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Disclosure: (Military personel and DoD civilian Employees Only) Voluntary. If not provided Today's Date (dd/mm/yyyy). ULUI DD FORM , This statement serves to inform you of the purpose for collecting the personal information required by the DD Form , Pre-Deployment. Would you say your health in general is: O Excellent O Very Good O Good O Fair O Poor. 2. Do you have any medical or dental problems? O Yes. 3. Are you.
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The issue of how long the service can take before responding to certain requests should be judged under a reasonableness standard. Where members have given the military the opportunity to grant the relief requested or to rectify any unwarranted denial of a request for relief, and have submitted appeals to the secretary of the service, administrative remedies have been exhausted for purposes of federal court intervention.
The military should not be able to avoid the consequences of unreasonable delays by transferring members to a war zone and away from the assistance of their attorneys. When in-service remedies have been exhausted, attorneys may go into federal district court to challenge any denial deemed arbitrary and capricious or without basis in fact.
GIs may prevail on a writ of habeas corpus or writ of mandamus in such a forum if they have provided a prima facie case warranting medical discharge or retirement, and the military has failed to disprove the existence of the medical condition identified in the prima facie case.
Previously, the VA performed its own medical evaluations after veterans were discharged and then assigned a VA disability rating and processed the VA disability benefits.
The integration of the military and veterans disability evaluation systems was meant to streamline the medical evaluation process and reduce the amount of time between discharge from the service and commencement of VA benefits. There are many factors affecting the length of time needed to get through the entire IDES process including, but not limited to, lack of adequate staffing, training of personnel on the new system, the number of medical conditions of the servicemember, and an increase in the number of servicemembers in the system.
Servicemembers should expect the process to take nearly one year and possibly longer. It should be noted that military disability ratings and VA ratings may differ because there are some conditions the VA considers and rates as disabilities that the military does not consider unfitting. These differences are described in DoD Instruction One example is the physical appearance of scarring or other disfigurement that does not interfere with functioning.
Be aware that these regulations may or may not already be updated for changes resulting from the implementation of IDES through DTM There are variations between services, so it is important to work with individual service regulations as well as the DoD Instructions and Directive. In addition, there is a significant body of case law on the disability system and the rights of those considered for medical discharge or retirement; unfortunately, almost all of the cases, like the regulations, deal with individuals who have already entered the system through a medical evaluation board.
Process Overview and Target Timeline Click image for larger version This graphic was created by IDES program administrators and includes the target number of days for each step in the process.
The dark hexagons identify points in the process where servicemembers may rebut or appeal decisions. Qualified medical examiners: are medical professionals who have been trained on IDES and how to report the medical information needed to make fitness for duty evaluations and disability ratings using standardized forms. They perform the medical examinations required to adjudicate the fitness for duty determination and disability rating determinations.
MEB members receive the case file from the PEBLO, consult, prepare a narrative medical report and render a decision on whether the servicemembers should be entered into the disability system. Servicemembers may file a rebuttal to the MEB report, in which case the MEB will evaluate the rebuttal and make a response.
Applies the disability ratings from the D-RAS to the unfitting conditions and publishes the disposition recommendation retention, discharge, retirement. If servicemembers appeals a FPEB decision, it is sent to the military department for disposition. MEBs do not formally convene, and they offer members no formal opportunity to testify or present evidence.
The regulations set out detailed requirements for MEB reports, including types of testing required for some specific medical conditions. The reports include diagnoses, origin and history of the conditions and descriptions of treatment.
The reports state whether the conditions are cause for referral into the physical evaluation board PEB , but should not offer opinions on whether or not members are medically fit or unfit for duty. These boards do not make recommendations for discharge or retirement, or suggest any percentage of disability.
Any MEB listing a psychiatric diagnosis must contain a thorough psychiatric evaluation and include the signature of at least one psychiatrist or psychologist with a doctorate degree in psychology. DTM, Appendix 5 to Attachment 4, page DTM, Attachment 10, page This is the only formal role commands have in the process once the disability proceedings have been initiated. This makes it essential that servicemembers communicate symptoms and their impact on duties to the command while seeking medical attention.
If servicemembers do not let their medical personnel know about symptoms, a condition may be overlooked. The down side is that, the more symptoms servicemembers present, the more medical evaluation needs to be performed and the longer the process takes.
Many servicemembers are reticent to say anything that might make the process take longer. It is difficult to come back to the VA later and report symptoms that are not already in the record and claim the symptoms as service connected. Servicemembers may also fear that signing the VA and DD forms referenced in the above paragraph may be used against them because they include information about the origin, incurrence or aggravation of their disease or injury, which in some cases may reveal conduct in violation of regulations.
However, Title 10, Chapter 61, Section of the US Code prohibits the use of such information against the best interests of the servicemember. DTM, Appendix 1 to Attachment 4, page. Note, though that information contained in unsigned medical records is sometimes used in administrative and disciplinary proceedings.
Another opportunity to get symptoms into the record occurs during the physical exam for discharge. If a condition found in a discharge examination is serious enough, the examiner may refer the servicemembers back to the MEB.
This is another area where it is not possible to know what will happen until servicemembers are there. The safest counseling approach is to make sure servicemembers understand it is in their interest to bring all symptoms to the attention of the medical examiner during the IDES process if not earlier.
DoDI In some cases, as when there is concern about misconduct or willful negligence, these may be formal investigations, not simply prepared by commands, but by appointed investigating officers, frequently military attorneys. Command members may be interviewed as part of formal investigations, and command attitudes may thus affect a basic determinant of eligibility for benefits.
However, it is always wisest to have attorneys or counselors review the reports and discuss them with clients before deciding on the value of a rebuttal. Even small errors regarding symptoms, severity, origin or effect on duties may affect the outcome. If rebuttal is appropriate, it offers an opportunity to provide additional documentation of the medical condition discussed in the report, or other medical conditions omitted from the report. Service members should be counseled to be prepared for pressure from the PEBLO to waive their right to a rebuttal so that they have an appropriate response ready.
Servicemembers or their representatives have only 5 days to submit the MEB rebuttal and request an impartial medical review. Extensions of time may be granted when good cause is shown.
Therefore, it is important to review medical records in advance and consider documentation concerning any adverse or incorrect information in the records before the MEB report is completed. The PEB will sometimes return reports to the medical treatment facility if medical evaluation or appropriate testing was not conducted, or documents such as the non-medical assessment were not included.
In addition, the MEB will sometimes submit an addendum if significant changes occurred since the initial medical board report was prepared. Medical information used to substantiate the existence or severity of unfitting conditions may not be more than 6 months old DTM, p. Note that requiring all medical evaluations to be performed by VA-certified physicians is meant to reduce the chance that MEB examinations and reports will be insufficient for meeting the needs of the PEB and the VA disability rating process.
IPEBs make findings and recommendations as to whether conditions result in medical unfitness, whether discharge or retirement is warranted, and whether conditions existed prior to entry or were the result of misconduct. They apply the previously-determined VA ratings to all conditions they find unfitting. Their findings and recommendations are terse, often presented without real explanation or rationale.
IPEB reports are then returned to the medical treatment facility and provided to the servicemembers along with further information about their rights from the PEBLOs. Findings and recommendations are considered final if members accept them at this point.
Request for Reconsideration Members who disagree with a recommendation for discharge or retirement, or with the disability rating, may make a written request for reconsideration to the PEB.
For these individuals, further medical evaluation and a new attempt at a medical evaluation board are often necessary, unless their cases show obvious abuse of discretion or lack any basis in fact, in which case resort to federal habeas corpus would be appropriate.
FPEBs provide the first and only opportunity for a hearing in the disability process. Members may be represented by attorney or non-attorney counsel, testify, and present witnesses and documentary evidence.
Hearings are informal, but board members may be vigorous in questioning members. FPEBs are required to provide some justification of their decisions. Some members choose to be represented by counselors from veterans service organizations such as the Disabled American Veterans DAV. Civilian attorneys and counselors may provide representation. In the Navy, at least, it is common for military attorneys to meet with clients for the first time on the day before the hearings, severely limiting preparation.
Military counsel often have a good understanding of the decision-making patterns, biases and attitudes of board members.
Perhaps as a result, some appointed attorneys tend to think that particular ratings for particular conditions are a forgone conclusion. Few have extensive experience in developing and presenting detailed medical and lay evidence, and the lack of time for advance preparation further limits this work. Civilian advocates can play a key role prior to hearings by preparing members to testify, preparing any witnesses and developing additional evidence of the extent or severity of medical conditions, their impact on performance of duties, etc.
Testimony or statements from lay witnesses, including fellow servicemembers, friends and family members, may be useful in arguing for increased disability ratings. Formal hearings offer important opportunities to provide evidence concerning pre-existence of medical conditions, service aggravation, and line of duty determinations. Attorneys or counselors can also provide important representation at the hearings.
Although formal rules of evidence do not apply, advocates can challenge inappropriate or harassing questions and note for the record improper considerations, failure to obtain necessary medical evidence, and the like. If necessary, they can remind board members of specific standards and presumptions applicable to individual cases, and can assist clients in summarizing the real impact of illnesses or injuries on their lives. Nothing prevents IPEBs on reconsideration, or FPEBs, from making findings less favorable to members than the prior findings and recommendations, so that members take some risks in pursuing their cases, and are well advised to have legal assistance.
This may be common practice, but unfortunately is not stated in the regulations. FPEBs can and do reduce disability percentages or make other reduced findings and recommendations. Appealing the Decision of the Formal PEB Further written appeal through the disability evaluation system is available in all of the services, though the form varies considerably.
While there are no further hearing rights, the member may still make written appeals to reviewers and, ultimately, the secretary of the service.
Since this is a lengthy procedure, it does not provide much help for those whose immediate goal is discharge. But for those discharged without proper benefits, the BCMRs offer an important remedy. These boards can change the final determinations in medical disability cases, place medically discharged personnel on medical retirement, increase disability ratings, or change administrative or end-of-term-of service discharges to medical retirement.
Application to the BCMRs must be made within three years of the error or injustice at issue, defined as the date of discharge. However, late applications are frequently accepted if the Board finds it in the interests of justice to do so. The BCMRs will review the propriety of the disability evaluation proceedings as well as factual matters. Failure to afford members their full rights in the disability proceedings will not warrant correction of the record unless the BCMRs also find the change to be medically warranted.
United States, Fed. Few cases result in the courts rebutting the findings, but there are instances when courts do rule in favor of servicemembers.
See, e. Stuart v. Pressure to deploy troops affected military commanders and doctors in making decisions about deployment; particularly in the Army, commands commonly overrode medical recommendations that members not deploy.
Here, as in other areas of military medical policy, public outrage and Congressional pressure led to policies which should result in more careful screening, and non-deployment of those with serious physical or psychological problems. DD must be completed within days of deployment and reviewed in a face-to-face interview with a credentialed health care provider.
The provider then makes a provisional determination of deployability. Service members with pre-existing conditions may be deployed after a medical evaluation if certain conditions are met: The condition is not of such a nature or duration that an unexpected worsening or physical trauma is likely to have a grave medical outcome or negative impact on mission execution The condition is stable and reasonably anticipated by the pre-deployment medical evaluator not to worsen during the deployment in light of physical, physiological, psychological, and nutritional effects of the duties and location Any required, ongoing health care or medications anticipated to be needed for the duration of the deployment are available in theater within the Military Health System.
Medication must have no special handling, storage, or other requirements e.
Medication must be well tolerated within harsh environmental conditions e. There is no need for routine evacuation out of theater for continuing diagnostics or other evaluations. The list is not all-inclusive; it states that additional factors to be considered when determining deployability include climate, altitude, rations, housing, duty assignment, and medical services available where the servicemembers will be stationed.
All deploying servicemembers are required to complete a person-to-person pre-deployment mental health assessment and three post-deployment mental health assessments. Servicemembers with conditions falling under these criteria should be referred to the disability evaluation system for Medical Evaluation Boards and possible discharge or retirement. Conditions not meeting the threshold to be referred to the MEB should display a pattern of stability without significant symptoms for at least three months prior to deployment.
Psychotic and bipolar disorders, however, are considered disqualifying for deployment, while those with psychotic conditions in remission or not impairing duty performance may be considered deployable. Whether a condition will deteriorate or symptoms will recur during deployment, considering environmental and mission demands, must also be considered in determining deployability.
Accordingly, these proceedings, and medical discharges generally, are important areas for counseling and advocacy. Clients who have the assistance of advocates or simply have full explanations of the medical standards and their rights are likely to fare much better than others in obtaining treatment and in the disability evaluation system.
As the current wars progress and increasing numbers of soldiers try to cope with illness and injury, those who face doctors and disability proceedings alone often find their conditions undiagnosed or under-diagnosed and their rights neglected.
The Task Force encourages counselors and attorneys to educate themselves in this area and to include military disability cases in their work. We strive to keep things current, but please search to be sure you have the most recent version of a memo or advisory before taking action.
If you have questions, please call or email us for assistance.