KAISERSLAUTERN, Germany -- In the end, getting a pension came down to days, not years.

When Jerred Mitchell, a noncommissioned officer at Ramstein Air Base, began getting sick more than two years ago, he started banking his annual leave.

Had he not done that, the Air Force master sergeant would be facing a medical retirement without a pension, less than three months shy of his 20-year mark.

"If I didn't save my leave for the last 2 1/2 years, I'd be in a different situation," Mitchell said.

On Feb. 22, a board acting on behalf of the Secretary of the Air Force denied his appeal to return to duty, directing that he be medically retired due to a rare disorder that can cause recurring blood clots.

Mitchell stood to lose his pension, an annual lifetime retirement benefit that military personnel qualify for after serving 20 years on active duty. For Mitchell, that comes to $19,459 a year after taxes, he said.

Mitchell's case highlights the vulnerability of service members struggling with health issues in the twilight of their careers.

As service members age and years of service take a heavy toll on their bodies, Pentagon regulations offer no protection or sanctuary from separation on medical grounds, regardless of how near to retirement they might be.

That means a pension rewarding a long, respectable career can vanish if a service member becomes unexpectedly ill or develops a physically debilitating condition before reaching 20 years.

Mitchell fretted for months while the Air Force weighed his future. In September, he filed an appeal to the Secretary of the Air Force asking that he be returned to duty after two Air Force physical evaluation boards ruled last year that he should be medically retired.

He was told he might hear back from the secretary's office within one to four months. It took more than six months.

Mitchell finally learned last month that his appeal was denied. But after a few more anxious days, he found out he'll get past the 20-year mark.

Months of fighting for his pension and waiting for answers paid off; the Air Force's slow pace of administrative action worked to Mitchell's advantage.

The days of leave Mitchell saved, plus extra time granted to him for out-processing and house-hunting by his command put him over the hump.

After taking into account Mitchell's leave and other time he's due, the Air Force Personnel Center approved his medical retirement for Aug. 31, three months past his 20-year mark of May 13, 2018.

A sliver of compassion

Though uncommon, getting discharged between 19 and 20 years on medical grounds does happen.

During the past five years, 69 active-duty airmen and 34 Air Force Reserve/Guard members were medically discharged with 19 years of service, officials said.

Most received a medical retirement, while a few were discharged with severance pay only. In both sets of circumstances, the airmen would not receive a separate military pension.

Military defense attorney David Sheldon of Washington has worked a few similar cases, he said, including a current one representing an airman with 18.5 years of service. The Air Force is trying to separate him for disability at 20 percent, despite the airman having support from his command for retention, Sheldon said.

Sheldon said he expects cases like this to rise, given the Pentagon's new policy announced last month, intended to force out most service members who are unable to deploy within 12 months.

Given the tougher retention standards, Mitchell knew his chances of a favorable decision were slim. But he was hoping for a sliver of compassion from the SAF folks. He had support from his commander to stay in and, realistically, he had too little time of obligated service remaining to deploy.

Mitchell was willing to hang up his uniform this spring. He told the Air Force, "'I just want to stay in till my 20-year mark and then I'll retire.' And they said, 'No.' "

Sanctuary for some

U.S. Code 1176 protects service members nearing 20 years of service -- and retirement eligibility -- from being discharged or denied reenlistment without just cause.

"Generally, what it addresses, once you're over 18 years, local commanders" can't issue an administrative discharge for lower-level misconduct, said Eric Mayer, an attorney in Kansas City who specializes in military law. "You can still do a knuckleheaded thing and get kicked out, it just has to go to a much higher level of approval."

But the federal sanctuary law doesn't extend to medical cases, officials said.

Service members "pending an approved or mandatory retirement are presumed fit for duty and must meet a higher standard to be found unfit for continued service," said Michael Dickerson, Air Force Personnel Center spokesman. "However, so-called sanctuary provisions do not apply for service members with 18-20 years of service if found unfit for continued service due to medical disability."

The nuance in the law isn't widely understood, Mitchell discovered. When he reached out to fellow airmen and veterans for advice, he kept hearing, 'Oh, you're good, you're in sanctuary. Nope, you don't have to worry about nothing.'"

Finally, a diagnosis

Mitchell always intended to stay in the Air Force beyond 20 years.

Now 40, Mitchell's career has stretched past 23 years, including his Reserve and Guard duty. He joined the Army when he was 17 and spent three years as a field artilleryman. He then did brief stints in the Army Reserve, Army National Guard, Air Force National Guard and Air Force Reserves. He enlisted in the Air Force in 2001, working in project and computer systems planning and implementation until 2009, when his career field merged into cable and antenna systems craftsman. Along the way, he deployed four times, including twice to Iraq during Operation Iraqi Freedom.

Mitchell's career was humming along until late 2016, when his left leg began to swell. Soon afterward, tests revealed deep vein thrombosis. The blood clots in his leg moved to his lungs, while the clots in his leg kept worsening, even after Mitchell went on blood thinners.

Doctors were baffled.

By January 2017, Mitchell finally received a diagnosis: antiphospholipid syndrome, a rare autoimmune system disorder that causes an increased risk of blood clots. There's currently no cure.

Around the same time, Mitchell began experiencing back pain. For years, he had minor aches in his back and legs, which intensified after his blood disorder developed. "I can't sit or stand too long," he said. "I can't stand in formation anymore."

The blood clots in Mitchell's lungs automatically triggered a medical board review, he said.

The deployment availability working group at Ramstein was first to review his medical condition, recommending that he be returned to duty, Mitchell said.

But the Air Force Personnel Center determines whether a member should be returned to duty -- sometimes with an assignment limitation code -- or be put through a full medical evaluation board review, according to the Air Force. The AFPC opted for the latter in Mitchell's case.

That triggered an informal physical evaluation board and, later, a formal physical evaluation board review at Randolph Air Force Base, Texas.

For his lower back pain and blood disorder, the boards assigned him a disability rating of 40 percent and recommended permanent retirement.

Mitchell appealed the ruling to the Secretary of the Air Force in mid-September.

Mitchell's medical records describe his duty and mobility restrictions. He can't run, and he can't lift more than 40 pounds. His health care provider recommended he be allowed to work half days as the mission allows and wear comfortable shoes.

The disorder has taxed Mitchell's body. This past year, he was up to two dozen medications a day to control his symptoms and has gained 60 pounds in two years from the drugs' side effects.

Mitchell also had letters of support from airmen and civilians with whom he's worked including his current commander, Lt. Col. Steven Brummitt.

In his letter to the board, Brummitt said Mitchell was one of his most productive communication planners, someone he leaned on for his expertise, leadership and problem solving.

"Bottom line: MSgt Mitchell is adding value to my organization despite his medical condition," Brummitt wrote. "He is in the perfect 'desk' job to support his physical limitations ..."

'Incompatible with worldwide service'

The physical evaluation board findings zeroed in on Mitchell's autoimmune disorder, stating the condition posed "obvious medical risk" to Mitchell's health and imposed "unreasonable requirements" on the military "to maintain or protect" him.

His back pain, meanwhile, rendered him unable to deploy, meet physical fitness requirements and perform common military tasks, the boards' members ruled.

Dickerson said the Air Force could not comment on a specific case due to privacy concerns. But he said that fitness for continued military duty is based on numerous factors, including but not limited to years of service, rank, career field, the effect of the medical condition on duties, fitness limitations, deployment and assignment requirements, treatment history and prognosis.

Mitchell asked the SAF Personnel Council -- charged with reviewing and acting on military personnel matters requiring secretarial level review -- to return him to duty.

The council denied his request, underscoring Mitchell's blood disorder and "high utilization of medical resources." It noted that Mitchell had 30 medical visits in November and 10 medical visits in December, requiring a range of medical specialties, including hematology, rheumatology, pulmonology, podiatry and cardiology.

"The Board determined that the member's extensive requirements for medical specialty follow-up were incompatible with worldwide service and therefore unfitting,'" the council wrote in its decision letter.

There's no mention of Mitchell's looming retirement date.

Mission comes first

An Air Force doctor who spoke to Stars and Stripes on condition of anonymity because she was not authorized to speak about the physical evaluation board process said the decision to retain or medically discharge an airman is not up to his or her doctor. The doctor presents information about the service member's medical condition, the prognosis and treatment.

"The gentlemanly thing to do would be to let him get to 20," said the doctor, who was familiar with Mitchell's case, but "ultimately, the mission comes first."

From 2013 to 2017, four active-duty members and one Reserve member with 19 years of active service were medically discharged with severance pay as opposed to medically retired, Dickerson said.

Disability severance is a one-time lump sum payment, equal to two months of basic pay for each year of service, according to the Defense Finance and Accounting Service.

In the same time period, 65 active-duty members and 33 Reserve/Guard members were medically retired with 19 years of service. This represents 1 percent of medically retired cases during that time frame, Dickerson said.

Medical retirement entitles service members to lifetime medical coverage and a monthly payment based on one's disability rating and years of active service. Depending on the disability rating, military medical retirement pay can be offset by the amount of disability compensation a member receives from the Department of Veterans Affairs.

In the Marine Corps, four Marines in the past five years were medically discharged after serving between 19 and 20 years, officials said. The Army and Navy did not provide numbers.

A more secure future

Reaching 20 years was huge for Mitchell.

As a medical retiree with less than 20 years, he would not have been eligible to collect VA and Department of Defense disability pay, which are paid from two different buckets of money. He would have taken the higher of the two, which would have been $3,270 a month from the VA for a 100 percent disability rating. The VA disability rating is higher because it accounts for all of Mitchell's ailments, not just those affecting his ability to do his military job.

It is not taxable by the federal government.

With 20 years under his belt, Mitchell will still receive VA disability pay, plus a pension.

It's a difference of about $20,000 a year, after taxes.

The pension is peace of mind, a safety net for his family if his condition continues to deteriorate and he's unable to work, Mitchell said. The VA can always downgrade his disability rating and reduce his VA disability pay, he said.

Mitchell, his wife, Joanna, and his two school-age kids plan to move about an hour outside of Dayton, Ohio, near Wright-Patterson Air Force Base.

His message to other service members: Don't put all your eggs in one basket.

Consider investing in the Pentagon's new blended retirement system, similar to a civilian 401K plan. It allows you to leave the military with an established retirement account even if you do not retire.

"You don't know if you're going to get sick ... and get pushed out," Mitchell said.