Headquarters US Air Force

Transcription

Headquarters U.S. Air Force
Integrity - Service - Excellence
Standards, Exams, I-RILOs, MEBs,
Profiles; Who comes up with this stuff?
An Approach to Team Management of Op Med
Lt Col Lynn G. Berry
Chief of Flt & Op Medicine Standardization
Maj David Miller
Chief of Physical Stds Policy Development
04 FEB 2015
1
Overview
•
Purpose
•
Background on Medical Standards
•
USAF Approach to Standards
•
Highlights from the other services
•
Team Approach to Management of Service Member Availability
•
Summary
•
Resources
2
Purpose
INFO: Provide the context for medical standards application
by the services and provide a common approach for
consideration in the future.
3
What are Medical Standards?

Medical standards (stds) are used to ensure a fit & ready force
 Certify to enter into service/specific duty
 Continued performance
 Stds really highlight conditions that MAY impair function

Different types of standards
 Accession (DoD)
 Deployment (DoD)
 Retention (Service Specific)
 Special Duty (Service Specific)
 Fly, Dive, Static Jump, HALO, Freefall, Undersea, etc.

Waiver authorities/process for most standards (service specific)
 Waive due to no limitation in function OR operational need
4
DoD Medical Standards

Accession Medical Standards Working Group (AMSWG)
 Co-led by OUSD/P&R and Health Affairs
 Meet 3-4 times/yr; service reps voting members
 MEPS, DoDMERB, waiver authorities
 DoDI 6130.03, Medical Standards for Appointment, Enlistment,
or Induction in the Military Services

For all DoDIs; services get input as policy rewritten/coordinated
 Ask for Subject Matter Expert (SME) input
 Services coordinate; concur, concur w/comments, nonconcur

DoDI 6490.07, Deployment-Limiting Medical Conditions for Service
Members and DoD Civilians

DoDI 1332.18, Disability Evaluation System (DES)
5
USAF Medical Standards

Retention and special duty standards established through Aircrew
Medical Standards Working Group

Listed in the Medical Standards Directory

If do not meet Medical Standards then…
 Waiver authority considers functional limitations
 AFI 48-123 describes functional requirements/waiver authority
 Retention; Considered a Trigger Event & provider must
 Refer to Deployment Availability Working Group (DAWG)
 Function in ASIMS (web-based IMR/profile program)
 Special Duty; Refer to SGP or Medical Stds Mgt Element (MSME)
 Future: Base Operational Medicine Cell (BOMC)
6
Sister Service empanels USAF

Obtain ASIMS access (details in references)
 Profiling, readiness & occupational health tracking application
 Cardiac Risk Assessment, Fitness Assessment scores
 Refer to DAWG function

Identify supporting USAF MSME (Future BOMC)
 Establish SOP for when/how to hand-off
 POC for all stds, SHPEs, profiles
 Can link with PEBLO and PH (PHA lead)

PCM of USAF Service Members
 Responsible for all narrative summaries/I-RILOs
 Empanel USAF = Complete I-RILO
 Complete assessments & examinations (PHAs, SHPEs, etc.)
7
USAF Medical Standards

Profiles (AF Form 469) from web-based program (ASIMS)
 Fitness restrictions (FR)
 Duty restriction (DR)
 Mobility restriction (MR)
 Templates currently available in ASIMS
 More detailed & evidence based coming

Assignment Limitation Code C (Code C)
 Does not meet retention stds; retained with Code C
 Number relates to medical needs, not always severity
 C1 & C2; Can deploy to some locs w/waiver from CoCOM
 C3; Rarely can get a deployment waiver
 Code C only occurs centrally after I-RILO
8
USAF Trigger Events
Refer to DAWG

Five trigger events ID Airmen that do not meet retention standards
 Providers; potential diagnoses that will require medical board
or assignment limitation Code C
 DAWG Surveillance Tracking
 Commanders request evaluation due to poor duty performance
or deployment concerns stemming from a potential medical
condition
 Central reviewers make requests (DPANM or ARC/SGP)
 After review of annual RILO with recommendation for MEB
 Cancellation of a deployment/TDY/PCS due to medical issue
Note: If access to ASIMS, then “Refer to DAWG” function can capture
PCM’s referral to the appropriate MSME.
9
AF MEB Process; Simplified View
MEB
Phase
TRIGGER
EVENT
DPANM (AD)
Review*
Separation
or
Retirement
PEB
Phase
(See Note)
IDES
DAWG
Medical
Monitoring
DAWG: Deployment Availability Working Group
DPANM; USAF Medical Standards Branch
(*ARC/SGP for ARC)
MEB; Medical Board (includes IDES)
Return to Duty with
or without Code C
PEB Phase; Informal Physical Examination Board
Note: Additional steps can occur between PEB
and separation/retirement/RTD
10
I-RILO versus Narrative
Summary

Initial Review-in-lieu of Medical Board
 USAF reviews all personnel centrally
 Evaluate functional limitations vs. other factors
 Critical to determine who we retrain
 Contains key information required for review (references)

Narrative summary
 If referred to IDES from DPANM or ARC/SGP
 After IDES C&P exam (5 duty days)
 Write addendum to I-RILO
 Address new diagnoses
 Any additional/updated information for the Informal PEB
 Address any disagreements between Unit CC and Provider
11
AF MEB Process; Simplified View
MEB
Phase
TRIGGER
EVENT
DPANM (AD)
Review*
I-RILO
Separation
or
Retirement
PEB
Phase
(See Note)
IDES
NS
DAWG
Medical
Monitoring
DAWG: Deployment Availability Working Group
DPANM; USAF Medical Standards Branch
(*ARC/SGP for ARC)
MEB; Medical Board (includes IDES)
Return to Duty with
or without Code C
PEB Phase; Informal Physical Examination Board
Note: Additional steps can occur between PEB
and separation/retirement/RTD
12
DPANM Variables for RTD
ARC/SGP or ANG/SGP as applicable

Prognosis of medical condition

Risk of sudden incapacitation/safety to member or team

Required medical specialists/frequency of visits

Required follow-up tests

Duty/deployment restrictions

Commander’s input

Lost duty days

Shortage of members in the field

Current level of training

Cost/length of training
Red indicates areas to
comment upon when
completing I-RILO. Also
must address any
disconnects with the
Commander’s Latter.
13
DoD MEB-IDES Timeline
Goal = 295 days
14
USA Profiles

Form used: DA 3349
 a.k.a. “Long form profile”
 Providers should be consistent
and detailed, but not too detailed
 HQDA EXORD 223-11, Army

Implementation of Electronic profile
(e-Profile) and ALARACT 205/2011
mandate conversion of all paper
(non-e-Profile generated) DA 3349s.

100% use of e-Profile is required – Hard
copy profiles are no longer valid

e-Profile automatically sends DA 3349 to
the Commander and updates MEDPROS
15
USA Profiles
Slide 16
Profile Types-Temporary

Temporary profile
 Definite endpoint
 Expectation is that the condition will improve or resolve
 No record APFT
 Unless Unit CC allows, stable temp conditions > 90 days
 No approval authority required
 e-Profile will enter into MEDPROS as a duty-limiting condition
 >30 days profile from original injury or illness
 Does not lead directly to a MEB*

Recurrent T profiles must show signs of progress
 Documented in Block 8 of the DA 3349

Recurrent T profiles may warrant a formal Fit-for-Retention
 Evaluation (FFRE), which may lead to an MEB or MAR2
17
18
Profile Types- Permanent

Permanent profile
 Indefinite endpoint
 Expectation is that the condition will NOT
 Improve or resolve to return to duty
 Or by one year from the date of injury or disease onset
 P profile is indicated when the Soldier has met his
 Medical Retention Determination Point (MRDP)
 For at least one condition
 Alternate APFT OK
 Approval authority required
 Mandates referral to MEB (if 3 or 4 level)
19
Physical Profiling – PULHES

PULHES
 Designation of general body area or system involved
P
- General or systemic problem
U
- Upper Body (from T-12 up)
L
- Lower Body (below T-12)
H
- Hearing
E
- Eyes
S
- Psychological

Only one (1) PULHES designation is needed per condition
20
Physical Profiling – Codes

Code designations (Block 2 of DA 3349)
 Reference is AR 40-501, Table 7-2
 Codes are limited to permanent profiles for administrative use
 Only are to be completed by the profiling officer
 Codes ARE NOT used for temporary profiles
 Up to three different codes can be listed

Code designations alert HRC assignments personnel
 about potential assignment restrictions
 HRC personnel are NOT medical personnel
 Selection of the codes is not intended to be used for
communication of medical information to the Soldier’s unit
21
USA Additional INFO
DD Form 689

“Sick Call Slip”

Handwritten or typed

DD 689 is “unit form”
 Not “hospital form”
 Not “get out of work free”

Restricted < 7 days
 MEDCOM MSG (June 2012)

Special considerations
 Can’t use for CON LV
 Cannot specify an alt APFT
DATE
INDIVIDUAL SICK SLIP
ILLNESS
INJURY
ORGANIZATION AND STATION
MEDICAL OFFICER'S SECTION
IN LINE OF DUTY
DISPOSITION OF PATIENT
DUTY
NOT EXAMINED
OTHER (Specify):
QUARTERS SICK BAY
HOSPITAL
REMARKS
SIGNATURE OF UNIT COMMANDER
SIGNATURE OF MEDICAL OFFICER
22
Profiles and Readiness
Injury
TREATMENT
Slide 23
USN/USMC Medical Standards

Sick In Quarters (SIQ) (non-work status)
 Not to Exceed 72 hrs
 Extensions up to 14 days
 OB related, different rules (OPNAVINST 6000.1c)

Convalescent Leave (non-work status)
 NTE 30 days
 Not charged as regular leave
 Maternity NTE 42 days
24

Light Limited Duty (LLD); medically restricted work status
 Max 30 day increments NTE 90
 Excused for performance of certain aspects of military duties
 New overlapping condition, NTE 90 consecutive days,
inclusive of convalescent leave
 Immediately returned to unrestricted duty or referral to a MEB
 Does not require a MEB
25

Limited Duty (TLD/LIMDU); medically restricted work status
 LIMDU period, maximum 6 months each, may be directed for
less (ex. LIMDU 2 months)
 2 periods maximum for enlisted without Service Headquarters
Approval
 All enlisted service member 3rd or subsequent periods for
LIMDU must receive Service Headquarters approval
 All Officer LIMDU must receive Service Headquarters approval
 Recommended by MEBR

PEB/IDES
 Direct PEB referral for Active Duty Service Members who are
not expected to be able to return to duty within 12 months.
26
Limited Duty Process Overview
Next
USN Limited Duty Overview
RTD
RTD
RTD
Addtn’l Periods of
Up to 90 days
Light Duty
PCM
30
Up to 6 months
TLD
(ACC 105)
MEB
30
TLD available
w/PERS Approval
Up to 6 addtn’l
months TLD
(ACC 105)
MEB
MEB
RTD
FIT*
IDES (executed by PEB) ACC 355
UNFIT
IDES: Not Fit and Not temporary
PEB: Looks at issue related to job
PLD
request
SEP
Mos 0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
A member is awarded TDRL if condition is
considered not stable for rating purposes.
PCM-Primary Care Manager
TLD-Temporary Limited Duty
MEB-Medical Evaluation Board
PDRL-Permanent Disability Retirement List
IDES-Integrated Disability Evaluation System
Legend
RTD-Return to Duty
SEP- Medical Involuntary Separation
TDRL-Temporary Disability Retirement List
PLD- Permanent Limited Duty
PPE- Periodic Physical Examination
17
TDRL
18
P
D
R
L
SEP w
severance
On TDRL, a SM is evaluated every 18
months with PPE. At each PPE
interval, the PEB makes a new
adjudication: Fit, Unfit. A final
disability rating must be made by 5
years.
*FIT members may be unsuitable for certain duties. A SM may not be administrated separated for a condition for which they were found fit.
Future Application
Four Key Questions

Does SM have a medical condition that limits their ability to;
1) Partake in desired activities off duty?
2) (FR) Participate in service fitness requirements?
3) (DR) Perform their assigned duties?
4) (MR) Deploy IAW DoDI 6490.07, Deployment-Limiting Medical
Conditions for Service Members and DoD Civilians

SMs confirm all 4 every visit (or note unchanged)

Provider responsible to address SM responses & validate
 Yes to last 3; need a service specific profile or document
disconnect (ex. asthma well-controlled and running)
 Yes to any of the 4; document care plan per service guidelines

Unit CC responsible know SM limitation to duty or deployment
 Not profiled; Contact Medical Team per service protocol
28
Future Application
Example

MSgt I.M. Heavy, 34 yo male medical technician, BMI=38, Dx Obesity
& Asthma x 3 yrs, on Flovent during spring & fall, rare use of
albuterol here to review PFTs. Answered questions per below
 Do you have a med condition that limits their ability to;

Partake in desired activities off duty? No.
 (FR) Participate in service fitness requirements? Yes.
 (DR) Perform their assigned duties? No.
 (MR) Deploy IAW DoDI 6490.07? Yes, Code C.

Med Tech presents following

Weight gain has been slowly increasing over 10 yrs
 Previous provider provided a Fitness Assessment (FA) restriction for
running and walking; Next FA in 3 months
 MSgt Heavy wants med renewal and renew last profile
 Currently a Assignment Limitation Code C-1 (I-RILO due 3 months)

What would you do?
29
Future Application
Example

Provider reviews nml PFT & shows 10 yrs BMI data
 Asks about physical activity & current diet
 Emphasizes I-RILO requires report of profiles over past year
 Another fitness restriction could become referral to IDES

Provider addresses positives in A/P
 Asthma; MR (Code C1), no FR or DR
 Instructs technician to collect all materials for I-RILO
 Obesity; cause for positive responses to Fitness Limitation
 No profile completed
 SM agrees to meet with dietician today
 Team to follow-up each week via secure messaging
 Leverage upcoming FA to assist to motivate life-changes
30
Summary

If you empanel SMs from another service, must be proactive
 In the future, it will get better…more clear

If you have a USAF question, find the MSME, SGP, or call
 Maj David Miller, (703)681-7563
 Really make contact with your supporting MSME
 Knowledge exchange; Discussion tab
 Questions are answered in 3 working days or less

USA and USN; references provided

All services; PCMs must document in AHLTA note
 SM fitness/duty/mobility limitations
 Be specific with expiration dates
31
USAF Resources

AFI 48-123, Medical Examinations and Standards



AFI 10-203, Duty Limiting Conditions


Medical Standard Directory (where all USAF are located)
https://kx2.afms.mil/kj/kx4/FlightMedicine/Pages/home.aspx
 Click on MSD in middle for most current version
 Click in left column MSD for historic and current version
Instructions on profiling system & provider responsibilities
DPANM Site (I-RILO templates under DAWG resources)

https://kx2.afms.mil/kj/kx8/AFPCMedicalRetentionStandards/Pages/home.aspx
Note: The AFMS Knowledge Exchange requires membership. Any DoD CAC holder
can gain membership. Otherwise will have to request membership and this can take
1-2 duty days if valid request.
32
USAF ASIMS Access

The ASIMS new user account request link is
https://asims.afms.mil/webapp/newaccount.aspx

Fill form out completely, select their clinic location from the list.
If they do not see their location, they can leave it blank and our
staff will contact them for clarification.

Depending on the location and how many local ASIMS
administrators it has, they will receive a response either same
day or within several days. If approved, they will receive an
automated email with login information.
33
USA Physical Profiling References
•
AR 40-501, Standards of Medical Fitness (14-Dec-2007,
RAR 04-Aug-2011)
http://www.apd.army.mil/pdffiles/r40_501.pdf
• HQDA EXORD 080-12, Army Disability Evaluation System
(DES) Standardization, 17 Feb 12
• MEDCOM OPORD 12-31, MEDCOM Implementation of
the IDES, 17 July 12
• DTM 11-015, Integrated Disability Evaluation System
(IDES), 03 May 12
• ALARACT 065/2011 HQDA EXORD 086-11 Warrior
Transition Unit Treatment Plan Oversight and MEB Referral
Reporting Process, 25 Feb 11
• DODI 1338.32, Physical Disability Processing, 10 July 06
• IDES Guidebook, Oct 2012
• AR 40-400 – http://www.apd.army.mil/pdffiles/r40_400.pdf
Slide 34
USA Resources

AR 40-501, Standards of Medical Fitness
 http://www.army.mil/usapa/epubs/pdf/r40_501.pdf.

AKO; Leader Guide for Profile Guidance
 [email protected]

E-Profile access

Army's Medical Readiness Web Data Entry (MWDE) application,
 Completing DD2875 & DD2929
 Submit to area Medical Readiness Coordinator (MRC)
 MEDPROS Help Desk; [email protected]
 (703) 681-4976 (761—DSN), (888) 849-4341 (Toll Free)
 See slides for regional personnel
 ASIMS interface; put data into ASIMS flows to MEDPROS
 Basic core IMR data will transfer
35
MEDPROS POCs
NRMC
WRMC
Japan
Korea
SRMC
WRA
MC
PRMC
For best results, view this PPT in “Slide
Show View” – then Click on RMC links
below to jump to a specific RMC Map
(click “Return” at bottom left of each RMC
map to return to this page.
MEDPROS Help Desk
(703) 681-4976 (761—DSN)
(888) 849-4341 (Toll Free)
[email protected]
Pacific RMC
Western RMC
Southern RMC
ERMC
Northern RMC
Europe RMC
36
MEDPROS POCs-CONUS (NRMC)
FT Belvoir, VA
NRMC Readiness Branch
Crystal Smith
Com: (703) 545-9162
[email protected]
FT Knox, KY
Daniel Minnick
Com: (502) 624-9527
DSN: 464-9527
[email protected]
Bethesda, MD
Donnie Nieves
Com: (301) 295-2666
[email protected]
FT Bragg, NC
Tammy Huddleston
Com: (910) 396-6516
[email protected]
FT Lee, VA
Angela Harris
Com: (804) 734-9583
DSN: 687-9583
[email protected]
FT Belvoir, VA
Selena Blount
Off: (703) 805-0541
BB: (571) 606-6713
[email protected]
Return
37
MEDPROS POCs-CONUS (SRMC)
FT Hood, TX
Stacey Daniels
Com: (254) 286-7235
DSN: 566-7235
[email protected]
FT Campbell, KY
Lew Long
Com: (270) 412-0422
DSN: 352-0422
[email protected]
FT Gordon, GA
Claudio Carrasco
Com: (706) 787-0627
DSN: 773-0627
[email protected]
Tyrone Ward
Com: (254) 288-4590
[email protected]
JBSA, TX
SRMC Readiness Branch
Mike Burley
Com: (210) 295-2323
DSN: 421-2323
[email protected]
Jackie Smith
Com: (210) 295-8626
DSN: 421-8626
[email protected]
FT Stewart, GA
Tawanna Campbell-Watts
Com: (912) 435-5296
DSN: 475-5296
[email protected]
FT Benning, GA
Cynthia Borel
Com: (706) 545-9688
DSN: 835-9688
[email protected]
Return
38
MEDPROS POCs-CONUS (WRMC)
FT Carson, CO
Joel Beall
Com: (719) 524-4669
DSN: 884-4669
[email protected]
Joint Base Lewis-McChord, WA
Paula Walker
Com:(253) 968-4672
DSN: 782-4672
[email protected]
basic core IMR data will transfer
FT Bliss, TX
MAJ John Burr
Com: (915) 742-8018
[email protected]
Return
FT Leonard Wood, MO
Christopher Clayton
Com: (573) 596-0131 Ext 63752
DSN: 581-3752
[email protected]
FT Riley, KS
Kim Foreman
Com: (785) 240-6580
DSN: 520-6580
[email protected]
COL Kevin Sharp
Com: (915) 742-7404
[email protected]
39
USN References
 SECNAVINST
1850.4E, DON,DEM
http://doni.daps.dla.mil/Directives/01000%20Military%20Personnel%20Support/01800%20Millitary%20Retirement%20Services%20and%20Support/1850.4E.pdf
 OPNAVINST
6110.1J (physical readiness standards)
http://doni.daps.dla.mil/Directives/06000%20Medical%20and%20Dental%20Services/06100%20General%20Physical%20Fitness/6110.1J.pdf
 MANMED
Chapter 1, Chapter 15; Med Exams, Chapter 18; MEBs
http://www.med.navy.mil/directives/Pages/NAVMEDP-MANMED.aspx
 MILPERSMAN
1301-225, Officer Special Assignments
http://www.public.navy.mil/bupers-npc/reference/milpersman/1000/1300Assignment/Documents/1301-200.pdf
 MILPERSMAN
1306-1200, LIMDU
http://www.public.navy.mil/bupers-npc/reference/milpersman/1000/1300Assignment/Documents/13061200.pdf
 BUMEDINST
1300.2, EFMP
http://www.med.navy.mil/directives/ExternalDirectives/1300.2A.pdf
 NAVADMIN
014-14, LIMDU Process
https://www.navycs.com/blogs/navadmin-014-14
DoD Resources

DoD Accession

DoDI 6130.03, Medical Standards for Appointment, Enlistment,
or Induction in the Military Services,
http://dtic.mil/whs/directives/corres/pdf/613003p.pdf

DoD Deployment
 DoDI 6490.07, Deployment-Limiting Medical Conditions for
Service Members and DoD Civilians,

DoD DES
 DoDI 1332.18, Disability Evaluation System (DES),
42

Headquarters US Air Force

Transcription

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