. 113. Similarly, in January 2003, the Office of the Inspector General responded to Coburn's allegations that separation orders were unlawfully issued in light of his ongoing MEB processing. The response mentions that a physician had initiated the MEB, and explains that it had been determined that Coburn should be retained until the medical process is completed and was in the MEB process and the orders should not have been processed for separation. Response to Inspector General Action Req. (Jan. 30, 2003), J.A. 88 (citing Army Reg. 635-200 ¶ 1-33(a)). Fourth, Coburn's Physical Profile, issued by Dr. Caycedo, notes MEB INITIATED. Physical Profile, June 28, 2002, J.A. 245. It also includes a numerical designator of 3 and states that his physical profile is permanent. Id. That numerical designator indicates medical or physical issues that may require significant limitations, Army Reg. 40-501 ¶ 7-3(d)(3) (2011), and a permanent 3 profile requires review[ ] by an MEB physician or physician approval authority, id. ¶ 7-4(b). Further, an active-duty soldier with a permanent profile who does not meet the medical retention standards must be referred to an MEB. Id. ¶ 7-4(b)(1) (emphasis added). As noted, Coburn was described as not meet[ing] medical retention standards, and thus was referred to a MEB. Storm Letter, J.A. 112. Fifth, in July 2002, Dr. Caycedo noted in a Consultation Sheet that Coburn was PRESENTLY UNDERGOING MEB and needed a FINAL EVALUATION PRIOR TO COMPLETION OF MEB. Consultation Sheet, July 2, 2002, J.A. 255. Finally, the ABCMR apparently assumed that the MEB process had commenced. In its 2003 Decision, the Board notes that Coburn was requesting in his application that he be reinstated on active duty in order to complete physical disability processing, and recognizes that Coburn's MEB was abruptly terminated. 2003 Decision at 2, 6, J.A. 78, 82. In sum, while there is no doubt a MEB was initiated, there is a question as to whether initiation and referral are distinct. There is also a question as to whether Coburn was in fact referred to a MEB as he claims.
A MEB is convened to document a Soldier's medical status and duty limitations insofar as duty is affected by the Soldier's status; and it appears that the MEB, alone, is charged with the duty of making a decision as to the Soldier's medical qualification for retention once a case is submitted to it. Army Reg. 635-40 ¶ 4-10. And, as noted above, the applicable regulations indicate that the actions of examination and potential referral to a MEB, see id. ¶ 4-9, are separate from a MEB evaluation and decision, see id. ¶ 4-10. In other words, the medical examination performed by an attending physician, which may or may not lead to a referral to the MEB, is distinct from a MEB evaluation. The termination of Coburn's MEB as it happened in this case is unfathomable. First, the initiating physician was Dr. Caycedo, and the terminating physician was Dr. Caycedo, acting with the approval of Dr. Schirner. However, there is no indication in the regulations that the referring physician can also serve as one of the physician members of the MEB, and neither party asserts that either Dr. Caycedo or Dr. Schirner served as one of the physicians on the MEB. Second, we can discern nothing in the regulations to indicate how these two physicians (who were not members of a MEB) could terminate Coburn's case once it had been submitted to the MEB process. And, finally, the Secretary's argument that medical information in the record justified the termination of Coburn's MEB process is perplexing, because no final decision had been issued by a MEB.