ACCESS TO CARE
Medical Evaluation Board Training Guide
Title 10, U.S.C., chapter 61, provides the Secretaries of the Military Departments with authority to retire or separate members when the Secretary finds that they are unfit to perform their military duties because of physical disability.
The functional proponent for the Physical Disability Evaluation System (PDES) is the U.S. Army Physical Disability Agency (USAPDA), located at Walter Reed Army Medical Center, 6900 Georgia Ave, NW, Washington, D.C. 20307-5001. Subordinate Physical Evaluation Boards (PEBs) are located at USAPDA; Fort Sam Houston, Texas; and Fort Lewis, Washington.
Your primary care doctor recommends possible medical board evaluation. The soldier is referred to and evaluated by the Medical Board Physician who initiates a permanent profile as necessary. After the profile is issued, the Soldier reports to Patient Affairs, Medical Board Section where a briefing and appointments for Phase I and Phase II of a physical exam are scheduled. A medical board packet is prepared by the Soldier's command and submitted to the Medical Board Section within seven days. The Soldier's packet is forwarded to the Physical Evaluation Board for a final decision. Once results are received, the Soldier is counseled on his/her electrive options. The Medical Boards Section and the Integrated Disability Evaluation System (IDES) is temporarily located on the 3rd floor at the south end of the hospital.
For assistance call:
IDES Reception Desk: 558-3352
PEBLO Team Supervisor: 558-3278
PEBLO Team Supervisor: 558-3425
PEBLO Clinic Supervisor: 558-2757
Soldiers are referred into the PDES by five ways:
- Medical Evaluation Board (MEB)
The medical treatment facility (MTF such as Reynolds Army Community Hospital) initiates a MEB under the provisions of AR 40-400, chapter 7, when a soldier has received maximum benefit of medical care for a condition which may render the soldier unfit for further military service. (Per DoDI 1332.38, soldiers shall be referred for evaluation within one year of the diagnosis of their medical condition if they are unable to return to military duty.) The MEB documents whether the soldier meets the medical retention standards of AR 40-501, chapter 3. If the soldier does not meet medical retention standards, the MTF refers the case to the applicable Physical Evaluation Board (PEB) for a determination of fitness under the policies and procedures of DoD Instruction 1332.38 and AR 635-40.
- MOS/Medical Retention Board (MMRB)
The MMRB is an administrative screening board conducted under the provisions of AR 600-60 that determines whether soldiers with permanent 3 or 4 physical profiles can physically perform their primary military occupational specialty (branch/specialty code for officers) in a worldwide, field environment. Referral to a Medical Evaluation Board/Physical Evaluation Board is one of four actions the MMRB Convening Authority (MMRBCA) may direct. When the MMRBCA directs referral to a MEB/PEB, conduct of the PEB is normally mandatory without regard to the findings of the MEB. The MEB may only return the soldier to duty when it determines the soldier meets medical retention standards and upgrades the profile to a permanent 2 or 1.
- Fitness for Duty Medical Examination
Commanders may refer soldiers under their command to the MTF for a medical examination under the provisions of AR 600-20, para 5-4, when they believe the soldier is unable to perform MOS or specialty code duties due to a medical condition. This examination may cause conduct of a Medical Evaluation Board, which normally will be forwarded to the Physical Evaluation Board when it finds that the soldier's medical condition falls below medical retention standards.
- HQDA action
The Commander, upon recommendation of The Surgeon General, may refer a soldier to the responsible Military Treatment Facility (Reynolds Army Community Hospital) for medical evaluation as described in #3 above. The Commander, PERSCOM, may direct referral into the Physical Disability Evaluation System when it disapproves an MMRB recommendation to reclassify a soldier (or branch transfer an officer).
- RC Non-duty Related Process
DoD Directive 1332.18, as implemented by DoDI 1332.38, affords RC members pending separation for medical disqualification (separation for failure to meet medical retention standards) the right to be referred to a PEB for solely a fitness determination. Referral is not mandatory but at the request of the soldier. These cases pertain to RC Active Status soldiers not on extended active duty whose disqualifying medical impairments were incurred outside of military service and involve no issue of aggravation while in a duty status. Referral to the PEB allows these soldiers to have fitness determined under the standards applied to Active Army soldiers and RC soldiers with service-incurred conditions (see below). The USAR Regional Support Command or the ARNG State Headquarters refers the case to the PEB—not the MTF. The MTF may conduct a physical on the soldier at the request of the RC, but does not conduct a MEB.
The individual responsible for counseling soldiers referred into the PDES with a MEB is the Military Treatment Facility (Darnall Medical Center) Physical Evaluation Board Liaison Officer (PEBLO). The PEBLO counsels the soldier on MEB/PEB findings and related rights and benefits. If the MTF determines that the soldier is not mentally competent, the PEBLO counsels the designated next-of-kin.
For USAR non-duty related cases, the soldier's commander or the commander's designee is the responsible individual.
For ARNG non-duty related cases, the State Military Personnel Office, Health Service Specialist, is the responsible individual.
The standard for determining fitness is whether the medical condition precludes the soldier from reasonably performing the duties of his or her office, grade, rank, or rating.
- Worldwide deployability: Per DOD Instruction 1332.38, inability to perform the duties of office, grade, rank or rating in every geographic location and under every conceivable circumstance will not be the sole basis for a finding of unfitness. Deployability, however, may be used as a consideration in determining fitness.
- Performance-based: The PDES relies heavily on the performance data provided by the soldier's immediate commander. Variance in case findings is often the result of inadequate information being provided relative to the soldier's duty performance.
Presumption of Fitness
When a soldier is referred for physical disability evaluation after having applied for length of service retirement, or an officer is within twelve months of mandatory retirement, or an enlisted soldier is within 12 months of his or her retention control point with retirement eligibility, the soldier enters the disability system under the presumption that he or she is physically fit. This is known as the Presumption of Fitness Rule. (This rule is not applied to RC cases referred under the non-duty related process described at paragraph 2c(5) above.)
- Philosophy: The soldier is presumed fit because he or she has continued to perform military duty up to the point of retirement for reasons other than physical disability. Disability retired pay is to compensate a soldier whose career is terminated solely for reasons of disability.
- History: The presumption rule originated as DoD policy in 1973 as a result of Congressional dissatisfaction with general ranked officers and medical officers retiring for physical disability when they were eligible for length of service retirement.
Overcoming the presumption
Application of the Presumption of Fitness Rule does not mandate a finding of fit. It is a rebuttal presumption that is overcome if the preponderance of evidence establishes the circumstances described below per DOD Instruction 1332.38.
- Acute, grave illness or injury: Within the presumptive period an acute, grave illness or injury occurs that would prevent the member from performing further duty if he or she were not retiring; or
- Deterioration of a chronic condition: Within the presumptive period a serious deterioration of a previously diagnosed condition, to include a chronic condition, occurs and the deterioration would preclude further duty if the member were not retiring; or
- Inadequate duty performance: The condition for which the member is referred is a chronic condition, and a preponderance of evidence establishes that the member was not performing duties befitting his or her experience in the office, grade, rank, or rating before entering the presumptive period.
Once a determination of physical unfitness is made, the PEB is required by law to rate the disability using the Veterans Schedule for Rating Disabilities (VASRD). DoD Instruction 1332.39 and AR 635-40, Appendix B, modify VASRD provisions inapplicable to the military and clarify rating guidance for specific conditions. Ratings can range from 0 to 100 percent rising in increments of 10.
Four factors determine whether disposition is fit for duty, separation, permanent retirement, or temporary retirement: Whether the soldier can perform in his MOS; the rating percentage; the stability of the disabling condition; and years of Active Service in the case of pre-existing conditions.
- Coverage for pre-existing disabilities: With the passage of the NDAA for FY 2000, members with unfitting disabilities determined to be hereditary or congenital or otherwise unfitting due to the natural progression of a pre-existing condition are entitled to disability retired or severance pay when the member is on a call to active duty of more than 30 days and has 8 years of Active Service at the time of disability separation or retirement.
- Permanent retirement: Permanent disability retirement occurs if the soldier is found unfit, the disability is determined permanent and stable and rated at a minimum of 30%, or the soldier has 20 years of active federal service.
- Temporary retirement: Temporary disability retirement occurs if the soldier is found unfit and entitled to permanent disability retirement except that the disability is not stable for rating purposes. "Stable for rating purposes" refers to whether the condition will change within the next five years so as to warrant a different disability rating. However, stability does not include latent impairment--what might happen in the future.
- Separation with severance pay: Separation with disability severance pay occurs if the soldier is found unfit, has less than 20 years of active federal service, and has a disability rating of less than 30%.
- Separation without benefits: Separation without benefits occurs if the unfitting disability existed prior to service, was not permanently aggravated by military service, and the member has less than 8 years of Active Service; or the disability was incurred while the soldier was AWOL or while engaging in an act of misconduct or willful negligence.
- Fit for Duty: The soldier is judged to be fit when he can reasonably perform the duties of his grade and MOS.
Periodic Medical Reexamination and Tenure
When placed on the Temporary Disability Retirement List (TDRL), the law requires the member to undergo a periodic medical reexamination within 18 months followed by PEB evaluation. The soldier may be retained on the TDRL or final determination may be made. While the law provides for a maximum tenure of 5 years on the TDRL, there is no entitlement to be retained for the entire period.
Factors affecting compensation
Military disability compensation is based on disposition, rank, and years of service.
- Retired pay: For permanent retirement or placement on the TDRL, compensation is based on the higher of two computations:
Soldiers on the TDRL receive no less than 50% of their retired pay base. The definition of retired pay base depends upon when the soldier entered the service. For those who entered prior to 8 September 1980, it is the highest basic pay received. For those who entered after 7 September 1980, it is the average of the highest individual of 36 months of basic pay.
- Disability rating times retired pay base; or,
- 2.5 x years of service x retired pay base.
- Severance pay: Disability severance pay equals 2 months basic pay for every year of service not to exceed 12 years.
- Promotion selection: Soldiers who are to be retired for disability who are on a promotion list will be retired at the higher grade. However, for those soldiers who entered the military after 7 September 1980, the definition of retired pay base results in no impact on retired pay. Soldiers being separated for disability who are on a promotion list will receive increased severance pay, since it is based on the basic pay of the soldier's grade.
Adjudication is normally by a three-member board composed of a mixture of military and civilian personnel. The President is normally a colonel, but may be a GS-13 Civilian Adjudication Officer. The Personnel Management Officer (PMO) may be a field grade officer or a GS-13 Civilian Adjudication Officer. The physician may be civilian or military. When military members are used as the President or PMO, they may be of any branch except the Special Branches. When an RC appears before the board, one member must be of the Reserve Components.
The initial findings and recommendations are based on a records review without the soldier's presence.
Soldiers who disagree with the informal findings and who are found unfit are entitled by law to a formal hearing. Soldiers who are determined fit may request the PEB President to grant them a formal hearing. Soldiers may elect to appear or not appear and to be represented by appointed counsel or by counsel of choice at no expense to the government. Soldiers may request essential witnesses to testify on their behalf. The PEB President determines whether witnesses are essential.
Appellate and Quality Review
USAPDA reviews those cases in which the soldier disagrees with the findings of the PEB and submits a rebuttal. Additionally, USAPDA designates certain cases for mandatory review and conducts a sample review of others. If USAPDA changes the findings of the PEB and the soldier nonconcurs and submits a rebuttal, the case is forwarded to the Army Physical Disability Appeal Board (APDAB) for final decision.
Differences between PDES and DVA
While both the Army and the Department of Veterans Affairs (DVA) use the VASRD, not all the general policy provisions set forth in the VASRD apply to the Army. Consequently, disability ratings may vary between the two agencies. The Army rates only conditions determined to be physically unfitting, compensating for loss of a career. The DVA may rate any service-connected impairment, thus compensating for loss of civilian employability. Another difference is the term of the rating. The Army's ratings are permanent upon final disposition. DVA ratings may fluctuate with time, depending upon the progress of the condition. Further, the Army's disability compensation is affected by years of service and basic pay; while VA compensation is a flat amount based upon the percentage rating received.