Disability Evaluation Systems (DES)

Transcription

1 Disability Evaluation Systems (DES) Recovery Care Coordinator (RCC) Course December 2018 Medically Ready Force Ready Medical Force 1

2 DES Agenda DES Overview DES Referral Criteria Major DES Elements DES Determinations DES Processes Legacy DES (LDES) Integrated DES (IDES) Temporary Disability Retired List (TDRL) Service Member Rights IDES Performance / Satisfaction Results Medically Ready Force Ready Medical Force 2

3 DES Overview DoD s mechanism to evaluate and return to duty, separate or retire Service members due to medical disability DES first implemented in 1947 Statutory authority: 10 USC, Chapter 61 Office of the Secretary of Defense (through USD/P&R) has oversight of the DES DoDI Disability Evaluation System DoDM , Vol 1 General Information / Legacy Disability Evaluation System DoDM , Vol 2 Integrated Disability Evaluation System DoDM , Vol 3 DES Quality Assurance Program DTM Revised Timeliness Goals for the Integrated DES (IDES) Secretaries of Military Departments operate their own DES, by law Publish DES implementing guidance and monitor performance Responsible for DES resourcing and training As of October, 2018: ~ 238,000 Service members have been referred into IDES Medically Ready Force Ready Medical Force 3

4 Criteria for DES Referral When the course of further recovery is relatively predictable or within 1 year of diagnosis, whichever is sooner, medical authorities will refer eligible Service members into the DES who: Have one or more medical condition that may, individually or collectively, prevent the Service member from reasonably performing the duties of their office, grade, rank, or rating including those duties remaining on a Reserve obligation for more than 1 year after diagnosis; Have a medical condition that represents an obvious medical risk to the health of the member or to the health or safety of other members; or Have a medical condition that imposes unreasonable requirements on the military to maintain or protect the Service member. In all cases, competent medical authorities will refer into the DES eligible Service members within 1 year of diagnosis Medically Ready Force Ready Medical Force 4

5 Reasonable Performance of Duty Common Military Tasks can the Service member perform regular daily tasks as required for the office, grade, rank, or rating Firing a weapon, performing field duty, wearing load-bearing equipment or protective gear Physical Fitness Test Deployability can the Service member be deployed individually or as part of a unit, with or without prior notification, to any vessel or location specified by the Military Department DoDi effective 30 July, 201 Service members considered non-deployable for 12 consecutive moths will be evaluated for (1) retention determination, or (2) referral into DES Special Qualifications For Service members whose medical condition disqualifies them for specialized duties, whether the specialized duties constitute the member s current duty assignment; the member has an alternate branch or specialty, reassignment or reclassification Medically Ready Force Ready Medical Force 5

6 DES Major Elements Medical Evaluation Board (MEB) documents medical status and duty limitations of Service members referred for disability evaluation Comprised of two or more physicians; requires psychiatrist/psychologist with doctorate in psychology for behavior health cases Determines whether Service member s medical condition(s) prevent them from performing duties of their office, grade, rank, or rating (meets Service-specific medical retention standards) Returns to duty those who can reasonably perform required duties Refers to Physical Evaluation Board those who cannot Member may request impartial medical review; rebut MEB findings Medically Ready Force Ready Medical Force 6

7 DES Major Elements (cont.) Physical Evaluation Board (PEB) (personnel action) makes fitness for service findings and recommends disability disposition to Secretarial authority Comprised of two or more members (Informal PEB) or three or more (Formal PEB) Determinations include: eligibility for DES referral, fitness for duty, disability compensation, qualification for Federal civil service/federal tax benefits Service member counseling includes being advised of the significance and consequences of the determinations being made and their associated rights, benefits, and entitlements Final disposition by personnel authorities finalize disability case Medically Ready Force Ready Medical Force 7

8 DES Determinations Evidentiary Standards Must cite objective evidence in the record distinguished from personal opinion, speculation, or conjecture to determine unfitness because of disability Doubt which cannot be resolved with evidence will be resolved in favor of the member s fitness through the presumption that the member desires to be found fit Clear and unmistakable evidence demonstrates the disability existed/did not exist before the member s current period of active duty and was/was not aggravated by their military Service Medically Ready Force Ready Medical Force 8

9 DES Determinations (cont.) Fitness determinations Fit -- Service member return to duty Unfit Disability rating 30% or above retires with disability retirement Disability rating 20, 10, or 0% separates with disability severance (unless Service member otherwise qualified for retirement) No Rating (separated without entitlement to disability benefits) Pre-existing condition not permanently aggravated by Service Separated due to a disability resulting from intentional misconduct, willful neglect, or disability incurred during a period of unauthorized absence Medically Ready Force Ready Medical Force 9

10 Legacy DES (LDES) DoD only process for evaluating Service members fitness for duty MEB determines if Service member meets medical retention standards PEB determines if Service member is fit for duty Oct 2015, USD (P&R) authorized Military Departments can direct & Service members could request, processing through LDES Military Departments published implementation guidance Legacy DES Timelines Active Duty & Reserve 70 Calendar days from the MEB completion date Not on Active Duty (NAD) 130 days from the date of administrative review by RC medical authority Medically Ready Force Ready Medical Force 10

11 Integrated DES (IDES) Integrates DoD s and VA s disability processes Each Department exercises its core competency: DoD determines fitness and makes final disposition to Secretarial authority VA determines veteran disability benefits / compensation VA conducts medical evaluations and provides disability rating(s) for both Departments use Former Service members receive VA benefits shortly after discharge Medically Ready Force Ready Medical Force 11

12 Integrated DES (IDES) (cont.) Sep 2011, IDES process became operational across DoD VA Military Service Coordinator helps Service member apply for VA disability benefits and schedules medical exams for all conditions MEB determines whether Service member meets medical retention standards PEB determines Service member s fitness and the appropriate disability determination If unfit, VA determines disability ratings for unfitting / serviceconnected conditions Service member transitions to veteran status with both DoD / VA disability benefits IDES Timelines (effective 30 July, 2018) Active Duty / non-active Duty case goal 230 calendar days Medically Ready Force Ready Medical Force 12

13 Temporary Disability Retired List (TDRL) Service members are assigned to the TDRL when they meet requirements for permanent disability retirement except their disability is not determined to be stable Service members must be re-examined at a minimum of every 18 months until they have been on the List for 3 years (effective Jan 2017) or are removed from TDRL Exception: cases involving a mental health issue resulting from a highly stressful event (i.e., PTSD) will be scheduled for an initial re-examination not later than 6 months from placement on TDRL Medically Ready Force Ready Medical Force 13

14 TDRL (cont) Re-evaluation includes: DoD, VA or civilian disability medical exam Physical Evaluation Board (PEB) fitness / disability determination Service members must be removed from TDRL by the 3rd anniversary of their placement on TDRL; in FY 2017 TDRL dispositions reflected: 88% were permanently retired; 11% were separated; 1% were returned to duty Medically Ready Force Ready Medical Force 14

15 Service Member Due Process Legal Counsel: DES assistance from Government legal counsel; private counsel retained at member s expense; or from a VA-accredited service organization representative Impartial Medical Review (IMR): A physician, independent of the MEB, can review the MEB findings and recommendations and advise the Service member whether the findings adequately reflect the complete spectrum of injuries or illnesses Rebuttal: Opportunity to contest MEB findings with evidence that can include the IMR report Medically Ready Force Ready Medical Force 15

16 Service Members Due Process (cont) PEB Appeal: Opportunity to appeal Informal and/or Formal PEB fitness determination Rating Reconsideration (Integrated DES): Request reconsideration of VA disability rating(s) for referred conditions Board for Correction of Military/Naval Records (BCMR/BCNR): Opportunity to request a correction of military records (disability determination) following separation Length of Service Retirement in lieu of disability retirement: Service members pending disability retirement who are eligible for length of service retirement may elect to be retired for disability or for length of Service. Medically Ready Force Ready Medical Force 16

17 Reducing IDES Timeliness Goal In July 2017, the Secretary of Defense directed the Under Secretary of Defense for Personnel and Readiness (USD(P&R)) to form a working group to determine changes to military personnel policies to support and enhance warfighting readiness and force lethality In December 2017; DSD / VCJCS mandated: Decrease standard for end-to-end Integrated DES (IDES) processing timeliness from 295 days to 230 days; achieve goal by March 1, 2019 July 30, 2018, USD(P&R) published Directive-type Memorandum (DTM) implementing a 230-day IDES timeliness goal Medically Ready Force Ready Medical Force 17

18 Reducing IDES Timeliness Goal (cont.) In July 2018; SECDEF directed that the Military Departments will, to the maximum extent feasible, complete disability evaluation processing* within 180 days by October 2019 Staffing SECDEF memo and will then publish a DTM implementing change DoD, Military Department and VA SMEs exploring options to optimized DES process *Measured from a Service member s referral into the DES to their date of separation, retirement, or return to duty. Medically Ready Force Ready Medical Force 18

19 IDES Performance As of 30 October, 2018, the IDES had 17,237 enrolled Service members: 13,816 from the Active Component and 3,421 from the Reserve Components Average time from referral into IDES to the date the Service member received VA benefits or was returned to duty: 203 days for Active Duty (AD) cases (73% met the 230-day goal) 201 days for Not on Active duty cases (74% met the 230-day goal) IDES DoD-VA core processing performance for June 2018 DoD core process: 113 for AD / 116 days for NAD (97 day AD / 111 day NAD goal) VA core process: 100 days for AD / 83 days for NAD (77 day AD / 63 day NAD goal) Medically Ready Force Ready Medical Force 19

20 Q3 FY18 Service Member Survey Results Review DoD IDES Service Member Satisfaction Survey Results (January 2018 to June 2018): All Components Percentages in red indicate those below the 80% goal Medically Ready Force Ready Medical Force 20

21 Contact Information Bret Stevens Director, Disability Evaluation Systems Health Services Policy & Oversight (HSP&O) (703) Medically Ready Force Ready Medical Force 21