Secretary of the Navy Physical Evaluation Board (PEB)

1. Secretary of the NavyPhysical Evaluation Board (PEB) COMMAND OUTREACH BRIEF by Mr. Robert Powers President, Physical Evaluation Board (PEB) Secretary of the Navy, Council of Review Boards May 2014

2. DES Purpose • Twin Goals of the Disability Evaluation System (DES) are to: • “Maintain a Fit Fighting Force” capable of fighting battles and winning wars; and • - “Compensate Service Members”where their disability caused the termination of their military service.

3. MEB & VA C&P Exam PEB & VA Rating Service Headquarters MEB VA Proposed Rating (15 days) PEB Informal Board (15 days) Admin and Record transfer (15 days) OR Separate: PDRL TDRL w/ or w/out severance Return to Duty Separate/VA benefits Formal Board (30 days) VA Rating Reconsideration (15 days) Member with questionable fitness for continued service BCNR and/or VA Appeal Appeal (30 days) 100 days IDES Process Case transfer to PEB Independent Med Review Notice & Comment Case transfer to SV HQ MTF/MEB VA/C&P Exam Member Can Accept or Appeal 120 days 75 days

4. Organizational Structure

5. DoN PEB’s Mission • Adjudicate Marines’ & Sailors’ fitness for continued naval service in a fair and timely manner. • “Fair” in accordance with Statute and DoD & VA Regulations. • - “Timely” by delivery of a decision in less than 120 days in accordance with Integrated Disability Evaluation System (IDES) policy timelines.

6. DOD IDES Phases Service HQ PEB • - 9% Fit for Duty • 31% Separated • 36% TDRL • 23% PDRL • 1% Other MEB Member Injury/condition • - 1 Location (Washington DC) • 7,513 Cases Received: • 5,701 (Active Component) • 299 (Reserve Component) • 1,406 (TDRL Active Component) • 107 (Reserve Component) • - 1,007 Requested FPEB - 32 Locations

7. PART II. Leadership and Advocacy

8. Decisional Points/Seams w/in IDES Appellate MTF FPEB IPEB COMMAND

9. Three Decisional “Elements” to Every Case • Diagnosis/Condition • Diagnosis by itself does not make a Marine or Sailor unfit! • MOS specific duties and VASRD are the applicable rules; match the facts to the MOS duties to show fitness/unfitness & to VASRD for correct rating. • Ensure Medical Evaluation Board Report (MEBR) is comprehensive • Obtain a complete & well written MEBR & Medical Addendums • Match to specific MOS duty elements and to VASRD. • Non-Medical Assessment (NMA) • Show how condition impacts Marine/Sailor’s ability to function within their rank & MOS/rating (assigned occupation). • Commanding Officer/ unit commander assessments • Witness statements • Statement of Member’s Wishes • Obtain a Statement of Marine/Sailor’s true desire. • Describe medical condition’s impact on their ability to perform MOS/rating.

10. PEBs v. Chg in End strength1991 – 2013 (TDRL not included)

11. Local Issues/Concerns • Obtain Commander’s unbiased assessment via NMA and reduce waiting time for Command’s NMA submission; • Ensure timely issuance, delivery, and transfer of DD-214 to the VA. • Reduce MTF’s diagnostic burden by narrowing MEBR to explaining condition(s) impact on MOS; and • Prioritize Medical Exams/Addendums for PEB cases.

12. PART III. PEB Performance & Metrics

13. Performance in PEB Phase

14. Performance w/ PEB-VA Team Monitoring inventory

15. DON Performance for all Phases Below 295 Days!

16. USMC & USN Determinations FY13

17. PEB Total Case Timeliness (Last 6 months)

18. DoN Breakdown for FY13: • NewTDRL Periodic • Navy2478 515 • Marine 3191783 • Total 5669 + 1298 = 6967 • NewTDRL Periodic • Active5425 1204 • Reserve 24494 • Total 5669 + 1298 = 6967 • Top three most common conditions (broad categories): • #1: Musculoskeletal (e.g., Degenerative Disc Disease) • #2: Mental (e.g., PTSD, Bipolar Disorder) • #3: Neuropsychological (e.g., TBI) Combat Related (AC) 119 (5%) 870 (27%) 989 (17%) Combat Related (AC) 933 56 989

19. General Issues/Concerns • Approval & Assignment for increased Permanent Structure request to sustain IDES performance. • Monitoring/matching overall goals and expectations expressed by Senior Leadership through DoD Recovering Warrior Task Force. • Monitoring/meeting prospective impact on PEB case-load: • End Strength Drawdown • Improve case monitoring of the Limited Duty Program • Improve case monitoring of the TDRL Program • Obtaining an IDES enterprise Case Management System that encompasses: 1) e-file transfer; 2) case tracking; 3) document amendment/version control; and 4) provides permanent storage.

20. Physical Evaluation Boards: Goals and Guidance • Twin Goals: • Maintain a “Fit” Fighting Force • Ensure Service Members that are found unfit are compensated • PEB President’s guidance (For each referred condition) • Can they do their job? (Non-Medical Assessment) • How medical condition affects Service Member’s ability to perform in MOS/Rate • Service Member’s desire

21. Physical Evaluation Boards: Goals and Guidance • Our Approach: • Performance based • Service Member focused • Bottom Line: Do what is right, by law, institution, and Service Member

22. Physical Evaluation Boards: Process and Appeals • Integrated Disability Evaluation System (IDES) Process: • Physician triggered at Medical Treatment Facility (MTF) • Medical Evaluation Board Report (MEBR) of referred conditions • VA Comprehensive Compensation and Pension Exam (C&P) • Referred and Claimed conditions • MEBR completed by MTF • PEB determination of “FIT” vs. “UNFIT” • Referred conditions, also assess claimed conditions • If FIT- return to duty, UNFIT - to VA for rating • UNFIT SM’s medically separated or retired

23. Physical Evaluation Boards: Process and Appeals • Appeals • IDES Appeal: Formal motion for reconsideration / Formal Hearing • One time VA reconsideration for rating

24. Physical Evaluation Boards: VA Rating • VA rating for UNFIT Service Members • All conditions are rated • Referred Conditions (DoN funded compensation) • 30% or higher for referred conditions = Temporary Disability Retired List (TDRL) or Permanent Disability Retired List (PDRL) • Less than 30% = Separation with severance pay • VA covers all service connected claimed conditions

25. Physical Evaluation Boards • Each Board (Informal or Formal) consists of 3 Officers • Presiding Officer: USMC Colonel or USN Captain • Second Line Officer: USMC Col/LtCol or USN CAPT/CDR • Medical Officer: USN Captain or Commander • Line Officers: Have wide military experience, proven performance, and education • Medical Officers: Have wide cross section of clinical experience • “Strongly preferred” that the Presiding Officer be of the same service as the Service Member • Reservist (members): Each board of the PEB shall include at least one member who is a Navy or Marine Corps Reservist

26. Adjudicative Officer Tasks • Determine Fit or Unfit • Diagnosis or disability • Determine if Combat Related • Armed Conflict • Extra Hazardous Service: Flight duty, parachute duty • Conditions Simulating War: Obstacle course, endurance/reaction course, live fire training, MCMAP • Instrumentality of War: Injury caused by military weapon, accidents involving ship/combat vehicle, military ordnance • Combat Zone: Designated Hostile Fire/Imminent Danger Pay Area

27. Non-Medical Assessment (NMA) • Crucial document summarizing SM’s limitations & assessment of the Service Member’s performance of duty from the perspective of the Commanding Officer or Officer in Charge. • Emphasis on performance. Highlight the Service Member’s ability/inability to execute duties as required of MOS/Rate/paygrade • Describe how the Service Member’s impairments impact his/her ability to function within the command: • Specifically state what the Service Member can and cannot do: (PFT/PRT, CFT, Swim, MCMAP, Deploy, etc.) • Indicate how the Service Member was injured and include details for combat related and combat zone. (Incident/Aggravation) • Does the SM desire to continue his/her service? • CO’s/OIC’s comments should not be written like a FITREP/Eval

28. NMA Lessons Learned • NMA – CO/OIC needs to sign (“acting” acceptable) • Clarify abilities and potential in MOS/Rate • If not working in MOS/Rate, be clear about whether Service Member could or could not do his/her job if working in his/her MOS/Rate • Ensure Service Member’s intent! Is this what he/she truly wants? • Interview and personal statement from Service Member • Ensure assessment covers all referred conditions • Provide specifics for combat related and combat zone conditions per SECNAVINST 1850.4E (Who, What, Where, When, How) • NMA is a key document in making fitness for duty determinations - need to make them count

29. Take-Aways • Sound mind, sound body, poor performance/Not MEB • MEB is Physician triggered/not Service Member or command • PEB makes decisions based on information at hand • Case decided on Service Member’s current condition, not future • Know your Marines and Sailors/Occupational fields • Interview and personal statement from Service Member • Each case on its own merit • Command Responsibility – Remove the stigma • Commanding Officer’s perspective is crucial

30. Medical Evaluation Board vs Physical Evaluation Board • Medical Evaluation Board (MEB): • Initiated at Military Treatment Facility (MTF) by two medical officers • Determination of limited duty • Potentially the need for submission to PEB for determination of FITNESS • Physical Evaluation Board (PEB): • MEB Report (MEBR) initiated at MTF, referred to PEB for determination of FITNESS • One medical officer and two line officers review informal level

31. Medical Evaluation Board vs Physical Evaluation Board • Service Member appear at “Formal” with counsel when outcome of informal ruling is disputed or PEB mandates hearing • Higher appeals process includes a Petition for Relief (PFR) and Board for Correction of Naval Records (BCNR)

32. When Physician(s) initiates PEB: • Diagnosis is a potential disability: • Medical doctor’s expert medical opinion the Service Member has a condition that will impede ability to perform in MOS/Rate • or has a condition that imposes an extraordinary burden on service to protect the Service Member (e.g. use of Humira) (or condition not compatible with continued service, e.g. psychosis) • Prolonged illness or course: Condition will require two or more six-month periods of limited duty before the Service Member can return to full duty including world wide assignment and deployment • Service HQ directed: Board directed based on serial periods of limited duty and or inability to assign Service Member worldwide

33. Do not initiate PEB when: • Service Member requests PEB • Mere presence of a diagnosis does not equate to a disability • Member fails PRT • Previous and current PRT instructions do not mandate a PEB for PRT/BCA/PFT/CFT failures • Member is pending elective surgery on referred condition • If surgery may alter decision or rating – Does not apply to urgent and required procedures (although elective surgery may not be allowed during IDES process)

34. Potential Outcomes of PEB • FIT: Service Member reasonably can perform duties of MOS/Rate • UNFIT: Service Member cannot perform duties of MOS/Rate • Presumed FIT (PFIT): In “presumptive period” and have a functional impairment that is minor and would not cause career termination – Generally overcome by grave illness or not in MOS/Rate prior to being PFIT • Conditions not considered a Disability: (e.g. ADHD, alcoholism) • Category II:Contributes to Service Member’s unfitting condition but independently unfitting • EPTS: Less than 8 years of service, genetic condition (origins that began prior to service and within natural progression - was not service aggravated)

35. What determines outcome? • Medical evidence: • Cannot perform in MOS/Rate, not compatible with service, imposes extraordinary burden on service to protect Service Member • Non-Medical Evidence: • Ability and or Inability to perform in MOS/Rate, PFT/CFT, deploy, or WWA • Member’s wishes: • FIT or UNFIT, possible PLD

36. Essential Components of Medical Evaluation Board Report (MEBR) • Why was the Service Member referred? • Clear and differentiated from claimed conditions and requires input from referring provider whose expertise led to the original referral • Service Member’s compensation from the PEB is determined by career ending condition • How the Service Member’s condition might impact ability to do MOS/Rate? Specific impairment of duties, or need for medication and or frequent medical supervision placing a burden on service, or condition not compatible with continued service

39. Non-Medical Assessment (NMA) Importance to Medical Officer • PFT/CFT: If not performed, why specifically? • Why is Service Member not in MOS/Rate? Please be specific, e.g. Service Member being referred for PTSD and NMA states not in MOS/Rate only due to “physical reasons” or “medical reasons” • Diagnosis does not mean disability: Key to know details of how diagnosis impairs ability to function in MOS/Rate, not just “at medical all the time” • Know what diagnoses are being referred: Not uncommon for us to see NMA only discussing one issue when multiple diagnoses are referred into the IDES

40. Physical Evaluation Board Liaison Officers (PEBLO) PEBLO – Local interface between Service Member/Command and IDES Process Military Treatment Facility PEBLOs work the Medical Evaluation Board process PEB PEBLOs work the Physical Evaluation Board process Coordinates correspondence between Service Member and PEB Conducts Integrated Disability Evaluation System Consultation Course and counseling

41. Typical Delay Points Package Paperwork Ensure Service Member is getting to appointments and NMA is complete, accurate and timely Service Member Election of Options Limited Duty Coordinator must be plugged in with PEBLO Formal Boards Commands need to be engaged with travel process for the Service Member Separation Commands must ensure Service Member completes all mandatory separation steps

42. Questions?