Department of the Navy Disability Evaluation System Naval Health Clinic Quantico, VA

1. Secretary of the Navy Council of Review Boards Department of the Navy Disability Evaluation System Naval Health Clinic Quantico, VA 7 Dec 2006

2. Performance based system. A medical diagnosis MAY NOT be a disability. Referral to PEB does NOT always spell the end of a career. Service HQ has final disposition authority. CO’s assessment is critical! Bottom LineUp-Front

3. Established by law (Title 10 USC, Chapter 61). Enacted to preclude service member’s separation due to medical condition without an opportunity to demonstrate fitness to continue service. Compensation for loss of career cut short by service illness or injury incurred while in receipt of basic pay. DoD DisabilityEvaluation System

4. Maintenance of a physically fit and combat ready force Equitable consideration of the interests of government and individual service member DoN Disability Evaluation System Objectives

5. Determine a service member’s fitness for continued naval service. (FIT or UNFIT) Rate member’s whose disabling injury or illness is determined to have been incurred or aggravated while in receipt of basic pay. Ensure member’s right to a full and fair hearing. PEB Mission

6. Taking care of Sailors and Marines Facilitate the Navy and Marine Corps in the management of personnel resources Our Business

7. The DES is a performance-based system! Designed to provide member every opportunity to be found FIT and avoid a medical discharge. Can the member do their job? Disabling condition may warrant disability retirement or severance. DoN Disability Evaluation System

8. Deliberate and documented process Multi-phased Record review (Informal PEB (IPEB)) Reconsideration of IPEB finding Personal appearance hearing with legal counsel (Formal PEB (FPEB)) Petition for relief BCNR Disability Evaluation System Process

9. Case Processing Flow How does the PEB work? PETITION FOR RELIEF INFORMAL BOARD FORMAL BOARD MEMBER HOSPITAL

10. Desired Case Processing Time 30 + days light duty (90 max) 6-12 months limited duty 1 month board dictation (72 days average) MEMBER MTF MEDICAL EVALUATION BOARD REPORT INFORMAL BOARD 40 days from receipt of the MEB (16 days average) FORMAL BOARD 90 days from receipt of the Findings 45 days from receipt of PFR PETITION FOR RELIEF

11. Disagrees Fit PEBLO/ MEMBER Unfit FORMAL BOARD Member’s Command NMA Member Disagrees INFORMAL BOARD PETITION FOR RELIEF Requests Reconsideration Accepts • Fit for Continued Naval Service • Unfit for Continued Naval Service - Separate w/wo benefits - Disability Retirement: PDRL, TDRL HOSPITAL Return to Duty Agrees with Finding Grant / Deny Treatment Fit for Full Duty or BCNR Fitness for continued service in question SERVICE HEADQUARTERS MEDICAL BOARD Returns to Duty Separation w/wo benefits Retires w/Disability (TDRL/PDRL) Admin Separation, PLD Temporary Limited Duty (up to 12 months) Condition permanently interferes with ability to serve on AD Temp? CASE PROCESSING Finding

12. Member’s Command NMA Member HOSPITAL Return to Duty Treatment Fit for Full Duty or MEDICAL BOARD Temporary Limited Duty (up to 12 months) Condition permanently interferes with ability to serve on AD Temp? CASE PROCESSING

13. LIMDU or Fit for Full Duty? Where does the Marine Corps need this Marine?

14. Enough to crew an aircraft carrier and embarked wing

15. True LIMDU population unknown Placement on LIMDU driven more by events than medical conditions Deployment cycle PCS orders to operational/overseas unit PRT or PFA cycle LIMITED DUTYDETERMINATIONS NO PEB CASELOAD PREDICABILITY

16. When maximum benefit of medical treatment and rehab attained When all available SIQ, Light Duty, Convalescent Leave, and LIMDU exhausted (12 months) When Service HQ denied additional LIMDU When Death Imminent How PEB Referral Has Been Decided NOT OPTIMAL FOR READINESS

17. “It is not within the mission of the Department of the Navy to retain members on active duty or in the Ready Reserve to provide prolonged, definitive medical care when it is unlikely the member will return to full military duty. PromptIdentification

18. Accordingly, line commanders, commanding officers of MTFs, and individual medical and dental officersshall promptly identify for evaluation by medical boards and appropriate referral to the PEB…, those members presenting for medical care whose physical or mental fitness to continue is questionable.” PromptIdentification Section 1005 SECNAVINST 1850.4E

19. Preserves the interests of the government and individual service member. Government Helps maintain operational readiness Individual Return to duty or provided DoD disability compensation (Severance or Retirement) Access to VA benefits & compensation WhyPrompt Referral?

20. Enables member to make “informed” decisions once made aware of benefits (DoD, DVA, DOL and Social Security) available. If eligible and elects, can continue treatment at MTF as retiree while receiving other benefits DVA benefits and compensation often greater and encompass family Prompt PEB Referral

21. PEB Referral Decisions Attending physician MTF Medical Evaluation Board MTF Convening Authority CNO or CMC may direct NOT Individual service member Commanding officer

22. Fit PEBLO/ MEMBER Unfit Member’s Command NMA Member INFORMAL BOARD • Fit for Continued Naval Service • Unfit for Continued Naval Service - Separate w/wo benefits - Disability Retirement: PDRL, TDRL HOSPITAL Return to Duty Treatment Fit for Full Duty or Fitness for continued service in question MEDICAL BOARD Temporary Limited Duty (up to 12 months) Condition permanently interferes with ability to serve on AD Temp? CASE PROCESSING Finding

23. Informal / Formal Board • Composition: - One Physician (O-5/O-6) - One Navy line officer (O-5/O-6) - One Marine line officer (O-5/O-6) • Functions: - Evaluate fitness for continued naval service - Validate line of duty determination - Assign VA code(s) /Determine disability % - Make combat related determination - Issue preliminary findings letter - Recommend findings with rationale

24. Who - What - How? PEB Board 1 - Physician (O6 or O5) 2 – Line Officers (O6 / O5 / O4) MEB Report CO’s Assessment Member’s Rebuttal Physical Exam Entire Medical Record LODI All Inpatient Records (Labs)

25. The mere presence of a medical condition does NOT necessarily result in UNFIT finding or entitlement to a disability rating. Diagnosis Vs Disability

26. FIT: Member can reasonably perform duties of their office, grade, rank or rating. PEB balances impact of member’s diagnoses, via objective medical and performance evidence, against member’s ability to perform duties of office, grade, rank or rating. What is FIT?

27. FIT does not mean “fit for full duty” or “suitable.” (Suitable means member meets all requirements for an overseas, remote or operational assignment) Although the PEB determines that a member is FIT, he/she may not be able to: Pass PFA/PFT Deploy Serve in Special Duty assignments (flight, parachute, dive, submarine, etc.) What is Not FIT?

28. Condition significantly impairs member’s ability to perform appropriate duties Multiple clinic or Emergency Room visits Objective findings on physical exam Commanding Officer’s assessment indicates job limitations, and / or absences from work UNFIT Call Characteristics

29. Directed by DODI 1332.39 Chapter 61, Title 10, USC established VASRD as the standard for assigning disability ratings Portions not applicable to military departments Rating % applied to only military (occupational) unfitting conditions Use of VASRD* http://ecfr.gpoaccess.gov *Electronic Version Access

30. Disability Rating & Disposition • Member < 20 years and a Disability Rating < 30% = Separate • Member < 20 years and a Disability rating > 30% = TDRL or PDRL • Member > 20 or more years and a Disability Rating = TDRL or PDRL

31. Severance pay computed using 2 X Base Pay X Years (maximum 12 years) Compensation • TDRL placement results in a minimum 50% of Base Pay to a maximum of 75% • PDRL compensation based on % of disability rating

32. Secretary of the Navy Council of Review Boards Combat Related • Engaged in Extra Hazardous Service • Direct Result of Armed Conflict • Conditions Simulating War • Instrumentality of War

33. Disagrees Fit PEBLO/ MEMBER Unfit FORMAL BOARD Member’s Command NMA Member INFORMAL BOARD Requests Reconsideration Accepts • Fit for Continued Naval Service • Unfit for Continued Naval Service - Separate w/wo benefits - Disability Retirement: PDRL, TDRL HOSPITAL Return to Duty Agrees with Finding Treatment Fit for Full Duty or Fitness for continued service in question SERVICE HEADQUARTERS MEDICAL BOARD Returns to Duty Separation w/wo benefits Retires w/Disability (TDRL/PDRL) Admin Separation, PLD Temporary Limited Duty (up to 12 months) Condition permanently interferes with ability to serve on AD Temp? CASE PROCESSING Case Processing Finding

34. Who - What - How? PEB Board (Formal) 1 - Physician (O6 or O5) 2 – Line Officers (O6 / O5 / O4) CO’s Assessment MEB Addendum Revised Inpatient Records (Labs) LODI New Legal Counsel Member Testimony Service appointed or Personal retain Personal appearance

35. Disagrees Fit PEBLO/ MEMBER Unfit FORMAL BOARD Member’s Command NMA Member Disagrees INFORMAL BOARD PETITION FOR RELIEF Requests Reconsideration Accepts • Fit for Continued Naval Service • Unfit for Continued Naval Service - Separate w/wo benefits - Disability Retirement: PDRL, TDRL HOSPITAL Return to Duty Agrees with Finding Grant / Deny Treatment Fit for Full Duty or BCNR Fitness for continued service in question SERVICE HEADQUARTERS MEDICAL BOARD Returns to Duty Separation w/wo benefits Retires w/Disability (TDRL/PDRL) Admin Separation, PLD Temporary Limited Duty (up to 12 months) Condition permanently interferes with ability to serve on AD Temp? CASE PROCESSING Finding

36. Normal Case Flow(UNFIT FINDING) PEB notifies SVC HQ. Mbr & command notified of HQ disposition action. (Day 90) MTF forwards Medical Evaluation Board Report to PEB PEBLO informs mbr. Mbr accepts. (Day 80) PEB accepts case: (Day 1) Informal PEB (IPEB) findings issued. (Day 5) Formal PEB considers case. (Day 70) PEBLO informs mbr of UNFIT findings. Election of options mbr req reconsider. (Day 16) IPEB reconsiders. No change. PEBLO informs mbr. Mbr demands formal hearing. (Day 30)

37. 5500 Active duty and Reserve 2100 Temporary Disability Retired List (reevals) OEF / OIF 1200 Case Volume

38. Secretary of the Navy Council of Review Boards OEF/OIF CASE PROCESSING • Marine Corps(1105 Total) • Adjudicated: • 896 USMC • 161 USMCR - Total Combat Related cases = 796 • In-process • 35 USMC • 13 USMCR • Navy(195 Total) • Adjudicated: • 112 USN • 75 USNR - Total Combat Related cases = 96 • In-process: • 4 USN • 4 USNR 25 SEP 06

39. DOD vs DVA System • DOD * Determine a service member’s medical fitness for military duty * Compensate for a loss of future military earnings • DVA * Determine service connection of disability * Compensate for the loss of future civilian earning capacity

40. Auth: 10 USC chap 61 Only unfitting conditions rated Ratings are permanent upon PDRL or separation Not bound by DVA rating decisions Auth: 38 CFR Service connected injuries/illness rated Ratings may change over time Not bound by military decisions DOD vs DVA System DOD DVA

41. PEB UNFIT finding does NOT always result in separation Service HQ retains disposition authority Can grant PERMANENT LIMITED DUTY Have better visibility into force readiness Prompt PEB Referral

42. A Service Headquarters decision Member found “UNFIT” by the PEB Member accepts PEB decision Member requests PLD approval via chain of command HQ may continue member on active duty Permanent Limited Duty (PLD)

43. Questions ?