The Integrated Disability Evaluation System (IDES)

1. The Integrated Disability Evaluation System (IDES) MEB – Medical Evaluation Board PEB – Physical Evaluation Board Jeanne Stokes, RN, Case Manager 20130412

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5. Learning Objectives • Describe the purpose of the IDES process • Discuss five different ways to be referred to the IDES. • Differentiate the Medical Evaluation Board & the Physical Evaluation Board. • Analyze determinations made by the Physical Evaluation Board. • Compare and Contrast the Reserve Component and Active Component Physical Evaluation Board determinations.

6. Learning Objectives • Review the timeline of the IDES process. • Difference between AGR/ADOS and M-Day/Technician IDES board processing. • Purpose of RC SMSC. • IDES Checklist • Common Issues with IDES Boards.

7. IDES Overview • The Secretary of the Army is charged with ensuring the fitness of Soldiers, and separating or retiring those who become unfit to continue military service because of physical disability. • The Army's first priority for Soldiers suffering from an illness or injury is to ensure delivery of the highest-quality and proper medical attention.

8. IDES Overview • However, if the treating physician believes that a Soldier is unable to perform full military duty or is unlikely to be able to do so within a reasonable period of time (normally 12 Months), the Soldier is referred to the Integrated Disability Evaluation System (IDES). • IDES is used to objectively determine either “fit for duty” or “unfit for duty” and the applicable disability benefits (which are provided by law) for Soldiers with duty-related impairment(s).

9. IDES Overview • The United States Army Physical Disability Agency (USAPDA) manages the Army's IDES and acts on behalf of the Secretary of the Army. • It is important to understand that IDES is a performance-based system. Simply because a Soldier has a medical condition does not mean that the Soldier cannot continue to serve on active duty or in the Reserve Component.

10. IDES Overview • It is the impact of that medical condition upon the Soldier’s ability to perform duties appropriate to his/her rank and branch/MOS that is important.

11. IDES System • IDES is initiated by referring a Soldier through any of the follow five different routes: • 1. Medical Treatment Facility (MTF) • 2. Medical Administrative Retention Review (MAR2) • 3. Fitness for duty medical examination • 4. HQDA action • 5. Reserve component (RC) non-duty-related process

12. Medical Evaluation Board • The MEB is an informal process, and the board itself is comprised of at least two physicians who compile, assess, and evaluate the medical history of a Soldier and determine if the Soldier meets, or will meet, retention standards

13. Medical Evaluation Board • If the Soldier meets retention standards, the Soldier is returned to duty in their respective or current Military Occupational Specialty (MOS). • If the Soldier does not meet retention standards, the case will be referred to a PEB for further disposition and determination of fitness. (The MEB determines whether or not a Soldier meets retention standards;' it does not determine fitness).

14. Physical Evaluation Board • The USAPDA agency has three Physical Evaluation Boards (PEBs), located at Crystal City, VA (NCR) PEB); Ft. Sam Houston, TX; and Ft. Lewis, WA. • PEBs are administrative boards that determine whether a Soldier’s disability prevents his/her continued performance in the Army.

15. Physical Evaluation Board • The PEB is comprised of two types of boards: • Informal • Formal.

16. Physical Evaluation Board • Informal PEB • The MEB is initially reviewed by the Informal PEB. • A Soldier does not appear before the Informal PEB. This board conducts a review of the medical and non-medical evidence of record contained in the MEB.

17. Physical Evaluation Board • The first determination made by the PEB is whether or not the Soldier is fit to continue to perform his/her primary military duties. • If the Soldier is determined unfit, the PEB then decides whether or not the Soldier is eligible for disability benefits.

18. Physical Evaluation Board • Formal PEB • The Formal PEB is the Soldier’s opportunity, with the assistance of legal counsel, to present evidence, testimony and documents in support of his/her case. • The Soldier may appear in person and present evidence pertinent to the case.

19. Physical Evaluation Board • The Soldier can be represented by an appointed Judge Advocate General Corps (JAGC) attorney or counsel of his/her own choosing (a civilian attorney or a representative from a National Service Organization such as Disabled American Veterans). • If the Soldier elects to have civilian counsel, it will be at no expense to the government.

20. Physical Evaluation Board • The PEB makes the decision of fitness by balancing the extent of a Soldier's condition against the requirements and duties that the Soldier may reasonably be expected to perform in his/her current job skill. • The mere fact that one or more medical conditions exist does not necessitate an unfit determination. A Soldier with a serious medical condition can be found fit when the evidence establishes that the Soldier can perform his/her duties despite the condition.

21. PEB Determinations • Determinations made by the PEB process include: • Fitness or unfitness to continue military service; • Eligibility for disability compensation • Disability codes and percentage rating  • Disposition of the case; and • Whether or not the injury or illness meets combat-related criteria to qualify the Soldier for additional tax, employment, or other benefits.

22. PEB Determinations • Final approval authority for all PEB findings and recommendations rests with the USAPDA. • Note: If the AC Soldier is found unfit by PEB, he/she may request COAD. If an RC Soldier is found unfit by PEB, he/she may request COAR. The PEBLO will facilitate this request. Regulatory guidance for COAD/COAR is found in AR 600-40, Chapter 6. • Consideration for COAD/COAR is NOT the responsibility of the PEB. This is approved or disapproved by the State.

23. Reserve Component Soldiers • There is no difference in PEB case processing for an RC Soldier from that of an AC Soldier. RC Soldiers are entitled to the same PEB determinations and disposition recommendations. • RC Soldiers not on active duty who have non-service-connected conditions may be referred to the IDES under the non-duty-related process for a determination of fitness only.

24. Reserve Component Soldiers • The command decides whether to submit a case as "duty-related" or "non-duty-related." Cases referred under the non-duty-related process are not authorized MEBs; the MTF does not provide care for non-duty related conditions

30. AGR/ADOS vs. M-DAY/Technician • AGR/ADOS Soldiers referred for a permanent profile Fort Riley for a phase I and phase II physical to determine medical retention with a permanent profile three ways: • Commander request for MRDP evaluation. • PHA/SRP – provider referral. • MMPS for > 12 months.

31. AGR/ADOS vs. M-DAY/Technician • If P3/P4 profile rec’d, the Unit will be asked to complete the MEB packet by Case Management. • MEB packet and medical record will be forwarded to Fort Riley for MRDP evaluation. • If Soldier meets MRDP and is determined to fall below retention standards IAW AR 40-501 Ch 3, the MEB will begin.

32. AGR/ADOS vs. M-DAY/Technician • Soldier will be assigned a Physical Evaluation Board Liaison Officer (PEBLO). • Soldiers assigned PEBLO will contact the individual Soldier, Unit RNCO and Case Manager for MEB appointments and processing through the MEB/PEB.

33. AGR/ADOS vs. M-DAY/Technician • M-Day/Technician Soldier’s will be referred for evaluation by COL Danaher, NEARNG State Surgeon, for MRDP and permanent profiles three ways: • Commander Request for MRDP evaluation. • PHA/SRP – provider referral. • MMPS for >12 months.

34. AGR/ADOS vs. M-DAY/Technician • If P3/P4 profile rec’d, the Unit will be asked to complete the MEB packet by Case Management. • MEB packet and medical record will be forwarded to RC SMSC, Pinellas Park, FL for packet validation. • If Soldier meets MRDP and is determined to fall below retention standards IAW AR 40-501 Ch 3, and Soldier’s board packet is validated, the board packet and medical record will be forwarded to an MTF and the Soldier’s case will be assigned a PEBLO.

35. RC SMSC • The Reserve Components Soldier Medical Support Center (RC SMSC) was established in Pinellas Park, FL to improve visibility of and accountability for RC Soldier medical evaluation board (MEB) packets and to eliminate the backlog of RC medical cases that has resulted from delayed or incomplete packets. • The RC SMSC serves as a link between RC Soldiers and the Army medical system by providing administrative medical support by reviewing packets and entering them into the MEB process.

36. RC SMSC • RC SMSC is managed by the Army Reserve Medical Command and is a joint mission serving both Army National Guard and Army Reserve personnel. All States can now send packets to the facility to obtain administrative review, which will support improved access to the medical evaluation process for Reserve Component Soldiers.

37. RC SMSC • RC SMSC supports States and Soldiers in the following ways: • Reduces the MEB decision timeline for RC Soldiers from 3 years to as little as one year • Standardizes MEB packet requirements • Provides guidance to States for packets that are incomplete or missing documents • Reviews and validates packets, ensuring only qualified Soldiers enter the MEB process • Serves as a central location for all RC Soldier MEB records to be validated

39. MEB Duty Related Checklist

40. PEB Non Duty Related Checklist

41. Common Issues with Boards • Shelf life of a board packet is 6 months. On average it takes a Unit 6-9 months to complete a board packet. • LOD’s. RC SMSC requires a LOD for each LOD related illness or injury no matter when the illness or injury occurred. • A LOD must be completed for every diagnosis a Soldier is service connected by the VA unless proven otherwise. • A memo to the president of the board will be completed by CM for each SC Dx that is not duty related and submitted in the board packet.

42. Common Issues with Boards • Soldiers requesting a Formal LOD when referred to the Non Duty Related board for a Non Duty Related injury or illness as the Soldier does not have an LOD at the time of referral to the IDES. • Note: CM is able to provide most of the board packet requirements. All that is really asked by the Unit is to complete the DA Form 7652, Commander’s Performance and Functional Statement, LOD’s and missing documentation memos requested by CM. • It is possible to have a board packet completed in one weekend, providing the Commander is available, as this has been done before.

43. MRDP – CMD request or MMPS > 12 mos. And found unfit. Duty Related Non Duty Related SM elects to proceed through the MEB. SM elects to be medically separated by the state. SM MUST BE COUNSELED SM elects to proceed through the PEB, Fort Lewis for Fit or Unfit adjudication. SM elects to be medically separated. M-Day / Technician SM’s MEB packet is forwarded to Pinellas Park, FL for validation then forwarded to a MTF for MEB processing. AGR/ADOS SM’s MEB packet is forwarded to Fort Riley. Assigned a PEBLO and process for MEB. MEB appt’s complete. SM found FIT with P2 profile and returned to duty. MEB appt’s complete. SM found FIT with P2 profile and returned to duty. SM found fit, returned to military duty with P2 profile. SM appeals unfit with COAD / COAR. MEB appt’s complete. Med and BH NARSUMS and DA form 3947 complete with all Dx’s not meeting retention standards. MEB appt’s complete. Med and BH NARSUMS and DA form 3947 complete with all Dx’s not meeting retention standards. MEB packet forwarded to PEB, Fort Lewis for final adjudication and possible benefits. SM receives DA form 199 with disabilities and benefits. SM’s COAD / COAR request is denied by the State. SM is processed for separation. SM’s COAD / COAR request is approved. Returned to duty with P3 profile. To be re-evaluated if status changes or 5 years. SM receives DA form 199. SM has a right to appeal with or without a statement and medical documentation. SM has a right to a formal hearing. SM receives DA form 199. SM’s packet forwarded for separation orders SM found fit after appeal. SM either retained on COAD/COAR and P3 profile or SM retained with a P2 profile. SM found unfit after appeal and hearing. SM’s MEB/PEB packet forwarded for separation orders.

44. Point of Contacts For questions regarding the process of the IDES, please contact your State Deputy State Surgeon. IDES Website http://www.hrc.army.mil RC SMSC, Pinellas Park SGT James Burnside, Administrative NCO (727) 563-3963 james.g.burnside.mil@mail.mil MEB, Local MTF PEBLO PEB, Fort Lewis Mr. Woody Anderson, Admin officer (253) 968-4436 woody.anderson@us.army.mil

45. References • Medical Retention Standards • AR 40-501 ch 3 • Physical Evaluation for Retention, Retirement, or Separation. • AR 635-40 • Office of the Surgeon General (OTSG) (20120901). Medical Readiness Leader Guide, Version 2.o.