DEPARTMENT OF THE AIR FORCE

Transcription

1 DEPARTMENT OF THE AIR FORCE HEADQUARTERS UNITED STATES AIR FORCE WASHINGTON, DC AFI _AFGM JANUARY 2018 MEMORANDUM FOR DISTRIBUTION C ALMAJCOM-FOA/CV FROM: SAF/MR SUBJECT: Air Force Guidance Memorandum to AFI , Warrior and Survivor Care By Order of the Secretary of the Air Force, this Guidance Memorandum immediately implements changes to AFI , Warrior and Survivor Care. Compliance with this Memorandum is mandatory. The purpose for the immediate changes is to implement new and extended guidance on Service Dogs, Emergency Family Member Travel, updated roles and responsibilities, changes specifying Temporary Duty Retired List as the only veteran category authorized at present for adaptive sports participation, and information to help Recovery Care Coordinator s to perform their job and manage base leadership expectations. In collaboration with the Chief of the Air Force Reserve (AF/RE) and the Director of the Air National Guard (NGB/CF), the Deputy Chief of Staff for Manpower, Personnel and Services (AF/A1) develops policy for Protocol. This instruction applies to all Regular Air Force, Air National Guard and Air Force Reserve personnel. To the extent its directions are inconsistent with other Air Force publications, the information herein prevails, in accordance with AFI , Publications and Forms Management. The attachment to this memorandum is updated to provide guidance changes that are effective immediately. An asterisk (*) indicates newly revised material. This memorandum becomes void after one-year has elapsed from the date of this memorandum, or upon publication of an Interim Change or rewrite of the affected publication, whichever is earlier. SHON J. MANASCO, SES, USAF Assistant Secretary of the Air Force (Manpower & Reserve Affairs) Attachment: Guidance Changes

2 AFI _AFGM Date Attachment Guidance Changes The below changes to AFI , 6 May 2015, are effective immediately. *1.5. Receipt of Gifts/Ethics. Airmen wounded during combat operations, injured in non-combat activities or suffering from serious illnesses face unique and difficult challenges, including navigation of various benefits and compensation systems, reintegration into family units, lifestyle changes brought upon them by their injuries, and possible return to civilian workforce as a disabled veteran. Many charities, Veterans service organizations, and other non- profit organizations exist that provide support and services to these Airmen in many forms. Although the Air Force cannot endorse any particular non- Federal entity, RCP personnel can facilitate access between the organizations and wounded, ill and injured Airmen and their families, when authorized to do so by the latter. AFI , Gifts to the Department of the Air Force, provides guidance, when it is appropriate for such gifts to be made to the Air Force for distribution to individuals. DoD , DoD Financial Management Regulation, Vol 12, Chapter 34, governs when combat- wounded, ill and injured Airmen and their families may accept such gifts in their personal capacities. * Airmen who incurred an illness or injury as a result of armed conflict; while engaged in hazardous service; in training for war; through an instrumentality of war; in a combat or similar area recognized by law or regulation may receive gifts from non-federal entities. * Gifts with a market value of $375 per gift on occasion and $1000 in gifts total from a single donor may be accepted without prior approval. Gifts beyond these totals require a written ethics determination that may be obtained through the local legal office. Receipt of items, monetary gifts, or specialty services provided by a government sanctioned agency or program, are by design approved for acceptance and do not require an ethics determination and do not have a monetary limit unless established as part of the agency or program offering the service or gift. * Consult the local Judge Advocate on appropriateness of any gifts offered that may not fit the above criteria. * The HQ Air Force Warrior and Survivor Care Branch (AF/A1SAZ) will: * Provide policy and guidance to the AFW2 program that will enable Commanders and the CMT to provide support to WII across the care continuum. * Coordinate responses with AFPC to all requests for information, Congressional requests, and Air Force and DoD Senior Leader inquiries regarding WII Airmen, programs, metrics, and Freedom of Information Act requests submitted to AF/A1S through HQ AF staffing process.

3 * Formulate a strategic legislative agenda, submitting initiatives for congressional action, and informing the field of new legislative initiatives and requirements relating to the total force Air Force on the subject of WII and related programs and benefits. * Provide AF position on all policy and program development to the OSD, Department of Veteran Affairs (VA), The Defense Health Agency (DHA) and the other Service wounded warrior programs within DoD. * Develop Warrior and Survivor Care budgets and address resource issues including manpower, budget development, funding shortfalls, and funding execution. * Serve as senior Air Force representative to OSD Warrior Care Executive Board, Joint/International Warrior Care planning events/boards, and any multi-departmental meetings, teams, and boards. * Interpret and provide Air Force input to the OSD, Joint Staff, and other Uniformed Services on issues impacting interdepartmental and inter-service community, wounded, ill and injured programs and related activities. * Collaborate with Air Force Airmen and Family Readiness (AF/A1SAA) in establishing policies consistent with operations in service delivery to WII Airmen and support to their families. * Provide HQ AF oversight to the programs and activities executed by AFPC/DPFW * The Directorate of Airman and Family Care at AFPC is responsible for executing the requirements of this instruction for the non-medical care of total force WII Airmen. * The Chief, Warrior Care Division (AFPC/DPFW) is responsible for the daily operational execution of the RCP and other related programs contained in this instruction and will: * Execute programs identified in this instruction under direction of AFPC/CC, necessary to enable Commanders with the assistance of the CMT, to provide support to WII across the care continuum. * Organize personnel appropriately and economically to fulfill the programs and requirements set forth in this instruction. * Develop responses to all requests for information, Congressional requests, and Air Force and DoD Senior Leader inquiries regarding WII Airmen, programs, metrics, and Freedom of Information Act requests and submit all responses through AFPC, and, as

4 required by AFPC/CC, through AF/A1 for coordination through the HQ AF staffing process. * Submit annual budget requirements to AF/A1SAZ prior to the first day of June of each year proceeding the start of the fiscal year. The budget should include detailed requirements for operations and maintenance costs, travel, and supplies. Detailed expenses for any adaptive sports activities, rehabilitative events, or training requirements should also be included. * Collaborate with Chief, Airman and Family Division (AFPC/DPFF) in establishing working relationships for the coordinated service delivery to WII Airmen and support to their families at all installations. * Involve installation A&FRC, AFR A&FR Offices, and Airman and Family Readiness Program Manager (A&FRP(M)) for Air National Guard units, in direct support of WII Airmen specifically at locations that do not have an RCC assigned. * Ensure RCCs visiting any installation meet with the A&FRC personnel, A&FR Director for AFR, or A&FRP Manager for ANG to review current cases and coordinate support opportunities for WII and families. * At a minimum, provide monthly lists of installation WII Airmen to the local A&FRC for availability to Wing leadership, including Guard and Reserve installations on a monthly basis. * Ensure RCCs update installation A&FRC, and A&FRPM for ANG, personnel whenever a local WII Airman is identified or when a change in status occurs, (i.e. permanent change of station, medical retirement or separation, move into/out of base housing, etc.). Identify Airmen living in/moving into base housing and notify the local Inspector General so they may fulfill their obligation to inspect WII housing. RCCs should also notify AFPC/DPFW to inform Air Force Inspection Agency of all required inspections. * Establish organizational structure to provide case management and support programs as outlined in this instruction. * Coordinate changes in processes and standard operating procedures that deviate from this instruction with AF/A1SAZ. * Notify AF/A1SAZ of resource or other constraints/barriers to fulfilling the requirements set forth in this instruction. * Submit a proposal through AFPC/CC for AF/A1S consideration on any program or significant process change not specifically covered under this instruction. No programs or significant changes can be made without prior approval from AF/A1S.

5 * Wing/Installation Commanders will ensure installation support is provided to local RCCs. This includes suitable office space allowing privacy so sensitive issues can be discussed, basic office items/equipment/supplies, and adequate system and security support provided to others working on the installation. Connection to the Air Force computer network will be provided after the RCC has completed all training required for access and meets all security requirements. (T-1) * While the RCCs main purpose is to provide non-medical care to RSMs, they also have limited responsibility in conducting AFW2 Program briefings, with slides approved by AFPC/DPFW. These briefing slides will be tailored based on the intended audience and time permitted. * Active Component Installations. At minimum, RCCs will brief installation senior leaders (wing commander and/or vice commander and command chief) within 120 days of their command assignment. RCCs will brief individual commanders who have enrolled RSMs assigned directly under their command. They will brief during wing standup meetings, installation Chiefs' Group, First Sergeants' Council, Company Grade Officer Council (CGOC), and Junior Enlisted Noncommissioned Officer (JENCO) at a minimum annually. RCCs shall develop appropriate support networks by engaging and collaborating with other installation support/helping agencies such as, but not limited to, the Sexual Assault Response Coordinator (SARC), Behavioral/Mental Health office, Military and Family Life Consultant (MFLC), A&FRC, Air Defense Council; and participate in community forums/meetings such as the Community Action Information Board (CAIB), Commander s Calls, town hall gatherings, Veteran Service Organizations (VSOs) or other venues. * ARC Locations. RCCs will brief ARC senior leaders (wing/installation commander and/or vice commander and command chief) within 120 days of their command assignment. RCCs will also brief commanders who have enrolled RSMs assigned directly under their command. * Overseas units where no RCC is located will receive annual briefs either in person if funding allows, or through video teleconferencing by RCP leadership. * The Airman and Family Readiness Program Manager (A&FRPM); AFR Airman and Family Readiness Director (AFR A&FRD). The A&FRPM and AFR A&FRD is tasked with assisting leadership with those Airmen who have been identified as Wounded, Ill or Injured. The A&FRPM and AFR A&FRD must rely on active duty (AD) resources to support Airmen identified in these categories due to the demand of care. A&FRPMs and A&FRD are staffed as a 1-deep position, tasked with all the day-to-day actions of an AD A&FRC. The AFRPM and AFR A&FRD provides Transition/Pre-Separation counseling as needed, plus ongoing information and referral support to identified community resources in coordination with the RCC. * At a minimum, the CMT members which must be included in the information sharing by the RCC include the NMCM and the Airman's Commander. Given the Needs

6 Assessment is done with the Airman, they are already aware of the information and do not need to be included in the initial CMT group for this action. * Other CMT members may be included as necessary based on the assessment by the RCC. Information may be shared through face-to-face meetings, telephone conferencing, encrypted s, or through individual contact depending on which method is deemed most appropriate by the RCC. * MCM's are not normally assigned to mental/behavioral health cases and will therefore not be included in the initial CMT meeting. In cases of physical injury, illness, or other cases where an MCM can be identified as assigned to the case, the MCM will be included in the initial meeting. * All contact methods, dates of contact, name and role of the person contacted, and the information shared will be documented in the case notes in DoD-CMS and those CMT members included in the contacts roster. * The following rules will also apply when determining enrollment eligibility * Airmen identified as SI (CAT 2) or VSI (CAT 3) on the Casualty Morning Report will automatically be enrolled by the WII Cell without a formal referral being required. * Purple Heart Recipients (automatic entry into program, no formal referral necessary). * Cases referred to the WII Cell from the IDES office will be reviewed for enrollment eligibility and will be automatically enrolled without requiring a formal referral if enrollment criteria is met. * Except in cases allowing automatic enrollment, a formal referral review process will take place as outlined in paragraph * Notify AFPC/DPFW Division Chief and prepare a case note that reflects Airman s desire not to be contacted. Update the Airman s case file in the Case Management database and conduct a review of pay of all known benefits and entitlements. If an Airman and/or family choose to opt out of RCP support, include a case note detailing their choice in the Contact Details section of the Airman s Department of Defense Case Management System (DoD-CMS) and Master Case Files. Review the case after one year for consideration for closure. * Procedures. The ICP will be entered into DoD-CMS and maintained electronically. The DoD-CMS is an Office of Secretary of Defense (OSD) level virtual database that provides greater security, continuity and management capabilities than paper versions. The DoD-CMS system is cleared to contain Personal Identifiable Information (PII) and all users of the system are required to have PII training annually and Health Insurance Portability

7 and Accountability Act (HIPAA) training annually to protect against unintended Personal Health Information (PHI) sharing on DoD-CMS. The ICP is the primary guiding document for the non-medical support of the Airman and their family. It includes a medical and non-medical needs assessment to determine where support is most required. Goals and action steps are created based on the needs and desires of the recovering Airman and family. Identified goals must be specific, measurable, and achievable and can be modified at any time by the Airman. This is why regular reviews must be accomplished to ensure progress is continuing based on the plan. * Closing out the ICP. An ICP may be closed out when the Airman has met all goals or declines any further support. All documents will be kept in accordance with the appropriate records disposition schedule. Once closed out, the ICP will be maintained as part of the Master Case File and will be moved to either the Suspended or Closed Out sections of DoD-CMS and can be re-activated by a supervisor if necessary. * Start an ICP in DoD-CMS within 5 business days of assignment, depending on the mental and physical condition/capability of the Airman. Make initial contact with the assigned Airman and family in person if at all possible. Face-to-face contact/introduction is the required method of introduction and if not feasible, the RCC must annotate the reason in DoD-CMS and notify AFPC/DPFW. If the Airman is in critical condition it may be appropriate to conduct a preliminary needs assessment with the Airman s family. When the Airman s medical condition allows, the RCC shall conduct an interview utilizing the comprehensive needs assessment checklist. During the interview, the RCC shall provide at a minimum, CMT points of contact (including websites and toll-free numbers as appropriate) and information on the RCP. * RCCs must ensure the Airman understands they will interact with their family. There may be unique occasions when an Airman does not want their family to receive support or wants to omit a family member(s) from being contacted. Should the Airman choose not to participate, the RCC will document declination (to include date and time) in the contact section of the case file in DoD-CMS and notify the RCC Program Manager (RCC PM) via to suspend the case. The RCC PM will suspend the case file and notify AFPC/DPFW of the action. The RCC will continue to be accessible to provide support to the Airman and his family. If at a future date the Airman changes their mind the RCC will reactivate the case file and include a note in the contact section stating the date and time of the Airman s decision and will notify the RCC PM. * The RCC should obtain a signed copy of the Privacy Act Statement and DD Form 2870, Authorization for Disclosure of Medical or Dental Information, then upload and attach the document to the Airman s case in DoD-CMS. If the Airman is unable to sign the document for reasons related to their own physical or mental capability then an individual with a general power of attorney may sign on their behalf. If RCCs cannot obtain a signed Privacy Act Statement within two weeks of assignment, then the RCC should bring this to the attention of the RCC PM who will in turn notify AFPC/DPFW. All circumstances surrounding an unsigned Privacy Act Statement and DD Form 2870 should be clearly documented in DoD-CMS. Any situation where the lack of a signed Privacy Act

8 Statement hinders support to the Airman should also be noted in DoD-CMS. A separate DD Form 2870 must be obtained for transfer of any related case management documentation for each organization outside the Air Force that may require it. This includes the need for a specific signed DD Form 2870 prior to the transfer of any information to the VA when the Airman is not in the IDES process. * Ensure documentation in DoD-CMS is updated regularly; at a minimum with each substantial contact. Make adequate time on a weekly basis to update case notes. Regularly review the CRP and make modifications in conjunction with the CMT supporting the Airman and family. Review the goals established in the CRP, and their status, with other CMT members on a regular basis. This allows CMT members to address challenges and help the Airman achieve their goals. The CMT members must coordinate their actions to eliminate redundancies, overlaps and confusion on the part of the Airman as to who is working what issue. *10.1. Purpose: This policy establishes procedures and assigns responsibilities to implement SCAADL payments to eligible Airmen authorized by Title 37 USC 439. The SCAADL program provides a special monthly compensation to permanently, catastrophically wounded, ill, and injured, and otherwise eligible, Airmen to compensate their designated caregiver for the time and assistance provided. *10.2. Applicability: This guidance applies to both RegAF and ARC Airmen who have a permanent catastrophic injury or illness incurred or aggravated in the line of duty and meets the criteria outlined in DoDI/DoDM , and meets the CAT 3 requirements outlined in DoDI , Enclosure 4. ARC Airmen do not have to be on orders to receive SCAADL. Commanders may use an interim LOD, in lieu of a final LOD, to help certify eligibility on DD Form If later the Airman is found not to be in the LOD, SCAADL payment will be terminated. *10.3. Permanent, Catastrophic Injury or Illness. A permanent, catastrophic injury or illness is a permanent, severely disabling injury, disorder, or illness incurred or aggravated in the LOD that compromises the ability to carry out ADLs to such a degree the Airman requires personal or mechanical assistance to leave home or bed, or requires constant supervision to avoid physical harm to self or others, and is unlikely to recover from such a disability. Permanent is defined as a lasting or remaining illness/injury without essential change; not expected to change in status, condition or place. Permanency of the injury or illness is a physician s call based on the situation the day the assessment was made. Because of the advancements in medical treatment, some situations that may seem permanent, or may not have a positive prognosis, can be improved with treatment and the situation, although still existing, may improve with time. Therefore, the Air Force will accept the decision of a medical provider as to the permanency of any medical condition. SCAADL is not to be used as a replacement for short or long term financial assistance for Airman who may recover from their injury/illness.

9 * AF/SG: Is responsible, through the local MTF, for ensuring a licensed RegAF or ARC DoD physician certifies initial, or any changes to, eligibility IAW this instruction and DoDI/DoDM * There is no authority for retroactive payments when the CMT, Airman and/or caregiver, believe the Airman was once eligible, but was never considered for SCAADL. CMT would need to assess for current eligibility if appropriate. * Be certified by a licensed DoD or Veterans Administration (VA) physician to have a catastrophic illness or injury and need assistance from another person to perform the personal functions required in everyday living or require constant supervision to avoid harm to self and others. In the absence of such assistance, the Airman would require hospitalization, nursing home care, or other residential institutional care. * Be an outpatient and no longer determined to be an inpatient at a military treatment facility, VA medical center, civilian hospital, nursing home, or other residential institutional care. Although individuals may be temporarily placed in an inpatient status, they remain eligible for the full monthly SCAADL payment providing the total number of inpatient days do not exceed 15 days a month. * Have a designated primary caregiver who provides assistance to the Airman with at least one of the following: * Inability to feed him or herself through loss of coordination of upper extremities or through extreme weakness or inability to swallow. This does not pertain to preparing food. * Without having continual personal care services at home, the Airman would require institutional care at a hospital, nursing home, or other residential facility; and * Not currently receiving or authorized services by another entity such as Tricare provided in-home custodial care services or other government funded support specifically designed to provide primary caregiver services. * Are responsible at the local medical unit to determine initial eligibility and monitor SCAADL eligibility every 180 days or when the Airman s condition changes that might warrant a change in SCAADL payment. (T-0) At no time will medical authority back date an application. Retroactive payments will only be considered in instances where a valid application (see para ) was not received by AFPC/DPFW from the CMT in a timely manner. In these instances, justification will be required to explain the delay in submission. AFPC/DPF will be the approval authority to authorize any retroactive pay resulting from late submissions. Approval authority will not be delegated. * Will forward the completed DD Form 2948, Application for Special Compensation for Assistance with Activities of Daily Living (SCAADL), AF SCAADL Worksheet, and supporting medical documentation to the RCC. The date of all signatures

10 on the application must be within 30 days of submission to ensure timeliness and accuracy of information; if not, another evaluation is required and only the current application will be submitted. (T-0) * Will provide training or references/resources to ensure the designated caregiver has the necessary skills to assist with the Airman s ADL supervisory/protection care needs. * Evaluates for initial and continued eligibility by the 150th day, or when the Airman s condition/dependency level changes. If revaluation has not been received by the 180th day, SCAADL compensation will be terminated. (T-0) * Submit SCAADL payment requests to Defense and Accounting Service (DFAS) NLT 5 work days from receipt of completed application, through the Case Management System (CMS). The CMS case will contain the completed and signed DD Form Completed and signed applications cannot be denied by AFPC/DPFW or DFAS if condition is validated by the physician and the application concurred with and signed by the commander. (T-0) * Ensure DFAS receives, as a minimum, the following to effect timely start/stop of SCAADL payments: * Provide monthly OSD SCAADL report to OUSD P&R as required. * Submit requests for appeal of tier rating or non-eligibility determination to RCC. * Notifies RCC/NMCM when in receipt of VA Caregiver stipend or Aid & Attendance compensation within 90 days post DOS. * Unit Commander or Service Designated Representative (on G-Series orders) will: * Certify SCAADL eligibility on DD Form * Address eligibility discrepancies with the CMT. If not resolved, the RCC will raise concerns through AFPC/DPFW. *10.8. Payment Start or Change Determination. * The start of SCAADL payment is based on the date the physician certifies eligibility on the DD Form If there is a delay in processing, the effective date remains the day the physician signed the form. The Airman will be paid amounts owed in their first payment. Exception: if physician signs before hospital discharge date, the effective date of SCAADL will be the day after the date of discharge. * In most cases, changes to compensation due to relocation of the Airman will be processed, with the effective date of relocation, prior to DOS. Every effort will be made to inform AFPC/DPFW of new address and effective date prior to DOS. If relocation

11 occurs within 90 days after DOS, inform AFPC/DPFW to determine if change of rate is appropriate. * AD Airmen will receive SCAADL as part of their normal twice-monthly pay; payment is taxable. * ARC Airmen not on Title 10 or Title 32 orders will receive SCAADL once a month towards the end of each month; payment is taxable. * Change of SCAADL payment may result in a debt to the Airman. *10.9. Payment Termination Determination. * CMT members assess for and request termination if the Airman no longer meets SCAADL eligibility. The Airman or designated guardian must be informed of termination and be afforded the opportunity to appeal, if appropriate. * AFPC/DPFW will be informed if VA Caregiver stipend or VA Aid & Attendance compensation is in place during 90 days post-dos to determine if remaining SCAADL compensation is to be terminated. * AFPC/DPFW will terminate SCAADL payment if reevaluation is not received by the 180th day, or by DOS, whichever comes first. * Termination of SCAADL payment may result in a debt to the Airman. * Appeals Process. * The Airman and/or designated guardian has the right to appeal the physician s or commander s certification on the DD Form * Once the Airman or designated guardian has indicated the desire to appeal, the DD Form 2948, a written statement justifying eligibility, and supporting medical documentation will be submitted to the RCC to begin the appeals process. RCC will submit the appeal package to AFPC/DPF for consideration. * The AFPC/DPF, with an advisory from a AFPC/DPFD physician, will review and provide the final results to the RCC to inform the Airman or designated guardian. This responsibility may not be delegated to a lower level to ensure objectivity in the review. (T- 1) AFPC/DPF s decision is final. * When the appeal decision is in the Airman s favor, AFPC/DPF will inform RCC that an evaluation is required through occupational therapy and/or behavioral health to determine the appropriate dependency level. A new SCAADL application package will be required.

12 * For appeals during a re-evaluation, the submitted reduction or termination will be processed while the appeal is being reviewed to avoid possible debt to the Airman. The effective date will be processed with no gap in payment to the Airman (prorated back to reduction or termination date). * Change or termination of SCAADL payment may result in a debt to the Airman. * DELETED * DELETED *12.1. The Air Force Adaptive Sports Program: Motivates, encourages and sustains participation and competition in adaptive and recreational sports and activities among the active or Temporary Disability Retired List (TDRL) wounded, injured, and ill Airmen of the US Air Force during their earliest stages of recovery. *Chapter 15 *SERVICE DOGS AND EMOTIONAL SUPPORT ANIMALS *15.1. Policy. This chapter implements policy for the use of service dogs and emotional support animals by Airmen who have been clinically classified as disabled due to wounds, illness or injury, as authorized by DoDI , Guidance on the Use of Service Dogs by Service Members, or who, on a physician s or therapist s recommendation, are recommended to have a service dog or emotional support animal to assist with coping with everyday life circumstances. Recovering disabled Airmen who have medical conditions that clinically require the assistance of a service dog or an emotional support animal for activities of daily living, may utilize service dogs on AF installations, if approved through the procedures outlined in this chapter. Additionally, authorized service dogs may be used on AF installations by all service members and their family members, regardless of service component or duty status. * This chapter applies to service dogs and emotional support animals only. However, emotional support animals are not granted the same rights as service dogs under the Americans with Disability Act (ADA), therefore, parts of this chapter may relate only to service animals. Animals trained to assist members with PTSD or other psychological illness will be considered service dogs for the purposes of this instruction. * This chapter does not apply to privately owned pets, except where those pets meet the qualifications, licensing and/or certification as a service or therapy animal. Standards for non-service animals are governed by AF Standardized Pet Policies, and in accordance with AFI , Family Housing Management, AFI , Privatized Housing Management, and installation pet policies.

13 *15.2. Definitions. * Service Dogs. A service dog is defined by the ADA as any dog trained to provide support to individuals with physical, cognitive or psychological disabilities. A service dog is individually trained to do work or perform specific tasks for the benefit of an individual with a disability. * To qualify, service dogs shall be adopted by service members in accordance with Section 2583 of Title 10, United States Code, from an accredited service dog organization approved by the U.S. Department of Veterans Affairs (VA). * The work or task a dog has been trained to provide, must directly relate to the person s disability. Generally, Airmen requiring a service dog are expected to require the service dog for an extended period of time, often for life. A service dog usually undergoes a period of training with the service member who will receive it. * Service Dogs in Training. Service dogs in training, who are undergoing a period of training designed to lead to their ultimate designation and employment as a service dog, may be approved at the discretion of the Installation Commander if the training supports a VA recognized and accredited organization. NOTE: An Airman is not authorized to train his/her own service dog. * Emotional Support Animals. Animals that provide therapeutic benefits to their owner through affection and companionship. * Disability. Disability is defined by the Americans with Disabilities Act as a physical or mental impairment that substantially limits one or more major life activities." * Handler. For this chapter, the term handler refers to the individual found eligible for a service dog, and who has obtained a service dog to assist with their disability. *15.3. Functional Area Responsibilities. * AF Warrior and Survivor Care Office (A1SAZ). * Will provide service dog and emotional support animal policy education and training. * Will assist with coordinating support and services from non-profit agencies and non-governmental organizations in execution of this policy, in accordance with DoD R, The Joint Ethics Regulation. * Installation Commanders. * Will ensure Airmen with assigned service dogs are granted facility access and accommodations to the greatest extent possible, commensurate with health and safety.

14 * Will ensure installation housing standards and future housing projects, meet obligations under the Fair Housing Act, Section 504 of the Rehabilitation Act of 1973 (Section 504), and the ADA with respect to service dogs providing assistance to individuals with disabilities. * Will establish designated service dog/emotional support animal relief areas at every AF installation to the greatest extent possible, commensurate with health and safety. * Relief areas should be accessible to and accommodate all persons with disabilities. They should be a minimum of 60 square feet of grass surface, with a trash receptacle, pick-up bags, a water source, drainage, and signage about use and responsible behavior. * Will not restrict service dogs or emotional support animals from staying with their handler in installation lodging and housing facilities. * Unit Commanders. * Participate in CMT suitability assessments to recommend or non-recommend an Airman be assigned a service dog or emotional support animal. * Documents recommendations, along with any recommended limitations on the use of a service dog or emotional support animal. * If an Airman is not approved for a service dog or emotional support animal by the Unit Commander, the Unit Commander will provide a written rationale and forward it to be reviewed by the first general officer in the Airman s chain of command. * Must counsel the member on facility access and other related issues before an Airman is assigned a service dog or emotional support animal. * Primary Care Managers. * Identifies Airmen as potential candidates for a service dog or emotional support animal. * Provide guidance to case management team members and Commanders on the medical benefits, applicability and appropriateness of service dogs or an emotional support animal based on the member s medical diagnosis. * Make recommendations to CMT as to whether Airmen are eligible and suited for a service dog or emotional support animal based on condition and treatment plan.

15 * Provides a clinical recommendation regarding the Airmen s condition and specific details related to the Airman s goals, abilities, and appropriateness of a service dog or emotional support animal. Presents the rationale for PCM recommendation to the CMT. * Responsible for registration, identification and badging requirements for service dogs or emotional support animals. * Will notify the RCC of their recommendation to provide a service dog or emotional support animal. * RCC refers the Airman to an accredited service dog organization in order to evaluate the Airman s suitability for a service dog. This assessment determines whether the accredited service dog organization will provide a service dog to the Airman. * RCC receives the results of the accredited service dog organizations suitability assessment and discusses with the PCM and CMT. * Case Management Team. * Weighs all matters deemed appropriate in the Airman s specific circumstances, and provides pertinent information to facilitate the PCMs decision to recommend or nonrecommend a service dog or emotional support animal. * Before reassigning an Airman with a service dog, ensure that laws pertaining to animal quarantine or other restrictions at the gaining location will not interfere with the Airman s access to, or use of the service dog. If retained on active duty, the Airman cannot depart until all requirements are met for the gaining location. * Guidelines for Airmen Found Eligible for Service Dogs * Must be financially able to take responsibility for a dog, including annual vaccinations, dog food, dog toys, and veterinary care. Many of the VA accredited agencies do not charge for the dog or the dog's training. * The member must be able to take responsibility for a dog or have someone designated and able to address this responsibility. The member must be able to meet the emotional, and physical needs of the service dog and have a strong desire to actively improve their quality of life and independence with their service dog. * Must register the service dog with their MTF, and ensure that proper service dog identification is clearly displayed. * Will enforce proper service dog behavior, maintain animal health standards, and adhere to limitations imposed by the chain of command, as appropriate.

16 *15.4. Eligibility and Procedures for Requesting a Service Dog * An Airman may be identified as potential candidate for a service dog by his/her primary care manager (PCM). Other medical providers familiar with the Airman, must make their recommendation for a service dog to the member s primary care manager. Airmen who believe they are potential candidates to receive a service dog may request one from their PCM. * An Airman s case management team evaluates and determines that a service dog may mitigate the Airman s disability. Each service dog request is reviewed and evaluated on a case-by-case basis. * Airmen with a documented disability, may request the assistance of a service dog in order to enhance their independence or their quality of life. Service dog programs are designed to help individuals with a wide range of disabilities and each case is reviewed and evaluated by the Airman s PCM for candidates of the service dog program. * Each case is reviewed and evaluated by the Airman s PCM for the following: * Ability and means (including family or caregivers), to care for the dog currently and in the future. * Goals to be accomplished through the use of the dog. * Goals to be accomplished through other assistive technology or therapy. * The PCM will convene the Airman s CMT, and any members necessary to enable an informed decision on the applicability of a service dog, to consider whether a service dog is required in light of the Airman s medical condition, whether the Airmen is suited for a service dog, and whether any limitations should be placed on the use of the service dog (such as areas where a service dog may not accompany an Airman). They will also consider whether appropriate accommodations are available for the Airman and service dog, and any other matters deemed appropriate for consideration. * The PCM will notify the CMT of their recommendation. * If the CMT does not recommend a service dog for the Airman or cannot reach a consensus, the PCM will refer the team s recommendation, rationale, and viewpoints to the MTF Commander (or equivalent) for review. The MTF/CC will consider the points of view of the CMT in making a recommendation and will provide written rationale for his/her recommendation. * The PCM will determine the need and will notify the member s chain of command.

17 * Each Commander must document his/her recommendation as to whether the Airmen should or should not receive a service dog, and any recommended limitations in addition to those outlined by the Airman s CMT. Considerable weight will be given to the clinical recommendations of the CMT or MTF/CC. * If the O-6 or GS-15 approves the recommendation for a service dog the decision is final, and the decision will specify any limitations on the use of a service dog. * If the O-6 or GS-15 disapproves the recommendation for a service dog, he/she must provide a written rationale for the decision. * If an Airman is not approved for a service dog by their PCM, the denying official must provide a written rationale for review by the MTF commander. * The reviewing official will provide their written decision for the conclusion to overturn or uphold the PCM determination. The Airman may appeal the decision to the Wing/CC or equivalent, whose decision will be final. * Upon receipt of a recommendation, the PCM will notify the Airmen of the final decision. * The PCM will ensure the Airman has an existing permanent profile or will immediately assign such a profile. * The PCM will ensure the Airmen is in the IDES or is immediately referred to the system. * For Airmen not already enrolled in the AFW2, the Unit Commander shall refer them to the local Recovery Care Coordinator to get enrolled. *15.5. Procedures for the Acquisition of Service Dogs * The CMT will work with the Airman to obtain service dogs from an accredited organization that is recognized by the VA. The AF does not provide service dogs. * Eligible veterans may be authorized certain VA benefits related to recognized service dogs such as payment for veterinary care and equipment required for optimal use of the dog. Dogs acquired from unapproved sources, may not qualify as service dogs and may be ineligible for VA benefits. *15.6. Service Dog Installation Access and Control * Service dogs generally must be allowed to accompany their handler into all installation facilitates that are considered public or unrestricted, including, but not limited to, hospitals, treatment facilities, recreational facilities, lodging facilities, fitness facilities,

18 and establishments that sell or prepare food, even if state or local health codes prohibit animals. * It may be appropriate to exclude service dogs from areas for readiness, mission accomplishment, or safety, sterile environments, or areas with specific infection control standards. * A service dog handler cannot be asked to remove his/her service dog from the premises unless the dog is out of control or the handler does not take effective action to control it. * The service dog must be harnessed, leashed, or tethered unless these devises interfere with the service dogs work or the individual s disability prevents using these devices. In that case, the service dog handler must maintain control of the animal through voice, signal or other effective controls. * Third party allergies or fear of dogs are not valid reasons for denying access to service dogs. * When a person who is allergic to dog dander and a person who uses a service dog must spend time in the same room or facility, they both should be accommodated by assigning them to different locations within the room or facility, if possible. * Disabled Airmen who use service dogs, cannot be isolated from their coworkers, treated less favorably than their coworkers as a result of their having a service dog. *15.7. Specific Rules Related to Service Dogs * To the extent permitted by law, Airmen may be held responsible for any damages and injuries a service dog may cause. * Airmen are required to control their service dogs and may be prohibited from bringing the dog on the installation if the dog is uncontrollably disruptive in the workplace or any other area of the installation, or is aggressive in any way toward people or other animals. * Airmen whom a service dog is recommended for, are not deployable. * It is unlawful to ask about an Airman s disability, require medical documentation, require a special identification card or training documentation for the dog or ask that the dog demonstrate performing its work or task. When it is not obvious what service a service dog provides, the disabled Airman is not required to answer questions other than: Is the service dog required because of a disability? And, what work or task has the dog been trained to perform?

19 * Airmen who acquired their service dogs before the publication of this instruction, must provide their PCM or CMT and Commander, the suitability assessment and medical necessity documentation for their service dog within 60 days of the effective date of this instruction. *15.8. Specific Rules Related to Emotional Support Animals * Airmen diagnosed with a cognitive or mental health condition, with a written prescription from a mental health provider that identifies the need for them to have an emotional support animal, reasonable accommodation should be provided in accordance with this chapter. * The installation commander has discretion in allowing the use of emotional support service animals to support Airmen. * Three keys to assisting commanders with the decision are, the emotional support service animal must be prescribed in writing by a mental health provider; the service animal must be trained and certified by a nationally accredited organization; and the animal must not interfere with the execution of the unit s mission. * The privilege to bring any service animal into a unit may be revoked without prior notice if the animal proves to negatively impact mission effectiveness, threatening to others, causes harm, or impacts allergies of other members. *Chapter 16 *EMERGENCY FAMILY MEMBER TRAVEL (EFMT) PROGRAM *16.1. EFMT Program Purpose. To implement and execute travel and reimbursement processes for the Air Force Casualty EFMT program for all eligible designated travelers as authorized by Title 37 USC 411h and administered per the Joint Travel Regulation (JTR), paragraph 7315; DoDI , DoD Personnel Casualty Matters, Policies and Procedures; AFI , Casualty Services; and AFI , Patient Administration Functions. *16.2. The Air Force provides round-trip travel and Per Diem for up to three eligible designated travelers, as authorized by Military Treatment Facility (MTF) commanders and approved by the Air Force Casualty (AFPC/DPFCS) program, to travel to bedside for VSI, SI, or Hostile Not Seriously Ill/Injured (NSI) Airmen to assist with their health and welfare. *16.3. Applicability. This guidance applies to both RegAF and ARC Airmen who have an injury or illness that was incurred or aggravated in LOD and meets the criteria outlined in AFI , Section It also covers civilian employees serving in an unaccompanied duty station IAW JTR section 7322 and Appendix Q.

20 *16.4. EFMT Notification. Upon official notification and authorization from AFPC/DPFC, including initial and extension requests, AFPC/DPFW will coordinate initial and round-trip transportation, Per Diem, travel orders, and maintain EFMT case records IAW the JTR (section 7315). *16.5. Initiating an EFMT Case. AFPC/DPFW will initiate an EFMT case once authorized by AFPC/DPFC within the Defense Travel System (DTS). * DTS Responsibilities: * Organization Defense Travel Administrator (ODTA). Initiates and builds profiles for each EFMT traveler within DTS. * Non-DTS Entry Agent (NDEA). Responsible for the following actions: * Making contact with travelers to arrange travel to and from bedside within DTS, or arrange travel with the after-hours travel agency, and provide traveler with initial and amended travel orders as appropriate. * Arrange passport appointments for each traveler (if applicable). * Monitor traveler s trips to and from bedside. * Provide reimbursement package to traveler upon final return trip to home location. * Complete voucher process within DTS. AFPC/DPFW will manage the EFMT voucher process and reimburse travelers for any applicable travel costs and Per Diem allowable IAW JTR. Once the traveler has completed all applicable travel and returns to their home location, AFPC/DPFW will send a reimbursement package to the traveler. * Close EFMT case upon completion once all reimbursement expenses have been paid. * Record all EFMT actions in Airman s case record within DoD-CMS. * Case Closure. AFPC/DPFW will close EFMT cases once all travel and per diem reimbursements have been provided to the traveler. * Reviewing Official (RO). Reviews all EFMT traveler information within DTS to ensure correctness, and submits to the AO for approval. * Authorizing Official (AO). Reviews all EFMT traveler information within DTS and approves/disapproves travel requests. *16.6. Vouchers.

21 * AFPC/DPFW will monitor for receipt of all applicable documentation from the traveler in order to complete the voucher process. * AFPC/DPFW will update DTS and submit the voucher claim to DFAS for traveler reimbursement of expenses. *16.7. Traveler Contact Hours. AFPC/DPFW will maintain reasonable contact hours when arranging travel for authorized designated travelers. *16.8. Auditing Procedures. AFPC/DPFW will maintain EFMT case records in order to comply with all applicable DTS audit requests. *Attachment 1 GLOSSARY OF REFERENCES AND SUPPORTING INFORMATION *References National Defense Authorization Act of 2008 AFPD 34-11, Warrior and Survivor Care Services AFPD 36-31, Personal Affairs AFI , Family Housing Management AFI , Privatized Housing Management AFI , Records Management Program AFI , Mortuary Affairs Program AFI , Public Web and Social Communication AFI , Casualty Services AFI , Officer Promotion and Selective Continuation AFI , Airman Promotion/Demotion Programs AFI , Line of Duty (LOD) Determination, Medical Continuation (MEDCON), and Incapacitation (INCAP) Pay AFI , Airman and Family Readiness Centers AFI , Physical Evaluation for Retention, Retirement and Separation AFI , Chaplain Corps Readiness AFI , TRICARE Operations and Patient Administration Functions AFMAN , Management of Records ANGI , Airmen Promotion/Demotion Programs DoD R, The Joint Ethics Regulation DoDI , Recovery Coordination Program DoDI , Guidance on the Use of Service Dogs by Service Members DoDI , DoD Personnel Casualty Matters, Policies and Procedures Joint Travel Regulations Title 10 USC 2583 Title 37 USC 411h TSGLI Website:

22 *Prescribed Forms None *Adopted Forms AF Form 847, Recommendation for Change of Publication AF Form 77, Letters of Evaluation (LOE) DD Form 214, Certificate of Release or Discharge from Active Duty DoD Form 2648, PreSeparation Counseling Checklist for Active Component Service Members DoD Form , PreSeparation Counseling Checklist for Reserve Component Service Members Released from Active Duty Form 2870, Authorization for Medical or Dental Information * Terms Adaptive Sports Program - ASP motivates, encourages and sustains participation and competition in introductory, recreational, and competitive rehabilitative sports and recreation events during the earliest stages of recovery for Airmen enrolled in the AFW2 program to enhance their recovery, rehabilitation, and quality of life. Airman/Airmen As used in this document refers to uniformed members of the active Air Force, Air National Guard, AF Reserves, and those individuals who are retired or medically separated due to an illness or injury incurred or exacerbated while serving in any component of the USAF. Airmen and Family Readiness Centers - A&FRCs provide programs and services to assist commanders in identifying, assessing, and preventing Airmen and Family Readiness related challenges to build and maintain unit cohesion and strengthen operational readiness. Care Management Team - The CMT is comprised of the Airman, the Airman s Commander, an RCC (and/or FRC), an MCM and an NMCM (as well as other medical professionals, chaplains and family support program representatives) and supports the implementation of the Airman s ICP. Disability Evaluation System - Disability law allows the SAF to remove those who can no longer perform the duties of their office, grade, rank or rating and ensure fair compensation to members whose military careers are cut short due to a service-incurred or service-aggravated physical disability. The DES ensures WII Airmen and their family member(s) receive quality, fair, and just care and benefits through a joint program between the DoD and VA. Emergency Family Member Travel - The Air Force provides round-trip travel and Per Diem for up to three eligible designated travelers, as authorized by MTF commanders and approved by the AFPC/DPFCS program, to travel to bedside for VSI, SI, or Hostile NSI Airmen to assist with their health and welfare. Family Liaison Officer FLOs are appointed to assist seriously ill and injured Airmen and their families and the families of Airmen who die while on active duty. FLOs help families of ill and injured Airmen navigate the various agencies involved in recovery, rehabilitation and

23 reintegration. In the case of Airmen who die while on active duty, FLOs may assist the family with navigating the various organizations necessary to receive entitlements and benefits. FLOs remain engaged as long as the family needs assistance. Federal Recovery Coordinator - Advises and assists in the advocacy navigation of DoD/VA health care and benefits for Active, Guard or Reserve Service Members or Veterans who have moderate to severe complex care needs. Interagency Comprehensive Plan - The single DoD approved care plan and is employed throughout an Airman s recovery, rehabilitation, and reintegration. Lead Coordinator - The LC is the case manager with the majority of contact with the WII Airman. Once the Airman receives separation or retirement orders, the LC transitions to the NMCM to provide the strongest support for transition. Medical Case Manager (MCM) MCMs develop an individualized plan of care and facilitate communication and coordination between members of the healthcare team. Medical Evaluation Board - Evaluates the Airman s medical history, condition, and extent of injury or illness, and recommends whether or not the medical condition will impede his/her ability to continue serving in full duty capacity in his/her office, grade or rank. Military Family Life Counselor - Trained, licensed professional counselors who provide short-term, solution-oriented consultations to individuals, couples, families, and groups. Military Treatment Facilities - A facility established for the purpose of furnishing medical or dental care to eligible individuals. Non-Medical Case Manager NMCM provides a wide range of flexible proactive personnel advocacy and services to support seriously ill or injured Airmen. These services include comprehensive information, assistance and guidance on all benefits/ entitlements for those remaining on active duty or transitioning back into the civilian sector. Additionally, they help resolve problems related to finances, benefits and compensation, administrative and personnel paperwork, housing and transportation and other matters that arise. Not Seriously Ill/Injured (NSI) - The casualty status of a person whose illness or injury requires medical attention, but may or may not require hospitalization, and medical authority classifies as less severe than SI. Operation Warfighter Program - OWF is a non-paid federal internship program for Airmen on active duty. The objective of OWF is to place Airmen in a supportive work environment to assist their rehabilitation and potentially increase career readiness while enabling federal agencies to better familiarize themselves with the skill sets and challenges of Airmen. Outreach, Communication and Marketing Program - Program focusing on increasing awareness and providing AF education on the AFW2 program services available to the WII

24 Airmen and their families and/or caregiver. The OCMP provides targeted and assessable program information to Airmen and their families and/or caregivers, the CMT, senior leaders, Public Affairs, non-government organizations, and non-profit organizations. Physical Evaluation Board - A fact-finding body investigating the nature, origin, degree of impairment, and probable permanence of the physical or mental defect or condition of any member whose case it evaluates. Physical Evaluation Board Liaison Officer - The PEBLO ensures disability cases referred to the PEB are complete, accurate, and fully documented, counsels evaluees concerning their rights in the disability process and maintains coordination with the member, medical facility, MPF, and HQ AFPC/DPPD. Post Traumatic Stress Disorder - PTSD is a mental health condition triggered by a terrifying event; either experiencing it or witnessing it. Recovering Airmen Mentorship Program - RAMP provides an avenue for the Airman to connect to someone that has experienced what he or she has, with similar injuries and recovery steps, AF background, rank, age, gender, geographic area, hobbies and interests. Recovery Care Coordinator The ultimate purpose of the RCC is to ensure that Airmen and families understand the likely path of the Airman s recovery, the types of care and services that will be needed and provided, and how much time recovery may take. RCCs oversee the development and implementation of the ICP and work with the MCM involved in various aspects of care for the Airman and advocate for the Airman across locations and agencies. Recovery Care Program - RCP provides non-medical support to seriously WII Airmen and their families and provides Airmen the skills necessary to return to self-sufficiency. Special Compensation for Assistance with Activities of Daily Living - SCAADL provides a special monthly compensation to permanently, catastrophically wounded, ill, and injured, and otherwise eligible, Airmen to compensate their designated caregiver for the time and assistance provided. Seriously Ill or Injured (SI) - The casualty status of a person whose illness or injury requires medical attention, and medical authority declares that death is possible, but not likely within 72 hours, and/or the severity is such that it is permanent and life-altering. Traumatic Brain Injury - TBI occurs when an external mechanical force causes brain dysfunction. Very Seriously Ill or Injured (VSI) - The casualty status of a person whose illness or injury is such that medical authority declares it more likely than not that death will occur within 72 hours

25 BY ORDER OF THE SECRETARY OF THE AIR FORCE AIR FORCE INSTRUCTION MAY 2015 Personnel WARRIOR AND SURVIVOR CARE COMPLIANCE WITH THIS PUBLICATION IS MANDATORY ACCESSIBILITY: Publications and forms are available on the e-publishing website at RELEASABILITY: There are no releasability restrictions on this publication OPR: AF/A1SAZ Supersedes: AFI , 21 June 2012 Certified by: AF/A1 (Robert E. Corsi, Jr) Pages: 56 This publication implements Air Force Policy Directive (AFPD) 34-11, Service to Survivors, Department of Defense (DoD) Instruction (DoDI) , Recovery Coordination Program (RCP), DoDI , Guidance for the Education and Employment Initiative (E2I) and Operation Warfighter (OWF), DoDI , Special Compensation for Assistance With Activities of Daily Living (SCAADL) and DoD s Military Adaptive Sports Program. This instruction also introduces elements of the Interagency Care Coordination Committee process for complex care management. It describes policy and procedures for the Air Force Warrior and Survivor Care program portfolio. It formalizes procedures for commanders and functional managers to provide non-clinical care and assistance to wounded, seriously ill and injured personnel and their families. It governs the training requirements for Family Liaison Officers (FLOs) and notional milestones for ensuring that information flow and family assistance is rendered in a timely and appropriate manner. It prescribes the operational framework for the Air Force Wounded Warrior (AFW2) Program to include the Air Force Recovery Coordination Program and provides operational guidance for Recovery Care Coordinators (RCC) and Non- Medical Care Managers. This instruction applies to commanders, managers, supervisors and functional staffs at all levels. It also applies to Air National Guard (ANG) and Air Force Reserve Command (AFRC) forces to the extent they are capable of providing required services; active duty commanders will provide support to ANG and ARC commanders as necessary to fully comply with all requirements. The authorities to waive wing/unit level requirements in this publication are identified with a Tier ( T-0, T-1, T-2, T-3 ) number following the compliance statement. See AFI , Publications and Forms Management, Table 1.1 for a description of the authorities associated with the Tier numbers. Submit requests for waivers