Understanding the Findings of the Integrated Disability Evaluation System

1. Understanding the Findings of the Integrated Disability Evaluation System WWR PEB Liaison Mr. Dean Trio

2. Prepare the Marine for his meeting with the PEBLO so he can easily absorb the information presented • Provide basic factual information about IDES and ensure the Marine understands the terminology • Educate the Marine on the implications of the various IDES dispositions as well as the VA and DoD ratings.

3. Enabling Learning Objectives • Identify the significance of the information presented to the Marine in the Findings of the Physical Evaluation Board Proceedings • Findings section (Finding, Disposition, Disability Rating) • Diagnoses and Rating (Categories, Ratings, Combat Codes) • Additional Findings • Identify the significance of the information presented to the Marine in the VA Decision Letter • Service-connectedness • Rating • Future routine exams • List of Evidence • Reason a higher rating was not proposed

4. Enabling Learning Objectives (2) • Identify the options presented to a Marine who is found unfit • Discuss the ramification of accepting unconditionally if the Marine is recommended for: • TDRL • PDRL • Separation with Benefits • Recognize the appropriate way to contest each type of determination: • Finding of Fit / Unfit for any condition • Rating assigned to any condition • Combat Code assigned to any condition

5. Prepare the Marine for what to expect when the PEBLO counsels him on his preliminary findings • Encourage the Marine to consult an IDES attorney before accepting the findings • Discuss PLD with the Marine before his findings are presented • Help the Marine understand the options available to him for contesting various findings by the VA and the PEB • Agree or disagree if a Marine expresses that he has been “screwed by the system”

6. Findings of the Physical Evaluation Board Proceedings Department of Defense

7. Boxes 8-10 reflect the proposed finding, disposition and rating When the PEBLO presents the proposed findings to the Marine, the PEBLO presents the Marine with the form pictured here. Marines should know what to look for when they review the form. Consultation with an IDES attorney is always encouraged. Each condition is categorized and rated separately; normally, if a condition is in Category I (Unfitting Conditions) the Disability Rating will be the same as the VA rating The additional determinations made by the PEB are included in Additional findings – these can affect a range of benefits Click image to see sample findings in full screen Findings of the Physical Evaluation Board

8. Findings Section Determines whether Marine will be returned to full duty If found unfit, the Marine will be separated if Combined Disability Rating < 30% If found unfit and Combined Disability Rating >= 30% Marine will be transferred to the TDRL if one of the unfitting conditions is not permanent Combined Disability Rating will determine the Recommended Disposition as well as the projected retirement benefits The Findings Section is based entirely on the sections which follow– Diagnoses and Ratings and Additional Findings

9. Diagnoses and Ratings Section • The PEB considers each condition separately • The PEB is not required to even consider any condition that was not referred, even if it was listed on the VA Claim Form by the Marine • The PEB does have the authority to consider additional conditions rated by the VA, but does not do so routinely • The Marine can NOT demand a Formal Board to have such conditions considered

10. Categorization of Findings • Each of the conditions referred to the PEB will be categorized individually: • Marines can DEMAND a formal board to contest a finding of Unfit (i.e., category I) • Marines can REQUEST a reconsideration or Formal Board (based on NEW evidence) to contest a finding of Fit (i.e., Category II, Category III or Category IV)

11. Additional Findings Paragraphs Finding must be yes to receive disability compensation Finding must be no to receive disability compensation Finding determines whether the Recommended Disposition for a Marine found Unfit will be TDRL or PDRL Each of these findings are normally found in paragraphs 11 and 12 of the “Additional Findings” area of Page 1 of the Findings of the Physical Evaluation Board Proceedings. However, while the PEB must make these determinations they are not required to publish them to the Marine.

12. Combat Codes • The PEB may also make a determination whether a condition is combat related. If they do so they will apply the appropriate combat code to each relevant condition and state this in Additional Findings: *The abbreviations listed are the most commonly used; however several alternative abbreviations may be seen (such as HD for Hazardous Duty) A Marine can not request a Formal Board to challenge the combat code (or lack thereof). Rather, the Marine appeals through OJAG (Code 13), either immediately or in veteran status Criteria for each combat code can be found in the instructions for DD Form 2860, Application for CRSC

13. VA Decision Letter

14. Conditions Rated Separately • Every referred and claimed condition should be addressed separately and specifically in the VA Decision Letter • The conditions will be presented in three groups: • Unfitting conditions related to military service • Claimed conditions related to military service • Claimed conditions not related to military service Both of these groups count towards the VA Disability Compensation aware. Although unfitting conditions are presented separately, the determination that a condition was unfitting is actually made by the PEB The final group is the conditions that were denied; these will not receive a rating and will not affect the VA Disability Compensation

15. Conditions Related to Military Service GROUP I: Unfitting Conditions We are proposing that the following unfitting conditions are related to your military service, i.e., service connected: Unfitting conditions are presented in a table introduced by this heading This is the rating for this condition Not every condition requires a future exam, however, when one will be required it will be noted here. The proposed combined rating for your unfitting conditions is 30%: The rating agency may determine that the condition claimed (in this case “Asthma”) should actually have been claimed as a similar or related condition, (in this case “Exercise Induced Asthma”). If so, this is how it will appear This future VA exam is distinct from any Periodic Physical Examination required by the DoD for Marines on TDRL. The VA exam will only affect the VA Rating DoD Rating This should correspond to the Combined Disability Rating on the Findings of the Physical Evaluation Board.

16. Conditions Related to Military Service GROUP II: Service-connected Claimed Conditions We are proposing that the following claimed conditions are related to your military service, i.e., service connected: This is the heading for Service Connected Claimed conditions (Group II) This is the rating for this condition When the VA does not indicate that a “routine future exam” will be scheduled, the onus is on the Marine to schedule an exam if the condition worsens There is NO additional language between Group II and Group III unless Special Monthly Compensations are awarded Obtaining a rating of 0% is a better result than having a diagnoses not acknowledged. The service-connectedness of this condition has been acknowledged by the Government. If the condition is aggravated, the Marine may become eligible for compensation in the future. Once the Marine leaves active duty establishing service connectedness is much more difficult.

17. Conditions Not Related to Military Service GROUP III: Not Service Connected We are proposing that the following claimed conditions are not related to your military service, i.e., are not service connected: The claimed conditions that were denied are presented under this heading At a minimum the Reason & Rationale will let you know if the condition was determined to not be a disability (as in the example) or whether it was found to be a disability that is not service connected We are proposing that the total combined rating for unfitting and claimed service-connected disabilities is 30% VA Rating This rating reflects the combination of disabilities identified in Group I and Group II Often, the Reason & Rationale is largely boilerplate that provides little in the way of explanation

18. We estimate that if the proposed ratings are adopted, you may be entitled after discharge from service to monthly VA compensation in the amount of $XXXX.CC based on the current statutory rates of disability compensation. This estimate is based on paying you as a single veteran with no dependents… After the Proposed Ratings and before the Evidence and Reasons there will be a section of possible benefits. The first paragraph is individualized and puts in dollar figures the VA compensation that is being proposed. Although presented as an estimate this merely protects the Government in case of a clerical error. Potential Entitlements In this section the Marine will find the actual dollars of VA compensation being proposed. This figure is based on the VA Rating found earlier, any special monthly compensations found earlier, the Marines family structure and the current pay table. Everything that follows this paragraph is usually boilerplate – i.e., the pages on Home Loan Guaranty, Voc Rehab, Medical Care, Clothing Allowance, etc. are provided to all Marines with no effort made to determine if they are eligible.

19. EVIDENCE • VA examination (General Medical), Gainesville, FL VAMC, dated May 3, 2013 • VA examination (Initial PTSD), Gainesville, FL VAMC, dated May 8, 2013 • VA Form 21-0819, VA/DOD Joint Disability Evaluation Board Claim received February 17, 2013 • VCAA Pre-Discharge Notice Response dated February 17, 2013 • Physical Evaluation Board Proceedings dated July 2, 2013 • Joint DOD/VA Disability Evaluation Pilot Referral dated February 10, 2013 • Medical Evaluation Board Proceedings dated June 14, 2013 • Commanders Performance and Functional Statement (Nonmedical Assessment) dated June 5, 2013 • Service treatment records from March 15, 2001 through February 17, 2013 Evidence The evidence relied upon to make the rating decision is listed here Check the list to make sure exams or other records that were submitted to the PEBLO are all accounted for

20. REASONS FOR DECISION 1. Evaluation of exercise induced asthma (also diagnosed and claimed as asthma) for Disability Evaluation System purposes and proposed entitlement to service connection for Department of Veterans Affairs (VA) benefits. Service connection for exercise induced asthma (also diagnosed and claimed as asthma) is proposed as directly related to military service. We have proposed a 30 percent evaluation for your asthma, bronchial based on: • Daily oral bronchodilator therapy • Inhalational anti-inflammatory medication A higher evaluation of 60 percent is not warranted unless there is: • Forced Expiratory Volume in One Second (FEV-1) of 40 to 55 percent predicted; or, • FEB-1 to Forced Vital Capacity (FEB-1/FVC) of 40 to 55 percent; or • At least monthly visits to a physician for required care of exacerbations; or, • Intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids How the VA Decides Each condition that was found to be service connected will be listed in a section titled “Reasons for Decision” Zero in on whatever comes after the word unless. The key to a ratings reconsideration is providing new evidence that directly addresses this standard

21. Marines Found Unfit The Options Presented to a Marine who is found unfit by the PEB

22. The Marine’s Three Options Implications vary based on Recommended Disposition. See following slides. Click to See Election of Options Form Usually used to request PLD If the 10 days expire, the PEB will begin to implement the Recommended Disposition as a Presumed Unconditional Acceptance. In this case, the Marine can still demand a Formal Board (until discharged). However, he can no longer accept conditionally or request PLD Marines should be prepared when they meet with the PEBLO. They should understand their right to counsel and have already considered PLD

23. Options when Recommended for TDRL All Marines should be encouraged to consult with an IDES attorney before accepting their findings

24. Options when Recommended for PDRL All Marines should be encouraged to consult with an IDES attorney before accepting their findings

25. Options: Severance with Benefits All Marines should be encouraged to consult with an IDES attorney before accepting their findings Although the Marine is not eligible for TRICARE permanently he can receive 180 days of medical coverage through TAMP

26. Contesting the Findings A Marine who accepts his findings unconditionally waives the right to request PLD Marines should always meet with an IDES attorney to discuss their options

27. Multiple Conditions Scenario: Sgt Williams was referred to the PEB for two conditions, and the Findings of the Physical Evaluation Board Proceedings (Informal) are presented below: Note: In the additional findings section the PEB states the disabilities are not combat related

28. IDES Findings • When a Marine is counseled by the PEBLO it feels like an overwhelming amount of information and he accepts the findings without understanding them • A Marine is upset by his low ratings and can not discuss his options rationally • A Marine is confused about the difference between unfitting and service-connected disabilities and doesn’t understand why he is not being medically retired

29. Resources Basic Resources Advanced Resources IDES Consultation Class Formerly known as “DTAP” PLD is covered Wounded Warrior Regiment PEB Liaison Dean Trio 703-432-1856 RCC IDES Handbook Companion to MegaLink sheets http://www.rcckit.com/policy IDES Attorneys POC varies by location WWR External Fact Sheet https://ehqmc.usmc.mil/sites/wwr/wrc/External%20Fact%20Slick%20Sheets/Integrated%20Disability%20Evauation%20System%20slick%20sheet.pdf

30. Cpl Diaz was presented his findings by the PEBLO and is unsure of whether he should accept the findings or not. Who is the best person to help him understand the findings and his options? His commanding officer An OIF/OEF Coordinator An IDES attorney A Federal Recovery Coordinator

31. Can a Marine request the VA reconsider the rating given to a condition that is service-connected but found to be not-unfitting while he is still on active duty? No, the decision is final Only if he first requests a reconsideration by the DoD and / or a Formal Board and the PEB changes its determination and the condition is now considered unfitting No, although he can ask the VA to reconsider the rating after discharge Yes

32. LCplAlvorado was transferred to the PDRL as the result of one unfitting condition which the PEB determined was the result of an Instrument of War (Combat Code: IW). Which of the following are true? She is eligible to apply for EPLD She is eligible for CRSC Any Military Retired Pay that is not offset by VA Disability Compensation will be tax exempt She is eligible for a Purple Heart A and B only A and C only B and C only B, C, and D only All of the above

33. GySgt Kleck was referred to the IDES for both PTSD and Tinnitus. In which of the following circumstances can he DEMAND a Formal Board? Both conditions are found to be unfitting and he wants to be found Fit for Duty The PTSD is found unfitting, the tinnitus is found to be not-unfitting and he wants the PTSD decision reversed so he can be found Fit for Duty The PTSD is found unfitting, the tinnitus is found to be not-unfitting and he wants to provide new medical evidence so the tinnitus will be found unfitting and his DoD rating will increase Both conditions are found to be not-unfitting and he does not want to be returned to duty A only A and B only A and D only C and D only All of the above

34. SSgt Buckhantz lives in a remote and isolated location. His PEBLO faxes his findings to him on 1 July 2013 and schedules a telephone consultation on 5 July 2013. After the counseling the Marine is unsure of what he wants to do. How long does he have to make a decision? 10 calendar days from 1 July, the day he received the findings 10 calendar days from 5 July, the day he received his counseling 10 business days (i.e., two weeks) from 1 July the day he received his findings 10 business days (i.e., two weeks) from 5 July, the day he received his counseling

35. PFC Clumber was referred to the IDES for only one condition – an anxiety disorder. He had no other claimed conditions. He was found unfit and the PEB determined that his disability “may be permanent.” Accordingly he will be transferred to the TDRL. He agrees with the rating, but does not think he needs to be reevaluated. How can he contest the finding that the condition “may be permanent.” By requesting a Formal Board By demanding a Formal Board By requesting a VA Rating Reconsideration By appealing to OJAG (Code 13) A only B and D only A and C only None of the above All of the above

36. The ratings for the conditions in which of the following Categories on the Findings of the Physical Evaluation Board are used to calculate the Combined Disability Rating for the DoD? Category I: Unfitting Conditions Category II: Conditions that are contributing to the unfitting conditions Category III: Conditions that are not separately unfitting and do not contribute to the unfitting conditions Category IV: Conditions which do not constitute a physical disability A only A and B only A, B, and C only A, B, and D only D only

37. Which of the following combat codes precludes the VA from withholding a portion of a Marine’s VA Disability Compensation to recoup a Military Severance payment? Armed Conflict (AC) Hazardous Service (HS) Instrument of War (IW) Simulation of War (SW) A only B only C only D only All of the above

38. Sgt Martell’s VA Decision Letter states that he will be scheduled for a “routine future exam” to reconsider his Left Shoulder Dislocation. The PEB categorized this injury as an unfitting condition, but found that the disability was permanent and recommended transfer to the PDRL. Sgt Martell accepts the findings. When he attends the “routine future exam” at the VA which of the following are possible outcomes? His DoD Rating will go up His DoD Rating will go down His VA Rating will go up His VA Rating will go down A only A and B only A and C only B and D only C and D only

39. Questions