United States v. Solomon ( 2022 )


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  •              U NITED S TATES A IR F ORCE
    C OURT OF C RIMINAL APPEALS
    ________________________
    No. ACM 39972
    ________________________
    UNITED STATES
    Appellee
    v.
    Jonathon S. SOLOMON
    Captain (O-3), U.S. Air Force, Appellant
    ________________________
    Appeal from the United States Air Force Trial Judiciary
    Decided 19 August 2022
    ________________________
    Military Judge: Willie J. Babor (arraignment); Michael W. Grant (trial);
    Andrew R. Norton (post-trial).
    Sentence: Sentence adjudged 8 November 2019 by GCM convened at
    Spangdahlem Air Base, Germany. Sentence entered by military judge
    on 24 August 2020: Dismissal, confinement for 9 years, forfeiture of all
    pay and allowances, and a reprimand.
    For Appellant: Major Matthew L. Blyth, USAF.
    For Appellee: Lieutenant Colonel Matthew J. Neil, USAF; Major Morgan
    R. Christie, USAF; Major Abbigayle C. Hunter, USAF; Major John P.
    Patera, USAF; Mary Ellen Payne, Esquire.
    Before POSCH, RICHARDSON, and CADOTTE, Appellate Military
    Judges.
    Judge RICHARDSON delivered the opinion of the court, in which Senior
    Judge POSCH and Judge CADOTTE joined.
    ________________________
    This is an unpublished opinion and, as such, does not serve as
    precedent under AFCCA Rule of Practice and Procedure 30.4.
    ________________________
    United States v. Solomon, No. ACM 39972
    RICHARDSON, Judge:
    A general court-martial comprised of officer members convicted Appellant,
    contrary to his pleas, of nine specifications of abusive sexual contact in viola-
    tion of Article 120, Uniform Code of Military Justice (UCMJ), 
    10 U.S.C. § 920
    . 1,2 The court-martial sentenced Appellant to a dismissal, nine years of
    confinement, forfeiture of all pay and allowances, and a reprimand. The con-
    vening authority deferred all forfeitures until entry of judgment, then sus-
    pended the adjudged forfeitures for six months while waiving the automatic
    forfeitures for the same period. 3
    Appellant raises 11 assignments of error 4 asking us to consider whether:
    (1) his convictions are factually and legally sufficient; (2) the military judge
    erred by failing to instruct the members on the charged term “medically nec-
    essary;” (3) the specifications fail to state an offense because the concept of
    “medical necessity” does not create a cognizable legal standard for guilt; (4) the
    military judge unconstitutionally relieved the Government of its burden to
    prove Appellant’s representations regarding the professional purpose were un-
    true; (5) the military judge abused his discretion in allowing an expert witness
    (Major (Maj) BC) to testify outside the scope of his expertise; (6) the military
    judge abused his discretion by allowing an expert witness (Dr. MC) to link Ap-
    pellant’s case to the “Milgram Experiment;” (7) trial counsel engaged in im-
    proper findings argument; (8) the military judge abused his discretion by al-
    lowing trial counsel to deliver the unsworn statements of three victims, and by
    allowing two special victims’ counsel to deliver unsworn victim statements; (9)
    Appellant’s sentence is inappropriately severe; (10) the military judge abused
    1 All offenses at issue in this case were alleged to have been committed between 10 Au-
    gust 2015 and 12 June 2017, and were referred to court-martial after 1 January 2019.
    Elements of the offenses are not listed in the Manual for Courts-Martial, United States
    (2012 ed.) (2012 MCM), but are outlined in the Manual for Courts-Martial, United
    States (2016 ed.) (2016 MCM); Appellant was on notice as to both editions. Unless oth-
    erwise noted, all references in this opinion to the non-punitive articles of the UCMJ,
    Rules for Courts-Martial (R.C.M.), and Military Rules of Evidence (Mil. R. Evid.) are
    to the Manual for Courts-Martial, United States (2019 ed.) (2019 MCM).
    2 After resting its case in chief, the Government withdrew and dismissed with prejudice
    one other specification of abusive sexual contact. Appellant was found not guilty of two
    other specifications of abusive sexual contact.
    3 The convening authority did not specifically approve Appellant’s entire sentence. On
    appeal, Appellant identifies this error but asserts no prejudice, and we find none. See
    generally United States v. Brubaker-Escobar, 
    81 M.J. 471
     (C.A.A.F. 2021) (per curiam).
    4 Appellant personally raises the part of issue (1) claiming the specification involving
    DR was legally insufficient, and personally raises issues (3), (4), and (11). See United
    States v. Grostefon, 
    12 M.J. 431
     (C.M.A. 1982).
    2
    United States v. Solomon, No. ACM 39972
    his discretion by denying a defense motion for a new trial at a post-trial hear-
    ing; and (11) the Government cannot prove beyond a reasonable doubt that the
    military judge’s failure to instruct the members that a guilty verdict must be
    unanimous was harmless. 5 In addition, the court considers the issue of timely
    post-trial processing and appellate review. We have carefully considered issue
    (11) and determine no discussion or relief is warranted. See United States v.
    Matias, 
    25 M.J. 356
    , 361 (C.M.A. 1987); see also United States v. Anderson, No.
    ACM 39969, 
    2022 CCA LEXIS 181
    , at *50–57 (A.F. Ct. Crim. App. 
    25 Mar. 2022
    ) (unpub. op.) (finding unanimous court-martial verdicts not required),
    rev. granted, No. 22-0193, ___ M.J. ___, 
    2022 CAAF LEXIS 529
     (C.A.A.F. 25
    Jul. 2022).
    I. BACKGROUND
    Appellant was a physician assistant, assigned to the Family Health section
    of the medical clinic at Spangdahlem Air Base (AB), Germany (“Clinic”). Each
    of Appellant’s nine convictions for abusive sexual contact corresponds to an
    encounter he had with a female patient. The first of these encounters was on
    5 December 2016 and the last was on 31 May 2017. 6 The last of these patients
    (CS) reported Appellant’s conduct to law enforcement about two days after the
    encounter.
    The evidence showed that each victim was first seen by a technician who
    checked her vital signs, asked questions pertaining to the visit, and recorded
    the results and responses in the patient’s record. Generally, chaperones are
    provided for appointments that require the patient to expose private areas of
    their bodies, and also are provided upon a patient or provider’s request. Based
    on the information gathered, the technician did not arrange for a chaperone to
    be present when each victim was seen by Appellant. After the technician left,
    no chaperone was present during the encounter and Appellant did not ask his
    patient if she wanted a chaperone. Appellant did not wear gloves when he
    touched each victim.
    During trial on the merits, both parties called witnesses, introduced docu-
    mentary evidence, and extensively cross-examined witnesses. The Govern-
    ment’s case included testimony from the following: each named victim; Clinic
    technicians (MM and TM); one of Appellant’s former flight commanders at the
    5 On 29 April 2022, we granted Appellant’s motion for leave to file issue (11) as a sup-
    plemental assignment of error. Beyond its opposition to Appellant’s motion, this court
    did not provide the Government an opportunity to respond to issue (11).
    6 The charged timeframe correlated to the period Appellant was assigned to the Clinic.
    The evidence admitted at trial indicates the actual time period during which Appellant
    committed the offenses.
    3
    United States v. Solomon, No. ACM 39972
    Clinic, who also testified as an expert in the field of family medicine (Maj BC);
    an expert in obstetrics and gynecology (OBGYN) (Dr. DT); and an instructor
    from a program Appellant attended to become a physician assistant (Colonel
    (Col) KK). During the testimony of each named victim, the Government had
    her draw on a figure of a woman to indicate where on her body Appellant had
    touched her. The Government introduced the patient medical records relating
    to each allegation, photos of the Clinic, and records describing Appellant’s per-
    formance as a healthcare provider.
    The Government also presented testimony from an agent from the Air
    Force Office of Special Investigations (AFOSI) regarding an interview agents
    conducted with Appellant. 7 The Government entered a portion of this recorded
    interview into evidence, which contained the following exchange regarding Ap-
    pellant’s knowledge and use of chaperones: 8
    [Special Agent]: So I know we had mentioned sexual assault. So
    does anything come to mind, when -- ?
    [Appellant]: Nothing. I mean, I do a lot of female exams and -
    you know - but I always have - you know - a chaperone in there
    - you know. Some of those females that have - like - lower pain -
    or you know - around, like, just below the belt line, I’ll feel down
    there without a chaperone, but that’s kind of common. Nothing
    - I mean, nothing, nothing comes to mind right now.
    The Defense’s case included testimony from another former flight com-
    mander at the Clinic (Maj VG), and a family practice care provider (Captain
    (Capt) DL) who attended a physician assistant training program with Appel-
    lant and later worked with him at the Clinic. The Defense also presented tes-
    timony from experts in the fields of internal medicine, cardiology, and AHLTA 9
    (Col ML); OBGYN (Dr. CS); and “physician assistant specialized in family
    medicine and orthopedics” (Lieutenant Colonel (Lt Col) SG).
    Appellant was convicted of nine specifications of abusive sexual contact
    against eight victims. Following, in chronological order beginning with the ear-
    liest offense, is a summary of the testimony from each victim supporting the
    convictions.
    7 This interview related to a specification of which Appellant was acquitted, and took
    place before the conduct of which Appellant was convicted.
    8 We transcribe the language from the prosecution exhibit, which differs slightly from
    the trial transcript.
    9 Testimony described AHLTA as an electronic medical record system used in the Air
    Force.
    4
    United States v. Solomon, No. ACM 39972
    A. BJ
    BJ was assigned to Spangdahlem AB. She made an appointment with the
    Clinic to get a “release to fly” to Oklahoma while pregnant. At the encounter
    with Appellant on 5 December 2016, she said she was feeling fine. After check-
    ing her eyes, ears, reflexes, and lymph nodes on her neck, Appellant asked her
    to lay back on the table, saying he needed to examine her breasts. She com-
    plied. Appellant “reached his hand in through the top of [her] shirt and began
    feeling [her] breasts” under her shirt and bra. Appellant touched her breasts
    in a “random” circular direction, with a “tapping/massage motion.” As he
    touched BJ, Appellant’s “hands were shaky. They were cold and clammy. He
    would not make eye contact and he would not speak.”
    B. RH
    RH was married to an Airman stationed at Spangdahlem AB. She made an
    appointment at the Clinic because of shortness of breath. Appellant placed his
    hand and the stethoscope down the front of her shirt, then on her back on the
    outside of her shirt. RH told Appellant she felt a pain like an “internal bruise”
    in her chest area. Appellant asked her to remove her shirt, and she did. Appel-
    lant pushed on her chest with his fingertips and asked if she felt pain. She
    responded yes at first, then no to the other touches, which were “in a circular
    motion around [her] breast on either side.” In RH’s telling, “When he got back
    to the center he asked [her] if [she] could pull [her] straps down on [her] bra,
    and then he continued the pattern.” Each time Appellant touched her breasts,
    she responded she felt no pain. When Appellant touched toward the bottom on
    her breast, he asked if she could take her bra off. Instead, she flipped the bra
    down, but did not take it off. Appellant continued the pattern of touching RH’s
    breasts in a circular pattern. While Appellant was touching her breasts, Ap-
    pellant was breathing heavily; she “had never noticed him breathing like that
    before” in prior examinations. Appellant did not explain the results of his ex-
    amination to RH. At the time of this encounter, she believed Appellant’s action
    had a medical purpose. He told her to wear a sports bra for a few weeks. He
    went to the computer, then left the room.
    RH made another appointment at the Clinic, this time because of groin
    pain. 10 She showed Appellant where she felt the pain, over her yoga pants at
    her “bikini line.” Appellant asked her to pull her pants down a little bit; she
    did. Appellant pressed down and asked if she felt pain; she said she did. He
    then asked RH “if it would be easier for [her] to take [her] leg out of [her] pant
    leg,” so she took one leg out; the other pant leg was above the knee. Standing
    10 This appointment was on 14 April 2017. Chronologically, Appellant’s conduct during
    this encounter was the second-to-last offense of which Appellant was convicted.
    5
    United States v. Solomon, No. ACM 39972
    between her legs, Appellant pressed in the same spot, asking if she felt pain;
    she said she did. Appellant then moved his hands “downward.” He asked if she
    felt pain; she said she did not. RH testified that Appellant touched her a total
    of six times. At the fourth touch, RH said she felt no pain. After the fifth
    touch—also without pain—Appellant asked RH “if [she] can reach down and
    pull [her] panties to the side;” she did. She was wearing a menstrual pad, and
    moved her underwear such that part of her vagina was exposed. On the sixth
    and last touch, Appellant touched “[i]n the outside of [her] vaginal area, the lip
    area, the outer lip area.” RH told Appellant she was uncomfortable, and he
    stopped. Appellant did not explain to RH why he touched her labia. In response
    to a member question, RH said Appellant sounded “nervous.” 11
    C. MR
    MR was stationed at Spangdahlem AB. After receiving care in an emer-
    gency room, she made a follow-up appointment at the Clinic. She brought an
    EKG printout with her; Appellant did not look at it. MR testified that Appel-
    lant once “tried to listen to [her] heartbeat through [her t-shirt] and he told
    [her] he could not hear it.” He asked her to remove her shirt and bra. MR asked
    for a chaperone. Appellant then handed her a gown and left. When Appellant
    returned without a chaperone, MR did not ask again, explaining: “I don’t know
    if he didn’t hear me, or whatever, but he was a doctor, so I trusted that he had
    my best intentions in mind.” Appellant placed the stethoscope on the gown,
    and said he could not hear through the gown. Appellant had her lay down.
    “[T]hen he had opened the gown to where [MR] was fully exposed from the
    waist up” and placed the stethoscope “[r]ight on [her] breast,” with his other
    hand “cupping . . . the bottom of [her] breast.” Appellant placed the stethoscope
    “on [her] breast six times, and once on [her] nipple.” During the three touches
    on the bottom part of her breast, “he would grab [her] breast” and move it with
    “a soft jiggle,” “and then he would remove his hand and place the stethoscope”
    on her breast. Appellant did not examine her other breast. MR believed at the
    time of this encounter that Appellant touched her breast for a valid medical
    reason.
    Appellant went to his computer, then asked whether she experienced any
    tingling, numbness, or cold feeling in her feet; she replied that she did not.
    Appellant asked her to take off her sock and boot. He then massaged her foot
    for what felt to MR like two minutes. He went back to his computer, then left
    the room. MR explained, “I had gotten dressed and I had waited about 10
    11 The question was, “When [Appellant] was touching your labia, can you describe what
    you recall hearing pertaining to [Appellant’s] demeanor, how he sounded, and what
    you heard concerning [Appellant] sounding serious, calm, nervous, confused, curious,
    or otherwise?”
    6
    United States v. Solomon, No. ACM 39972
    minutes, and then no one had come in the room, so I had left.” Appellant did
    not tell MR his findings based on his examinations.
    D. SC
    SC was a German national married to an Airman stationed at
    Spangdahlem AB. She made an appointment at the Clinic to get a referral to
    her off-base provider to refill her birth-control prescription. Appellant found a
    substitute medication, and SC agreed to get that medication instead of a refer-
    ral. Appellant asked her to get on the table for an examination, and told her
    he wanted to check her heart rate. At the time, SC was wearing jeans, an outer
    blouse, a tank top, and a bra. Appellant struggled with getting his hand and
    stethoscope down the front of her blouse, so SC asked if she should remove her
    blouse, to which he replied, “If [you] don’t mind.” She removed her blouse, leav-
    ing on her tank top. Appellant “went further down with the telescope, in-be-
    tween [her] breasts . . . moving it around for a while, and he was saying, ‘I
    cannot find your heartbeat.’” SC then offered to remove her tank top, and did,
    leaving on her bra. SC testified that Appellant “was still with the stethoscope
    in-between [her] breasts for some time, and then he went with the stethoscope
    on [her] right-hand side, down on [her] body.” Appellant repeatedly told SC to
    take deep breaths.
    Appellant moved the stethoscope down to SC’s lower groin, then asked SC
    to unbutton and unzip her jeans. He told her he was going to check her pulse.
    He placed the stethoscope under her underwear, getting to “a finger-width
    away from [her] vagina.” She felt the cold metal of the stethoscope. In response
    to a question from counsel, SC agreed that “when his hand and the stethoscope
    were down there,” Appellant touched her pubic hair. After Appellant took the
    stethoscope out of her pants, he asked her about getting a pap smear, telling
    her that on military installations they check patients yearly. He left the room
    briefly, then returned and offered to perform a pap smear, but SC “was really
    uncomfortable by that point” and declined. During the encounter, Appellant
    never tried to check her pulse on her wrist or neck. Appellant did not explain
    the results of his examination to SC. SC believed at the time of this encounter
    that Appellant touched her groin for a medical reason.
    E. EP
    EP was married to an Airman stationed at Spangdahlem AB. She made an
    appointment at the Clinic to obtain refills of medication prescribed by the pro-
    vider she had seen during her recent pregnancy. She had seen Appellant be-
    fore, including when Appellant ordered an MRI and referred her to an ortho-
    pedic specialist for pelvic pain. A chaperone was present for that prior exam.
    After they discussed the refills, EP told Appellant the results of the MRI of her
    pelvis. Appellant “asked [her] to lay on the exam table and pull [her] pants
    7
    United States v. Solomon, No. ACM 39972
    down. And [she] pulled them down and he continued to do an exam, feeling on
    [her] pubic area.” EP also pulled her underwear down. She did not lay down,
    but was reclined on her elbows. Appellant palpitated different places in her
    pelvic area with his fingers. At one point, EP “noticed that his fingers spread
    apart a little bit more, and was almost, like, coursing through [her] pubic hair.”
    She testified she had noticed “it wasn’t how he was palpitating the rest of [her]
    pelvis. It was definitely a difference.” Appellant stopped, and placed his hand
    near his nose. EP described Appellant’s next action with his hand as an “itch”
    or “wipe” of his nose, and said “[i]t sounded like he smelled his fingers.” He did
    not explain to EP why he needed to examine her in that way. When she left,
    EP “felt things were not done how they should have been done,” explaining
    that she did not anticipate she would undergo an exam. Also, she thought Ap-
    pellant should have been wearing gloves. Sometime afterwards, she talked to
    her friend SC—the same SC described above—about the encounter.
    F. DB
    DB was married to an Airman stationed at Spangdahlem AB. She made an
    appointment at the Clinic as part of her enrollment in Tricare. Appellant lis-
    tened to her heart with a stethoscope. DB asked Appellant whether she should
    remove her shirt so he could hear better. 12 Appellant agreed. Appellant went
    behind a curtain while DB removed her clothing; she could not remember
    whether she removed only her shirt at that point, or also her bra. When her
    upper body was fully unclothed Appellant “touch[ed] around the chest area,
    around the armpit” with his hands from the bottom of her breasts to the outer
    and upper sides. Appellant was standing directly in front of her, not to the side.
    The encounter ended with a discussion about making an appointment for a pap
    smear. DB was nervous because it was her first appointment at a military
    clinic and she “just didn’t know exactly how everything goes when you go to
    the doctor.”
    G. DR
    DR lived with her active-duty husband, who was stationed at Spangdahlem
    AB. She made an appointment at the Clinic for a prescription refill, but the
    morning of the appointment had a positive home-pregnancy test. She met with
    Appellant, who sent her to the lab to confirm. She went back to the Clinic and
    Appellant told her the lab results. He “asked [her] to lay back and slide [her]
    12 DB also thought Appellant might be conducting a breast examination, as DB had
    received breast implants about a year prior. However, she did not remember asking
    Appellant to check her breasts, and Appellant did not tell her he wanted to perform a
    breast examination.
    8
    United States v. Solomon, No. ACM 39972
    pants down a little bit.” She pulled her pants to about thigh-level, and was
    wearing thin thong-style underwear. DR explained,
    I remember him standing off to the right of me and reaching
    down in beside my underwear and in-between my thighs, and he
    didn’t really say what he was doing until his hand was already
    there, to the right of my labia, and he was there and he was rub-
    bing and all he said was, “In the coming months, you’ll feel pain
    in this area.”
    DR felt two of Appellant’s fingers touching her, and confirmed that he did
    touch her labia. At the time of this encounter, she thought Appellant was
    touching her for a medical reason, but mostly was thinking about her preg-
    nancy results. In response to a member question, DR said that Appellant
    “sounded kind of nervous” based on “his breathing and mannerisms.”
    H. CS
    CS was on active duty at the time of her appointment with Appellant on
    31 May 2019. She made the appointment at the Clinic because she had “an
    extended cold.” Appellant said he wanted to listen to her lungs. He listened,
    with a stethoscope to her back but over her t-shirt and sports bra, said he
    “couldn’t get a good listen,” and said he wanted to listen under her shirt. CS
    untucked her t-shirt, then Appellant put the stethoscope under her shirt. He
    said he thought he heard wheezing, and wanted to listen from the front. He
    moved the stethoscope “in a W shape across, underneath [her] breasts, to lis-
    ten.” At her sternum, “[h]e lifted [her] sports bra up with his other hand to
    slide his hand inside, between the breasts, to listen.” Appellant touched her
    breasts with his hand, not just the stethoscope. Appellant did not tell her what
    he heard. He did not check her ears, nose, or throat, but did check the lymph
    nodes on her neck. CS had breast implants placed about seven months before
    this encounter.
    Appellant went to the computer, then asked CS whether her cold was in-
    terfering with her upcoming abdominal surgery; she confirmed it was. Appel-
    lant then asked to look at her abdomen and “see [her] stomach, the damage.”
    CS laid down, with the top two buttons of her uniform pants undone. Appellant
    put his hands on her abdomen, then below the belly button. Appellant “tiptoed
    his fingers down further into [her] pelvic area.” When his fingers were “[b]asi-
    cally touching” her pubic hair, CS stopped Appellant by falsely telling him “the
    damage did not go down that far.” Appellant did not ask CS to cough, bear
    down, or do a sit up. CS had not complained of pain.
    Appellant went back to his computer, and said he forgot to do a lymph node
    exam. He wanted to check the nodes under her armpit. She lifted her arms,
    then Appellant’s “fingers, in a wavy motion, touch[ed] the side of [her] ribcage
    9
    United States v. Solomon, No. ACM 39972
    and breasts.” She “laugh[ed] and giggl[ed],” and apologized for being ticklish.
    Appellant “laughed and giggled too, and continued the exam.” Appellant
    touched her “[o]n the side of the ribcage, all the way through to the side boob
    area” on both sides, then under the armpit.
    By the end of the encounter, CS felt “[s]hocked, uncomfortable, violated,
    [and] unsure.” She thought Appellant’s examination of her pubic area was
    “very excessive, unnecessary,” but Appellant acted like he was doing it for a
    medical reason. She texted her friend on the way to the pharmacy, saying:
    “Omg,” “Something just happened at the doctors,” and “I feel almost violated?”
    In the next days, she reported the incident to base law enforcement. A noncom-
    missioned officer testified about what CS told him had happened, and about
    CS’s positive character for truthfulness.
    II. DISCUSSION
    A. Legal and Factual Sufficiency
    1. Additional Background
    In the case under review, the Government’s theory of guilt generally was
    that Appellant (1) identified potential victims—women with appointments for
    a reason that did not necessitate a chaperone, (2) touched the women initially
    with a stated medical purpose, (3) touched the women in sensitive or progres-
    sively more sensitive parts of their bodies, (4) did not get a chaperone, (5) did
    not perform the touching in a manner that correlated with any stated medical
    purpose, and (6) did not document the actual areas he touched in the women’s
    medical records. The Government used facts supporting its theory to prove the
    elements of the offenses, including Appellant’s intent to gratify his sexual de-
    sire.
    2. Law
    We review issues of legal and factual sufficiency de novo. United States v.
    Washington, 
    57 M.J. 394
    , 399 (C.A.A.F. 2002) (citation omitted). Our assess-
    ment of legal and factual sufficiency is limited to the evidence presented at
    trial. United States v. Dykes, 
    38 M.J. 270
    , 272 (C.M.A. 1993) (citations omitted).
    “The test for legal sufficiency is whether, after viewing the evidence in the
    light most favorable to the prosecution, any rational trier of fact could have
    found the essential elements of the crime beyond a reasonable doubt.” United
    States v. Robinson, 
    77 M.J. 294
    , 297–98 (C.A.A.F. 2018) (quoting United States
    v. Rosario, 
    76 M.J. 114
    , 117 (C.A.A.F. 2017)). “[I]n resolving questions of legal
    sufficiency, we are bound to draw every reasonable inference from the evidence
    of record in favor of the prosecution.” United States v. Barner, 
    56 M.J. 131
    , 134
    (C.A.A.F. 2001) (citations omitted). The evidence supporting a conviction can
    10
    United States v. Solomon, No. ACM 39972
    be direct or circumstantial. See United States v. Long, 
    81 M.J. 362
    , 368
    (C.A.A.F. 2021) (citing Rule for Courts-Martial (R.C.M.) 918 (c)) (additional ci-
    tation omitted). “[A] rational factfinder[ ] could use his ‘experience with people
    and events in weighing the probabilities’ to infer beyond a reasonable doubt”
    that an element was proven. 
    Id. at 369
     (quoting Holland v. United States, 
    348 U.S. 121
    , 140 (1954)). “The term reasonable doubt . . . does not mean that the
    evidence must be free from conflict.” United States v. Wheeler, 
    76 M.J. 564
    , 568
    (A.F. Ct. Crim. App. 2017) (citing United States v. Lips, 
    22 M.J. 679
    , 684
    (A.F.C.M.R. 1986)), aff’d, 
    77 M.J. 289
     (C.A.A.F. 2018). “Court members may
    believe one portion of a witness’s testimony but disbelieve others.” United
    States v. Bare, 
    63 M.J. 707
    , 713 (A.F. Ct. Crim. App. 2006) (citing United States
    v. Harris, 
    8 M.J. 52
    , 59 (C.M.A. 1979)). The “standard for legal sufficiency in-
    volves a very low threshold to sustain a conviction.” United States v. King, 
    78 M.J. 218
    , 221 (C.A.A.F. 2019) (internal quotation marks and citation omitted).
    The test for factual sufficiency is “whether, after weighing the evidence in
    the record of trial and making allowances for not having personally observed
    the witnesses, [we are ourselves] convinced of the [appellant]’s guilt beyond a
    reasonable doubt.” United States v. Turner, 
    25 M.J. 324
    , 325 (C.M.A. 1987). “In
    conducting this unique appellate role, we take ‘a fresh, impartial look at the
    evidence,’ applying ‘neither a presumption of innocence nor a presumption of
    guilt’ to ‘make [our] own independent determination as to whether the evidence
    constitutes proof of each required element beyond a reasonable doubt.’”
    Wheeler, 
    76 M.J. at 568
     (alteration in original) (quoting Washington, 57 M.J.
    at 399).
    The elements of the abusive sexual contact specifications of which Appel-
    lant was found guilty include the following: (1) Appellant committed sexual
    contact upon another person by touching a certain body part of that other per-
    son; (2) Appellant did so by making a fraudulent representation that the sexual
    contact served a professional purpose, to wit: that the sexual contact was med-
    ically necessary; and (3) Appellant did so with the intent to gratify his sexual
    desire. 13 See, e.g., Manual for Courts-Martial, United States (2016 ed.), pt. IV,
    ¶¶ 45.b.(7)(c), 45.b.(8)(c). 14 The term “sexual contact” includes touching the
    body part of any person if done with the intent to gratify one’s sexual desire.
    See Manual for Courts-Martial, United States (2012 ed.), pt. IV, ¶ 45.a.(g)(2).
    13 The specifications concerning BJ, MR, EP, DR, and CS alleged “an intent to arouse
    or gratify.”
    14 As indicated in note 1, supra, elements of this offense are not listed in the 2012
    MCM, but may be derived from reviewing the text of the UCMJ article. See 2012 MCM,
    pt. IV, ¶¶ 45.a(d), 45.a(b)(1)(C), 45.a(g)(2)(B).
    11
    United States v. Solomon, No. ACM 39972
    “Touching may be accomplished by any part of the body.” Id. The term “fraud-
    ulent representation” is not defined in the statute or the Manual for Courts-
    Martial dating back to 2012. The Military Judges’ Benchbook contains a sam-
    ple definition: “A ‘fraudulent representation’ is a representation of fact, which
    the accused knows to be untrue, which is intended to deceive, which does in
    fact deceive, and which causes the other person to engage in the sexual con-
    tact.” Military Judges’ Benchbook, Dept. of the Army Pamphlet 27-9 at 599 (10
    Sep. 2014).
    We review de novo whether a specification states an offense. See United
    States v. Turner, 
    79 M.J. 401
    , 404 (C.A.A.F. 2020) (citation omitted); United
    States v. Schloff, 
    74 M.J. 312
    , 313 (C.A.A.F. 2015). “[W]here defects in a speci-
    fication are raised for the first time on appeal, dismissal of the affected charges
    or specifications will depend on whether there is plain error -- which, in most
    cases, will turn on the question of prejudice.” United States v. Humphries, 
    71 M.J. 209
    , 213 (C.A.A.F. 2012) (footnote and citations omitted). “In the context
    of a plain error analysis of defective indictments, ‘[the] [a]ppellant has the bur-
    den of demonstrating that: (1) there was error; (2) the error was plain or obvi-
    ous; and (3) the error materially prejudiced a substantial right of the accused.’”
    
    Id. at 214
     (alterations in original) (quoting United States v. Girouard, 
    70 M.J. 5
    , 11 (C.A.A.F. 2011)) (additional citations omitted).
    The standard for determining whether a specification states an offense is
    whether it alleged every element of the charged offense either “expressly or by
    necessary implication,” so as to provide an accused both notice and protection
    against double jeopardy. United States v. Dear, 
    40 M.J. 196
    , 197 (C.M.A. 1994)
    (internal quotation marks and citations omitted). “This is a three-prong test
    requiring (1) the essential elements of the offense, (2) notice of the charge, and
    (3) protection against double jeopardy.” 
    Id.
    When failure to state an offense is asserted for the first time on appeal, “the
    sufficiency of the specification may be sustained ‘if the necessary facts appear
    in any form or by fair construction can be found within the terms of the speci-
    fication.’” United States v. Crafter, 
    64 M.J. 209
    , 211 (C.A.A.F. 2006) (quoting
    United States v. Mayo, 
    12 M.J. 286
    , 288 (C.M.A. 1982)).
    3. Analysis
    We consider Appellant’s claims as they relate to each element of the offense
    of abusive sexual contact.
    a. Sexual contact
    Appellant claims the Government did not sufficiently prove the element of
    sexual contact in Specifications 8, 7, and 5 regarding SC, DB, and, to an extent,
    BJ.
    12
    United States v. Solomon, No. ACM 39972
    i) SC
    Appellant asserts SC’s testimony does not support the allegation that Ap-
    pellant touched her groin with his hand and not with the stethoscope he was
    holding in his hand. In her testimony, SC did not make a distinction between
    Appellant touching her with his hand and with the stethoscope. SC testified
    she could “feel only the metal,” yet she also said Appellant touched her pubic
    hair. The Government argues that SC’s testimony—including that Appellant
    reached down into the narrow space under SC’s pants and underwear with his
    hand on a stethoscope, touched her groin until he got to within a finger-width
    of her vagina, and touched her pubic hair—is evidence that Appellant touched
    SC’s groin with his hand. We agree that a rational factfinder could come to this
    same conclusion. 15
    ii) DB
    Appellant asserts DB’s testimony does not support the allegation that Ap-
    pellant touched her breast. Both parties agree that DB testified that Appellant
    touched her chest area and around her armpit. Appellant claims DB’s drawing
    shows lines that “do not overlap with her breasts.” The Government suggests
    that same drawing “shows Appellant touched the side of her breast and up into
    her armpit.” Moreover, the Government asserts other testimony supports the
    conclusion that the breast extends to the armpit. DB’s testimony that Appel-
    lant first touched her chest in order to hear her heartbeat, then examined her
    breasts, lends support to the interpretation that Appellant touched at least one
    of DB’s breasts, albeit perhaps only the outer contours.
    iii) BJ
    Regarding BJ, Appellant does not claim the act that BJ described was not
    a sexual contact. Instead, he asserts her “confusion and credibility issues pre-
    vented the Government from meeting its burden to prove [Appellant’s] guilt
    beyond a reasonable doubt” and claims “nothing that [BJ] said can leave this
    [c]ourt with any confidence of what occurred in that room.” The Government
    responds that BJ’s “memory of what happened at the appointment was clear
    and credible.” Having considered BJ’s testimony as a whole, we are convinced
    a rational factfinder could believe BJ’s description of Appellant touching her
    breasts with his hand under her shirt and bra.
    15 We note that sexual contact may be accomplished using a stethoscope and not the
    hand directly, but it was not charged in this manner in this case. See United States v.
    Schloff, 
    74 M.J. 312
    , 314 (C.A.A.F. 2015).
    13
    United States v. Solomon, No. ACM 39972
    b. Fraudulent representation
    As described above, the second element of each offense is that Appellant
    made a sexual contact by making a fraudulent representation that the sexual
    contact served a professional purpose, to wit: that the sexual contact was med-
    ically necessary. The military judge provided the court members a definition of
    “fraudulent representation,” which Appellant does not claim—nor do we find—
    was erroneous:
    A fraudulent representation is a representation of fact, which
    the accused knows to be untrue, which is intended to deceive,
    which does in fact deceive, and which causes the other person to
    engage in the sexual contact. The fraudulent representation that
    the sexual contact served a professional purpose need not have
    been made by the accused to the alleged victims. It is sufficient
    if the accused made such a fraudulent representation to any per-
    son, which thereby caused an alleged victim to engage in the sex-
    ual contact.
    A fraudulent representation that a touching is for a professional
    purpose need not be solely expressed in words. In determining
    whether a fraudulent representation was made, you may con-
    sider the totality of the accused’s conduct and not just his verbal
    statements. A false representation may be inferred from con-
    duct, or a combination of words and conduct.
    A patient’s confusion or doubt about the purpose of the touching
    does not preclude a conviction as long as you find beyond a rea-
    sonable doubt that the patient allowed the touching to occur be-
    cause of the accused’s fraudulent representation of a profes-
    sional purpose.
    The military judge also instructed the members that the “term ‘to wit’
    means ‘namely’ or ‘that is to say.’”
    Appellant asserts that, for each specification, the evidence failed to suffi-
    ciently prove that he made a fraudulent representation that the contact was
    medically necessary. As his counsel argued at trial, Appellant asserts on ap-
    peal that if his contact served any professional purpose, i.e., it was “within the
    scope of normal medical practice” or “rested on solid medical reasoning,” it was
    medically necessary and thus not a fraudulent representation. The Govern-
    ment counters, as it did at trial, that Appellant had no medical reason to con-
    duct the purported exams and did not properly conduct those exams, and there-
    fore they were not medically necessary.
    Whether Appellant’s contacts served any professional purpose—or were
    within the scope of medical practice, or rested on solid medical reasoning—is
    14
    United States v. Solomon, No. ACM 39972
    not inconsistent with a fraudulent representation. Appellant’s sexual contacts
    had a root in medical care, which is how he had the opportunity and ability to
    deceive his victims. He represented to each victim that he needed to touch them
    for a medical purpose, and for that reason, they allowed him. However, circum-
    stantial evidence—including how Appellant touched each victim, how physi-
    cian assistants should conduct exams, Appellant’s failure to arrange for the
    presence of a chaperone before touching sensitive areas, Appellant’s lack of
    feedback to the victim about the exam, and the lack of medical documentation
    of the exam—was proof that Appellant knew he did not need to touch the vic-
    tim’s private areas in the manner he did, but through his words or actions
    falsely represented that he did. The element of fraudulent representation was
    met because Appellant caused each victim to believe the purpose of the sexual
    contact was professional medical care, when Appellant knew 16 the purpose of
    the contact was something else—in this case, an intent to gratify his sexual
    desire.
    c. Intent
    Intent may be proved by circumstantial evidence. See King, 78 M.J. at 221.
    “[T]he ability to rely on circumstantial evidence is especially important in
    cases . . . where the offense is normally committed in private.” Id.
    Appellant asserts the facts do not support the third element of all the spec-
    ifications: an intent to arouse his sexual desire. The parties’ arguments regard-
    ing CS are illustrative. Appellant asserts that “[t]he manner of the touching,
    repeatedly passing a stethoscope below the breasts, does not support an intent
    to arouse or gratify his sexual desire” and “the Government’s proof relies on
    vague critiques of technique to substitute for evidence of [Appellant’s] intent.”
    The Government asserts “[t]he places on [CS]’s body that Appellant touched,”
    along with “[t]he lack of a medical reason to conduct the touching of [CS], and
    Appellant’s uncharacteristic failure to follow the chaperone policy, document
    his exams, and explain the results of his exam to [CS] all sufficiently prove
    Appellant’s intent was to gratify his sexual desires.”
    The Government proved intent in this case with circumstantial evidence.
    The Government presented evidence of the technique Appellant used to touch
    his patients. One example is testimony from RH that Appellant stood between
    her legs and asked her to move her underwear to the side. Expert testimony
    16 After discussion with the parties beforehand, the military judge provided the mem-
    bers an instruction that mistake was a defense to Specifications 1–11, stating, in part,
    “[i]f the accused at the time of an offense was under the mistaken belief that the sexual
    contact served a professional purpose, to wit: that the sexual contact was medically
    necessary, then he cannot be found guilty of abusive sexual contact.”
    15
    United States v. Solomon, No. ACM 39972
    explained why medical providers are trained to stand on the outside of the pa-
    tient’s legs to examine the groin, and opined that in this case moving the un-
    derwear was not necessary.
    Some of the evidence went beyond the technique Appellant employed to
    make the charged contact, for example: sniffing his fingers after touching a
    victim’s pelvis and pubic hair (EP), rubbing a victim’s foot without explanation
    (MR), and demonstrating on a victim where she would feel pain due to preg-
    nancy by touching her labia (DR). Most of the evidence supporting intent did
    not consist of a single fact and instead was comprised of a constellation of facts.
    For example, the Government argues on appeal:
    Appellant is a competent provider who would have known a
    medical exam was not necessary for a birth control refill, would
    have been able to hear [SC]’s heartbeat on her chest, would have
    known there are multiple other benign body locations to check[ ]
    for pulse, and, if he had truly been taking the femoral pulse,
    would have done it correctly. Appellant’s intent in touching [SC]
    was to gratify his sexual desires, and the evidence proves it.
    Another example is BJ, who testified that Appellant tapped or massaged her
    breasts in a “random” direction with cold, clammy, shaky hands and without
    speaking.
    The Government even presented evidence that the breast was a sexual or-
    gan. Dr. DT testified that from a medical viewpoint, the breast is not a sexual
    reproductive organ, “[b]ut in society it’s a sexual organ.” Dr. DT further ex-
    plained that his “patients are not physicians, and so [he] treat[s] it as a sexual
    organ” and utilizes chaperones for breast exams.
    Additionally, the Government relied on evidence introduced under Mil. R.
    Evid. 404(b) of Appellant not following the chaperone policy and not adequately
    documenting the patient encounters, 17 in order to show Appellant had the plan
    or design, and created the opportunity, to be alone with his victims and commit
    sexual contacts that gratified his sexual desire, and then cover up his crimes.
    An example is DB, who came to see Appellant for a physical for which no chap-
    erone was anticipated. Appellant had her remove her shirt and bra and exam-
    ined her breast implants, but did not document this breast exam in her patient
    records. BJ’s experience was similar. The Government’s cross-examination of
    17 A court member posed a written question asking whether “the deliberate failure to
    document a physical exam [is] considered falsification of an official record.” Both par-
    ties objected, and the military judge did not ask the question. However, this later
    prompted the Government to request and—without objection from the Defense—the
    military judge to add this failure to document to the Mil. R. Evid. 404(b) instruction.
    16
    United States v. Solomon, No. ACM 39972
    one of Appellant’s friends and peers from physician assistant training, Capt
    DL, emphasizes many of these points:
    Q. Okay. When you’re listening to a woman for chest or lung
    sounds, have you ever gotten to the point where you’d ask a
    woman to take off both her shirt and her bra just so you could
    try to hear her lungs?
    A. If the wire were in the way, sure, I might ask them to take off
    both their bra and their shirt, and I would have them get into a
    gown.
    Q. And you’d get a chaperone?
    A. Yes, I would.
    Q. And you’d step out of the room?
    A. I would step out of the room while they were - while they were
    undressing, yes.
    Q. And you would explain to them why they’re getting a gown
    on?
    A. Yes. And once again, this would be in a situation where I
    thought it was necessary because they had a primary pulmonary
    complaint.
    Q. And as part of your training in either phase one or phase two,
    were you ever trained to listen for lung or heart sounds directly
    over the nipple?
    A. I don’t believe that I would do that, no.
    Q. And that’s because fat tissue interferes with sound coming
    through?
    A. Yes, it attenuates sound.
    Q. And you weren’t trained to listen over the sternum either,
    were you?
    A. Just to the lateral aspect of the sternum - the sternal border,
    but not - no, not directly over the sternal bone, no.
    Regarding documentation, Capt DL answered in the affirmative the mem-
    ber question:
    In the context of your experience as a [physician assistant] at
    Spangdahlem, if you thought a patient could be at risk of an un-
    diagnosed congenital heart disorder, or sudden cardiac death,
    would you make any particular effort to document the exams you
    17
    United States v. Solomon, No. ACM 39972
    did based on those potential conditions, even on a very busy day,
    and even if AHLTA was down?
    To be sure, some people would not expect a medical provider to get sexual
    gratification from touching many of these patients the way Appellant did. In-
    deed, the members could have used their “experience with people and events,”
    see Long, 81 M.J. at 369, and rejected the inference that Appellant had the
    requisite sexual intent when he touched a patient. 18 However, the tests for le-
    gal and factual sufficiency do not center on any other person’s subjective no-
    tions of what is sexually gratifying. A rational trier of fact could find beyond a
    reasonable doubt that Appellant had an intent to gratify his sexual desire when
    he touched his patients in the manner the patients described. Moreover, we
    are personally convinced by the evidence supporting the element of intent for
    each specification of which Appellant was found guilty.
    d. Failure to state an offense
    Appellant personally claims that “the amorphous concept of ‘medical neces-
    sity’ does not create a cognizable legal standard for guilt.” He asserts that the
    “addition of the phrase ‘to wit: that the sexual contact was medically necessary’
    rendered the charges fundamentally flawed such that they cannot support the
    conviction.” The Government asserts Appellant forfeited this issue by not mov-
    ing to dismiss for failure to state an offense; the issue does not amount to plain
    error; and no substantial right of Appellant was prejudiced.
    At the outset, we note Appellant does not assert that he lacked notice or
    lacked protection from double jeopardy as a result of the Government’s charg-
    ing scheme. See Crafter, 
    64 M.J. at 211
    . We understand Appellant’s argument
    to be that the phrase “medically necessary” has no medical meaning, yet at
    trial was likened to “standard of care,” and resulted in a conviction based on a
    negligence standard. While the meaning of the phrase “medically necessary”
    was the topic of much discussion among the parties and the military judge at
    the trial, none of that discussion involved failure to state an offense. Accord-
    ingly, this issue is forfeited and we review for plain error. Humphries, 71 M.J.
    at 213.
    The addition of the phrase “medically necessary” did not change the re-
    mainder of the specifications alleging all elements of the crime of abusive sex-
    ual contact. It modified the element of fraudulent representation; it narrowed
    18 During closing argument, trial defense counsel asked the members to do just this,
    rhetorically asking them, “He’s going to run his fingers through the pubic hair of a 285-
    pound woman for sexual gratification, like, that just doesn’t make sense. Who is 6
    months post-partum? No.”
    18
    United States v. Solomon, No. ACM 39972
    the professional purpose to a medical one, and not some other professional pur-
    pose like educational. 19 Even if we were to find error by the inclusion of the
    phrase “medically necessary” in the specifications, we would find no prejudice;
    Appellant has not convinced us that he was convicted based on a negligence
    standard or anything less than proof beyond a reasonable doubt. See Section
    E, infra. The evidence relating to standard of care was not used to show that
    Appellant provided substandard or negligent medical care—that is, simply was
    wrong about whether the examination was medically necessary—and was thus
    guilty of abusive sexual contact by a negligence standard. Instead, the Govern-
    ment used that evidence to show that Appellant was a competent provider who
    knew what exams were medically indicated and how to perform them, and was
    not, in fact, conducting what he thought were medically necessary exams.
    We conclude that a rational factfinder could have found beyond a reasona-
    ble doubt all the essential elements of Appellant’s convicted offenses. Further-
    more, after weighing all the evidence in the record of trial and having made
    allowances for not having personally observed the witnesses, we are convinced
    of Appellant’s guilt beyond a reasonable doubt. Therefore, we find Appellant’s
    convictions both legally and factually sufficient.
    B. Instructions on the Elements and Definitions of the Offenses
    Appellant asserts two errors related to the military judge’s instructions on
    findings. First, he claims the military judge erred by failing to instruct the
    members on the charged term “medically necessary.” He also claims the mili-
    tary judge unconstitutionally relieved the Government of its burden to prove
    Appellant’s representations regarding the professional purpose were untrue. 20
    We find the former claim waived and consider the merits of the latter.
    1. Additional Background
    The specifications of which Appellant was convicted allege a sexual contact
    with an intent to gratify his sexual desire, “by making a fraudulent represen-
    tation that the sexual contact served a professional purpose, to wit: that the
    sexual contact was medically necessary.”
    Before opening statements, the military judge held an Article 39(a), UCMJ,
    
    10 U.S.C. § 839
    (a), hearing for trial defense counsel “to present argument on a
    19 The sample specification in the Manual guides practitioners to describe the profes-
    sional purpose at the heart of the fraudulent representation, starting with the words,
    “to wit.” See 2016 MCM, pt. IV, ¶ 45.f.(7)(c).
    20 Appellant claims a due process violation, but does not articulate how prejudice re-
    sulted: “In essence, by relieving the Government of having to prove that no professional
    purpose existed, the Government no longer had to prove the representation was fraud-
    ulent.” We consider Appellant’s issue as an error in instruction.
    19
    United States v. Solomon, No. ACM 39972
    concern they have in regards to the way the Government has charged the case
    and/or potentially what the elements of the offense will be.” Circuit defense
    counsel (CDC) argued:
    In taking a look at the Benchbook, it does have a definition as to
    what a fraudulent representation is, but it doesn’t have a defini-
    tion as to what a professional purpose is. The Defense’s perspec-
    tive on this is that by adding this “to wit” language, the Govern-
    ment has added to what it is that they have to prove, not reduced
    what it is they have to prove. So in terms of looking at the Bench-
    book as to what the second element is, which is that a fraud - the
    accused made a fraudulent representation that a sexual contact
    served a professional purpose.
    If you look at it one way, that the “to wit” language modifies
    fraudulent representation, or if you look at it a different way, the
    “to wit” modifies “professional purpose,” or the “to wit” modifies
    both. The “to wit,” in the Defense’s position, can’t modify the pro-
    fessional purpose to lessen what it is the Government has to
    prove. In effect, the Government has to prove that there was a -
    sort of stating it in the converse, the Government has to prove
    that, beyond a reasonable doubt, that a fraudulent representa-
    tion was made, and that it did not actually serve a professional
    purpose.
    Because if you look at the definition of what a fraudulent repre-
    sentation is, it says - it sort of breaks it into five parts, one of
    which is that the accused knew - or, a statement - the represen-
    tation the accused knew to be untrue. So kind of reading those
    in conjunction, the Defense’s position is that that means the Gov-
    ernment has to prove beyond a reasonable doubt that it did not
    serve a professional purpose. That the Government can’t go so
    far as to use the “to wit” language to narrow what professional
    purpose means, to only mean “medically necessary.”
    (Emphasis added).
    The circuit trial counsel (CTC) countered that “to wit” means “namely,” and
    that language simply identifies “how [Appellant] went about the actus reus of
    going about perpetuating the fraud.” He argued that inclusion of that language
    on the charge sheet did not place on the Government the burden “to disprove
    all potential other reasons why [Appellant] could be taking that action,” or, put
    another way, “to prove beyond a reasonable doubt that there was zero [ ] pro-
    fessional purpose for this.”
    20
    United States v. Solomon, No. ACM 39972
    The military judge provided the parties his ruling on what the elements of
    the offenses were. Regarding the wording at issue, he stated:
    Furthermore, I find that based on the above, the Government
    has not limited the scope of the term “professional purpose” nor
    have they increased the elements necessary to prove the offense
    charged.
    Lastly, I find that the Defense has failed to demonstrate based
    on the law that the Government must disprove beyond a reason-
    able doubt that there was no possible professional purpose for
    the exam. I find that the elements require that the Government
    prove beyond a reasonable doubt, among other things, that the
    accused committed the sexual contact by making a fraudulent
    representation that the sexual contact served a professional pur-
    pose, namely in this case that it was medically necessary.
    The military judge further clarified that, in order to have a fraudulent rep-
    resentation, Appellant must have the intent to make the contact not because
    it was medically necessary, but to gratify his sexual desires. Conducting a med-
    ically necessary exam would not result in a fraudulent representation. Con-
    ducting an exam that was not medically necessary, in order to gratify his sex-
    ual desires, would meet the elements. “My ruling is that the Government has
    to prove that that abusive sexual contact took place by the accused [who] made
    a fraudulent representation that that touching itself was necessary.” The mil-
    itary judge summarized as follows:
    [Military Judge (MJ)]: Did he fraudulently misrepresent to that
    person that he needed to touch her in a way in order that it was
    medically necessary to conduct the exam or do his medical du-
    ties. That’s the issue. So I think both parties agree exactly what
    you just said, [CDC], which is if there is evidence that comes out,
    the fact-finder finds - can find that if there is evidence that the
    accused had a medical purpose for touching and engaging in
    those actual - the actus reus - the actual acts, then he can’t have
    fraudulently [represented]. We don’t even get to the intent of his
    sexual - gratifying his sexual desire if we can’t show the fraudu-
    lent representation. Do we agree?
    CTC: We agree, sir.
    MJ: Counsel, that’s what you wanted us to agree on, right?
    CDC: Yes, Your Honor.
    21
    United States v. Solomon, No. ACM 39972
    MJ: Okay. Counsel, I’m hoping that we’re all on the same page,
    but if this comes up and becomes an issue, we’ll take it up on the
    record and we’ll deal with it. . . .
    ....
    MJ: [W]hen I say medical purpose and medically necessary, I
    think we’ve discussed that enough now on the record why I said
    those are synonymous. Because in order for it to be medically
    necessary, there has to be a medical purpose. And I am assuming
    that if there is a medical purpose, then it’s medically necessary
    for him to do it. But I don’t think that’s the crux of any argument
    now that we’ve fleshed this out. I think we’re all on the same
    page on that, right?
    CDC: And I anticipate that we will likely - the Defense will be
    providing testimony as to what exactly is medically necessary as
    a medical purpose, things of that nature.
    MJ: That’s what I’ve anticipated all along. It makes sense to me.
    At the beginning of his opening statement, the trial defense counsel stated:
    What you’re going to hear is several women who had uncomfort-
    able interactions with [Appellant]. What you will not hear is that
    these contacts served any sexual purpose. To the contrary, the
    evidence will show that each of these contacts had a valid medi-
    cal purpose, that [Appellant] did not have a sexual intent when
    he touched these women. That’s the evidence you will hear to-
    day.
    The military judge provided several opportunities for counsel to bring up
    issues relating to the findings instructions he would give. One opportunity was
    right before they recessed for the evening—the day before the members would
    be provided findings instructions. The military judge again asked the parties,
    “[L]ook at the drafts that you submitted to me. Look at the draft that I provided
    to you.”
    The Government proposed draft instructions on findings, which the mili-
    tary judge addressed with the parties the next morning. The military judge
    held a lengthy discussion with the parties—primarily the Government—about
    whether to instruct on accident or mistake. In the section on mistake, the Gov-
    ernment proposed how the military judge should instruct with regard to the
    charged “professional purpose, to wit: that the sexual contact was medically
    necessary.” The Government’s proposed instructions included the following
    paragraph:
    22
    United States v. Solomon, No. ACM 39972
    The requirement for medical necessity is a part of the specifica-
    tion that is unnecessary to and independent from the allegation
    of the offenses proved and, as such, it may be treated as “a use-
    less averment” that “may be ignored.” The [P]rosecution need
    only prove that the accused intended to falsely represent or acted
    with reckless disregard as to his representation that the touch-
    ing was for a professional purpose.
    Defense counsel reviewed the language, and responded,
    We would object to that. We think that it would be appropriate
    to give a definition of medical necessity. But based on Your
    Honor’s previous ruling on this subject - this is a matter that we
    took up early on before the members got here about - you know
    - how many elements there are and what are the definitions of
    the elements, and what Your Honor said was that - you know -
    medical necessity and medical purpose are synonymous. So the
    defense’s position would be that giving a simple definition of,
    okay, medical necessity –
    MJ: Let’s be - real quick, when I - for purposes of the motion in
    the way I was explaining things, I was explaining medical pur-
    pose and medical necessity as one term for my explanation of my
    ruling. We’ve had this now discussion a couple times. I did not
    rule at any time in this court-martial that there’s a legal defini-
    tion for medical necessity or medical purpose. So just - I want to
    make that clear. So you’re saying that you would be amenable to
    a definition of medical necessity, but you don’t believe - could you
    just kind of focus in on what - the instruction they’re asking for?
    ....
    [Defense Counsel (DC)]: Yes, Your Honor. We would object to
    this. The Government basically added language to the charge
    and said this is how the accused allegedly said that it was -
    served a professional purpose, to wit: that it served - it was med-
    ically necessary. Now they’re saying, “Well, that language that
    we added in there to explain to you what this alleged medical
    purpose was is useless and you should just disregard it.” . . .
    Neither the Government nor the Defense proposed a definition of “medical
    necessity.” The military judge ruled he would not instruct the members to dis-
    regard the charged language of “medical necessity,” as the Government pro-
    posed. Ultimately, he did provide standard instructions on accident and mis-
    take.
    23
    United States v. Solomon, No. ACM 39972
    Concluding their discussion about findings instructions, the military judge
    asked trial defense counsel as follows:
    MJ: Defense, are there any instructions that you requested at
    any time during this trial that you want in here that I didn’t give
    you?
    DC: No, Your Honor.
    MJ: All right, so you’re happy with these instructions?
    DC: Yes, Your Honor.
    MJ: And they’re legally correct?
    DC: Yes, Your Honor.
    After the military judge read his findings instructions to the court mem-
    bers, he asked counsel for both sides whether they “object[ed] to the instruc-
    tions given or request[ed] additional instructions,” to which both replied, “No,
    Your Honor.”
    2. Law
    Whether the military judge correctly instructed the court members is a
    question of law we review de novo. United States v. Payne, 
    73 M.J. 19
    , 22
    (C.A.A.F. 2014) (citation omitted).
    Military judges are required to “determine and deliver appropriate instruc-
    tions.” United States v. Barnett, 
    71 M.J. 248
    , 249 (C.A.A.F. 2012) (quoting
    United States v. Ober, 
    66 M.J. 393
    , 405 (C.A.A.F. 2008)). Required instructions
    include, inter alia, a “description of the elements of each offense charged,” any
    applicable special defenses, and “[s]uch other explanations, descriptions, or di-
    rections as may be necessary and which are properly requested by a party or
    which the military judge determines, sua sponte, should be given.” R.C.M.
    920(e). Not all words in a specification require definition, even when they are
    essential to an element of the offense. See United States v. Bailey, 
    77 M.J. 11
    ,
    15 (C.A.A.F. 2017) (noting that words “generally known and in universal use”
    do not require judicial definition) (quoting United States v. Nelson, 
    53 M.J. 319
    ,
    321 (C.A.A.F. 2000)).
    When counsel discuss a potential instruction with the military judge, but
    do not propose language, object to other proposals, or affirmatively request a
    particular instruction, they have waived the issue. See United States v. Rich,
    
    79 M.J. 472
    , 477 (C.A.A.F. 2020). “Whether an appellant has waived an issue
    is a legal question we review de novo.” United States v. Schmidt, 
    82 M.J. 68
    ,
    72 (C.A.A.F. 2022) (citation omitted).
    The Courts of Criminal Appeals (CCA) have the unique authority to ad-
    dress errors raised for the first time on appeal despite waiver of those errors
    24
    United States v. Solomon, No. ACM 39972
    at trial. See, e.g., United States v. Hardy, 
    77 M.J. 438
    , 442–43 (C.A.A.F. 2018);
    Article 66(d)(1), UCMJ, 
    10 U.S.C. § 866
    (d)(1) (charging the CCAs to affirm only
    so much of the findings and sentence that they find is correct and “should be
    approved”). CCAs assess the entire record and determine “whether to leave an
    accused’s waiver intact, or to correct the error.” United States v. Chin, 
    75 M.J. 220
    , 223 (C.A.A.F. 2016).
    “Failure to object to an instruction or to omission of an instruction before
    the members close to deliberate forfeits the objection.” R.C.M. 920(f). We re-
    view forfeited issues for plain error. United States v. Davis, 
    79 M.J. 329
    , 331
    (C.A.A.F. 2020) (citation omitted). In a plain error analysis, the appellant “has
    the burden of demonstrating that: (1) there was error; (2) the error was plain
    or obvious; and (3) the error materially prejudiced a substantial right of the
    accused.” Girouard, 70 M.J. at 11 (citation omitted).
    3. Analysis
    We find Appellant waived the issue of the military judge providing the
    court members a definition of “medically necessary.” We disagree with Appel-
    lant’s statements on appeal that the defense counsel “was specific in stating
    that the military judge should instruct on the definition of medical necessity”
    and “[t]hey would have every reason to believe the final version would include
    a definition for medical necessity.” We find the Defense did not specifically re-
    quest such an instruction, nor did it propose a specific instruction or object to
    the military judge’s instructions.
    In the context of an instruction on mistake, the Defense objected to the Gov-
    ernment’s suggestion that “medical necessity” “may be ignored.” It did not ob-
    ject to the idea of providing a definition of “medical necessity,” and even sug-
    gested “it would be appropriate,” but it neither proposed language to the mili-
    tary judge nor requested the military judge craft a definition. 21 The Defense
    did not request any additional instructions to those the military judge gave,
    which did not include a definition of medically necessary. If the Defense ex-
    pected to hear and read a definition of medically necessary from the military
    judge, it had the opportunity to raise the issue with the military judge before
    the members began their deliberations. It did not, and so waived the issue. We
    have reviewed the entire record, and have determined to leave intact Appel-
    lant’s waiver of error relating to a definition of medically necessary.
    We next consider Appellant’s claim of improper burden shifting. The mili-
    tary judge provided a lengthy ruling on his interpretation of the elements the
    21 In his analysis of this assignment of error, Appellant appears to propose a definition,
    as he finds “reasonable medical care” synonymous with “medical necessity.”
    25
    United States v. Solomon, No. ACM 39972
    Government would have to prove beyond a reasonable doubt for Appellant to
    be found guilty. Included in his ruling were these statements:
    I find that the Government has to prove beyond a reasonable
    doubt that the accused committed sexual contact upon the
    named individuals, that he did so by making a fraudulent repre-
    sentation that the sexual contact served a professional purpose,
    that the [G]overnment alleges namely that the professional pur-
    pose was that he fraudulently misrepresented [sic] that the con-
    tact was medically necessary.
    I find that medically necessary and medical purpose are synon-
    ymous in this context. . . .
    ....
    Now, this ruling does not limit evidence coming forward that
    there was no fraudulent representation because there was in
    fact a professional purpose for the exam. If evidence of a profes-
    sional purpose comes out specific to the charged offense, that
    then would negate the Government’s position that the fraudu-
    lent representation was medically necessary.
    ....
    Lastly, I find that the Defense has failed to demonstrate based on
    the law that the Government must disprove beyond a reasonable
    doubt that there was no possible professional purpose for the
    exam. I find that the elements require that the Government
    prove beyond a reasonable doubt, among other things, that [Ap-
    pellant] committed the sexual contact by making a fraudulent
    representation that the sexual contact served a professional pur-
    pose, namely in this case that it was medically necessary.
    (Emphasis added).
    Appellant cites only the sentence of the military judge’s ruling in which he
    stated the Government did not have to disprove beyond a reasonable doubt
    that there was no possible professional purpose. He claims that “by relieving
    the Government of having to prove that no professional purpose existed, the
    Government no longer had to prove the representation was fraudulent,” be-
    cause if it served any professional purpose, it would not have been fraudulent. 22
    22 Appellant’s specific argument is: “A representation is only true [sic] if an accused
    represents something fraudulent that the accused knows is fraudulent.”
    26
    United States v. Solomon, No. ACM 39972
    We do not share Appellant’s interpretation of the military judge’s ruling.
    The military judge found that even if the contact could serve a possible profes-
    sional purpose, Appellant nevertheless could make a fraudulent representa-
    tion to carry out his non-professional purpose. The Government still was re-
    quired to prove that Appellant’s representations regarding the professional
    purpose were fraudulent. 23 Moreover, Appellant does not allege how he was
    prejudiced by this part of the ruling. For example, he does not allege that the
    military judge extended this error to his rulings on any objections or to his
    instructions to the court members on the Government’s burden of proof. Thus,
    even if the ruling suggested the Government’s burden was lowered—and we
    find it did not—we find no prejudicial error.
    C. Expert Testimony – Medical Necessity
    1. Additional Background
    The concept of “standard of care” was introduced first by trial defense coun-
    sel, during individual voir dire. It became an issue after several patients testi-
    fied, and just before the Government planned to call Maj BC as a witness. The
    military judge held an Article 39(a), UCMJ, hearing to consider the Defense’s
    oral objection to Maj BC’s anticipated testimony as an expert witness. The Gov-
    ernment proffered Maj BC would “opine whether different procedures as de-
    scribed by the patient [were] medically necessary.” The CDC argued:
    I don’t believe that this witness is basing that opinion on actual
    guidelines, on actual standards of practice, on a standard that is
    actually appropriately applied in that type of community. My
    understanding is he’s going to testify to say, “Well, in my expe-
    rience in how we do things at Spangdahlem, that’s not how I
    would have done that.”
    23 Appellant asserts that because the military judge “failed to instruct the members on
    the meaning of medical necessity . . . it is impossible to know what standard the mem-
    bers applied when determining whether [Appellant] made a fraudulent representation
    that certain touching served a professional purpose.” Appellant cites Ruan v. United
    States, ___ U.S. ___, 
    142 S. Ct. 2370 (2022)
    , in support of this position. In Ruan, the
    United States Supreme Court addressed the mens rea required to violate a federal law
    circumscribing dispensing controlled substances, and found the requirement was
    knowingly or intentionally acting in an unauthorized manner. 
    Id. at 2375
    . In Appel-
    lant’s case, the mens rea was already part of fraudulent representation, which the mil-
    itary judge defined for the members as: “a representation of fact, which the accused
    knows to be untrue, which is intended to deceive, which does in fact deceive, and which
    causes the other person to engage in the sexual contact.”
    27
    United States v. Solomon, No. ACM 39972
    The military judge asked the Government, “I mean, so the point is there has to
    be some standard of care that you’re saying that was breached. How do we get
    to that standard of care?” The CTC agreed.
    After ascertaining the Defense would agree Maj BC was qualified regarding
    “what a clinical assessment is, how diagnoses work in relation to that, and . . .
    treatment” as well as “what AHLTA is and what the records are and what they
    mean,” the military judge used the phrase “standard of care” when he asked
    the CDC if he understood the Defense’s position:
    MJ: Where you are - if I understand correctly, the issue that’s
    before the court at this moment is whether or not he is qualified
    as an expert, to discuss whether - what the standard of care was
    during these specific type of exams, and whether based on the
    records that standard of care was breached. Am I --
    CDC: That’s - generally speaking, yes, Your Honor.
    MJ: Well, let’s - is that the issue or not? When you say generally
    speaking - I don’t want to miss anything.
    CDC: Well, it’s - I don’t know if this witness actually even knows
    what the standard of care means, according to some of those le-
    gal definitions. So the standard that I understand this witness
    is going to use is, “Based on my practice, and the way we do
    things at the Clinic, that wouldn’t have met the standard of
    care.” Or, “That wouldn’t have been consistent with what we nor-
    mally do.” And that’s not what an expert is supposed to testify
    to, or be able to testify to.
    The CDC anticipated Maj BC would testify “that this is a deviation from
    the standard of care, that’s going to match in with it being whether or not it’s
    medically necessary.” He further argued, “That’s what it really comes down to,
    is at this point, how has this expert established what a standard of care actu-
    ally is, to then be able to take the next step and talk about whether or not the
    standard of care is being met?” The Government countered, “Defense raised
    this issue of standard of care. It’s a little bit of a red herring because what we’re
    talking about is medical necessity.”
    Maj BC testified during this Article 39(a), UCMJ, hearing that he was a
    board-certified and licensed nurse practitioner, with associate’s and bachelor’s
    degrees in nursing and a master’s degree as a family nurse practitioner. More-
    over, he had treated thousands of patients over about seven years. For some
    period, he was Appellant’s flight commander as well as a fellow primary care
    manager at the Clinic. He testified, inter alia, about clinical assessment, diag-
    nosis, and treatment; the peer-review process; the practice of nurse practition-
    28
    United States v. Solomon, No. ACM 39972
    ers compared to physician assistants; 24 generally accepted standards for med-
    ical examinations; national guidelines; and documenting in medical records,
    including using AHLTA.
    The military judge ruled against Appellant, both orally and in a written
    ruling. Among his findings were that Maj BC was “qualified to give expert
    opinions relied upon by others within his field of practice in the medical com-
    munity, for example, family health, and whether the standard of care has been
    met or deviated from.” He continued: “[T]he panel will benefit from hearing
    from a medical expert who can better explain what the standard of care is and
    what is or is not medically necessary. The testimony will likely assist the trier
    of fact to understand this evidence.” Regarding Maj BC, the military judge fur-
    ther stated:
    He has experience, education, and training in national guide-
    lines, and although they are not absolute rules, he has learned
    how to judge the standard of care in his community based on his
    education, training, and clinical experience. He further testified
    that practitioners learn how to note if they are deviating from
    the recognized standard of care, and that this is considered in
    the overall assessment on whether an action is medically ac-
    ceptable or necessary.
    The military judge conducted an analysis under Mil. R. Evid. 403 and de-
    termined Maj BC’s “testimony and opinion will be probative and reliable based
    on his education, training, and experience, and his significant background and
    training on how to conduct similar peer review analysis which he has experi-
    ence in.” And, noting the Defense had the assistance of several expert consult-
    ants, the military judge concluded Appellant “is not at a disadvantage if the
    [G]overnment offers this evidence at trial.” He found “the testimony will not
    mislead the members, but on the contrary will be helpful in putting these spe-
    cialized issues in context.”
    The Government called and re-called Maj BC on the merits to testify as a
    lay witness and an expert witness. Maj BC first testified about his professional
    24 Regarding the difference between nurse practitioners and physician assistants,
    Maj BC testified, “There is little difference in regards to clinical practice. It more has
    to come down to a legal sense. Nurse practitioners are afforded more clinical autonomy,
    based upon state laws.” Col KK, who testified on the merits not as an expert but based
    on his experience training medical providers, stated he provided the same level of
    training to both nurse practitioners and physician assistants because they use “evi-
    dence based” and “standardized guidelines to train.”
    29
    United States v. Solomon, No. ACM 39972
    history, including working at the Clinic between 2016 and 2019. He also testi-
    fied more generally about family practice care, and specifically about the facts
    of this case. In line with the Government’s request, the military judge recog-
    nized Maj BC as “an expert in the areas of nurse practitioner, clinical assess-
    ment, diagnosis, and treatment as it pertains to family health or medicine.”
    After the Government called several more of the victims, it re-called Maj BC to
    address their testimony, and repeated this pattern. In total Maj BC testified
    five separate times on the merits.
    The Government questioned Maj BC about the medical necessity of Appel-
    lant’s actions as the victims described. An example is this exchange regarding
    SC:
    Q. So based on what she said she told him, and what’s docu-
    mented in the practice management section of the medical rec-
    ords, would it have been appropriate or necessary, or within
    medical practice standards for him to recommend that she get a
    Pap [exam] done on 23 March 2017?
    A. It would not.
    Maj BC, Dr. CS, and Dr. DT testified to some extent about what “standard
    of care” meant to them. On one of the few occasions the Government asked
    Maj BC about the standard of care, Maj BC answered in the context of medical
    necessity:
    Q. Was what was described by [MR] a targeted exam that was
    within the standard of care for this patient?
    A. Not at all.
    Q. What do you mean not at all? Why not?
    A. Because the - as we’re trying to ascertain here from the wit-
    ness’ report, the listening that was being done, it served no med-
    ical purpose. You’re using your stethoscope to listen, either
    lungs, heart, bowels, stuff like that - arteries. When you place
    your stethoscope over a dense area like breast tissue, as we’ve
    already heard from other witnesses, it can be harder to hear
    breast - or, lung sounds, or heart sounds in those areas. When
    you do it - when you place your stethoscope over and then you
    push the breast tissue up even more, you’re almost guaranteeing
    you that the stethoscope that you’re wearing and you’re using
    has no utility at all.
    And:
    30
    United States v. Solomon, No. ACM 39972
    Q. So one last question. As a provider - you know - with your
    experience as a recognize[d] expert in this field, you’re familiar
    with what the standard of care would be for somebody going
    through an[ ] assessment, diagnosis, and treatment?
    A. Yes.
    Q. And if they fall out of what is in that standard, or what they
    did was not medically necessary, you’d be able to identify that?
    A. Yes.
    Q. Was there anything about [MR’s] testimony, or documenta-
    tion she presented, that would come up with any clinical reason
    why the accused would need to manipulate her breast and touch
    her nipple in that way?
    A. Not in the way she described, no.
    After the last victim testified and the Government again re-called Maj BC,
    the CDC asked Maj BC about “standard of care”:
    Q. You talked a little bit about the standard of care. Can you
    define what standard of care is?
    A. I guess that’s - I’m not a lawyer, but I guess that’s a little bit
    tenuous to say. I would say standard of care would be what a
    provider of like specialty would perform, consistent with na-
    tional guidelines. I’m not a wordsmith on that.
    Q. Fair enough. But you talked about the standard of care quite
    a bit, so I just wanted to make sure that it was clear what you
    meant and what you understood the standard of care was, and
    then we can discuss that a little bit more. So is it standard of
    care, like, what an average provider would do, what an excellent
    provider would do?
    A. It’s what the minimum expectation would be for that condi-
    tion in that specialty.
    Q. Minimum. The absolute minimum.
    A. The minimum.
    ....
    A. Okay. Hopefully this will articulate it better. So in my spe-
    cialty, the standard of care as we’re trying to elicit here - the
    standard of care would be defined in the example of a patient
    who is 20 years old, female, comes in to be seen for a left ankle
    sprain. So in the course of that left ankle sprain they came in
    31
    United States v. Solomon, No. ACM 39972
    for, the assessment of the standard of care being met or not met
    will be determined by what the provider decides to do based
    upon that concern. Did they check their vital signs? Did they
    gather a correct history and physical exam? Did they ask the
    right questions? Is that demonstrated that they considered other
    alternative diagnosis? Did the physical exam fit the reason for
    their visit that day? Did the diagnosis concur or fit for what they
    were being seen for and match the physical objective supporting
    findings? And then, did the treatment and/or any other evalua-
    tion match and/or be consistent for that diagnosis. Now, the na-
    tional guidelines help inform what is consistent, rational, or rea-
    sonable when it comes to assessment and diagnosis of those con-
    ditions. And so taking that as a clinical picture as a whole, we
    review that in our specialty, as other specialties review each
    other inside theirs, as far as meeting the standard of care.
    The Government also called Dr. DT, who was proffered and accepted as “an
    expert in OBGYN.” 25 During re-direct examination, Dr. DT answered in the
    affirmative that “[s]etting aside this whole standard of care issue - legal, med-
    ical, or otherwise - [there are] medical standards” and that “there are left/right
    limits to what providers should be doing in the exam room.”
    The Defense called Dr. CS, who was proffered and accepted as an expert
    “MD with a specialty in OBGYN.” In response to trial defense counsel’s ques-
    tion, Dr. CS provided an explanation of how he forms opinions about medical
    necessity:
    Q. [ ] In terms of standard of care, guidelines, recommendations,
    how did those inform the medical community’s practice of deter-
    mining whether or not things are medically necessary or unnec-
    essary; exams, treatments, or procedures?
    A. Well, we all need starting points to be able to determine
    things like that. So guidelines can help us, and again, guidelines
    are written typically by people who have knowledge, education,
    training, and experience. And essentially, that’s what every-
    thing boils down to. So when I testify, or when I talk to my stu-
    dents I am relying on my knowledge, education, my - and my
    personal experience in medicine, and that helps me to define
    what I think is medically necessary and good medical care.
    25 Dr. DT testified, inter alia, about whether he would perform certain exams, or per-
    form exams in a certain way, as described by various patients. Additionally, he pro-
    vided his opinion about whether some of Appellant’s actions were “clinically correct.”
    32
    United States v. Solomon, No. ACM 39972
    The CTC cross-examined Dr. CS regarding whether Appellant might have
    been inspecting SC for deep vein thrombosis. After Dr. CS referenced his direct
    examination testimony, during which he “talked about standard of care and
    . . . respected minority,” 26 the CTC asked:
    Q. Okay. But you would look at - you would agree standard of
    care is not the legal standard we’re applying in this case?
    A. Well, it depends on which one. You said standard of care, so I
    always think legal in that case, because that’s the way my brain
    is trained. But if you want to tell me another standard that we’re
    talking about, that’s fine.
    Q. Well, we’re talking about medical necessity.
    A. And I just said, in my eyes, that’s not medically necessary,
    but there could be a respected minority who would find it medi-
    cally necessary.
    Dr. CS testified later on re-cross-examination that “standard of care” and
    “whether something was medically necessary” were “not the same thing.”
    Maj BC, Dr. CS, and Dr. DT all had similar descriptions of “standard of
    care.” Maj BC said “‘standard of care’ would be what a provider of like specialty
    would perform, consistent with national guidelines.” Dr. CS agreed “standard
    of care” could be paraphrased as what a “similarly trained practitioner in the
    community . . . would do under the same circumstances.” Dr. DT said “stand-
    ard of care” in a peer-review setting was “an expectation [by a group of his
    peers] that I’m going to utilize the same training, knowledge, and professional
    recommendations to provide a certain degree of care to my patients.”
    Maj BC also testified that he understood Appellant’s case was not about
    medical malpractice. The Government clarified with Dr. CS that this case was
    a criminal case, and not about malpractice. Dr. DT agreed that “standard of
    care” may have a legal definition, as in the context of medical malpractice.
    2. Law
    We review a military judge’s decision to permit a witness to testify as an
    expert for abuse of discretion. United States v. Flesher, 
    73 M.J. 303
    , 311
    (C.A.A.F. 2014). As the United States Court of Appeals for the Armed Forces
    (CAAF) has noted:
    26 Dr. CS testified “respected minority” are the medical providers who have a different
    way of practicing care than the majority of providers, but are not negligent “if they still
    use appropriate thought processes, they’ve had appropriate training, and if their care
    is reasonable.”
    33
    United States v. Solomon, No. ACM 39972
    A military judge abuses his discretion when his findings of fact
    are clearly erroneous, the court’s decision is influenced by an er-
    roneous view of the law, or the military judge’s decision on the
    issue at hand is outside the range of choices reasonably arising
    from the applicable facts and the law.
    
    Id.
     (quoting United States v. Miller, 
    66 M.J. 306
    , 307 (C.A.A.F. 2008)).
    “A witness may testify as an ‘expert’ on a particular subject matter only if
    the military judge determines that the witness is qualified based on his or her
    ‘knowledge, skill, experience, training, or education’ regarding that subject.”
    United States v. Allison, 
    63 M.J. 365
    , 369 (C.A.A.F. 2006) (quoting Mil. R. Evid.
    702). This threshold “requires only that the proffered witness have some spe-
    cialized knowledge as a result of experience or education.” United States v.
    Mustafa, 
    22 M.J. 165
    , 167–68 (C.M.A. 1986). We have held that by this stand-
    ard, a person may qualify as an expert witness even if he or she is not “a star
    in the field.” United States v. Anderson, 
    36 M.J. 963
    , 978 (A.F.C.M.R. 1993)
    (citations omitted), aff’d, 
    39 M.J. 431
     (C.M.A. 1994). Under Mil. R. Evid. 702,
    an expert witness may testify, including providing opinions, so long as the tes-
    timony is helpful and based upon sufficient facts, reliable principles, and reli-
    able application of the principles to the facts. “The CAAF has identified six
    factors for courts to analyze to determine whether a proponent of expert testi-
    mony has met the Mil. R. Evid. 702 criteria,” which are:
    (1) the qualifications of the expert; (2) the subject matter of the
    expert testimony; (3) the basis for the expert testimony; (4) the
    legal relevance of the evidence; (5) the reliability of the evidence;
    and (6) that the probative value of the expert’s testimony out-
    weighs the other considerations outlined in [Mil. R. Evid.] 403.
    United States v. Knarr, 
    80 M.J. 522
    , 537 (A.F. Ct. Crim. App. 2020) (alteration
    in original) (quoting United States v. Billings, 
    61 M.J. 163
    , 166 (C.A.A.F. 2005)
    (citing United States v. Houser, 
    36 M.J. 392
    , 397 (C.M.A. 1993))).
    3. Analysis
    Appellant asserts the military judge abused his discretion by allowing
    Maj BC “to testify outside the scope of his expertise.” Appellant argues that the
    military judge “erred in concluding that Maj [BC], a nurse practitioner with a
    narrow scope of experience, could help define the bounds of medical necessity
    for a physician assistant.” Appellant also claims “Maj [BC] spoke with a cer-
    tainty his experience could not support.” We find the former issue waived and
    the latter issue a matter of weight, not admissibility. These issues require no
    further discussion and do not warrant relief. See Matias, 
    25 M.J. at 361
    .
    We understand Appellant’s remaining arguments to be (1) the military
    judge erred by allowing Maj BC to testify about “standard of care,” when the
    34
    United States v. Solomon, No. ACM 39972
    issue was “medical necessity,” and (2) “the military judge’s ruling imposed no
    practical limit on Maj [BC]’s testimony beyond Maj [BC]’s own beliefs about an
    amorphous, unwritten standard of care.” We find the military judge did not
    abuse his discretion when he accepted Maj BC as an expert and permitted him
    to provide expert testimony. The military judge understood the applicable law,
    and his application of the facts to the law was not clearly erroneous.
    In his ruling the military judge used the phrase “standard of care,” as he
    had during the hearing, almost synonymously with “medically necessary.” In
    its case in chief, the Government generally did not do so; it focused heavily on
    the latter, whereas the Defense questioned Maj BC at length about “standard
    of care.” The expert witnesses differentiated the concepts of “standard of care”
    and “medically necessary” in response to direct questions. Moreover, the expert
    witnesses each explained their understanding of “standard of care” in similar
    terms. What became clear through Maj BC’s trial testimony is that he believed
    “standard of care” is not the same as national guidelines, but is informed by
    them, and relates to peer reviews of medical records. 27 While sometimes using
    the phrase “standard of care,” Maj BC testified about medical necessity—for
    example, when he opined that one of Appellant’s methods had “no utility at all”
    and he could discern no clinical reason for it. Such testimony was proper to
    assist the factfinder in determining whether Appellant fraudulently repre-
    sented that his contact served a professional purpose.
    Appellant claims the military judge erred when he did not limit Maj BC’s
    testimony regarding “standard of care.” But even if the military judge confused
    “standard of care” with “medical necessity” in his ruling, Appellant chose to
    make “standard of care” an issue in his case, including through the testimony
    of Maj BC. We find the military judge did not err in allowing Maj BC to answer
    questions relating to standard of care through his expert testimony relating to
    whether Appellant’s action were medically necessary.
    D. Expert Testimony – Milgram Experiment
    Appellant asserts the military judge abused his discretion by allowing
    Dr. MC “to link this case with the Milgram experiment.” We disagree.
    27 The Defense introduced testimony that peer reviews were “an ongoing regular as-
    sessment of provider skills” whereas a standard of care review focuses on something
    more specific and usually is related to a malpractice claim. Through another defense
    witness, the Defense elicited testimony that “[p]eer review . . . almost always will in-
    volve standard of care.”
    35
    United States v. Solomon, No. ACM 39972
    1. Additional Background
    The Government planned to call Dr. MC, a forensic psychologist, to testify
    on three subject areas, including obedience to authority and “the Milgram ex-
    periment” in particular. The Defense objected, and the military judge con-
    ducted an Article 39(a), UCMJ, hearing, to consider the objections. 28 After
    hearing the arguments of counsel and considering the evidence presented, in-
    cluding testimony from Dr. MC, the military judge ruled Dr. MC could testify
    about the Milgram study.
    Dr. MC provided a lengthy explanation of the study to the court members.
    An experimenter named Stanley Milgram conducted the study at Yale Univer-
    sity in the 1960s. The study involved three individuals: a volunteer “subject,”
    the “experimenter in a white lab coat,” and a “learner” who the subject thought
    was another volunteer but actually was a “confederate” participant in the
    study. The “learner” was to be given words to memorize, then would have to
    recite back those words. The experimenter and subject were in the same room;
    the subject could hear but not see the learner. Dr. MC stated the “basic setup
    of the study” was the experimenter informed the subject “that every time the
    learner made a mistake on his words, [the subject] had to give [the learner] a
    shock, push a button to give him a shock.” The subject was to increase the
    shock level 15 volts each time, and the voltage levels had labels like “mild
    shock,” “medium shock,” “extremely intense shock,” and “dangerous serious
    shock,” and “the last couple of shock levels just have [ ] ‘XXX.’” Dr. MC contin-
    ued:
    And the other main significant characteristic of the study is that
    there was an experimenter - someone identified as an experi-
    menter in a white lab coat standing over the subject and kind of
    giving him instructions on what to do and encouraging him to
    continue if he showed any kind of hesitance to continue doing
    what they were instructed to do. And there was a script that the
    experimenter was using to give those instructions.
    Q [CTC]. What were the findings of those studies? What were
    psychologists able to learn?
    A. Well, in a very basic sense, what the study - at least the basic
    study that I’m describing to you now - found was how often or
    how willing people were to go all the way to 450 volts. And it’s
    important to understand that the learner, who was the confed-
    erate, remember, and he was of course not getting really - real
    shocks - also had a script, and there were places along the way
    28 On appeal, Appellant does not renew his other objections to Dr. MC’s testimony.
    36
    United States v. Solomon, No. ACM 39972
    at certain shock levels where he would scream or pound on the
    wall, asked to be released, talk about a heart condition, and at
    some point, I think around 300 or so, he stops responding alto-
    gether. He doesn’t say anything. He isn’t answering the ques-
    tions about the words learned and so on. And so one of the things
    that the experimenters just wanted to know is - you know - how
    far would people go under those circumstances? And as I men-
    tioned a minute ago, one of the ancillary aspects of the study was
    asking other people what do you think you would do, what do
    you think other people would do in that - in those circumstances?
    Would you resist and say, “No, I’m not doing this anymore, be-
    cause this guy seems like he’s getting hurt.” Or would they just
    go all the way and do what they were told? And most people un-
    derestimated the actual results. And the actual results were that
    everybody, every one of the subjects went past 300 volts [labeled
    “extremely intense shock”], and two-thirds of the subjects went
    all the way to 450 volts.
    Dr. MC explained this study involved 40 male subjects, but Milgram and
    others performed myriad variations after the original published paper:
    Now because of the way the study was done it’s difficult, if not
    impossible, to do it today, because today we have stronger re-
    strictions from an ethical point of view on what we can do with
    people, even volunteers. We can only cause them so much psy-
    chological distress. And as I mentioned, one of the things that
    Milgram pointed out is that these people seemed to show a lot of
    distress with what they had done and just kind of this realiza-
    tion that they were capable of doing these deeds that they had
    done. But, there have been other attempts to replicate at least
    parts of Milgram’s research, and although again, if there are var-
    iations on it then you’re going to expect to find different results
    somewhat, but I think for the most part the psychological com-
    munity feels that the attempts at replication have, in a general
    sense, validated that research, even if it’s not exactly the same
    as the way he did it back in the 60s.
    After the Defense objected, then withdrew its objection, the CTC asked
    Dr. MC whether the study related to Appellant’s case:
    Q. With your review of the facts and hearing the witness testi-
    mony, is there a parallel between the research you’ve described
    on how people respond to and comply with people in position of
    authority, is there any of that evidence that parallels those prin-
    ciples you’ve heard as part of that research?
    37
    United States v. Solomon, No. ACM 39972
    A. I believe it does, yes.
    Q. And the research or variations you described on peer support
    or modeling, does the evidence and testimony, and information
    presented as part of this case parallel those principles that
    you’ve describe[d] as peer support or modeling when somebody
    gets to view somebody else rejecting authority?
    A. Again, in my opinion, yes.
    Later, Dr. MC testified about how the subjects of the Milgram study re-
    acted to the debriefing:
    And one of the justifications that they often gave for [why they
    did what they did] is . . . “You’re the experimenter. I figured you
    knew what you were doing and you weren’t going to let the guy
    get hurt. So I just kind of trusted you to take care of things.”
    ....
    So they said - they were kind of trusting this authority figure to
    do the right thing, and figure out that “He knows better than I
    do. He knows what’s going on more than I do. So if he’s telling
    me to go ahead, then it must be okay.”
    The CTC asked, “How did the authors of this study explain their findings?”
    Dr. MC responded:
    Well, they actually coined a term which is - the term is “normal-
    izing trust” and essentially what they explain is that part of a
    functioning society is that there are certain people that we just
    have to kind of turn over our trust to, because they have special-
    ized learning or expertise, or value that we can’t provide, and so
    we kind of have to trust that they provide it. And then they also,
    in discussing that concept of normalizing trust, talked about
    what happens when we start getting evidence that that belief is
    false, or not warranted. And essentially what they say is, well,
    you look for rationales, justifications, to kind of help explain that
    disparity between what we believe we should be doing, which is
    trusting these people, and the evidence that’s telling us we
    shouldn’t.
    Defense’s cross-examination of Dr. MC ended with this exchange:
    Q. You talked about normalizing trust, and you said that once
    people find out maybe they weren’t supposed to trust them, they
    start to think differently about their experiences and think dif-
    ferently about what happened to them.
    38
    United States v. Solomon, No. ACM 39972
    A. Well, no. What they’re - they’re trying not to think differently.
    It’s actually the opposite. They’re resisting the evidence coming
    in that contradicts that belief. So they are - what they’re doing
    is they’re finding rational - rationalizations that justify their
    continued trust in the authority figure.
    Q. Or justify their actions after - or, during their contact with
    that authority figure.
    A. Yes, during their contact with the authority figure.
    Neither party had more questions of Dr. MC, the court members posed no
    questions, and the Government rested its findings case.
    2. Law
    “We review a military judge’s decision to admit evidence for an abuse of
    discretion.” United States v. Norwood, 
    81 M.J. 12
    , 17 (C.A.A.F. 2021) (citation
    omitted); see also Flesher, 
    73 M.J. at 311
     (applying abuse of discretion to ad-
    mission of expert testimony). We will find an abuse of discretion when the
    judge’s findings of fact are clearly erroneous, the judge’s decision is influenced
    by an erroneous view of the law, or the decision is outside the range of choices
    reasonably arising from the applicable facts and the law. See Norwood, 81 M.J.
    at 17.
    Under Mil. R. Evid. 702, an expert witness may testify, including providing
    opinions, so long as the testimony is helpful and based upon sufficient facts,
    reliable principles, and reliable application of the principles to the facts. See
    also Knarr, 80 M.J. at 537.
    “However relevant and reliable an expert’s testimony might be,” that testi-
    mony may be excluded under Mil. R. Evid. 403. United States v. Traum, 
    60 M.J. 226
    , 236 (C.A.A.F. 2004).
    3. Analysis
    Appellant asserts the military judge erred in his application of Mil. R. Evid.
    401 and 403 concerning relevance and probative value. 29 He concedes that the
    Government, through Dr. MC, could offer testimony “that people tend to trust
    authority figures, including medical providers,” but claims the “military judge
    should have found anything beyond generic testimony on obedience to author-
    ity irrelevant under Mil. R. Evid. 401.” Appellant argues that “[t]he relevance
    29 Appellant argues, “While the military judge’s analysis of the Houser and Daubert
    factors is flawed, it is the Mil. R. Evid. 401 and 403 analysis that is manifestly errone-
    ous.” See Daubert v. Merrell Dow Pharms., Inc., 
    509 U.S. 579
    , 592–95 (1993); United
    States v. Houser, 
    36 M.J. 392
     (C.M.A. 1993).
    39
    United States v. Solomon, No. ACM 39972
    of a fifty-plus-year-old study of dubious ethical nature, with a different subject
    population and context, is minimal.”
    Additionally, he asserts the military judge erred in his Mil. R. Evid. 403
    analysis by finding the evidence “would help the factfinder understand medical
    necessity.” He asserts the “danger of unfair prejudice was evident” as “the ex-
    pert psychologist connected a deeply concerning study—linked to obedience or-
    ders in Nazi Germany—to the facts of this case” and the evidence tended to
    “engender issue confusion and mislead the members.”
    On appeal, the Government describes the relevance of Dr. MC’s testimony:
    “The Milgram experiment helped explain the psychology behind why the par-
    ticipants did certain things in response to an authority figure’s directive, de-
    spite their discomfort,” and “the Milgram experiment helped explain why the
    victims in this case did not do certain things during, or immediately after, their
    respective exams and why they trusted Appellant, despite their discomfort.” In
    summary, “Dr. MC linked the subjects in the Milgram experiment to the vic-
    tims in the case at hand by testifying that the two groups were similarly ‘ra-
    tionalizing their participation’ because the authority figure ‘knows better than
    I do.’”
    At trial, the military judge found the proffered testimony about conforming
    to authority was probative of multiple issues. On one issue, we agree with Ap-
    pellant that such testimony would not help the members determine “medical
    necessity.” However, the military judge also found the evidence was probative
    based on, “more importantly,” the issues raised during the examinations of
    witnesses. Regarding relevance, he stated:
    I believe that the [D]efense has opened the door when they asked
    questions about why certain complaining witnesses did not stop
    the exam or did not ask for a chaperone, or did not report to law
    enforcement, and why they didn’t do things specifically in the
    exam environment, or why they did do certain things.
    The military judge then found the testimony would not result in unfair preju-
    dice, confusion of the issues, or wasted time. He “believe[d] the issues already
    . . . [have been] presented to the panel for consideration,” and found that pre-
    senting the study would not “waste any time.” As for prejudicial effect, on ap-
    peal the parties point out that it was trial defense counsel who presented to
    the members a link between this study and Nazi Germany. 30
    At this point in the trial, the Defense had elicited testimony about how the
    victims reacted during the encounters with Appellant, and that all but one did
    30 Appellant argues that “[t]he Milgram experiment is infamous, and anyone with a
    passing familiarity would make the link between the two.”
    40
    United States v. Solomon, No. ACM 39972
    not report Appellant’s actions. Dr. MC used the study to inform his opinion
    relating to the victims’ reactions to Appellant’s sexual contacts. In this context,
    such testimony was not confusing and tended to help the factfinders under-
    stand the issues. Dr. MC did not agree the study was unethical, but noted it
    placed significant psychological stress on the subjects and therefore likely
    would not be replicated today. We find the military judge did not abuse his
    discretion in allowing Dr. MC to testify in this case about the Milgram study.
    E. Trial Counsel Argument
    Appellant claims the CTC made improper argument by: “(1) framing the
    allegations against [Appellant] in terms of a disconcerting psychological exper-
    iment involving fictitious shocking of subjects to the point of death; (2) provid-
    ing definitions, sometimes conflicting, for the key term of each charge—medi-
    cal necessity; and (3) arguing propensity.”
    1. Additional Background
    During voir dire, all members agreed “to keep all of these allegations sepa-
    rate and not infer guilt for one specification based on another specification.”
    Before they began deliberations, the military judge provided the court mem-
    bers a lengthy “spillover” instruction, which included the following:
    An accused may be convicted based only on the evidence before
    the court, not on evidence of a general criminal disposition. Each
    offense must stand on its own and you must keep the evidence
    of each offense separate. Stated differently, if you find or believe
    that the accused is guilty of one offense, you may not use that
    finding or belief as a basis for inferring, assuming, or proving
    that he committed any other offense.
    If evidence has been presented which is relevant to more than
    one offense, you may consider that evidence with respect to each
    offense to which it is relevant.
    Further, the military judge instructed the court members about the limited
    use of some evidence. Specifically, evidence of Appellant violating the patient
    chaperone policy and failing to document patient encounters could be consid-
    ered to prove Appellant: (1) intended to commit sexual contact and had an in-
    tent to arouse or gratify his sexual desires; (2) created an opportunity to engage
    in prohibited sexual contact to arouse or gratify his sexual desire; and (3) had
    a plan or design to commit the offenses by creating an opportunity to be present
    with the alleged victims without a chaperone, and ensuring he could not be
    41
    United States v. Solomon, No. ACM 39972
    caught by another provider reviewing his documentation, so that he could en-
    gage in prohibited sexual contact to arouse of gratify his sexual desires. 31 The
    military judge reminded the members that they could not consider this evi-
    dence for any other purpose, and also could not conclude from it that Appellant
    was a bad person or had general criminal tendencies and that he therefore
    committed the offenses charged.
    The Government displayed about 140 slides during its findings argument.
    One slide echoed the military judge’s instructions about opportunity, plan or
    design, and intent. Other slides showed commonalities in the fact patterns of
    each offense concerning a patient. The Government addressed each specifica-
    tion with a set of slides tailored to that offense but with the same framework:
    the victim’s complaint when she made the appointment, the “[C]linic process”
    for getting a chaperone, the five steps involved in Appellant’s “cover up” of his
    actions, and the drawing the victim made in court identifying where Appellant
    touched her. Some slides included one or more yellow triangular high-voltage
    warning signs.
    In his argument, the CTC likened Appellant’s conduct to that of the exper-
    imenter in the Milgram study. He argued that Appellant “turned up the volt-
    age,” testing how far the patient would allow him to go, to see what she was
    “comfortable with.” He argued that Appellant was opportunistic: “[The victim
    was n]ot there for a reason that would require a witness, [Appellant] starts to
    test the boundaries, the voltage goes up, gets access, and does not do something
    that’s medically necessary.” The CTC also suggested an explanation for why
    the victims permitted Appellant’s conduct and did not report him. The follow-
    ing is illustrative of the Government’s theme in findings argument:
    Does Airman [TM] go out and get a chaperone right now because
    it’s a sensitive exam? No, he does not. But, as you’ll see when we
    get into the room, that’s where this goes. And the accused does
    not go out and get a chaperone when he knows he should. He
    knows he should. He’s already describe[d] for law enforcement
    that he knows he should. And he doesn’t do it.
    Here’s how the coverup works. He differentiates her from the
    patient pool from when he gets in there. She comes in for a rea-
    son. He’s going to see her for that reason. But then he makes a
    31 In his written ruling denying the Defense motion to exclude evidence of the chaper-
    one policy under Mil. R. Evid. 404(b), the military judge found, inter alia, “[t]he evi-
    dence presented can be viewed by the factfinder as reasonably showing that in order
    to meet his intent, the accused created an opportunity where he could engage in the
    fraudulent exams without witnesses (chaperones) present. Further, that by doing this
    on nine different occasions, he created a common plan or scheme.”
    42
    United States v. Solomon, No. ACM 39972
    decision when he gets her on the table. “Hey, let’s see where this
    goes. Let’s see where this goes.” And he pushes the limits. He
    pushes the limits. There’s no reason for a sensitive exam there.
    The technician knows; for irregular heartbeats, as you’ve heard
    already, are common. Like one of the most common things. He
    knows nobody’s coming in. So he pushes the limits to test the
    boundaries. He increases the voltage.
    ....
    He’s ramping up the voltage. This is exactly the same as Doctor
    [MC] testified to, about the studies of human behaviors; we rely
    on sources of authority, right? We’re like, “Oh, yeah.” We trans-
    fer trust to those individuals who are in white lab coats. We do
    that. And she had - she testified she had no idea that there was
    anything wrong. She had no idea that maybe something was
    amiss. And he doesn’t perform the real breast examination. He
    doesn’t do it, right. And he doesn’t document it. Because it never
    happened. It never happened.
    Again, every single victim was snared under this exact same spe-
    cific set of circumstances.[32] How many until it’s just no longer
    a coincidence?
    Trial counsel also argued, “So if it’s something you didn’t need to do based
    on how she presented, it wasn’t necessary.” He also noted:
    Let’s take a time out right here. Medical necessity. If you don’t
    need to do it as part of how the clinical assessment goes, if you
    don’t need to do it, it’s not necessary. That’s the standard that’s
    in front of you. There’s been a lot of talk about standard of care.
    Could the person do anything they wanted? No, because - you
    know - we’ll talk about this some more - a like-minded group
    “Hey, look, alright, I wouldn’t have done that,” which we’ve
    heard multiple times from every expert. “I wouldn’t have done
    that.” But - you know - standard of care is not it, is it medically
    necessary? So if it’s something you didn’t need to do based on
    how she presented, it wasn’t necessary. It wasn’t necessary.
    Towards the beginning of his rebuttal argument, the CTC again argued
    coincidence, stating,
    32 The phrase “each victim [was] snared under the exact same specific circumstances”
    was in all capital letters on a slide showing the nine victim-patients, and the same or
    similar slide followed the set of slides presented for each specification.
    43
    United States v. Solomon, No. ACM 39972
    [W]e’re going to talk about Occam’s razor. Have you ever heard
    about Occam’s razor? The simplest answer is likely the right one.
    It marries up in this case with another phrase, maybe you’ve
    heard it. If it happens once, it’s an accident. Twice, it’s a coinci-
    dence. Third time, it’s a trend. Have you ever heard of that
    phrase? What’s 10? I don’t know how the phrase ends. Does it
    keep going to 10? Four is a group, five is a crowd, six is - I don’t
    know. The simplest solution is likely the right one.
    Additionally, and with a corresponding slide, the CTC argued:
    Because for any one of these offenses to have been innocent, any
    one of them to be an innocent, well-intentioned medical proce-
    dure, at least four things would have had to happen. Four un-
    likely events.
    A sensitive exam was required despite there being no indication
    or need for one during the [reason for] the appointment. One,
    that he had ineptly performed the exam. That he had ineptly
    perform[ed]. What is- he didn’t really do the exam that - you
    know - everybody is saying happened - he didn’t actually do it
    when you get into it. That he just forgot to have a chaperone.
    He’s inept. He forgot a chaperone, and he just happened to forget
    to document that one part of the exam, and the accompanying
    complaint - you know - a significant part - witness - significant
    part - doesn’t document that either that would indicate a sensi-
    tive procedure had been done. All unlikely events. For one pa-
    tient. For a single event. The probability that the chaperone,
    combined with a lack of documentation for that specific thing is
    improbable for one of them. Improbable circumstances. That
    that would have occurred together. It’s exceedingly low.
    But members, the probably that this happened 10 different
    times approaches zero. Approaches zero. The judge will give you
    instructions that say you can consider this as opportunity, plan,
    intent, gratify sexual desires by the way he worked this system.
    Trial defense counsel did not object during the CTC’s findings argument,
    or to his accompanying slide presentation. 33 The military judge advised the
    court members both before and after findings argument that the arguments of
    counsel were not evidence.
    33 The Defense raised one objection during rebuttal argument, on a matter unrelated
    to the issues Appellant raised on appeal.
    44
    United States v. Solomon, No. ACM 39972
    2. Law
    We review claims of prosecutorial misconduct and improper argument de
    novo. See United States v. Voorhees, 
    79 M.J. 5
    , 9 (C.A.A.F. 2019). When an
    appellant did not object at trial to trial counsel’s argument, courts review for
    plain error. 
    Id.
     (citing United States v. Andrews, 
    77 M.J. 393
    , 398 (C.A.A.F.
    2018)).
    Plain error occurs when (1) there is error, (2) the error is clear
    or obvious, and (3) the error results in material prejudice to a
    substantial right of the accused. Thus, we must determine: (1)
    whether trial counsel’s arguments amounted to clear, obvious
    error; and (2) if so, whether there was a reasonable probability
    that, but for the error, the outcome of the proceeding would have
    been different.
    
    Id. at 9
     (internal quotation marks and citations omitted). The burden to estab-
    lish plain error, including prejudice, is on the appellant. 
    Id. at 9, 12
    .
    In presenting argument, trial counsel may “argue the evidence of record,
    as well as all reasonable inferences fairly derived from such evidence.” United
    States v. Baer, 
    53 M.J. 235
    , 237 (C.A.A.F. 2000) (citation omitted). Trial counsel
    may strike hard but fair blows; they may not “inject [their] personal opinion
    into the panel’s deliberations, inflame the members’ passions or prejudices, or
    ask them to convict the accused on the basis of criminal predisposition.” United
    States v. Sewell, 
    76 M.J. 14
    , 18 (C.A.A.F. 2017) (citations omitted). In deter-
    mining whether trial counsel’s comments were fair, we examine them in the
    context in which they were made. United States v. Gilley, 56 M.J 113, 121
    (C.A.A.F. 2001) (citations omitted). We do not “surgically carve out a portion of
    the argument with no regard to its context.” Baer, 
    53 M.J. at 238
     (internal
    quotation marks omitted).
    In United States v. Burton, 
    67 M.J. 150
     (C.A.A.F. 2009), a case in which the
    appellant was charged with two sexual offenses occurring four years apart, the
    CAAF considered the trial counsel’s findings argument that had invited the
    court members to compare the charged offenses. After noting the military
    judge’s spillover instruction, trial counsel told the court members that they
    “could not use guilt of one offense as proof of guilt of another offense.” 
    Id. at 152
    . Then the trial counsel in Burton
    told the panel it could “take these things and compare them for
    [the appellant’s] propensity to commit these types of offenses.”
    He invited the panel to “take both of [the victims’] stories and
    lay them next to each other and compare them and see what this
    particular person’s M.O. is.”
    45
    United States v. Solomon, No. ACM 39972
    
    Id.
     (second alteration in original). The CAAF held that “[t]he Government may
    not introduce similarities between a charged offense and prior conduct,
    whether charged or uncharged, to show modus operandi or propensity without
    using a specific exception within our rules of evidence, such as [Mil. R. Evid.]
    404 or 413.” 
    Id.
     (citation omitted). The CAAF continued: “It follows, therefore,
    that portions of a closing argument encouraging a panel to focus on such simi-
    larities to show modus operandi and propensity, when made outside the ambit
    of these exceptions, is not a ‘reasonable inference[ ] fairly derived’ from the
    evidence, and was improper argument.” 
    Id. at 153
     (alteration in original) (quot-
    ing Baer, 
    53 M.J. at 237
    ). As the CAAF noted:
    The real risk presented by trial counsel’s improper argument
    was that it would invite members to convict [the] appellant
    based on a criminal predisposition, not that members would now
    perceive properly admitted direct evidence of charged conduct as
    propensity evidence. This greater risk was properly addressed
    by the military judge’s spillover instruction. The military judge
    having instructed the panel that counsel’s arguments were not
    evidence and given a general spillover instruction, it was not
    plain and obvious that an additional instruction was wanted or
    needed.
    Id. at 154 (citation omitted). “In the context of the entire trial,” including the
    Government’s presentation of evidence and argument, and the military judge’s
    instructions, the CAAF did “not believe that any error in trial counsel’s argu-
    ment rose to the level of plain error that would require the military judge to
    sua sponte instruct on the proper use of propensity evidence or take other re-
    medial measures.” Id. (citation omitted).
    It is a permissible inference, referred to as the “doctrine of chances,” to con-
    sider two otherwise independent events that, taken together, are unlikely to
    be coincidental. See Estelle v. McGuire, 
    502 U.S. 62
    , 69 (1991). That differs
    from the inference covered by the character evidence rule, which prohibits in-
    ferring a defendant’s guilt based on an evil character trait. See Michelson v.
    United States, 
    335 U.S. 469
    , 475–76 (1948). The “doctrine [of chances] posits
    that ‘it is unlikely that the defendant would be repeatedly innocently involved
    in the similar suspicious situations.’” United States v. Matthews, 
    53 M.J. 465
    ,
    470 (C.A.A.F. 2000) (quoting 1 Edward J. Imwinkelried, Uncharged Miscon-
    duct Evidence § 5:28 at 78 (1999)). The doctrine most often is employed to show
    the unlikelihood of accident. See generally Edward J. Imwinkelried, An Evi-
    dentiary Paradox: Defending the Character Evidence Prohibition by Upholding
    a Non-Character Theory of Logical Relevance, The Doctrine of Chances, 40 U.
    RICH. L. REV. 419 (2006).
    46
    United States v. Solomon, No. ACM 39972
    3. Analysis
    Appellant did not object to the argument or the accompanying slides at
    trial. We review trial counsel’s argument for plain error.
    a. Milgram experiment
    Appellant claims the following errors related to the CTC referencing testi-
    mony about the Milgram experiment: (1) the experiment has negative conno-
    tations; and (2) repeating the word “voltage” and displaying high-voltage sym-
    bols in the slides.
    We find no error—let alone any error that was clear or obvious—in allowing
    trial counsel to argue reasonable inferences from facts in evidence, including
    the description of the Milgram experiment. Whether that original experiment
    would be replicated in light of today’s ethical standards was addressed through
    Dr. MC’s testimony. Moreover, its connection to “Nazi Germany” was elicited
    by the Defense and was not part of trial counsel’s argument.
    We find trial counsel displaying high-voltage signs on slides and repeating
    the word “voltage” in argument was not clearly erroneous. Trial counsel used
    “voltage” as a metaphor, and did not imply that Appellant shocked, used elec-
    tricity, or otherwise inflicted physical pain to his patients. We generally agree
    with the Government’s characterization, on appeal, of this evidence—namely,
    that trial counsel “employed the idea of increasing the voltage [ ] in the context
    of Appellant testing the boundaries of the victims and the victims complying
    with his requests.” This was permissible argument in light of the evidence pre-
    sented.
    b. Definitions
    Appellant asks us to find trial counsel improperly argued the meaning of
    “medically necessary.” He argues trial counsel argued “several formulations”
    for the “standard for necessity” and these standards were “inconsistent both
    with each other and with a criminal trial.” We find trial counsel did not commit
    error in his argument about medical necessity.
    First we consider and reject Appellant’s claim that the CTC argued “medi-
    cally necessary” meant “required.” Appellant quotes the CTC’s argument that,
    “[i]f you don’t need to do it as part of how the clinical assessment goes . . . it’s
    not necessary,” and “if he didn’t have to do it as part of the reason why she
    presented, it’s not necessary. It’s not medically necessary.” (Emphasis added).
    Based on these statements by the CTC, Appellant argues on appeal:
    Each of these formulations creates an artificial medical stand-
    ard—that there is some established standard of what you must
    do with each patient. The corollary is that doing more is a crime.
    This cannot be. It is directly contrary to what the military judge
    47
    United States v. Solomon, No. ACM 39972
    explained, that medical necessity is the same as saying “for a
    medical purpose.”
    We do not read trial counsel’s argument as conveying the idea that some stand-
    ard required Appellant to perform certain actions on his patients for his actions
    to be medically necessary. Moreover, as discussed in Section B, supra, the mil-
    itary judge did not rule that “medically necessary” was synonymous with “med-
    ical purpose.” As the military judge explained to the parties, outside the pres-
    ence of the members: “I am assuming that if there is a medical purpose, then
    it’s medically necessary for him to do it. But I don’t think that’s the crux of any
    argument now that we’ve fleshed this out.”
    Appellant also claims that the CTC distinguished “medically necessary”
    from “standard of care,” andthen subsequently embraced the latter, “inject[ing]
    a civil negligence analysis into a criminal trial.” We disagree that the CTC
    blurred the concepts or argued a negligence standard. During their testimony,
    the Government clarified with Maj BC, Dr. DT, and Dr. CS that this case was
    a criminal case, and not about malpractice; the CTC’s findings argument did
    not suggest anything to the contrary.
    The CTC suggested the members should give more credit to the testimony
    of the family medicine providers than to the Defense’s specialists because those
    providers are the most “similarly situated” to Appellant in terms of “standards
    of care medicine.” Specifically, the CTC posited: “Who were the similarly situ-
    ated providers who know what they do and what they don’t do at a family prac-
    tice - not a specialist - a family practice [provider] and how they respond to
    specific types of clinical indicators that present there.” The CTC’s argument
    here was not about the meaning of medical necessity or the burden of proof,
    but to which witness’s testimony the factfinder should afford the most weight
    when determining whether Appellant’s purpose was for medical necessity.
    c. Propensity
    Appellant claims the Government went beyond the military judge’s ruling
    that permitted evidence of failure to document and failure to use a chaperone
    as evidence of common plan or scheme, intent, and opportunity. Appellant as-
    serts the findings-argument slides are “a study in propensity,” with “[e]ach
    complaining witness [ ] lumped together, irrespective of the differences in the
    facts.” The essence of Appellant’s claim is that the CTC’s argument “invited
    the members to convict [Appellant] because of the strength of a supposed pat-
    tern, rather than allowing each offense to stand on its own merits.” Appellant
    does not challenge directly the military judge’s ruling which found the Govern-
    ment could introduce evidence under Mil. R. Evid. 404(b) that Appellant, by
    failing to utilize a chaperone “on nine different occasions, [ ] created a common
    plan or scheme.”
    48
    United States v. Solomon, No. ACM 39972
    The Government asserts that arguing a pattern was a “perfectly permissi-
    ble description of the common plan and scheme Appellant employed to commit
    his crimes.” The Government accurately notes that “trial counsel clearly laid
    out the steps in the scheme and applied that framework to the individual evi-
    dence of each victim and specification separately.” Finally, the Government
    asserts the CTC argued against propensity in findings argument when he par-
    aphrased Dr. MC’s testimony and stated, “[T]here is no character type that
    makes somebody more or less likely to commit the offense.” 34
    We find the CTC did not improperly argue propensity. We do not read the
    CTC’s argument to suggest that Appellant was someone prone to commit these
    crimes or who had a general criminal disposition. Moreover, the CTC did not
    invite the court members to conclude that because Appellant was accused of
    more than one sexual offense, the allegations were more likely to be true, or
    otherwise to consider improper “spillover” of evidence. We read the CTC’s ref-
    erences to “Occam’s razor” and coincidence—that the “simplest solution is
    likely the right one”—to be an argument about making reasonable and rational
    inferences from all the evidence presented in this case. See Long, 81 M.J. at
    369. The CTC was permitted to argue the credibility of the witnesses and the
    lack of accident or mistake, as well as a common plan. 35
    The CTC addressed the facts of each specification individually, while also
    highlighting the commonalities. He was permitted to argue evidence that Ap-
    pellant had a plan or scheme—to include the limited-purpose evidence involv-
    ing chaperones and documentation—and was not prohibited from explaining
    how Appellant employed a similar plan or scheme with each victim. We find
    no error in the Government’s findings argument, 36 much less plain error.
    34 The CTC continued: “And that’s the exact principle that the accused was counting
    on when he took the steps with his patients in a very unique set of circumstances that
    repeated over and over again, to go past the point of medical necessity, so that he could
    touch the genitalia of these victims, to gratify his sexual desire.”
    35 The military judge provided the members lengthy instructions regarding witness
    credibility, and instructed them on the defenses of accident and mistake of fact appli-
    cable to the offenses under review. Appellant does not claim those instructions were
    erroneous.
    36 Although we do not find error, we do not recommend the CTC’s approach as a model
    argument. Counsel should be wary of presenting arguments or slides that so closely
    approach the line between proper and improper matters, including spillover, propen-
    sity, or inflaming the passions of the fact-finder.
    49
    United States v. Solomon, No. ACM 39972
    F. Format of Victim Impact Unsworn Statement
    Appellant contends that the military judge abused his discretion in allow-
    ing victims to have their written unsworn statements read to the court mem-
    bers. Specifically, he asks this court to find error where trial counsel read three
    victim unsworn statements to the court members, and where the military
    judge—without articulating good cause—allowed special victims’ counsel to
    read their clients’ unsworn statements to the court members. Appellant asks
    us to set aside his sentence as a remedy. We find relief is not warranted.
    1. Additional Background
    In an Article 39(a), UCMJ, hearing during presentencing, the military
    judge discussed with the parties the victim unsworn statements and their
    presentation. 37 The CTC stated, “[RH] wants to read her statement by phone.
    And then two of the [Special Victims’ Counsel (SVCs)] are going to read their
    statements.” The Defense objected to portions of some statements, which por-
    tions the victims then edited. Ultimately, six victim unsworn statements were
    admitted as court exhibits without objection.
    With the court members present—and after the Government rested its case
    in presentencing—the CTC told the military judge that “some of the victims
    requested that [trial counsel] read their statement on their behalf,” to which
    the military judge responded, “Okay.” Soon thereafter, the CTC stated, “[T]wo
    of the victims have counsel in the room, and those counsel are going to read
    them and then publish[38] them,” to which the military judge responded, “Great.
    Thank you for pointing that out.” Trial counsel then read Court Exhibits 1 and
    2—victim statements of SC and MR—to the members, and published them.
    RH, appearing by telephone, read Court Exhibit 3 to the members, and trial
    counsel published it. Trial counsel then read and published Court Exhibit 4—
    the victim statement of EP. The SVC for BJ read and published Court Exhibit
    5, and the SVC for CS read and published Court Exhibit 6. The counsel did not
    read the statements in a dramatic fashion. 39 Immediately after the victim
    statements were given, Appellant made an oral unsworn statement, then de-
    fense counsel published Appellant’s written unsworn statement and rested.
    37 This hearing followed earlier sessions concerning the substance of the victim un-
    sworn statements.
    38 We understand the term “publish” used in this context to mean to provide a copy of
    the exhibit to the court members.
    39 Having listened to the audio recording of the readings, and reviewed the transcript,
    we generally agree with Appellant’s characterization in his brief that the readings
    were “sometimes monotone and sometimes emotional.” None displayed significant
    emotion.
    50
    United States v. Solomon, No. ACM 39972
    Appellant presented no other information in presentencing for the members’
    consideration.
    Before the members’ deliberations on sentence, the military judge provided
    them instructions regarding victim unsworn statements and Appellant’s un-
    sworn statement. At no point did the trial defense counsel lodge an objection
    to the delivery of the victim unsworn statements.
    2. Law
    We review a military judge’s interpretation of R.C.M. 1001 40 de novo, but
    review a decision regarding the presentation of victim-impact statements in
    presentencing for an abuse of discretion. See United States v. Hamilton, 
    78 M.J. 335
    , 340 (C.A.A.F. 2019); United States v. Barker, 
    77 M.J. 377
    , 382−83
    (C.A.A.F. 2018). A military judge abuses his discretion when he makes a ruling
    based on an erroneous view of the law. See Barker, 77 M.J. at 383.
    Article 6b, UCMJ, 10 U.S.C. § 806b, details several rights belonging to
    crime victims. Among them are the “right to be reasonably heard at . . . [a]
    sentencing hearing relating to the offense,” and the “reasonable right to confer
    with the counsel representing the Government” at a court-martial proceeding
    relating to the offense. Article 6b(a)(4)(B) and 6b(a)(5), UCMJ, 10 U.S.C.
    §§ 806b(a)(4)(B), 806b(a)(5); see also R.C.M. 1001(c)(1) (“[A] crime victim of an
    offense of which the accused has been found guilty has the right to be reason-
    ably heard at the presentencing proceeding relating to that offense.”).
    “The right to make an unsworn victim statement solely belongs to the vic-
    tim or the victim’s designee and cannot be transferred to trial counsel.” United
    States v. Edwards, ___ M.J. ___, No. 21-0245, 
    2022 CAAF LEXIS 283
    , at *16
    (C.A.A.F. 14 Apr. 2022) (first citing Hamilton, 78 M.J. at 342; and then citing
    Barker, 77 M.J. at 378). This right “is separate and distinct from the [G]overn-
    ment’s right to offer victim impact statements in aggravation, under R.C.M.
    1001(b)(4).” Id. (quoting Barker, 77 M.J. at 378). “Upon good cause shown, the
    military judge may permit the crime victim’s counsel, if any, to deliver all or
    part of the crime victim’s unsworn statement.” R.C.M. 1001(c)(5)(B).
    Notwithstanding a victim’s right to be reasonably heard, a military judge
    has the responsibility to “[e]nsure that the dignity and decorum of the proceed-
    ings are maintained,” and shall “exercise reasonable control over the proceed-
    ings.” R.C.M. 801(a)(2)–(3); see also LRM v. Kastenberg, 
    72 M.J. 364
    , 372
    (C.A.A.F. 2013) (noting that a victim’s “right to a reasonable opportunity to be
    40 Rules addressing a victim’s right to be reasonably heard were contained in R.C.M.
    1001A, 2016 MCM. However, those rules are now contained in R.C.M. 1001(c). See
    2019 MCM, App. 15, at A15-18 (“R.C.M. 1001(c) is new and incorporates R.C.M. 1001A
    of the MCM (2016 edition).”). Our analysis cites to these versions as applicable.
    51
    United States v. Solomon, No. ACM 39972
    heard on factual and legal grounds” is “subject to reasonable limitations and
    the military judge retains appropriate discretion under R.C.M. 801”).
    Where an appellant did not object to the presentation of victim matters, we
    review for plain error. Cf. United States v. Gomez, 
    76 M.J. 76
    , 79 (C.A.A.F.
    2017). An appellant bears the burden of establishing the three prongs of the
    plain-error framework: “(1) there was error; (2) the error was clear or obvious;
    and (3) the error materially prejudiced a substantial right.” 
    Id.
     (citation omit-
    ted). When testing for prejudice in the context of sentencing, we determine
    whether the error substantially influenced the adjudged sentence by consider-
    ing the following four factors: “(1) the strength of the Government’s case; (2)
    the strength of the defense case; (3) the materiality of the evidence in question;
    and (4) the quality of the evidence in question.” Hamilton, 78 M.J. at 343 (quot-
    ing United States v. Bowen, 
    76 M.J. 83
    , 89 (C.A.A.F. 2017)). “An error is more
    likely to be prejudicial if the fact was not already obvious from the other evi-
    dence presented at trial and would have provided new ammunition against an
    appellant.” Barker, 77 M.J. at 384 (citation omitted). An error is more likely to
    be harmless when the evidence was not “critical on a pivotal issue in the case.”
    United States v. Cano, 
    61 M.J. 74
    , 77−78 (C.A.A.F. 2005) (internal quotation
    marks and citation omitted).
    3. Analysis
    The issue on appeal is not whether the military judge erred by allowing the
    victims’ unsworn statements to be admitted and presented 41 to the court mem-
    bers; Appellant does not object to the substance of the statements. The issue is
    whether the military judge erred by allowing trial counsel and two special vic-
    tims’ counsel to deliver aloud the properly admitted statements to the court
    members just before they were provided written copies, and whether that error
    resulted in material prejudice.
    We make several assumptions for purpose of analysis: (1) Appellant for-
    feited, but did not waive, this issue; 42 (2) trial counsel may not read aloud a
    41 We are mindful that unsworn victim statements are not admitted as “evidence.”
    United States v. Tyler, 
    81 M.J. 108
    , 112 (C.A.A.F. 2021).
    42 Appellant did not object to the presentation of the victim unsworn statements en-
    tered as court exhibits, although he had objected to the substance of some earlier ver-
    sions.
    52
    United States v. Solomon, No. ACM 39972
    victim’s admitted written unsworn statement to the sentencing authority dur-
    ing presentation of victim matters; 43 and (3) the military judge failed to con-
    sider whether the victims showed good cause to allow their counsel to read
    aloud their statements. 44 Assuming error, we find no prejudice.
    In this case, counsel’s readings of these statements provided no “new am-
    munition” against Appellant. See Barker, 77 M.J. at 384. We find that simply
    reading the written documents to the court members did not amount to any
    significant addition to, or expansion of, the statements. See Edwards, 
    2022 CAAF LEXIS 283
    , at *17–18 (finding that in producing a victim-impact video
    containing images and music, “trial counsel made creative and organizational
    decisions that . . . incorporated her own personal artistic expression,” and
    thereby “misappropriate[d] the victim’s right to be heard”). Any error here “did
    not involve the subject matter, but rather the form in which it was presented.”
    See United States v. Kerr, 
    51 M.J. 401
    , 406 (C.A.A.F. 1999).
    We find trial counsel and special victims’ counsel reading aloud the victim
    unsworn statements had no substantial influence on the sentence. Those read-
    ings did not change the strength of the parties’ cases, with the Government’s
    case being significantly stronger than Defense’s. 45 The readings were not an
    improper government attempt to “slip in evidence in aggravation that [ ] would
    otherwise be prohibited by the Military Rules of Evidence.” Hamilton, 78 M.J.
    at 342. Had the victims personally read their statements to the members, they
    may have imparted more emotion than counsel, whose readings did not add
    substance to the words on the page. We are not convinced Appellant suffered
    any prejudice when trial counsel and special victims’ counsel read the victims’
    statements aloud to the court members in this case. Finding no prejudicial er-
    ror, we decline to grant relief on this issue.
    43 We do not consider a related issue not raised in this case: whether, during argument
    on sentence, counsel is permitted to read out loud some or all of the already-admitted
    victim unsworn statements. Cf. Tyler, 81 M.J. at 113 (finding that “presentencing ar-
    gument may include comment on the victim’s unsworn statement”).
    44 We could presume the military judge knew and followed the law, including when
    and how to apply the standard of whether good cause was shown; the record is clear
    this military judge was familiar with R.C.M. 1001(c). See United States v. Erickson, 
    65 M.J. 221
    , 224 (C.A.A.F. 2007) (“Military judges are presumed to know the law and to
    follow it absent clear evidence to the contrary.”).
    45 The victims were not parties, and their unsworn statements were not part of the
    Government’s case. See Edwards, 
    2022 CAAF LEXIS 283
    , at *16; L.R.M., 72 M.J. at
    368 (finding the victim was a “nonparty to the court[ ]-martial”). We acknowledge, how-
    ever, that the content of those statements favored the Government.
    53
    United States v. Solomon, No. ACM 39972
    G. Sentence Severity
    1. Additional Background
    In presentencing, the Government introduced into evidence a Letter of Ad-
    monishment (LOA) Lieutenant General (Lt Gen) Timothy Ray, Commander,
    Third Air Force, 46 issued to Appellant on 30 September 2016 for conduct while
    Appellant was on temporary duty to Camp Bullis, Texas, and Appellant’s re-
    sponse to the LOA. The LOA alleged that Appellant “repeatedly brushed [his]
    arm and elbow against [SL] and [DN], contacting their breasts on several oc-
    casions.” 47 It also stated Appellant stared at SL’s breasts, making her feel un-
    comfortable. Paragraph 2 stated:
    You are hereby admonished! As an officer in the United States
    Air Force, you have significant authority over others, and you
    must treat them with dignity and respect at all times. You are
    also expected to maintain the highest standards of deportment
    and good behavior. [SL] described troubling conduct that went
    beyond your negligently entering her personal space, and I felt
    strongly that your poor behavior needed to be addressed at a
    higher level. Let me be very clear about one thing. You were a
    hair’s breath away from my offering you a much more severe
    sanction, one that might have had career-ending consequences.
    You are very fortunate that your Squadron, Group, and Wing
    Commanders spoke up for you. If they were not convinced you
    could internalize the message that any unwanted or offensive
    conduct toward a fellow Airman or civilian is unacceptable, I as-
    sure you that this action would have been much harsher. Going
    forward, I expect you to scrupulously adhere to the highest
    standards and to be a model officer. Be warned, the Air Force,
    as an institution, has a long memory, and I and your future com-
    manders will not hesitate to take swift action against you if you
    ever again engage in similar behavior.
    In his response to the LOA, Appellant insisted he “did not intentionally touch
    the breast of any female during training at Camp Bullis, Texas.” He also main-
    tained that he did not know he made anyone at training feel uncomfortable.
    He said such behavior was “not in [his] character,” and “[he] continue[d] to
    46Lt Gen Ray was not the commander who referred the charge and specifications
    against Appellant in June 2019 to a general court-martial.
    47 Specification 12, of which Appellant was acquitted, alleged this touching of SL’s
    breast with his elbow.
    54
    United States v. Solomon, No. ACM 39972
    strive for excellence in patient care as well as set a good example for others
    around [him].”
    In addition to the LOA, the Government introduced a personal data sheet,
    and Appellant’s officer performance reports and enlisted performance reports.
    Six victims made unsworn statements describing the impact Appellant’s
    crimes had on them. Following are some excerpts from their statements:
    •   SC said that she had been “worried” about having a male pro-
    vider, Appellant. “It took me a few visits w[h]ere technicians had
    to be present in the room before I knew I could trust my new
    doctor.” She described how Appellant’s actions towards her af-
    fected her “worklife,” stating, “Having a male customer in the
    store alone with me made me tense also panic at times.”
    •   MR said: “I have nightmares. I have daydreams – distractions in
    my life rethinking about what he did to me” and, “I will have to
    live with what he did to me, the trust he violated, for the rest of
    my life.”
    •   RH said: “I have had to seek therapy and have had to relive those
    moments over and over again. All the pain and discomfort has
    numb[ed] my emotions at times and I would never wish this ex-
    perience on anyone. The empty feelings this has given me while
    having had to work through months of depression has been hard
    on my mental and emotional state and has interfered with eve-
    ryday life and interactions with co-workers and loved ones.”
    •   EP said, “I still struggle with self-blame for why I did not report
    this offense directly or even stop [Appellant] and ask for a chap-
    erone before he violated me. . . . This is where a lot of my anger
    stems from and regret can last a long time. I experience imme-
    diate anxiety for any doctor’s appointment to this day, even if
    the appointment is for my children. I question every move a doc-
    tor makes and am left with the lingering impact of me not feeling
    really [ ]comfortable with male physicians.” EP also described
    how Appellant’s crime affected her schooling, her views on par-
    enting, and her relationships with her husband and children.
    •   BJ said, “In December 2016, after my appointment, I knew
    something about it felt odd. I went home and scrubbed my body
    repeatedly because I felt so disgusting and shameful. It was even
    worse because I was pregnant at the time and I felt that I had
    not protected my baby. Afterward, I would think to myself that
    he is my doctor and I should trust him, but I couldn’t, or any
    other male doctor after him. . . . I experienced symptoms of anx-
    55
    United States v. Solomon, No. ACM 39972
    iety, depressing and crippling shame.” She continued, “Flash-
    backs turned into night terrors to where I would wake up in a
    panic. It’s difficult for me to trust anyone since a doctor should
    arguably be a person you can trust the most.”
    •   CS described how “[t]hat day, that experience, changed every-
    thing” for her. She noted: “Prior to that appointment, I had no
    issues, hesitations, or anxiety when going to a medical appoint-
    ment. I had trust in the medical staff. I never felt the NEED for
    a chaperone. Prior to that appointment, I’d never experienced
    anxiety over being alone with male medical professionals.” After
    the appointment, she worried about seeing Appellant again, and
    did at the post office. She added: “I . . . couldn’t even proceed to
    pick up my mail. Instead, I ran out crying and endured an anxi-
    ety attack in my car.” She also stated: “Because of [Appellant’s]
    actions, I fear going into medical exams, I have lost trust in male
    medical providers, and have increased anxiety. His actions were
    a key factor in my decision to no longer continue my military
    service.”
    Appellant introduced no evidence in presentencing. He provided written
    and oral unsworn statements, mostly addressing his childhood, family, and ca-
    reer.
    Trial counsel argued for a sentence consisting of a dismissal, “a minimum
    of 10 years of confinement,” and forfeiture of all pay and allowances. The De-
    fense argued against a dismissal and for nine months of confinement. Neither
    party argued for a reprimand.
    2. Law
    We review issues of sentence appropriateness de novo. United States v.
    Lane, 
    64 M.J. 1
    , 2 (C.A.A.F. 2006) (citing United States v. Cole, 
    31 M.J. 270
    ,
    272 (C.M.A. 1990)). We may affirm only as much of the sentence as we find
    correct in law and fact and determine should be approved on the basis of the
    entire record. Article 66(d)(1), UCMJ. “We assess sentence appropriateness by
    considering the particular appellant, the nature and seriousness of the of-
    fense[s], the appellant’s record of service, and all matters contained in the rec-
    ord of trial.” United States v. Sauk, 
    74 M.J. 594
    , 606 (A.F. Ct. Crim. App. 2015)
    (en banc) (per curiam) (alteration in original) (quoting United States v. Ander-
    son, 
    67 M.J. 703
    , 705 (A.F. Ct. Crim. App. 2009) (per curiam)). Although we
    have great discretion to determine whether a sentence is appropriate, we have
    no authority to grant mercy. United States v. Nerad, 
    69 M.J. 138
    , 146 (C.A.A.F.
    2010).
    56
    United States v. Solomon, No. ACM 39972
    3. Analysis
    Appellant asserts his sentence is inappropriately severe because the nine
    years in confinement (1) is arbitrary, (2) is excessive, given he also was ad-
    judged a dismissal, and (3) combined with the dismissal, “falls heaviest on his
    family.” He asks this court to set aside and reassess his sentence.
    Appellant argues the sentence to confinement was arbitrary, noting Appel-
    lant was convicted of nine specifications and was sentenced to nine years in
    confinement. First, we note the Government made no such argument during
    sentencing. However, Appellant’s trial defense counsel did make a connection
    between time and specifications. The Defense suggested that nine months is
    the maximum amount of confinement the members should adjudge, stating,
    “You’ve got nine different specifications. That’s 30 days to think about those
    few seconds in that exam room.” Appellant does not assert—and we do not
    find—that an argument for a period of confinement to reflect on one’s crimes
    is improper. We do not join in Appellant’s speculation that the members arbi-
    trarily sentenced him to one year for each specification. 48 Similarly, Appellant
    has not put forth any convincing argument that his sentence was too severe or
    punishes his family.
    Appellant committed crimes against the victims by taking advantage of his
    position of trust as their medical care provider. While Appellant did not phys-
    ically harm his victims, many indicated they suffered lasting psychological
    harm as a result of his actions against them. The members had before them all
    the evidence from the findings portion of the trial, plus evidence of Appellant’s
    service record that the Government introduced in presentencing. Included was
    the admonishment Appellant received less than three months before his first
    assault on a patient, which strongly warned that “any unwanted or offensive
    conduct toward a fellow Airman or civilian is unacceptable.” The members also
    had the victims’ and Appellant’s unsworn statements for their consideration.
    Having given individualized consideration to Appellant, the nature and seri-
    ousness of the offenses, Appellant’s record of service, and all other matters con-
    tained in the record of trial, we do not find his sentence, which includes con-
    finement and a dismissal, is inappropriately severe as a matter of law.
    48 We could just as easily speculate that the members found the Government’s recom-
    mendation of ten years in confinement too high for Appellant’s offenses against eight
    victims, and determined nine years was the minimum time in confinement warranted.
    See R.C.M. 1002(f) (directing the sentencing authority to “impose punishment that is
    sufficient, but not greater than necessary”).
    57
    United States v. Solomon, No. ACM 39972
    H. Motion for a New Trial – Newly Discovered Evidence
    1. Additional Background
    Appellant, as a medical provider, was subject to the Clinic’s credentialing
    process. While he was under investigation for the conduct at issue in his court-
    martial, Appellant’s authority to perform medical-provider duties was held in
    abeyance for 30 days, then suspended. Lt Col BL, the chief of the medical staff
    at Spangdahlem AB and head of its credentialing function, notified Appellant
    of these actions. According to Lt Col BL, the next step after suspension was a
    quality assurance investigation (QAI). Not wanting to interfere with the ongo-
    ing criminal investigation, Lt Col BL, in coordination with the Air Force Med-
    ical Operations Agency (AFMOA), decided the QAI would involve only a review
    of patient records and no interviews.
    A family health physician assistant stationed at Ramstein AB, Germany,
    Capt MA, was detailed to complete the QAI. She understood her duty was “to
    examine allegations that [Appellant] made inappropriate verbal comments
    and/or inappropriate physical contact with a patient.” Capt MA testified in a
    post-trial hearing that although she was asked to review a minimum of ten
    percent of the records in a certain time frame, she “decided to review all female
    encounters in the entire time frame”—which was between 24 April 2017 and
    5 June 2017. In her report, she found the documentation overall to be “scarce,”
    and provided several examples. Additionally, she concluded “all 109 encoun-
    ters had poorly constructed subjective assessments”—that is, the patient’s
    stated reason for the encounter and answers to questions—and that Appel-
    lant’s “decision making was scarcely ever in the [assessment and plan], leaving
    . . . only a diagnosis code and orders placed by the provider.” She also found
    Appellant did not perform a pap smear during the encounter for 22 of 23 pa-
    tients who were due. The QAI memorandum, dated 2 July 2018, comprised one
    page with an attachment of the encounters she reviewed. The QAI was not
    provided to trial counsel.
    Appellant was sentenced on 8 November 2019. Lt Col BL testified in a post-
    trial hearing that after receiving a summary of the results of Appellant’s court-
    martial, he used that summary and the QAI “to move forward from a creden-
    tialing standpoint.” Lt Col BL asked Appellant’s squadron commander to de-
    liver the QAI memorandum to Appellant while she was visiting him in confine-
    ment. In his testimony on this issue, Lt Col BL explained why he did not take
    action on the QAI results until after the court-martial:
    [AFMOA] said, “Okay, well - you know - file it away, keep it,
    because that part of the process has to happen. So when the
    criminal investigation is done, you’ve now got this part at least -
    at least this part of it done and you can move forward whenever
    58
    United States v. Solomon, No. ACM 39972
    they finish.” And so we put it in a folder and - you know - with
    the knowledge, okay, his medical documentation was - you know
    - shoddy in some ways, but quite honestly since that wasn’t the
    question that we were really kind of concerned about, given the
    nature of the allegations, we just didn’t pay too much heed to it
    at that time. It wasn’t a - it wasn’t a big event to see that written.
    It was going to be a process we would deal with later, if and when
    he got back to clinical care.
    Regarding discovery, Lt Col BL remembered a request “for all of [Appel-
    lant’s] clinical records” but did not remember “getting an official request for
    peer review and such.” He did not provide the QAI memorandum to Appellant,
    or mention it to Appellant’s counsel, before the court-martial. Lt Col BL also
    explained that credentialing matters are generally “protected” and “not sup-
    posed to be used in a criminal finding. But the converse is not true.” Lt Col BL
    was unable to explain the full nature of that protection.
    In its notice dated 1 October 2019, the Defense provided the Government
    its anticipated witness list. The first of 26 names listed was Lt Col BL, whom
    the Defense stated “Would testify regarding the culture in the [Medical Group],
    complaints made at or around the same time regarding provider care.” Lt Col
    BL was not called as a witness during Appellant’s trial or sentencing.
    In its pretrial discovery requests and motions, the Defense did not specifi-
    cally ask for any credentialing actions, or for any QAI in particular. It did,
    however, request:
    Paragraph 2n: Access to, with specific direction to the location,
    format, and what files were used or accessed, and/or copies of
    any electronic files or databases used to further the investigation
    of this case, including but not limited to AHLTA, any medical
    records databases, complaints systems, patient advocacy sys-
    tems, patient logs, patient appointment systems, etc.
    ....
    Paragraph 6l: Copies of any records of the Spangdahlem Air
    Base Clinic regarding any complaints filed against any provider
    from 2014 to present. Any formal complaints, reports to law en-
    forcement, patient advocacy requests, requests for a different
    provider, credentialing complaints, etc. Additionally, any poli-
    cies or memoranda of the Spangdahlem Air Base Clinic regard-
    ing policies on patient care, levels of care, speed of care, limits of
    care, etc.
    (Emphasis added). In response to these requests, the Government stated:
    59
    United States v. Solomon, No. ACM 39972
    Paragraph 2n: The Government disclosed the ROI and victim
    video interviews on 22 Apr 2019. On 2 and 3 Jul 2019, the Gov-
    ernment disclosed portions of the OSI case file and we are cur-
    rently tracking down additional information per this request
    which we will make available all records in compliance with the
    above stated rules, regulations, and other applicable authority.
    With the exception of the above, the Government denies the re-
    quest until such time as the defense clarifies what specific infor-
    mation they are seeking and state the rule or basis in law for
    your entitlement.
    ....
    Paragraph 6l: The Government is currently tracking down addi-
    tional information per this request which we will make available
    all records in compliance with the above listed rules, regulations,
    and other applicable authority. With the exception of the above,
    the Government denies the request until such time as the de-
    fense clarifies what specific information they are seeking and
    state the rule or basis in law for your entitlement.
    The Defense did not later specify to the Government a basis for its entitlement
    to the requested information.
    After its pretrial interview of Lt Col BL, the Government sought AFMOA
    assistance obtaining peer reviews of Appellant’s patients’ records. The AFMOA
    response was that because peer review records were protected by statute, the
    requester needed to provide information about how, when, and why the docu-
    ments would be used. The Government did not make further requests for the
    records. The military judge found that the Government did not have reason to
    believe those records contained any exculpatory information. Trial counsel
    were not aware of the existence of the QAI until after Appellant received it—
    when defense counsel asked the Government whether it had provided the QAI
    documents in discovery.
    The Defense also requested the “medical records of all patients seen by [Ap-
    pellant] from 2014 to present.” The Government’s response was substantially
    the same as its response, detailed above, to the Defense’s discovery request
    contained within “paragraph 6l.” Later, the Defense narrowed its request to
    medical records of patients Appellant saw at Spangdahlem AB. In response,
    the Government provided to the Defense around 60,000 pages of patient rec-
    ords. Among these pages were the records of the 109 female patients that Capt
    MA reviewed in her QAI.
    60
    United States v. Solomon, No. ACM 39972
    Before trial, the Defense had identified at least two potential witnesses who
    had performed peer reviews on Appellant’s patients’ records. Moreover, the de-
    fense team included experts in gynecology, cardiology, pulmonology, and foren-
    sic psychology, and an expert physician assistant.
    On 6 February 2020, Appellant filed a motion to compel discovery and for
    appropriate relief, including a new trial. The Defense requested—and the Gov-
    ernment did not oppose—a post-trial Article 39(a), UCMJ, hearing on its mo-
    tion, which the military judge granted. Due to the parties’ request for a contin-
    uance and various logistical issues, the hearing ultimately was scheduled for
    17 July 2020 and a new military judge was detailed. By the time of the hearing,
    the Defense had received its requested discovery materials; therefore, the only
    outstanding issue was the Defense’s request for a new trial. On 14 August
    2020, after considering the pleadings, evidence, argument, and transcript of
    the court-martial proceedings, 49 the post-trial military judge issued a 19-page
    written ruling, denying the Defense’s motion for a new trial.
    Appellant asserts the military judge erred in his ruling by (1) considering
    the nondisclosure a discovery violation and not a Brady 50 violation; (2) finding
    the Defense made a general and not specific discovery request; (3) misunder-
    standing the resulting prejudice in the context of the lengthy trial; (4) classify-
    ing the QAI as cumulative and collateral; and (5) finding the QAI did not meet
    the criteria for “newly discovered evidence.” We first address the implications
    of the Government’s failure to provide the QAI to the Defense before trial, then
    the military judge’s remedy of providing no relief upon Appellant’s post-trial
    motion for a new trial based on newly discovered evidence.
    2. Law and Analysis
    a. Discovery and Brady
    In reviewing discovery matters, we conduct a two-step analysis: “first, we
    determine whether the information or evidence at issue was subject to disclo-
    sure or discovery; second, if there was nondisclosure of such information, we
    test the effect of that nondisclosure on the appellant’s trial.” United States v.
    Coleman, 
    72 M.J. 184
    , 187 (C.A.A.F. 2013) (quoting United States v. Roberts,
    
    59 M.J. 323
    , 325 (C.A.A.F. 2004)).
    “The failure of the trial counsel to disclose evidence that is favorable to the
    defense on the issue of guilt or sentencing violates an accused’s constitutional
    49 The transcript of the trial was certified on 2 April 2020. The record of trial was not
    certified until 25 August 2020, after the post-trial hearing and the military judge’s
    ruling.
    50 Brady v. Maryland, 
    373 U.S. 83
     (1963).
    61
    United States v. Solomon, No. ACM 39972
    right to due process.” Coleman, 72 M.J. at 186 (citing Brady v. Maryland, 
    373 U.S. 83
    , 87 (1963)). Such cases are reviewed for harmless error. 
    Id.
     (citing
    Smith v. Cain, 
    565 U.S. 73
    , 75 (2012)). Favorable evidence includes “impeach-
    ment evidence as well as exculpatory evidence.” Strickler v. Greene, 
    527 U.S. 263
    , 280 (1999) (citation omitted); see also United States v. Claxton, 
    76 M.J. 356
    , 359 (C.A.A.F. 2017) (quoting Strickler, 527 U.S. at 280).
    There are three components of a true Brady violation: The evi-
    dence at issue must be favorable to the accused, either because
    it is exculpatory, or because it is impeaching; that evidence must
    have been suppressed by the State, either willfully or inadvert-
    ently; and prejudice must have ensued.
    Strickler, 527 U.S. at 281−82.
    Prejudice is shown when the undisclosed evidence is material; “[s]uch evi-
    dence is material ‘if there is a reasonable probability that, had the evidence
    been disclosed to the defense, the result of the proceeding would have been
    different.’” Strickler, 527 U.S. at 280 (quoting United States v. Bagley, 
    473 U.S. 667
    , 682 (1985)); see also Coleman, 72 M.J. at 186 (adopting this test for prej-
    udice). A reasonable “possibility” of a different result is not sufficient. Strickler,
    527 U.S. at 291. We evaluate prejudice from the nondisclosure “in the context
    of the entire record.” Turner v. United States, ___ U.S. ___, 
    137 S. Ct. 1885
    ,
    1893 (2017) (quoting United States v. Agurs, 
    427 U.S. 97
    , 112 (1976)); see also
    United States v. Stone, 
    40 M.J. 420
    , 423 (C.M.A. 1994) (noting that “recourse
    to the entire record of trial is required to determine the effect of the undisclosed
    evidence on the conviction”). A Brady violation is demonstrated “by show-
    ing that the favorable evidence could reasonably be taken to put the whole case
    in such a different light as to undermine confidence in the verdict.” Kyles v.
    Whitley, 
    514 U.S. 419
    , 435 (1995).
    “A military accused also has the right to obtain favorable evidence under
    Article 46, UCMJ, 
    10 U.S.C. § 846
     (2006), as implemented by R.C.M. 701–703.”
    Coleman, 72 M.J. at 186–87 (footnotes omitted). The CAAF “has held that Ar-
    ticle 46[, UCMJ,] and its implementing rules provide greater statutory discov-
    ery rights to an accused than does his constitutional right to due process.” Cole-
    man, 72 M.J. at 186 (citing Roberts, 59 M.J. at 327) (additional citation omit-
    ted). When “the defense made a specific request for the undisclosed information
    . . . we apply the heightened constitutional harmless beyond a reasonable
    doubt standard.” Id. at 187 (citations omitted).
    In this case, whether labeled a mere discovery violation or a Brady viola-
    tion, the Government’s failure to provide the QAI to the Defense before trial
    was error. The meaningful issue on appeal is how the military judge addressed
    that error. Appellant claims the military judge made erroneous conclusions
    62
    United States v. Solomon, No. ACM 39972
    and thereby abused his discretion in denying the Defense motion for a new
    trial. We disagree.
    The military judge first considered the nature of the violation before fash-
    ioning a remedy. Because he found the Defense did not specifically request the
    QAI, he analyzed the violation under a harmless-error standard. While he con-
    sidered the QAI to be favorable to the Defense, he also found it immaterial,
    cumulative, and collateral. Additionally, he found the Government’s case was
    strong, and that there was other evidence of sexual intent, consciousness of
    guilt, and plan and scheme. He concluded the Defense did not meet “their bur-
    den to show the failure to disclose the QAI create[d] a reasonable probability
    of a different trial result . . . .”
    We agree that the Defense did not make a specific request for the QAI, and
    the military judge analyzed the violation under the correct standard. The De-
    fense did not request records relating to credentialing actions against Appel-
    lant. The Defense requested “credentialing complaints, etc.” filed at the Clinic
    against “any provider from 2014 to present” and access to “complaints sys-
    tems.” Perhaps because such requests were overbroad, they did not focus the
    Government on obtaining a document that would be used to further credential-
    ing actions against Appellant. After the Government notified the Defense that
    it encountered resistance obtaining the requested information, the Defense did
    not reply to the Government and articulate why the information it sought
    should not be protected from disclosure. Neither the Defense nor the Govern-
    ment pursued the matter. The Defense did not request “peer reviews,” which
    might have netted the QAI inasmuch as it was a type of peer review. 51 Trial
    counsel did not know about the QAI, much less hide it from the Defense.
    Despite finding that the Defense made only a general request, the military
    judge also assumed arguendo that the Defense made a specific discovery re-
    quest, and nevertheless found the error harmless beyond a reasonable doubt.
    He added to this specific analysis the fact that the Defense was in possession
    of the patient records reviewed in the QAI, and that other evidence would have
    rebutted the QAI’s findings.
    [T]he main problems the Defense needed to overcome was not
    whether [Appellant] was good at documenting patient encoun-
    ters, but if and why he performed sensitive exams when not med-
    ically necessary, in a way that was not clinically effective, and
    51 Before trial and after interviewing Lt Col BL, a defense witness, the Government
    sought more information about peer reviews—a different category from credentialing
    actions—but did not pursue them until responding to the Defense’s post-trial motion.
    63
    United States v. Solomon, No. ACM 39972
    under circumstances that were counter to any provider with a
    minimal level of competence. . . .
    . . . Ultimately, the argument that [Appellant] demonstrated
    poor documentation practices would only have carried the De-
    fense theory so far. The members would still have to disregard
    strong evidence that [Appellant] performed unnecessary sensi-
    tive exams under suspicious circumstances notwithstanding the
    documentation, in order to find a reasonable doubt existed as to
    [Appellant’s] actions and intentions.
    The military judge concluded that the “nondisclosure of the QAI memoran-
    dum, its attachments, and related documentation would not have affected the
    outcome of the trial and is harmless beyond a reasonable doubt.” While not
    dispositive, we agree with the military judge that the Defense did not specifi-
    cally request the QAI, but even if it had, the Government’s failure to provide it
    to the Defense in pretrial discovery was harmless beyond a reasonable doubt.
    With this backdrop of the nature of the discovery violation, the military judge
    considered the requested remedy of a new trial—which we now review.
    b. Motion for a new trial
    A military judge decides a post-trial motion for a rehearing by applying the
    criteria for petition for a new trial set forth in Article 73, UCMJ, 
    10 U.S.C. § 873
    , and R.C.M. 1210(f). United States v. Williams, 
    37 M.J. 352
    , 355–56
    (C.M.A. 1993) (citation omitted). We review such rulings for an abuse of dis-
    cretion. 
    Id. at 356
     (citations omitted).
    A military judge abuses her discretion when her findings of fact
    are clearly erroneous, the court’s decision is influenced by an er-
    roneous view of the law, or the military judge’s decision on the
    issue at hand is outside the range of choices reasonably arising
    from the applicable facts and the law.
    United States v. Webb, 
    66 M.J. 89
    , 93 (C.A.A.F. 2008) (citations omitted). We
    also review a military judge’s selection of a remedy for an abuse of discretion.
    United States v. Gore, 
    60 M.J. 178
    , 187 (C.A.A.F. 2004).
    A petitioner may petition for a new trial “on the grounds of newly discov-
    ered evidence or fraud on the court.” Article 73, UCMJ, 
    10 U.S.C. § 873
    . A new
    trial shall not be granted on the grounds of newly discovered evidence unless
    the petition shows that:
    (A) The evidence was discovered after the trial;
    (B) The evidence is not such that it would have been discovered
    by the petitioner at the time of trial in the exercise of due dili-
    gence; and
    64
    United States v. Solomon, No. ACM 39972
    (C) The newly discovered evidence, if considered by a court-mar-
    tial in the light of all other pertinent evidence, would probably
    produce a substantially more favorable result for the accused.
    R.C.M. 1210(f)(2); see United States v. Luke, 
    69 M.J. 309
    , 314 (C.A.A.F. 2011);
    United States v. Johnson, 
    61 M.J. 195
    , 198 (C.A.A.F. 2005). “No fraud on the
    court-martial warrants a new trial unless it had a substantial contributing ef-
    fect on a finding of guilty or the sentence adjudged.” R.C.M. 1210(f)(3). Exam-
    ples of fraud on a court-martial which may warrant granting a new trial in-
    clude “confessed or proved perjury . . . which clearly had a substantial contrib-
    uting effect on a finding of guilty” and “willful concealment by the prosecution
    from the defense of evidence favorable to the defense which . . . would probably
    have resulted in a finding of not guilty . . . .” R.C.M. 1210(f)(3), Discussion.
    The CAAF repeatedly has found that “‘requests for a new trial . . . are gen-
    erally disfavored,’ and are ‘granted only if a manifest injustice would result
    absent a new trial . . . based on proffered newly discovered evidence.’” United
    States v. Hull, 
    70 M.J. 145
    , 152 (C.A.A.F. 2011) (quoting Williams, 37 M.J. at
    356); see also Johnson, 61 M.J. at 199.
    The military judge found Appellant did not satisfy all three prongs for a
    new trial premised on newly discovered evidence under Article 73, UCMJ. Cer-
    tainly, the QAI was not discovered until after trial. Regarding the discovera-
    bility, however, the military judge considered the QAI another form of peer
    review which could have been discovered by the Defense prior to or during trial.
    We find no error in his conclusion. The Defense had access to several personnel
    who would be familiar with the Air Force credentialing processes, including
    Lt Col BL. Moreover, Appellant knew that his medical-provider privileges
    were first in abeyance, then suspended. And even if the military judge erred in
    finding the QAI was cumulative and collateral, those findings did not signifi-
    cantly impact his other conclusions. Most importantly, however, based on es-
    sentially the same reasons as to why he determined the nondisclosure was
    harmless beyond a reasonable doubt, the military judge found “the QAI mem-
    orandum, considered in light of all the other pertinent evidence, would not
    have produced a substantially more favorable result for [Appellant] in this
    case.” We find the military judge did not abuse his discretion in denying the
    Defense motion for a new trial.
    The QAI memorandum contained the findings, conclusions, and recommen-
    dations of Appellant’s peer; it reflected one medical provider’s opinion. The De-
    fense had access to the same records considered in the QAI, and had five med-
    ical experts who could perform their own review of those records. Moreover, as
    experts, they would have been able to testify about any opinion they formed
    after conducting such review.
    65
    United States v. Solomon, No. ACM 39972
    Appellant suggests the post-trial military judge did not “grasp[ ] the full
    nature of the trial,” especially the importance of the evidence regarding Appel-
    lant’s documentation. He asserts that records introduced as a prosecution ex-
    hibit 52 indicating that Appellant’s recordkeeping ability was “superior” stood
    unrebutted, and “thus the failure to document suggested devious intent.” We
    agree with the conclusion of the military judge that at trial “relatively little
    emphasis” was placed on these records, and with his overall analysis of the
    exhibit:
    The documentation alone was not evidence of sexual gratifica-
    tion or intent, or evidence of a guilty conscious [sic] or plan and
    scheme, it was part of a larger picture in which the Government
    tried to prove [Appellant] used his knowledge of the [C]linic pro-
    cedures to perform unnecessary sensitive exams on certain fe-
    male patients under circumstances in which his actions were not
    likely to be discovered.
    While several witnesses testified at trial about Appellant’s documentation
    of the victim-patient encounters, no witness testified about his proficiency at
    documenting all patient encounters. In closing, the Government argued this
    “selective documenting” along with “selective chaperone” indicated “an effort
    to create an opportunity to act on [ ] sexual intent.” Again, we agree with the
    post-trial military judge’s conclusion:
    The QAI evidence of poor documentation may have supported
    the defense argument of ineptitude, but in the face of the testi-
    mony of expert witnesses that the sensitive exams performed by
    [Appellant] on named victims were not medically necessary, [Ap-
    pellant’s] actual behavior with patients (i.e., nature of touchings,
    failure to ask for consent, asking patients to remov[e] undergar-
    ments, unbuttoning the pants of a patient, running his fingers
    through pubic hair, etc.), and [Appellant’s] selective use of the
    chaperone policy, the QAI memorandum is not so compelling
    that a factfinder would disregard all the other evidence.
    52 Prosecution Exhibit 22 was comprised of three documents, each an Air Force Form
    1562, Credentials Evaluation of Health Care Practitioners. The form covering May
    2011 to September 2012, while Appellant was a student, indicates Appellant was “su-
    perior” in 12 areas, including “record keeping,” but “good” in “competence and skill”
    and “case presentations.” The form covering the period from June 2011 to July 2015
    indicates Appellant was “superior” in all 14 areas. Another form, covering only April
    2015 to June 2015, indicates Appellant’s “record keeping” and performance in five
    other areas were “not observed.”
    66
    United States v. Solomon, No. ACM 39972
    We conclude that providing the members with the QAI—either the docu-
    ment or the testimony of its author—would not have moved the scales in favor
    of Appellant. We agree with the military judge that had the Defense received
    Capt MA’s QAI memorandum beforehand, it would not have affected the out-
    come of Appellant’s trial.
    I. Timeliness of Appellate Review
    1. Law
    Whether an appellant has been deprived of his due process right to speedy
    post-trial and appellate review, and whether constitutional error is harmless
    beyond a reasonable doubt, are questions of law we review de novo. United
    States v. Arriaga, 
    70 M.J. 51
    , 55 (C.A.A.F. 2011) (citing United States v.
    Moreno, 
    63 M.J. 129
    , 135 (C.A.A.F. 2006)).
    In Moreno, the CAAF established a presumption of facially unreasonable
    delay when the convening authority does not take action within 120 days of
    sentencing, when a case is not docketed with the CCA within 30 days of con-
    vening authority action, or when the CCA does not render a decision within 18
    months of docketing. 
    63 M.J. at 142
    . In United States v. Livak, this court es-
    tablished an aggregated sentencing-to-docketing 150-day threshold for facially
    unreasonable delay for cases referred to trial on or after 1 January 2019. 
    80 M.J. 631
    , 633 (A.F. Ct. Crim. App. 2020) (deducing aggregate standard from
    standards announced by our superior court in Moreno).
    If there is a Moreno-based presumption of unreasonable delay or an other-
    wise facially unreasonable delay, we examine the claim under the four factors
    set forth in Barker v. Wingo, 
    407 U.S. 514
    , 530 (1972): “(1) the length of the
    delay; (2) the reasons for the delay; (3) the appellant’s assertion of the right to
    timely review and appeal; and (4) prejudice.” Moreno, 
    63 M.J. at 135
     (citations
    omitted). In Moreno, the CAAF identified three types of prejudice arising from
    post-trial processing delay: (1) oppressive incarceration; (2) anxiety and con-
    cern; and (3) impairment of a convicted person’s grounds for appeal and ability
    to present a defense at a rehearing. 
    Id.
     at 138–39 (citations omitted).
    “We analyze each factor and make a determination as to whether that fac-
    tor favors the Government or the appellant.” Id. at 136 (citation omitted).
    Then, we balance our analysis of the factors to determine whether a due pro-
    cess violation occurred. Id. (citing Barker, 407 U.S. at 533). “No single factor is
    required for finding a due process violation and the absence of a given factor
    will not prevent such a finding.” Id. (citation omitted). However, where an ap-
    pellant has not shown prejudice from the delay, there is no due process viola-
    tion unless the delay is so egregious as to “adversely affect the public’s percep-
    tion of the fairness and integrity of the military justice system.” United States
    v. Toohey, 
    63 M.J. 353
    , 362 (C.A.A.F. 2006).
    67
    United States v. Solomon, No. ACM 39972
    Recognizing our authority under Article 66(d), UCMJ, we also consider if
    relief for excessive post-trial delay is appropriate even in the absence of a due
    process violation. See United States v. Tardif, 
    57 M.J. 219
    , 223–24 (C.A.A.F.
    2002).
    2. Additional Background and Analysis
    Appellant was sentenced on 8 November 2019. The post-trial Article 39(a),
    UCMJ, hearing on the Defense’s motion concluded on 17 July 2020, and the
    military judge issued his ruling on the post-trial motion on 14 August 2020.
    The military judge signed the entry of judgment on 24 August 2020 and the
    record of trial was certified the next day. Appellant’s case was docketed with
    the court on 15 October 2020.
    Applying Livak, we find a facially unreasonable delay in the docketing with
    this court; and applying Moreno, we find a facially unreasonable delay in this
    court issuing its opinion in Appellant’s case more than 18 months after the case
    was docketed with the court. However, we determine no violation of Appellant’s
    rights to due process and a speedy appellate review. The reasons for the delays
    include the post-trial hearing to decide Appellant’s motion for a new trial, as
    well as the time required for Appellant to file his brief, which he did on 6 Jan-
    uary 2022—over 14 months after his case was docketed with the court. The
    Government submitted its answer on 11 February 2022, and Appellant replied
    to the answer on 27 February 2022. The delay became facially unreasonable
    on approximately 15 April 2022.
    Analyzing the Barker factors, we find both delays are long, though not ex-
    cessively so. Appellant filed his post-trial motion three months after his sen-
    tence was announced, and it took six months for the military judge to hold the
    hearing and issue his ruling. The length of the delay in the court issuing this
    opinion is partially owing to 12 defense-requested enlargements of time that
    the court granted before the case was joined, plus one enlargement for the De-
    fense to file its reply brief. After Appellant’s eighth request for enlargement of
    time, and in each request thereafter, his counsel averred that Appellant had
    been specifically informed of his right to timely appellate review, was consulted
    with regard to the motion, and agreed with this court granting the enlarge-
    ment. Counsel for both parties requested to exceed the page limit for their
    briefs, which requests were granted. Relevant too, on 29 April 2022, the court
    granted Appellant’s 19 April 2022 motion for leave to file a supplemental as-
    signment of error brief and denied his motion to cite supplemental authority;
    then granted Appellant’s second motion to cite supplemental authority, dated
    6 July 2022. The record of trial comprises 14 volumes, including 2,113 tran-
    script pages, 29 prosecution exhibits, 5 defense exhibits, 6 court exhibits, and
    152 appellate exhibits. Appellant raised 12 assignments of error—many with
    68
    United States v. Solomon, No. ACM 39972
    multiple sub-issues—all of which this court carefully considered, and that con-
    tributed to the length of appellate delay and this opinion.
    Appellant has not asserted his right to speedy appellate review or pointed
    to any particular prejudice resulting from the presumptively unreasonable de-
    lay, and we find none. Finding no Barker prejudice, we also find the delay is
    not so egregious that it would “adversely affect the public’s perception of the
    fairness and integrity of the military justice system.” See Toohey, 
    63 M.J. at 362
    . As a result, there is no due process violation. See 
    id.
    We determine Appellant is not due relief even in the absence of a due pro-
    cess violation. See Tardif, 57 M.J. at 223–24. Applying the factors articulated
    in United States v. Gay, 
    74 M.J. 736
    , 744 (A.F. Ct. Crim. App. 2015), aff’d, 
    75 M.J. 264
     (C.A.A.F. 2016), we find the delays in post-trial and appellate review
    justified and relief for Appellant is not warranted.
    III. CONCLUSION
    The findings and sentence as entered are correct in law and fact, and no
    error materially prejudicial to the substantial rights of Appellant occurred. Ar-
    ticles 59(a) and 66(d), UCMJ, 
    10 U.S.C. §§ 859
    (a), 866(d). Accordingly, the find-
    ings and sentence are AFFIRMED. 53
    FOR THE COURT
    FLEMING E. KEEFE, Capt, USAF
    Acting Clerk of the Court
    53 The Statement of Trial Results failed to include the command that convened the
    court-martial as required by R.C.M. 1101(a)(3). Appellant asserts no prejudice and we
    find none. See United States v. Moody-Neukom, No. ACM S32594, 
    2019 CCA LEXIS 521
    , at *2–3 (A.F. Ct. Crim. App. 16 Dec. 2019) (unpub. op.) (per curiam).
    69
    

Document Info

Docket Number: 39972

Filed Date: 8/19/2022

Precedential Status: Non-Precedential

Modified Date: 5/29/2024