IN THE CASE OF:	  

		BOARD DATE:	       23 October 2008

		DOCKET NUMBER:  AR20080010727 


THE BOARD CONSIDERED THE FOLLOWING EVIDENCE:

1.  Application for correction of military records (with supporting documents provided, if any).

2.  Military Personnel Records and advisory opinions (if any).


THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE:

1.  The applicant requests correction of his records to show he was granted 4 years of additional constructive service credit (CSC) for completion of a Doctor of Philosophy (PhD) degree prior to entry on active duty.

2.  The applicant states that he was not granted CSC credit for his PhD studies due to his participation in a “joint” Medical Doctor (MD)-PhD degree program.  He also states that although the degrees were bestowed concurrently following the completion of all requirements for both degrees, the MD-PhD program did not double count academic credit and led to the completion of two fully independent, terminal professional degrees.  He further adds that his Health Professions Scholarship Program (HPSP) entry was allowed only after completion of all PhD degree requirements, based on the U.S. Army HPSP requirement that participants make uninterrupted progress towards the MD degree, arguing that a distinction was perceived at the time of his entry.   

3.  The applicant provided the following additional documentary evidence in support of his request:  

	a.  Academic Transcripts, dated 4 June 2008, Washington University School of Medicine, St. Louis, Missouri. 
      
	b.  Academic Transcripts, dated 16 June 2008, Washington University, St. Louis, Missouri.    

	c.  DA Forms 67-9 (Officer Evaluation Report), for the periods 20060701 to 20070630 and 20070701 to 20080417. 

	d.  Self-authored letter, dated 3 June 2008.    

	e.  Letter of Support, dated 25 May 2008. 

CONSIDERATION OF EVIDENCE:

1.  The applicant's records show that he attended Kansas State University from August 1994 to May 1998 and was awarded a Bachelor of Biochemistry Degree on 18 May 1998.  

2.  The applicant’s records also show he attended Washington State University from 1998 to 2006, during which he completed two degrees.  He was granted an MD degree and a Doctor of Medicine degree on 19 May 2006.  His entry on active duty was in the context of his participation in the U.S. Army HPSP during the final two years of his academic studies at Washington University School of Medicine (WUSM).  The HPSP is an Army program which offers full financial support in exchange for future service as a physician, dentist, nurse practitioner, or other specialty.  Following verification of eligibility for a commission including physical and academic qualifications, the applicant was placed on inactive Reserve status while under fully funded training at his university.

3.  On 31 March 2004, the applicant submitted an application for appointment as a commissioned officer in the U.S. Army Reserve (USAR), in accordance with Army Regulation (AR) 135-101 (Appointment of Reserve Commissioned Officers for Assignment to Army Medical Department Branches).  

4.  On 24 May 2004, the applicant was extended an appointment as a USAR commissioned officer in the rank of second lieutenant (2LT) and he executed an oath of office on the same date.

6.  On 29 July 2004, the U.S. Army Human Resources Command (HRC), St. Louis, Missouri (MO), published Orders C-07-419613, appointing the applicant in the USAR, effective 24 May 2004, and assigning him to the USAR Control Group (Officer Active Duty Obliger (OADE)).

5.  On 31 March 2006, by memorandum, HRC-St. Louis, MO, notified the applicant that he was appointed in the Medical Corps (MC) of the USAR, for an indefinite term.  He was credited with 4 years of CSC.  

6.  On 31 March 2006, HRC-St. Louis, MO, published Orders A-03-607838, ordering the applicant to active duty in the grade of captain (CPT).

7.  On 19 May 2006, the applicant executed an oath of office as a CPT in the USAR.  

8.  In his self-authored letter, dated 3 June 2008, the applicant states:

	a.  He is writing to clarify the details of his request that CSC be granted  towards his promotion in recognition of the PhD degree he earned prior to beginning his current assignment.  His former brigade S-1 indicated that she felt his case deserved review in light of CSC that has been awarded in other similar historical cases with which she was familiar, and CSC that was awarded to other officers with whom he concurrently inprocessed.

	b.  he is a captain in the Medical Corps (MC), currently completing his second year of Internal Medicine residency at Walter Reed Army Medical Center (WRAMC).  He graduated from WUSM in May 2006 having earned both a Doctor of Medicine degree and Doctor of Philosophy degree in Molecular Microbiology and Microbial Pathogenesis.  He entered active duty as an intern physician in Internal Medicine at WRAMC very shortly following graduation from WUSM.  His entry onto active duty was in the context of his participation in the HPSP during the final two fiscal years of his time at WUSM.

	c.  at the time of his graduation and entry onto active duty status, he was granted 4 years of CSC in recognition of his completion of the MD degree, and to justify promotion from the second lieutenant (2LT) rank of a Medical Service Corps medical student participant in the HPSP to the minimum MC rank of CPT.  It is his understanding that all other members in his incoming class of intern physicians would have received no less than 4 years of CSC for identical reasons.  He later learned that some members of his incoming class of physicians were awarded more than 4 years of CSC on the basis that they had earned advanced graduate degrees in a scientifically relevant field (Masters of Public Health, Masters of Science in Microbiology, etc.)  In most instances, these physicians were granted additional years of CSC without having actively sought out additional recognition for the non-MD graduate degrees they had earned.

	d.  following review of his personnel records by his brigade S-1, and inquiry to the U.S. Army Human Resources Command (HRC), it was reported that he did not qualify for additional CSC because his MD and PhD degrees were earned “concurrently” which runs contrary to Army policy.  He requests that the Board reverse this decision and grant additional CSC in recognition of his PhD degree for the following reasons:
		(1)  The Medical Scientist Training Program (MSTP) at WUSM is a coordinated, dual-degree program through which participants earn both an MD degree and PhD degree.  Despite the program’s coordinated nature, the degree requirements for each individual degree are maintained and there is no “dual” application of credits to satisfy the requirements for both degrees.  In total, I spent eight years earning both degrees.  Substantiation of the independent nature of these degrees is provided by the letter of support submitted on his behalf by the Administrative Director of the MSTP; the maintenance of separate transcripts for each degree by the WUSM and Graduate School of Arts & Sciences; and the fact that the degrees were bestowed at two separate, physically distinct graduation ceremonies.  Additionally, when entering the HPSP, his entry was not scheduled until after the time that he had completed all requirements for the PhD degree and his registration had been switched back to the School of Medicine.  Per the information provided to him by his HPSP recruiter, HPSP policy required that participants make continuous, uninterrupted progress towards completion of the MD degree.  As such, he was allowed to participate in the HPSP as a dual degree candidate, but could not be working to complete requirements for the PhD degree while participating.  At that time components of the Army clearly understood the completion of the two degrees to be separate, discrete activities.

		(2)  The PhD degree in Molecular Microbiology and Microbial Pathogenesis he earned prior to entry onto active duty is an asset that he brought to the Army.  He believes the additional 4 years he spent training in an academic environment and honing his critical thinking skills have contributed markedly to his professional development.  He has included in this request his two most recent OERs, as well as a letter in support of his request from his current Residency Program Director.  All three documents indicate that he has performed solidly from his very first day of active duty, and has been recognized for bringing a level of maturity and knowledge well in advance of that expected from his limited time in service.

	e.  The Army has in place programs (Long Term Health Education and Training program) through which active duty officers are given the opportunity to earn PhD degrees in scientific fields from civilian institutions.  Participants are allowed to accrue time in service while earning the pay and benefits of an officer during the time required to their earning a graduate degree.  In his case, he will be able to contribute directly to the completion of the mission (having already earned the degree) as he pursues his intended career working in the field of Infectious Disease, rather than need to step out for an extended period to train up for the upcoming mission.

9.  The DODI 6000.13 (Medical Manpower and Personnel) implements policy, assigns responsibilities, and prescribes procedures to carry out medical manpower and personnel programs.  This Instruction applies to the Office of the Secretary of Defense, the Military Departments, the Chairman of the Joint Chiefs of Staff, the Inspector General of the Department of Defense, the Uniformed Services University of the Health Sciences, the Defense Agencies, and the DOD Field Activities (DOD Components).  The term “Military Services” as used herein, refers to the Army, the Navy, and the Air Force.  It does not apply to inter-Service transfers under 10 USC section 716, except as provided in DOD Directive 1300.4 or to the original appointment of Reserve commissioned officers as Regular officers in the Regular Army, Regular Navy, Regular Air Force or Regular Marine Corps under Section 533(f) of reference (c). It is DOD policy that medical manpower, personnel, and compensation programs be established to provide the DOD Components with sufficient military medical personnel to meet all mission requirements.  A prospective health professions officer’s entry grade and rank within grade shall be determined by the number of years of entry grade credit awarded on original appointment, designation, or assignment as a health professions officer.  The entry grade credit to be awarded shall equal the sum of constructive service credit and prior commissioned service credit, except in cases where the total exceeds the maximum credit allowed, as stated in paragraph 6.1.3.  A period of time shall be counted only once when computing entry grade credit, and qualifying periods of less than one full year shall be proportionately credited to the nearest day, except where noted otherwise.

10.  In an advisory opinion obtained on 25 September 2008 in the processing of this case, the Chief, Graduate Medical Education Division, Office of the Surgeon General, recommends that no additional credit be awarded for the PhD degree and stated that in accordance with DOD guidance, no additional credit may be given for more than one advanced degree in a single field or closely related field. The applicant's PhD is in a closely related field.  Additionally, the additional degree must add adjunctive skills to the primary specialty and must contribute directly to performance in the anticipated position in the military service concerned.  The applicant's PhD in this case did not allow him to advance in his residency program or become Board Certified ahead of his peers.  Finally, the additional degree must not have been earned concurrently with primary credentials and although the applicant was in a dual-degree program, and it appears that the degrees were separate, they were conferred simultaneously.

11.  On 25 September 2008, the applicant was furnished with a copy of the advisory opinion.  He responded with a rebuttal on 2 October 2008.  He stated that the Advisory Opinion recommends against the award of additional credit for the PhD degree.  The negative recommendation is based upon three arguments drawn from language in the governing the DOD Instruction 6000.13 and           AR 135-101.  He offers the following arguments to rebut those put forth in the Advisory Opinion.  

	a.  Paragraph 6.1.2.2.2 states that “No additional credit may be given for more than one advanced degree in a single field, or closely related field.”  The PhD is in a closely related field.” 

		(1)  The sentence from Paragraph 6.1.2.2.2 is misconstrued, since it is taken out of its original context.  The Advisory Opinion fails to include the initial sentence of Paragraph 6.1.2.2.2 that states, “Credit for master’s and doctorate degrees in a health profession other than medicine and dentistry, whether it is the primary degree or an additional advanced degree, shall be awarded based on actual full-time equivalent education of up to two years for a master’s degree and up to four years for a doctorate.”  This statement indicates that advanced degrees, other than the MD, DO, DDS, etc., should generally lead to the provision of additional constructive credit.  It is difficult to understand the inclusion of “whether it is the primary degree or an additional advanced degree,” unless it is anticipated that a degree might be possessed in addition to a doctorate degree in medicine or dentistry.  The language substantiates the claim to constructive credit for the PhD degree, since he spent an additional four years as a full time student earning the degree. 

		(2)  Paragraph 6.1.2.2.2 only later states, “No additional credits may be given for more than one advanced degree in a single field, or closely related field.”  Notably Paragraph 6.1.2.2.1 deals with “professional” degrees more directly related to clinical care giving (MD, DO, DDS, PhD in Pharmacy, etc.), while Paragraph 6.1.2.2.2 speaks to “advanced” degrees that must be felt to be of a separate nature.  Given this separation, it seems more reasonable that the statement in Paragraph 6.1.2.2.2 prohibiting additional credit for “advanced” degrees in closely related fields refers to the hypothetical case of an incoming officer who possesses two master’s or doctorate degrees in similar fields, e.g. analytical chemistry and organic chemistry. 

		(3)  Furthermore, DOD Instruction 6000.13 offers no criteria for objectively determining what constitutes a “closely related field”, and the Advisory Opinion offers no support for the statement, “The PhD is in a closely related field.” However, AR 135-101 utilizes language in Table 3-1 (4) very similar to the language of DOD 6000.13 Paragraph 6.1.2.2.2, and AR 135-101 Table 3-1 (4) directs the reader to AR 135-101 Table 3-4, where advanced degrees that may qualify for additional constructive credit are listed.  Amongst those degree fields listed are: Microbiology, Immunology, Parasitology and Clinical Laboratory Science.  If these fields were considered a priori “closely related,” then             AR 135-101 would contain language that directly contradicts DOD Instruction 6000.13, and their inclusion in Table 3-4 would be nonsensical. 

	b.  Paragraph 6.1.2.2.3 states, “The additional degree must add adjunctive skill to the primary specialty and must contribute directly to performance in the anticipated position in the Military Service concerned(sic).” The PhD Degree did not allow the applicant to advance in his residency program or become Board Certified ahead of his peers.” 

		(1)  The Advisory Opinion uses (literally) unachievable criteria for judging whether the PhD degree has added adjunctive skill and directly contributed to his performance in military service.  The American Council for Graduate Medical Education (ACGME) provides accreditation of residency training programs.  The ACGME requires that all accredited internal medicine residency programs provide thirty-six months of training for resident physicians (ACGME Program Requirements for Residency Education in Internal Medicine, available for download at this web site: http://www.acgme.org/acWebsite/downloads/RRC_progReq/140_im_07012007
Moreover, the American Board of Internal Medicine (ABIM) certifies physicians who practice as internists.  ABIM rules governing certification requires (in a fashion that provides overlap with the ACGME) that all candidates complete no less than thirty-six months of ACGME accredited residency training before one may sit for the certification examination (see ABIM web site at this address http://www.abim.org/certification/policies/imss/im.aspx).  In light of the stipulations by the ACGME and ABIM, it is literally impossible for one to complete an accredited internal medicine residency program or become Board certified ahead of one’s peers less than thirty-six months after beginning residency.  He has completed twenty-seven months of training at this time.  Further, since these time requirements define the usual duration necessary for the successful completion of residency training, and subsequently complete the Certification Examination, the only discriminating power that the criteria used in the Advisory Opinion might have, would be to identify physicians whose performance is substantially below the norm as reflected by their failure to complete residency and Board certify alongside their peers. 

		(2)  The PhD degree, earned in the discipline titled “Molecular Microbiology and Microbial Pathogenesis”, reflects the current multi-disciplinary nature of the field of microbiology and the thesis work addresses the immune response to a protozoan that serves as a model for the parasite that causes malaria.  Earning the degree involved mastering sophisticated techniques of molecular biology; parasitology; and molecular and cellular immunology. As a PhD student, he spent significant time cultivating micro-organisms in cell culture, monitoring the immune response to infection in animals, and analyzing serum samples for immune response proteins.  As a physician, he has uniquely been able to teach colleagues and medical students important details regarding the subtleties of medical specimen collection, identification of micro-organisms via laboratory culture, and the principles of molecular biology that underlie the sophisticated laboratory analyses used today. 

		(3)  Finally, earning a PhD degree is a formative process very different from the clinical training one receives in a hospital as part of earning an MD degree.  The additional training and skills obtained via mock-grant proposal writing exercises, the preparation of research presentations, and coordinating lengthy experiments that required the coordinated acquisition and application of many expensive resources have contributed to his performance in his position. In support of the notion that the training he obtained by earning the PhD degree has brought valuable adjunctive skills and contributed directly to his performance, he requests that members of the ABCMR review committee refer back to documents submitted with his original application: a) the two most recent OERs and b) the letter of support written by the acting residency Program Director.  Additionally, since the time his application was filed, he has also been selected to serve as Chief of Medicine Residents for the Walter Reed Army Medical Center for the 2009-2010 Academic Year.  This honor highlights his track record of first-rate performance since entry into service. 

	c.  Table 3-1(4) of AR 135-101 states that “Additional degree must not have been earned concurrently with primary credential.  No additional credit will be given for more than one degree in a single field.”  Although the applicant was in a duel(sic)-degree program, and it appears that the degrees were separate, they were conferred simultaneously. 

		(1)  The Advisory Opinion offers no evidence or interpretation of the available data to support the assertion that the PhD and MD degrees were conferred simultaneously.  To reiterate information available in his original application, the applicant states that the degrees were bestowed on the same day, but awarded during separate, distinct graduation ceremonies held hours apart at different locations, literally miles away from one another.  For the question of whether the degrees were “earned concurrently” [language directly from AR 135-101 Table 3-1 (4)], he requests that ABCMR committee members review the documents submitted with his original application, particularly the transcripts that are held by different schools within the University, and his narrative summary that highlights the opinion held by the OTSG-GME authority at the time he was allowed to enter the HPSP that PhD research activities did not constitute progress towards the MD degree and vice versa.  He refers to definitions of “concurrently” found in the Merriam-Webster Online Dictionary: operating or occurring at the same time; running parallel.  Since a standard MD degree program requires four years to complete, and PhD programs require, on average, four to six years to complete, it is difficult to understand how completion of the two degrees in eight years of time can be construed as completing them at the same time, or in parallel, for the purpose of limiting the amount of constructive credit that might be awarded for the additional degree. 

		(2)  Ultimately, the Advisory Opinion’s recommendation is that no CSC be awarded for the PhD degree, since he earned the degree by participating in a coordinated dual-degree program, supports a perverse scheme for the award of CSC.  Under this scheme, a physician who has also earned a master’s degree in microbiology via twelve months of study prior to entering medical school would be awarded one year of CSC in addition to the standard four years awarded for the MD degree.  In contrast, a physician that takes 8 years to earn an MD degree as well as a PhD, but does so through a coordinated dual-degree program, could never be awarded more than the standard 4 years of CSC.  Even when entering active duty as peers, assuming all other things equal, the physician with the master’s degree would have an earlier date of rank, and by the inclusion in earlier promotion pools would be promoted before the physician with the doctorate degree who brought 3 years more scientific training to the service than his colleague with a master’s degree. 

	d.  The situation described in the conclusion of c(2) above is exactly the situation he currently faces.  He does not begrudge his colleagues of the credit they rightly deserve, but he once again requests a full review of the details of his case, and the award of the CSC that he believes he justly deserves. 

12.  Section 6.1.1 states that credit for prior service as a commissioned officer (other than as a commissioned warrant officer) shall be granted to recognize previous commissioned experience, while maintaining cognizance of the level of professional knowledge, skill, and experience required at specific rank levels of each health profession.  For entry grade credit, the Medical Service Corps (MSC), the Biomedical Sciences Corps (BSC), and the Army Medical Specialist Corps (AMSC) are considered as the same Corps.  The Secretaries shall establish procedures to ensure the awarding of prior commissioned service credit is applied in an equitable and consistent manner.  Credit shall be awarded as follows:

	a. Section 6.1.1.1: Service on active duty or in an active status as a commissioned officer in any of the Uniformed Services, in the corps or professional specialty in which being appointed, shall be credited on a day-for-day basis with any commissioned service performed before such appointment. 

	b.  Section 6.1.1.2: Service on active duty or in an active status as a commissioned officer in any of the Uniformed Services, but not in the corps or professional specialty in which being appointed, shall be awarded one-half day of credit for each day served in the case of individuals seeking an original appointment as a health professions officer.

	c.  Section 6.1.1.3. Commissioned service on active duty or in an active status while participating in an educational program leading to appointment in a specialty in which constructive service credit is awarded, shall be awarded day-for-day credit for service performed. An officer on active duty or in an active status who completes a program that would qualify for credit under subparagraph 6.1.2.2., below, in less than the number of years normally required to complete such education, may be given constructive credit by the Secretary of the Military Department concerned in the amount of the difference between the actual number of years the officer took to complete and the amount of time normally required to complete the program.  The maximum constructive service creditable for completing such a program shall be the number of years (to the nearest year) normally required to complete the advanced education or receive the advanced degree, in accordance with Sections 533 and 12207.  CSC may be awarded only if such advanced education or an advanced degree is required as a prerequisite for original appointment as a commissioned officer in a particular officer category.

	d.  Section 6.1.2. Constructive Service Credit. This credit provides a person who begins commissioned service after obtaining the additional education, training, or experience required for appointment, designation, or assignment as an officer in a health profession, with a grade and date of rank comparable to that attained by officers who begin commissioned service after getting a baccalaureate degree and serve for the period of time it would take to obtain the additional education.

13.  Army Regulation 135-101 prescribes policy, procedures and eligibility criteria for appointment in the Reserve Components of the Army in the six branches of the Army Medical Department (AMEDD).  Grade and date of rank upon original appointment and assignment to an AMEDD branch will be determined by the number of years of entry grade credit awarded.  Except as limited by maximum credit limits (14 years), entry grade credit granted will be the sum of CSC and credit for prior active commissioned service. Entry grade credit awarded to AMEDD officers upon-appointment or assignment will be recorded on one of the following forms: DA Form 5074-R (Record of Award of Entry Grade Credit (Medical and Dental Officers)) for Medical Corps (MC) or Dental Corps (DC) officers (fig 3-1); or DA Form 5074-1-11 (Record of Award of Entry Grade Credit (Health Services Officers)) for Army Nurse Corps (ANC), Medical Service Corps (MSC), Army Medical Specialist Corps (AMSC), or Veterinary Corps (VC) officers. 

14.  Paragraph 4, Table 3-1 of this regulation, states that additional credit for additional advanced degrees may be granted on a year for each year (or school year) limited by the level of degree.  The degree must add adjunctive skills to the primary specialty and must contribute directly to performance in anticipated duty position.  Credit is awarded based on full time equivalent education up to 24 months for a master’s degree or up to 36 months for a doctorate.  An additional degree must not have been earned concurrently with primary credential.  A credential includes time spent in attainment of a lower degree.  No additional credit will be given for more than one degree in a single field.  

15.  Paragraph 6, Table 3-1 of this regulation states that additional credit in unusual cases based on special education or professional experience in the specialty in which assigned when experience is accrued after qualifying degree and licensure, if applicable.  

DISCUSSION AND CONCLUSIONS:

1.  The evidence of record shows that the applicant was appointed as a 2LT in the USAR on 24 May 2004.  His entry on active duty was in the context of his participation in the HPSP during the final two year of his academic studies at Washington University School of Medicine.  The evidence of record further shows that on 19 May 2006, the applicant completed and was granted two fully independent and terminally professional degrees, an MD degree and a Doctor of Medicine; yet, they were two concurrent degrees.  

2.  The applicant's arguments are noted; however, by law, a period of time shall be counted only once when computing entry grade credit.  By regulation, CSC may not be granted in those cases where an additional degree was earned concurrently with primary credential.  Therefore, the applicant’s additional degree does not meet the criteria for award of additional CSC and relief cannot be granted in this case.









BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

___X____  __X_____  __X_____  DENY APPLICATION

BOARD DETERMINATION/RECOMMENDATION:

The evidence presented does not demonstrate the existence of a probable error or injustice.  Therefore, the Board determined that the overall merits of this case are insufficient as a basis for correction of the records of the individual concerned.



															XXX
      _______ _   _______   ___
               CHAIRPERSON
      
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 Record of Proceedings (cont)                                         AR20080010727



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ABCMR Record of Proceedings (cont)                                         AR20080010727



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