Disability Evaluation Systems (DES) 1
DES 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 2
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 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 31 August: more than 208,000 Service members have been referred into the DES since Nov 2007 3
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 4
Reasonable Performance of Duty Common Military Tasks: Whether the Service member can perform the common military tasks required for the Service member s office, grade, rank, or rating including those during a remaining period of Reserve obligation. Examples include routinely firing a weapon, performing field duty, or wearing load-bearing equipment or protective gear. Physical Fitness Test Deployability: Whether the Service member is deployable individually or as part of a unit, with or without prior notification, to any vessel or location specified by the Military Department. When deployability is used by a Service as a consideration in determining fitness, the standard must be applied uniformly to both the AC and RC of that Service. Special Qualification: 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; or reclassification or reassignment is feasible. 5
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 6
DES Major Elements (Con t) 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) Findings 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 7
Fit -- Service member return to duty Unfit DES Determinations 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) o Pre-existing condition not permanently aggravated by Service o Separated due to a disability resulting from intentional misconduct o Willful neglect, or disability incurred during a period of unauthorized absence 8
Disposition Trends 2003 2015 Disposition Percentage 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 NDAA 08 and DES Pilot/IDES 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 RTD 23.6% 18.6% 20.0% 20.2% 19.9% 17.0% 13.4% 12.6% 10.4% 11.3% 7.9% 5.8% 5.1% Separated 57.1% 62.3% 59.8% 55.5% 52.2% 45.3% 36.9% 33.2% 32.5% 32.3% 28.4% 27.4% 28.2% PDRL 3.7% 3.8% 4.1% 5.0% 6.5% 10.3% 13.5% 21.8% 27.6% 26.6% 35.6% 42.5% 42.5% TDRL 15.6% 15.4% 16.2% 19.3% 21.5% 27.3% 36.2% 32.3% 29.5% 29.8% 28.1% 24.3% 24.2% RTD Sep TDRL PDRL 9
Legacy DES (LDES) DoD-only process for evaluating Service members fitness due to disability MEB determines whether Service member meets medical retention standards PEB determines whether Service member is fit for duty, the appropriate VA Schedule for Rating Disability (VASRD) rating for unfitting condition(s), and the appropriate disability determination October 2015, USD (P&R) authorized Military Departments could direct and Service members could request, on a case-by-case basis, processing through LDES when it is in the best interest of the Service or Service member Replaces May 2015 USD(P&R) memo granting Departments of the Army and Air Force authority to process Initial Entry Trainees through the LDES Military Departments published implementation guidance Legacy DES Timelines (excluding Service member transition) Active/Reserve Component duty-related cases 70 calendar days from the date the provider completes the MEB narrative summary to the date the review authority makes a determination, excluding appellate review Non-duty related cases 130 days from the date of administrative review by the designated RC medical authority of the medical information that causes the disqualification and ends with the date of the PEB decision 10
Integrated DES (IDES) Integrates DoD s and VA s disability processes VA conducts medical evaluations and provides disability rating(s) DoD determines fitness and final disposition Sep 2011, IDES process became operational across DoD MEB determines whether Service member meets medical retention standards PEB determines whether Service member is fit for duty and the appropriate disability determination o VA determines disability ratings for unfitting / service-connected conditions o Service member may request reconsideration of VA disability rating IDES Timelines Active Component cases 295 calendar days from date of referral to the DES to the point of return to duty or notification of VA benefits decision Reserve Component cases 305 calendar days from the date of referral to the DES to the point of return to duty or notification of VA benefits decision 11
Temporary Disability Retired List (TDRL) Service members are assigned to the TDRL when the member meets the initial requirements for permanent disability retirement except that the disability is not determined to be stable but may be permanent 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 For cases involving a mental health issue resulting from a highly stressful event, Service members will be scheduled for an initial re-examination not later than 6 months from placement on TDRL Re-evaluation includes: VA or DoD 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 12
Service Member Rights 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 Appeal: Opportunity to appeal Informal and/or Formal PEB fitness determination Rating Reconsideration (Integrated DES): Request reconsideration of VA disability rating(s) Board for Correction of Military/Naval Records (BCMR/BCNR): Opportunity to request a correction of military records (disability determination) following separation 13
IDES Performance As of August 31, 2017, the IDES had 22,402 enrolled Service members: 18,668 from the Active Components and 3,734 from the Reserve Components Average time from referral into IDES to the date the Service member received VA benefits or was returned to duty: 248 days for Active Component in August 2017 (77% of cases met the 295-day goal) 305 days for Reserve Component in August 2017 (56% of cases met the 305-day goal) IDES DoD-VA core processing performance for August 2017 DoD core processes: 94 for AC / 104 days for RC (105 day AC / 125 RC goals) VA core processes: 82 days for AC / 106 days for RC (100 day AC / RC goals) 14
Q2 17 Service Member Survey Results Review Percentages in red indicate those below the 80% goal 15
QUESTIONS Bret Stevens Director, Disability Evaluation Systems Health Services Policy & Oversight (Warrior Care Policy) bret.stevens1.civ@mail.mil 703-604-5642 16
DES References 10 USC, Chapter 61, Retirement or Separation for Physical Disability DoD Instruction 1332.18 Disability Evaluation System, August 5, 2014 DoDM 1332.18, Volume 1, DES Manual: General Information and Legacy DES Time Standards, August 5, 2014 DoDM 1332.18, Volume 2, DES Manual: Integrated DES, August 5, 2014 DoDM 1332.18, Volume 3, DES Manual: Quality Assurance Program, November 21, 2014 17