Secretary of the NavyPhysical Evaluation Board (PEB)

COMMAND OUTREACH BRIEF by

Mr. Robert PowersPresident, Physical Evaluation Board (PEB)

Secretary of the Navy,

Council of Review Boards

May 2014

Twin Goals of the Disability Evaluation System (DES) are to: - “Maintain a Fit Fighting Force” capable of fighting

battles and winning wars; and

- “Compensate Service Members” where their disability caused the termination of their military service.

DES Purpose

Separate:PDRLTDRLw/ or w/out severance

MEB

PEB & VA Rating Service HeadquartersMEB & VA C&P Exam

Member with questionable fitness for continued service

PEB Informal Board (15 days)

Formal Board (30 days) VA Rating Reconsideration (15 days)

OR

Return to Duty

Admin and Record transfer (15 days)

VA Proposed Rating (15 days)

Appeal (30 days)

100 days

Separate/VA benefits

BCNR and/or VA Appeal

Case transfer to PEB

MTF/MEB VA/C&P Exam

Member Can Accept or Appeal

120 days 75 days

Independent Med Review

Notice & Comment

IDES Process

Case transfer to SV HQ

P re s id e ntP h y s ica l E v alu a tio n B o a rd

(P E B )M r. R o b e rt P o w e rs

D ire c torS E C N A V C o u n c il o f R ev ie w B o a rds

M r. Je ff R ie hl

A ss is ta n t S E C N A V(M & R A )

H o n . Ju a n M . G a rc ia III

Organizational Structure

Adjudicate Marines’ & Sailors’ fitness for continued naval service in a fair and timely manner. - “Fair” in accordance with Statute and DoD & VA

Regulations.

- “Timely” by delivery of a decision in less than 120 days in accordance with Integrated Disability Evaluation System (IDES) policy timelines.

DoN PEB’s Mission

Member

Injury/condition

MEB

PEB

- 32 Locations

- 1 Location (Washington DC)- 7,513 Cases Received: 5,701 (Active Component) 299 (Reserve Component) 1,406 (TDRL Active Component) 107 (Reserve Component)- 1,007 Requested FPEB

- 9% Fit for Duty- 31% Separated- 36% TDRL- 23% PDRL- 1% Other

DOD IDES Phases

Service HQ

PART II. Leadership and Advocacy

Decisional Points/Seams w/in IDES

MTF

Appellate

FPEB

IPEB COMMAND

1) Diagnosis/Condition a) Diagnosis by itself does not make a Marine or Sailor unfit!

i. MOS specific duties and VASRD are the applicable rules; match the facts to the MOS duties to show fitness/unfitness & to VASRD for correct rating.

ii. Ensure Medical Evaluation Board Report (MEBR) is comprehensive Obtain a complete & well written MEBR & Medical Addendums Match to specific MOS duty elements and to VASRD.

2) Non-Medical Assessment (NMA)a) Show how condition impacts Marine/Sailor’s ability to function within

their rank & MOS/rating (assigned occupation). i. Commanding Officer/ unit commander assessmentsii. Witness statements

3) Statement of Member’s Wishes a) Obtain a Statement of Marine/Sailor’s true desire.b) Describe medical condition’s impact on their ability to perform

MOS/rating.

Three Decisional “Elements” to Every Case

PEBs v. Chg in End strength1991 – 2013 (TDRL not included)

Local Issues/Concerns

Obtain Commander’s unbiased assessment via NMA and reduce waiting time for Command’s NMA submission;

Ensure timely issuance, delivery, and transfer of DD-214 to the VA.

Reduce MTF’s diagnostic burden by narrowing MEBR to explaining condition(s) impact on MOS; and

Prioritize Medical Exams/Addendums for PEB cases.

PART III. PEB Performance & Metrics

Performance in PEB Phase

Performance w/ PEB-VA Team

Monitoring inventory

DON Performance for all Phases

Below 295 Days!

USMC & USN Determinations FY13

FIT SEP w/ Severance SEP w/o Benefits TDRL PDRL0%

5%

10%

15%

20%

25%

30%

35%

40%

14%

26%

1%

23%

36%

5%

35%

1%

23%

36%

USN

USMC

PEB Total Case Timeliness (Last 6 months)

DoN Breakdown for FY13:

Combat Related (AC)119 (5%)

870 (27%) 989 (17%)

Combat Related (AC)933 56 989

New TDRL Periodic Navy 2478 515Marine 3191 783

Total 5669 + 1298 = 6967

New TDRL Periodic Active 5425 1204Reserve 244 94

Total 5669 + 1298 = 6967

Top three most common conditions (broad categories):#1: Musculoskeletal (e.g., Degenerative Disc Disease) #2: Mental (e.g., PTSD, Bipolar Disorder)#3: Neuropsychological (e.g., TBI)

General Issues/Concerns

Approval & Assignment for increased Permanent Structure request to sustain IDES performance.

Monitoring/matching overall goals and expectations expressed by Senior Leadership through DoD Recovering Warrior Task Force.

Monitoring/meeting prospective impact on PEB case-load: End Strength Drawdown Improve case monitoring of the Limited Duty Program Improve case monitoring of the TDRL Program

Obtaining an IDES enterprise Case Management System that encompasses: 1) e-file transfer; 2) case tracking; 3) document amendment/version control; and 4) provides permanent storage.

Physical Evaluation Boards:Goals and Guidance

Twin Goals:

Maintain a “Fit” Fighting Force

Ensure Service Members that are found unfit are compensated

PEB President’s guidance (For each referred condition)

Can they do their job? (Non-Medical Assessment)

How medical condition affects Service Member’s ability to perform in MOS/Rate

Service Member’s desire

Our Approach:

Performance based

Service Member focused

Bottom Line: Do what is right, by law, institution, and Service Member

Physical Evaluation Boards:Goals and Guidance

Physical Evaluation Boards:Process and Appeals

Integrated Disability Evaluation System (IDES) Process:

Physician triggered at Medical Treatment Facility (MTF)

Medical Evaluation Board Report (MEBR) of referred conditions

VA Comprehensive Compensation and Pension Exam (C&P)

Referred and Claimed conditions

MEBR completed by MTF

PEB determination of “FIT” vs. “UNFIT”

Referred conditions, also assess claimed conditions

If FIT- return to duty, UNFIT - to VA for rating

UNFIT SM’s medically separated or retired

Physical Evaluation Boards:Process and Appeals

Appeals

IDES Appeal: Formal motion for reconsideration / Formal Hearing

One time VA reconsideration for rating

Physical Evaluation Boards:VA Rating

VA rating for UNFIT Service Members

All conditions are rated

Referred Conditions (DoN funded compensation)

30% or higher for referred conditions = Temporary Disability Retired List (TDRL) or Permanent Disability Retired List (PDRL)

Less than 30% = Separation with severance pay

VA covers all service connected claimed conditions

Physical Evaluation Boards

Each Board (Informal or Formal) consists of 3 Officers

Presiding Officer: USMC Colonel or USN Captain

Second Line Officer: USMC Col/LtCol or USN CAPT/CDR

Medical Officer: USN Captain or Commander

Line Officers: Have wide military experience, proven performance, and education

Medical Officers: Have wide cross section of clinical experience

“Strongly preferred” that the Presiding Officer be of the same service as the Service Member

Reservist (members): Each board of the PEB shall include at least one member who is a Navy or Marine Corps Reservist

Adjudicative Officer Tasks

Determine Fit or Unfit

Diagnosis or disability

Determine if Combat Related

Armed Conflict

Extra Hazardous Service: Flight duty, parachute duty

Conditions Simulating War: Obstacle course, endurance/reaction course, live fire training, MCMAP

Instrumentality of War: Injury caused by military weapon, accidents involving ship/combat vehicle, military ordnance

Combat Zone: Designated Hostile Fire/Imminent Danger Pay Area

Non-Medical Assessment (NMA) Crucial document summarizing SM’s limitations & assessment of the

Service Member’s performance of duty from the perspective of the Commanding Officer or Officer in Charge.

Emphasis on performance. Highlight the Service Member’s ability/inability to execute duties as required of MOS/Rate/paygrade

Describe how the Service Member’s impairments impact his/her ability to function within the command:

Specifically state what the Service Member can and cannot do: (PFT/PRT, CFT, Swim, MCMAP, Deploy, etc.)

Indicate how the Service Member was injured and include details for combat related and combat zone. (Incident/Aggravation)

Does the SM desire to continue his/her service?

CO’s/OIC’s comments should not be written like a FITREP/Eval

NMA Lessons Learned NMA – CO/OIC needs to sign (“acting” acceptable)

Clarify abilities and potential in MOS/Rate

If not working in MOS/Rate, be clear about whether Service Member could or could not do his/her job if working in his/her MOS/Rate

Ensure Service Member’s intent! Is this what he/she truly wants?

Interview and personal statement from Service Member

Ensure assessment covers all referred conditions

Provide specifics for combat related and combat zone conditions per SECNAVINST 1850.4E (Who, What, Where, When, How)

NMA is a key document in making fitness for duty determinations - need to make them count

Take-Aways

Sound mind, sound body, poor performance/Not MEB

MEB is Physician triggered/not Service Member or command

PEB makes decisions based on information at hand

Case decided on Service Member’s current condition, not future

Know your Marines and Sailors/Occupational fields

Interview and personal statement from Service Member

Each case on its own merit

Command Responsibility – Remove the stigma

Commanding Officer’s perspective is crucial

Medical Evaluation Board vs Physical Evaluation Board

Medical Evaluation Board (MEB):

Initiated at Military Treatment Facility (MTF) by two medical officers

Determination of limited duty

Potentially the need for submission to PEB for determination of FITNESS

Physical Evaluation Board (PEB):

MEB Report (MEBR) initiated at MTF, referred to PEB for determination of FITNESS

One medical officer and two line officers review informal level

Medical Evaluation Board vs Physical Evaluation Board

Service Member appear at “Formal” with counsel when outcome of informal ruling is disputed or PEB mandates hearing

Higher appeals process includes a Petition for Relief (PFR) and Board for Correction of Naval Records (BCNR)

When Physician(s) initiates PEB: Diagnosis is a potential disability:

Medical doctor’s expert medical opinion the Service Member has a condition that will impede ability to perform in MOS/Rate

or has a condition that imposes an extraordinary burden on service to protect the Service Member (e.g. use of Humira) (or condition not compatible with continued service, e.g. psychosis)

Prolonged illness or course: Condition will require two or more six-month periods of limited duty before the Service Member can return to full duty including world wide assignment and deployment

Service HQ directed: Board directed based on serial periods of limited duty and or inability to assign Service Member worldwide

Do not initiate PEB when: Service Member requests PEB

Mere presence of a diagnosis does not equate to a disability

Member fails PRT

Previous and current PRT instructions do not mandate a PEB for PRT/BCA/PFT/CFT failures

Member is pending elective surgery on referred condition

If surgery may alter decision or rating – Does not apply to urgent and required procedures (although elective surgery may not be allowed during IDES process)

Potential Outcomes of PEB FIT: Service Member reasonably can perform duties of

MOS/Rate

UNFIT: Service Member cannot perform duties of MOS/Rate

Presumed FIT (PFIT): In “presumptive period” and have a functional impairment that is minor and would not cause career termination – Generally overcome by grave illness or not in MOS/Rate prior to being PFIT

Conditions not considered a Disability: (e.g. ADHD, alcoholism)

Category II: Contributes to Service Member’s unfitting condition but independently unfitting

EPTS: Less than 8 years of service, genetic condition (origins that began prior to service and within natural progression - was not service aggravated)

What determines outcome? Medical evidence:

Cannot perform in MOS/Rate, not compatible with service, imposes extraordinary burden on service to protect Service Member

Non-Medical Evidence:

Ability and or Inability to perform in MOS/Rate, PFT/CFT, deploy, or WWA

Member’s wishes:

FIT or UNFIT, possible PLD

Essential Components of Medical Evaluation Board Report (MEBR)

Why was the Service Member referred?

Clear and differentiated from claimed conditions and requires input from referring provider whose expertise led to the original referral

Service Member’s compensation from the PEB is determined by career ending condition

How the Service Member’s condition might impact ability to do MOS/Rate? Specific impairment of duties, or need for medication and or frequent medical supervision placing a burden on service, or condition not compatible with continued service

Non-Medical Assessment (NMA)Importance to Medical Officer

PFT/CFT: If not performed, why specifically?

Why is Service Member not in MOS/Rate? Please be specific, e.g. Service Member being referred for PTSD and NMA states not in MOS/Rate only due to “physical reasons” or “medical reasons”

Diagnosis does not mean disability: Key to know details of how diagnosis impairs ability to function in MOS/Rate, not just “at medical all the time”

Know what diagnoses are being referred: Not uncommon for us to see NMA only discussing one issue when multiple diagnoses are referred into the IDES

Physical Evaluation Board Liaison Officers (PEBLO)

PEBLO – Local interface between Service Member/Command and IDES Process Military Treatment Facility PEBLOs work the

Medical Evaluation Board process PEB PEBLOs work the Physical Evaluation Board

process Coordinates correspondence between Service Member

and PEB Conducts Integrated Disability Evaluation System

Consultation Course and counseling

Typical Delay Points Package Paperwork

Ensure Service Member is getting to appointments and NMA is complete, accurate and timely

Service Member Election of Options Limited Duty Coordinator must be plugged in with

PEBLO

Formal Boards Commands need to be engaged with travel process for the

Service Member

Separation Commands must ensure Service Member completes all

mandatory separation steps

Questions?