Army Profiles Yesterday, Today and Tomorrow

1. Army ProfilesYesterday, Today and Tomorrow Scott Deitche D.O. Sports Medicine Fellow

2. Objectives Explain the purpose, importance and impact of a profile Overview of the Medical Evaluation Board (MEB) system Provide historical background of the profile system and form Provide instructions/guidance for ACCURATE profile writing Offer keys to help STRIVE for EXCELLENCE as PHYSICIANS and OFFICERS

3. CG Commanding General EPTS Existed prior to service MEB Medical evaluation board MOS Military occupational specialty RTD Return to duty MTF Medical treatment facility MMRB MOS medical retention board PEB Physical evaluation board PEBLO Physical evaluation board liaison office SM Service member TRDL Temporary disabled and retired list Abbreviations

4. The Profile • Written documentation describing a SM’s functional capacity “RATHER THAN THE DEFECT PER SE” AR 40-501-7-3 • Written by a profiling Officer • Directed to the SM’s Commander to provide guidance for duty restrictions

5. Profiling Officer • Appointed by Commanders of Army MTF’s • One or more physicians, dentists, optometrists, podiatrists, audiologist, nurse practitioners, physical therapists and physician assistants • No limitations for physicians

6. Profiling Officer • Dentists, optometrists, podiatrists, physical therapists, and occupational therapists have no limitations with “T-1” and “T-2” profiles but can not exceed 30 days on a T-3 profile • T-3 greater than 30 days must be cosigned by a physician • Further details referenced in AR 40-501-7-6

7. Profile FormsIndividual Sick SlipDD 689 • Initiated at the SM’s unit or at sick call • Designed for routine sick call injuries/illnesses • Intended to offer guidance for duty restrictions for up to 30 days

8. Sick Slip Notes“Keep an honest man honest” • Date, time, sign and stamp your sick slips • Provide a contact phone number (the CO will call to verify your information) • Fill out the SM identification fully (these forms have been modified and given to other SM’s) • Keep it simple (Gastroenteritis with electrolyte imbalance & dehydration is “stomach flu”) • “DD Form 689 is not used during maneuvers or in theater of war operations.”FM 10-426

9. Sick Slip Notes“Keep an honest man honest” • Understand that 24 hours ends at 0600 the next day (whatever time you write your sick slip) • Limit quarters to 48 hours • Protect the SM and the unit (think about communicable diseases) • Use traditional boiler plate terms, phrases and times: (Walk the walk and talk the talk)Ankle Sprain 1. No run, jump march x 72 hours 2. May wear non-regulation soft-soled shoes at SM’s option x 7 days

10. Sick Slip Notes“Keep an honest man honest” • Remind SM that the sick slip needs to be presented to the unit before SM goes toes up in quarters (AWOL) • Make a copy for the chart (good habit but not always practical) • Document in note “sick slip provided” vs. RTD • “No field duty” and “No overseas duty” are unacceptable medical recommendations • Commanders prefer DA 3349 when conditions require limitations lasting longer than a seven days

11. Long Form (old)DA 3349 • Changes driven by deployments related to the events of 9-11 • The “unwritten law” if a block in item 7 was left unmarked on a permanent profile an MEB/MMRB was indicated • Limitations: vague,conflicting, no statement of deployable status, wasted space (item 8), and aimed at limiting physical fitness training vs.. functional status

12. Long Form (revised)DA 3349 • Defines functional and fitness training limitations • Removes need for “P” and “T” letters inappropriately used • Clear statement of deploy ability • Questions the author for need of MMRB/MEB • Expiration date

13. Six FunctionsPULHES PPhysical capacity or stamina- describes general physical capacity, normally includes conditions of the cardiac, pulmonary, endocrine and nervous systems (Diseases such as asthma and diabetes) UUpper extremities- anatomy/pathology from the shoulders to the finger tips including the cervical, thoracic and upper lumbar spine LLower extremities- Concerns anatomy/pathology from lower lumbar spine down to the feet, legs, pelvic girdle

14. Six FunctionsPULHES HHearing and ears- anatomy/pathology of the ears and includes auditory acuity EEyes- concerns anatomy/pathology of the eye and visual acuity SPsychiatric- includes psychiatric disease and emotional states.

15. Four Numerical Designations1-2-3-4 1 SM is considered to possess a high level physical fitness and is medically fit for any military assignment 2 SM possess some medical condition/limitation which may impose limitations on assignment 3 SM possess one or more medical conditions which require assignment limitations which if permanent require an MMRB/MEB 4 SM possess a condition which significantly limits military assignments, if permanent requires an MMRB/MEB and does NOT indicate SM is unfit for duty

16. DA 3349 Codes(Item 2) • Alpha codes which further help in determining assignment limits or identify if an MMRB/MEB has been performed. • Table 7-2 in AR-40-501 • Helpful review when writing a permanent profile (aids in abbreviating limitations)

17. Writing the Profile “101” • Temporary profiles may only cover a 3 month period • Make the right decision at the right time! (Consider diagnosis, treatments, rehab time, SM’s MOS and trial of duty) • Permanent profiles MUST be typed • Cross out corrections on permanent profiles are a “No-go!”

18. Writing the Profile “101” • Have someone (not your mother) proof read your permanent profiles • Make cross checks/avoid conflicting recommendations (Run at own pace and distance and unlimited running???) • Permanent profiles require 3 signatures: - 2 Physician -1 Approving authority signature (Hospital Commander or DCCS types)

19. Writing the Profile “101” • Always consider the SM’s MOS when writing your restrictions • Permanent profiles limiting deployable status require an MMRB/MEB (may be a field/ equipment issue) • A SM who does the push-up/sit-up events but does an alternate aerobic event does NOT earn promotion points for the APFT (big deal for enlisted population) • A SM MUST be able to take a regular 3 event APFT after the profile expires • A SM may take an alternate APFT after termination of a temporary profile over 90 days at the discretion of the Commander with input from the profile officer (good for the post-op SM)

20. Writing the Profile “101” • Upon expiration of a profile, the SM is allowed twice the time of the profile to fitness train for the APFT (Not to exceed 90 days) • Write in lay terms and do not provide non-functional information in the profile =>Hypercholesterolemia • You may include a medical/surgical diagnosis after you write in lay terms what the medical condition is in item 1 (“KISS” or in this case “KISD” Keep it Simple Doc) • For APFT guidance refer to FM 21-20 (the training NCO’s Bible)

21. Temporary vs. Permanent Profiles • Temporary profiles are intended for conditions which only TEMPORARILY affect function • “In no case will individuals in military status carry a “T” modifier for more than 12 months without positive action being taken either to correct the defect or to affect other appropriate disposition.” • Be aware of your actions and the impact on the SM and the Army

22. The Problems • Too many Soldiers with profiles in deploying units affects our combat readiness on the unit status report (AR 220-1) • Unit Commanders often do not fully understand the Profile/MEB/MMRB system and do not challenge it • It is OUR mission as Medical Officers to support both our Field Commanders and the SM • As a whole, physicians seek to avoid performing MMRB/MEB’s • Physicians often hold a higher opinion of themselves and do not recognize the Combat Mission of the Army… (general commentary from a combat support brief discussing newly assigned Surgeons)

23. The Solutions • Utilize your PEBLO to help guide your MEB/MMRB actions • Insure the SM’s medical problems has been diagnosed and treated • Recognize who needs an MMRB/MEB and communicate this information to Unit Commanders • Understand our Soldiers needs and desires • Expedite the process by skipping the MMRB and recommending the MEB when the situation arises • Follow the regulatory guidelines of AR 40-501 • Be a combat multiplier

24. Medical Evaluation Board Overview • Medical evaluation after period of treatment • Permanent Profile generated which recommends MEB or MMRB • Profile and medical record reviewed by PEBLO • Unit and SM receive notice from PEBLO of medical board proceedings • SM receives a briefing detailing Phases I and IIPhase I = screening labs and exams (dental, vision, and hearing) Phase II = physician evaluation and dictated summary • Phase I and II serve as a combined report and sent to one of three PEB locations(WRAMC, BAMC, MAMC) • The PEB conducts an informal board resulting in a SM’s duty status(Separate with/without disability, Fit for duty, TDRL, retires SM) • SM receives a private brief from PEBLO and reviews PEB findings and accepts or disputes the findings • Disputes result in a formal board where the SM is present(SM may have an attorney present)

25. “The Fine Print” Courtesy of Doowee, Cheatum and Howe esquire(Not really…it just sounds good) • A medical board does not protect a SM from being separated under a less than honorable discharge (disciplinary actions take priority) • Based on the a SM’s MOS he or she may or may not be found fit for duty (Every case is different) • A medical board process may extend a SM’s ETS date

26. Summary • Make hard “RIGHT” decisions • Communicate with leaders • Learn about the Proifle/MEB/MMRB system and know your local resources • Use AR 40-501 as your guide • Remember your role as a force multiplier!