For two decades, Air National Guard pilot Joseph “Mitch” Hall climbed into planes serving our country.
He first enlisted in the Air Force. The first three years with his wings, he was gone about 250 days a year helping to fight the war on terrorism overseas in Afghanistan and Iraq.
Stateside, he was a pilot instructor.
Now a senior lieutenant colonel in the 141st Air Refueling Wing, he’s tracked drug smugglers and mapped forest fires from the air for the Washington National Guard.
But it’s the latest year of his military service that he says sticks out.
“Chaotic. Scary,” Hall said. “Uncharacteristic of the previous 20-plus years, I guess, will probably be the best way to describe it.”
In 2023, he hurt his left shoulder while practicing for a physical fitness test on base. Due to this and other medical conditions diagnosed around the same time, he has been unable to fly a plane since March 2023.
His shoulder injury required physical therapy. So, Hall put in his claim with the military to pay for it. His local wing commander gave initial approval.
But when his paperwork was sent to the National Guard Bureau headquarters in Virginia, that approval was overturned, and his medical care was temporarily shut off.
Hall said without medical benefits, he was not able to continue treatment. “It's a huge setback when you miss a month, month and a half, two months and in that month and a half, two months, you're just fighting to get the ball rolling again,” he said.
His experience isn’t unique.
A Scripps News investigation uncovered cases like Hall’s across the country. In the last couple of years, hundreds of injured and sick Air National Guard members have filed claims for medical care and pay that get approved by local commanders and then denied by national headquarters, according to military data.
Those decisions hinge on what’s known as a line of duty determination — also called an LOD. It confirms that an illness, injury, disease, or death was either sustained during a period of military service or made worse by military duties. In either case, the National Guard is legally obligated to cover medical care expenses and certain pay benefits, which is why Mitch Hall was so perplexed by his denial.
“I was in uniform, on active-duty orders at the military gym, being tested for physical fitness, and had a shoulder injury,” he said. “But someone at some faraway location decided to not concur with all of my leadership.”
A system change
All LODs weren’t always sent up to be reviewed by headquarters.
In 2019, Hall had serious injuries to his upper body stemming from an accident while on military duty status. He broke nearly a dozen bones when his pickup truck fell off its jacks, rolled over and crushed him.
“My left clavicle was broken in multiple places, had to be rebuilt. My left lung was punctured by one of the nine ribs that was broken. My left scapula was also broken,” he said. “The actual pressure, being squeezed that hard, did some trauma, so both of my eyes actually kind of blacked out.”
Back then, his local unit ruled Hall’s injuries were sustained in the line of duty, and his wing commander made the final decision.
Hall said that was his first time dealing with the LOD determination system. While the process wasn’t perfect, he says, he got some of the care he needed. For example, his medical records show he only got 30 days of physical therapy instead of the 180 days recommended. But ultimately, he says the Air National Guard was taking care of him.
“I think the process back then probably worked as well as it was supposed to,” Hall said. “I haven't felt like we were abandoned up until this last year or two.”
In May of 2023, the Air Force changed its policy. It requires all LOD claims from Air National Guard members, completed at the local level, to be submitted to a board of four people at National Guard Bureau headquarters. The board ultimately decides whether the servicemember’s medical condition was in the line of duty or not. The board is known as the ARC LOD Determination Board. It’s made up of a medical, legal and two administrative reviewers.
National Guard officials familiar with the board’s composition and functions said the agency currently has one medical doctor, two nurse practitioners and one part-time physician’s assistant who can serve as the medical reviewer to look over an LOD case.
Before the policy change, this board reviewed only a fraction of Air National Guard cases, called formal LODs, typically generated when airman misconduct was suspected in relation to the injury or claim, according to policy documents.
The National Guard Bureau declined Scripps News' request for a formal interview with leaders about changes to the decision-making process, and would not discuss individual cases.
Scripps News learned funneling all claims through the board’s extra layer of scrutiny was put in place against the recommendations of a multi-year study by outside contractor Booz Allen Hamilton.
Documents obtained by Scripps News from a source privy to the study show the contractor found the LOD system lacked a “unifying vision," and it was taking too long for cases to be processed. It recommended that cases be reviewed in 60 days and that the local unit commander should make the final determination.
Individuals from the National Guard Bureau, who asked not to be named because they were not authorized to speak publicly, told Scripps News that after the contractors' recommendations, the National Guard Bureau set out to train local units.
But when headquarters did an audit to see how the local units were doing, they determined there was “a decrease in accuracy” because they found “commanders didn't have the time or the knowledge or the expertise to adjudicate complex line of duty determinations”. Leaders told Scripps News that they determined “it would be more effective and efficient if the decision was back to the ARC LOD board”.
But the change also resulted in an increase in denials.
The Bureau provided Scripps News with data from Nov. 1, 2023 through June 30, 2024, showing that 691 LODs were initiated and completed for Air National Guard members. At the base level, 631 received interim approval as "in the line of duty” by local commanders. That‘s a 91% local approval rate.
Of the 631 locally approved claims, the ARC LOD Determination Board disagreed 23% of the time, ultimately overturning 146 of the cases from the past 8 months.
“What we've seen has had devastating effects,” said Jeremy Sorenson, director of Guard and Reserve affairs at USJAG, an advocacy group that defends the rights of service members. “Their medical care is not covered by the U.S. government. Their paycheck is taken away from them. Their ability to feed their families is taken away from them, stripped by the U.S. government, which they swore an oath to.”
Sorenson represents Mitch Hall and a dozen other service members who had their medical benefit claims denied by the National Guard. He said LODs are overturned without evidence.
“There has been no evidence provided,” he said. “Simply some words on a piece of paper.”
Words on a piece of paper that Hall and another member of his unit compared — and they noticed some troubling similarities.
The pattern of denial
“It took me a little while to discover that this is systemic,” said Lt. Col. Richard Cullen, who served alongside Mitch Hall in the Washington Air National Guard. “We just had a sense that it wasn't right. What we were facing wasn't right.”
Cullen has had seven medical claims approved at the local level and later formally denied at headquarters. One of his requests for coverage involved treatment for pain in his neck.
But when his claim was denied by the ARC LOD Determination Board, he carefully read through their comments, and that’s when something caught his eye.
The determination board's legal expert inaccurately stated that the board's medical review “indicates a diagnosis of other tear of lateral meniscus” in an LOD about Cullen’s neck. Meniscus tears happen in the knee.
“In the last sentence,” he said, as he showed reporters his documents. “I would hope most of us would know that a meniscus is not in the neck.”
The medical reviewer ultimately recommended Cullen’s LOD should be overturned, determining the neck injury did not occur in the line of duty. In addition to the legal expert, two other people on the board reviewed and agreed, yet the sentence about the tear in the knee remained.
Cullen and Hall then started to take a closer look at all their denials and found similar wording in the documents received from headquarters.
Injuries and illnesses were described as “degenerative” or as a “chronic condition” which the documents would say “clearly ... pre-dates this period of service.”
Again and again, the National Guard concluded the airmen’s medical conditions were the result of the “natural progression” of long-standing injuries or illnesses. The medical reviewer determined their current military duties didn’t make their conditions worse.
“Being in the military for 22 years, my first inclination is there's one of three issues when you have a situation like we have today with the LODs: It's either incompetency, apathy or corruption,” Mitch Hall said.
Hall and Cullen believe National Guard Headquarters is searching for ways to blame injuries on “pre-existing conditions” and “natural progression” to avoid paying for treatment.
Scripps News found the same justification was used to deny claims of Air National Guard members across the country.
In Mississippi, Master Sgt. James Buckley filed three claims. All were approved by his local unit and later denied by headquarters. The paperwork said his migraines were due to “natural progression” and his sleep apnea and hypertension “pre-existed this period of service.”
In Phoenix, Maj. Christine Kjornes had to stop flying when an illness she first experienced in pilot training was aggravated. Her claim was considered a “natural progression” and was denied.
In Nashville, an Air National Guard captain reported neck pain while doing pushups on base. He asked us not to use his name because he fears reprisal.
He eventually required spinal surgery. His claim was approved locally as a service-aggravated injury, but the medical reviewer at headquarters rejected that, writing off his condition as a “natural progression of the disease.”
National Guard officials familiar with the LOD process told Scripps News the board approaches every case with a presumption that the medical condition should be considered “in the line of duty” and merits coverage. But when the illness or injury involves a preexisting or chronic condition, officials said the medical reviewer would need to see a sudden worsening — an “acute exacerbation” — and not simply the natural progression of the condition resulting from everyday living.
SEE MORE | Battle for Benefits: Arizona National Guard pilot wins appeal of medical care denial
“It's cut-and-paste verbiage, multiple sentences that are cut and paste, and we see them on every single not-in-the-line-of-duty determination that we get,” said Sorenson, who is advocating for a dozen National Guard members in similar situations.
Of the 15 denials Scripps News looked over, in all but one case, we found the initial approvals were based on the opinions of doctors and trained specialists. Then, the four reviewers on the ARC LOD Determination Board at headquarters, who have never treated or even spoken to the service member about their condition, had the power to overturn local recommendations.
Guard officials familiar with the process also said the medical reviewers look at “data” and “case studies” to determine if a medical condition is progressing normally. They say that research and evidence is available for service members to review with their local military providers on the internal case tracking system.
But Hall says he has never seen that extra research. He says he questions the medical review because he has never spoken to or been seen by the reviewer.
“No one from that office has reached out or visited or asked me if I would be willing to come in,” said Hall. “They just make a decision based off of maybe some notes.”
Air Force policy requires the National Guard Bureau to provide a “preponderance of the evidence” to deny medical coverage for service members on active-duty orders for 30 days or less or while on active duty for training. If the service member is on active-duty orders for more than 30 days, headquarters must provide “clear and unmistakable evidence” that an injury or illness is not eligible for coverage.
The burden of proof is higher for the latter, and both require evidence.
In emails shared with Scripps News, Master Sgt. James Buckley asked the National Guard Bureau for the evidence, and he was told to file a Freedom of Information Act request.
It’s taking longer to process cases
Last year, the Air Force extended the LOD processing timeline from 60 to 90 days.
The Guard says they are currently receiving over 108 cases a month, and it’s taking 3.5 months, on average, for cases to reach final adjudication.
It’s a data point that indicates the new system may not be as efficient as previously thought.
And then come the appeals.
“I have appealed six of the seven,” said Richard Cullen. “I am in the seventh month of three appeals, and with the remaining three staggered behind that, with no indication, no advertised timeline.”
When a service member gets a denial, they have a month to file an appeal. They can submit more medical records and documents to try to get a different outcome. It’s a process Cullen believes is a transfer of responsibility.
“The fact that I am having to now circle back to all these other medical providers and get all this documentation,” said Cullen, “is indicative that there is an inversion of the responsibility to the service member being made by National Guard Bureau. What they are doing is presupposing not in the line of duty and making me and everyone else, in essence, come back and now prove to you why it was in the line of duty.”
“There is an appeal process, and it goes right back through the same people that made the original determination,” said Jeremy Sorenson of USJAG.
The Guard told Scripps News, in the past “some” appeals were being reviewed by the same people, but that changed in May of 2024 to allow a “second independent review”.
They told us, since the 2023 policy change, there has been an increase in LOD determination appeals.
Mitch Hall said he’s also appealing his denials, which resulted in significant gaps in his medical coverage and his military pay. He’s now worried he’s going to have to retire from the Air National Guard at a time when he’s physically unable to return to his civilian career as a pilot.
“You kind of feel abandoned,” Hall said. “I'm getting no support for that while we're trying to rebuild our lives.”
Hall’s situation is further complicated by a forest fire that swept through his neighborhood last August. His home burned to the ground. Now he’s trying to get a mortgage to rebuild his home while his finances and health remain in limbo.
“I believe in my soul that if the average American knew about this process failing, they would be pretty enraged,” Hall said.
After an appeals process that lasted 15 months, Christine Kjornes in Phoenix was able to prove her medical condition was caused “in the line of duty.” However, the gaps in her military pay and medical benefits had devastating results. She was unable to get regular treatment for her condition, and without income, she had to sell her home.
Her grievances were heard at the highest level of appeal within the Air Force, the Board for Correction of Military Records. In August 2023, the board ruled earlier delays and denials of her claim constituted “an error or injustice.” Kjornes was granted back-pay and benefits. She is waiting for the final paperwork, so she can medically retire.
Inspector general reviews complaints
Dozens of Air National Guard members from across the country, including Hall and Kjornes, have also filed complaints about their LOD denials with the Air Force inspector general. The IG’s office provides independent assessment and oversight of efficiency, economy, readiness, waste and abuse and reports to the secretary of the Air Force.
“I hope there are enough people in high places that see the situation and put themselves in the shoes of those that have been on the receiving end of it,” Hall said.
Since February of this year, Scripps News has been asking the military about the complaints and concerns from Air National Guard members regarding their new LOD policy.
Reporters requested an interview with Air Force Secretary Frank Kendall, but his office declined. Air Force officials did agree to respond to questions via email.
The Air Force officials said in the email that the “inspector general is committed to ensuring systemic issues are identified and addressed, and that individual cases are handled as expeditiously as possible while ensuring rigorous analysis,” and revealed that an inquiry was initiated in November 2023.
They also said the Air Force averages 40 inspector general cases related to line of duty determinations each calendar year. The IG is currently “handling 42 priority LOD and LOD-related cases” with a prioritization “based on case age and potential impact to the complainant,” according to Air Force officials.
The Air Force told Scripps News the IG established a “Case Resolution Focus Team in May 2024 to accelerate priority LOD” case outcomes. A technical review process has also been established “to independently review LOD medical determinations” with a “fresh set of eyes” to “determine if errors were present in the original processing.”
The Air Force would not reveal which cases are receiving prioritization and independent review of medical determinations. Mitch Hall said he has not received any notification as to whether his case is under review, but he said he would hope everyone gets resolution.
“I'm proud of my career and I was happy to serve, and it's been great, with this exception,” said Hall. “I haven't felt like we were abandoned up until this last year or two, and it's a cold hard fact to realize.
He believes the LOD process needs more reforms to better support service members who have dedicated their lives and their bodies to the needs of this country.
If you have a denied claim and would like to potentially share your story, reach out to Karen Rodriguez at karen.rodriguez@scripps.com or Melissa Blasius at melissa.blasius@abc15.com.
