Medical Evaluation Boards Across the Services

What Every Primary Care Provider Should Know
Eileen M. Vasenko, MD
MEB Physician
Fort Belvoir Community Hospital
Integrated
Disability Evaluation System (IDES)
 “The DES will be the mechanism for determining
return to duty, separation, or retirement of Service
members because of disability in accordance with
Title 10, United States Code.”
 DoD Instruction (DoDI) 1332.18 (Revised 5 Aug 2014)
 http://dtic.mil/whs/directives/corres/pdf/133218p.pdf
 Establishes policy for the DES across the services for
Regular, Guard, and Reserve service members.
 Defines responsibilities and operational standards at all
levels of the DES.
2
IDES statistics
 Number of Service Members enrolled in the Integrated
Disability System (IDES) as of 31 Dec 2014:
 Army: 16,984 (12,772 Active; 4,212 Guard/Reserve)*
 Air Force: 2,802 (2,382 Active; 420 Guard/Reserve)*
 Navy: 2,187 (2,051 Active; 83 Reserve)*
 USMC: 2,650 (2,565 Active; 85 Reserve)*
 Coast Guard: data not available
*IDES Performance Report Dec 2014—Defense Health Agency
3
IDES statistics
In December 2014:
 66%
of DoD IDES cases resulted in
retirement (with benefits)
 29% were separated (without
benefits)
 4% were returned to duty
---IDES
Performance Report Dec 2014—Defense Health Agency
4
IDES Timeline
 Four Phases of IDES (295 days)
 Medical Evaluation Board (MEB) phase:
100 days (140 RC)
 Physical Evaluation Board (PEB) phase:
120 days
 Transition Phase: 45 days
 Reintegration Phase: 30 days
5
IDES Timeline
6
What’s an MEB?
Medical Evaluation Board (MEB):
 Informal board made up of two or more
physicians


Any MEB listing a behavioral health diagnosis must
contain a thorough behavioral health evaluation and
include the signature of at least one psychiatrist or
psychologist with a doctorate in psychology.
Aviator MEBs should include a Flight Surgeon
 MEB reviews a service member’s:
 medical history
 current physical exam
 duty limitations
7
What’s an MEB?
Medical Evaluation Board (MEB):
 Documents whether the SM has a medical
condition that will prevent him or her from
reasonably performing the duties of his or her
office, grade, rank, or rating (fails retention
standards)
 If such a condition exists, the MEB findings are
then referred to a Physical Evaluation Board.
***Only one condition which fails retention standards is
required to initiate an MEB.***
8
DES Due Process
 Once the MEB is completed, the SM has the opportunity to
review the MEB packet and then must elect one of the
following (often with JAG/Legal Counsel assistance):
 Accept the MEB findings as written, allowing the MEB to
be sent to the PEB.
 Impartial Provider Review (IPR)

A medical provider unrelated to the case reviews the
entire MEB packet for accuracy and completeness.
 Rebuttal (appeal) of the MEB findings.

SM will often provide additional documentation not
available to the provider when writing the MEB.
9
What’s a PEB?
 Each service has its own Physical Evaluation
Board (PEB).
 Informal PEB (IPEB) consists of two military
personnel of at least field grade or civilian equivalent or
higher.
 Formal PEB (FPEB) consists of at least:
 a president (military O-6, or civilian equivalent)
 a medical officer (cannot be the Service member’s physician,
cannot have served on the Service member’s MEB, and cannot
have participated in a TDRL re-examination of the Service
member)
 line officer (or non-commissioned officer at the E-9 level
for enlisted cases) familiar with duty assignments.
10
What’s a PEB?
 Physical Evaluation Board (PEB) determines:




Whether SM is fit for continued military service
Whether SM is eligible for disability compensation
Disability codes and percentage rating
Whether condition is combat-related
 IPEB: reviews appropriate medical and personnel
records, and related documentation to determine fitness
for duty.
 Neither the service member nor counsel may be
present at the informal hearing.
 FPEB: meets with SM if SM appeals IPEB findings.
 Findings and service disability ratings are reported on a
service-specific form.
11
Reserve Component (RC)
 Guard/Reservists may be retained on active duty if a
condition is found during active service or at
demobilization which needs further treatment.
 Orders can be extended to permit MEB process.
 SM may be placed in a Medical Hold status.
 Army service members may be maintained at:


WTU (Warrior Transition Unit) and treated at an MTF
or
CCU (Community Care Unit), and treated by providers
near their home.
 Not every service requires RC service members to
remain activated for treatment.
12
Reserve Component (RC)
 Line of Duty (LOD) is required to indicate
whether condition was incurred while in the line
of duty
 MEB is NOT required when an RC member is
referred for impairments unrelated to military
status and performance of duty.
 Army has an RC Soldier Medical Support Center
(RC SMSC) to track Reserve cases.
 RC FPEB will include a Guard or Reserve Officer
(or E-9 for Enlisted).
13
Key service DES Differences
 USN/USMC, USAF, and USCG Medical Boards are
typically written by the Primary Care Provider or
Specialist treating the referred condition.
 Command has active role in USCG MEBs
 Army has a separate MEB Department (under Patient
Administration) to exclusively write and administrate MEBs.
 PCM or specialist refers SM to MEB Dept. for possible MEB.
 MEB provider reviews case to determine need for an MEB, and
writes Narrative Summary for each case if indicated.
 Administrative personnel (PEBLO/Contact Representative)
interact with SM, guide them through MEB process, and
manage paperwork flow.
14
WRNMMC Intranet IDES Site
 https://www.wrnmmc.intranet.capmed.mil/Administ
ration/PatientAdmin/IDES/SitePages/Home.aspx
15
Key Players in the DES Process
 The Primary Care Provider
 The Service Member
 The Command
 The MEB Providers (Medical and Behavioral Health)
 The PEBLO (Physical Evaluation Board Liaison Officer)
 The Contact Representative (administrative assistant to the




PEBLO)
The VA MSC (Medical Services Coordinator)
The Service Member’s JAG
The PEB (Physical Evaluation Board)
The VA D-RAS
= Army IDES
= AF IDES
16
When do I start an MEB?
 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 conditions 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.

DoDI 1332.18
17
When do I start an MEB?
 Medical Retention Decision Point (MRDP):
 Illness or injury has kept SM from performing
required military duties for 12 months

May be less than 12 months for certain medical
conditions with diminished likelihood of
improvement.
 Examples: Insulin-requiring diabetes, Terminal
cancer, Schizophrenia
 No further treatments are available which
could improve the condition to allow return to
full duty
18
When do I start an MEB?
 Medical Treatment Facilities (MTFs) will not
delay disability processing for nondisabling conditions such as elective
surgery.
 If a member needs emergency surgery,
treatment, or hospital care, consider a delay in
retirement or discharge only when it could
cause a change in the disability disposition
or rating.
19
History is the Key
 Review the medical records
 AHLTA
 Hard copy records --if available
 Get an accurate history of the condition in question.
 Get to know your MEB/IDES providers; they may review
the case to provide you some guidance.
 Start with the earliest notes, and move forward
in time.
 Memories and accuracy of memory frequently change over months
and often years, with or without treatment.
20
Documentation is Essential
 If it’s not in the medical record, did it happen?
 Theater incidents occurring before 2005 are often not welldocumented due to limited or absent internet/Ahlta access.
 Obtain hard copy records.
 Obtain VA records.
 Request SM obtain copies of outside provider reports for review
and entry into Ahlta Clinical Notes or HAIMS.
 The medical records should be able to stand alone as the
source of medical information.
 Meeting between the MEB provider and the SM is not required
during an Army MEB.
 Information added by the SM during an MEB interview may not be
historically accurate when compared to medical records.
21
US Army PDES
22
US Army DES Resources
 AR 40-501 Standards of Medical Fitness (Aug 2011)
 http://armypubs.army.mil/epubs/pdf/r40_501.pdf
 The IDES Guidebook
 https://www.usapda.army.mil/usapda/docs/IDES_GUIDEBOOK_and_R
ef_Guide_13_Aug_13.pdf
 AR 600-60 Physical Performance Evaluation System
 http://armypubs.army.mil/epubs/pdf/r600_60.pdf
 AR 40-400 Patient Administration
 http://armypubs.army.mil/epubs/pdf/r40_400.pdf
 AR 635-40 Physical Evaluation for Retention,
Retirement, or Separation
 http://armypubs.army.mil/epubs/pdf/r635_40.pdf
23
MEB Documents
 Permanent Profile (DA 3349)
 VA/DOD Joint Disability Evaluation Board Claim Form
 Narrative Summary (NARSUM)
 Summary of all medical issues, but focusing on the medical condition(s)
which fail(s) retention standards
 ERB/ORB/PQR
 NCOERs/OERs (last three)
 Commander’s Statement (DA 7652)

Indicates impact of medical condition on the ability of the SM to perform his
or her military duties
 Current LES, RPAS, Orders
 Line of Duty (LOD)

required for all RC service members for condition which fails retention
standards
 VA Compensation and Pension exams
 DA 3947 (MEB Proceedings)
24
Write a Good Profile
 Profiles are guidelines for the Service Member’s
command regarding limitations
 Direct communication between medical provider and
command
 Write in layman’s terms rather than medical terms and
abbreviations
 Block 1: List diagnoses in lay terms
 Block 5: Limitations in basic soldiering tasks
 Block 8: Detail further limitations, especially those
preventing MOS duties.
25
Army Profile
 Only written using
eProfile computer
program.
 Handwritten profiles
are not acceptable.
 Avoid “Dead Man”
Profiles (all boxes
marked “NO”).
26
Permanent PULHES of 3 = MEB
 PULHES:
 P: Physical/Systemic condition: DM, Migraines, TBI,
Cardiac, Pulmonary, Cancer, Skin, GI, GU
 U: Upper extremity: Neck, shoulder, upper back, arm,
hand
 L: Lower extremity: Lower back, legs, feet, pelvis
 H: Hearing: Severe hearing loss, SPRINT Category E
 E: Eyes: Loss of vision, requires special glasses or
contacts
 S: Psychiatric conditions
27
The VA/DOD Joint Disability Evaluation Board Claim Form
28
VA Form 21-4138: used for additional claimed conditions.
29
US Army NARSUM Template
30
DA 3947
MEDICAL EVALUATION
BOARD PROCEEDINGS
31
US Air Force PDES
32
US Air Force DES Resources
 Air Force Instruction 36-3212: Physical Evaluation for
Retention, Retirement, and Separation
 http://static.e-publishing.af.mil/production/1/af_a1/publication/afi36-
3212/afi36-3212.pdf
 Air Force Instruction 48-123, Chapter 5: Medical
Examination and Standards: Continued Military Service
(Retention Standards)
 http://static.e-publishing.af.mil/production/1/af_sg/publication/afi48-
123/afi48-123.pdf
 Air Force Instruction 10-203: Duty Limiting Conditions
 http://static.e-publishing.af.mil/production/1/af_a3_5/publication/afi10-
203/afi10-203.pdf
 Air Force Instruction 41-210: Tricare Operations and
Patient Administration
 http://static.e-publishing.af.mil/production/1/af_sg/publication/afi41-
210/afi41-210.pdf
33
USAF DES
 AFI 48-123, Chapter 5, Continued Military Service
(Retention Standards)
 Section 5B establishes medical conditions and defects
that are potentially disqualifying and/or preclude
continued military service.
 Airmen with conditions listed in this chapter require
evaluation for continued military service.
 MEB/PEB completed per Air Force Instruction 363212: Physical Evaluation for Retention, Retirement,
and Separation
34
USAF DES
 The attending physician at the medical treatment
facility (MTF) will:
 Conduct the examination.
 Prepare the documents required to identify
medical defects or conditions that may
disqualify the member for continued active duty.

PEB requires specialty evaluations, such as cardiology
consultations for heart conditions or psychiatric
consultation for mental conditions.
 Refer the case to a MEB.
35
USAF DES
 Medical Officers on the MEB will:
 Evaluate the documentation.
 Recommend the disposition of the MEB case and refer it
to the approving authority (AFI 48-123, Chapter 5).
 PEBLO (Physical Evaluation Board Liaison
Officer):
 Ensures disability cases referred to the PEB are
complete, accurate, and fully documented.
 Counsels evaluees concerning their rights in the
disability process.
 Maintains coordination with the member, medical
facility, MPF, and HQ AFPC/DPPD.
36
USAF DES
 Once a case is referred to the PEB:
 The member may not take leave outside the local
area.
 The member may not go on TDY.
 The member will not be reassigned, except for
emergency reasons, until receiving notification of
the final determination.
 The PEBLO asks the member's commander or
servicing MPF to ensure the member stays available
for possible additional disability evaluation
processing.
37
US Navy/US Marine Corps DES
38
US Navy DES Resources
 Manual of the Medical Department (MANMED) Chapter 18,
Medical Evaluation Boards
 http://www.med.navy.mil/directives/Documents/NAVMED%20P-
117%20(MANMED)/MMDChapter18.pdf
 SECNAVINST 1850.4E, Department of the Navy Disability
Evaluation Manual
 http://doni.daps.dla.mil/Directives/01000%20Military%20Personnel%20Support/01800%20Millitary%20Retirement%20Services%20and%20Support/1850.4E.pdf
 SECNAVINST 1850.4E, Encl. 8: Conditions that are normally
cause for referral to the PEB.
 http://doni.daps.dla.mil/Directives/01000%20Military%20Personne
l%20Support/01800%20Millitary%20Retirement%20Services%20and%20Support/1
850.4E%20Enclosure%208.pdf
39
USN/USMC DES
 MEB will generate an MEBR (Medical Evaluation Board
Report). The MEBR will do one of the following:
 Recommend placement of an active duty service member on a
period of temporary LIMDU.
 Verify that the member is “fit for duty,” after being cleared
from LIMDU, and should be able to execute the duties of their
respective office.
 Refer the case to the Department of the Navy (DON)
Physical Evaluation Board (PEB) for disability adjudication
and determination of fitness for continued service, in
accordance with SECNAVINST 1850.4 series, “Department of
the Navy Disability Evaluation Manual.”
40
USN/USMC LIMDU
 Limited Duty (LIMDU):
 Service Member reports to their work space
 Member is excused from the performance of certain aspects
of military duties as defined in their individual LIMDU writeup.
 LIMDU or Abbreviated Medical Evaluation Board Report
(NAVMED 6100/5) is required for limited duty in excess
of 90 days.
 May last up to 6 months.
 Enlisted active duty: if more than two consecutive
LIMDUs (12 months) for the same condition => MEB.
 Subsequent LIMDUs may be written for other conditions.
 All Officer LIMDUs require a referral to service
headquarters.
41
LIMDU vs Light Duty
 LIMDU is similar to light duty, except that LIMDU
periods:
 Last longer than light duty periods.
 Require notification to Service Member’s:
 parent command
 respective service headquarters
 servicing Personnel (PSD) department
 May necessitate the transfer of the member
from the parent command if it is a deployable
unit.
42
LIMDU
 Continuing care, recovery, and
rehabilitation are conducted during
LIMDU in an effort to return the member
to medically unrestricted duty status.
 LIMDU may only be provided to a
patient as the result of the actions of
an MEB.
43
USN/USMC
LIMDU Board
A LIMDU/Abbreviated
MEBR is a single sheet
document lasting up to 6
months, and adjudicated by
an MEB.
A dictated Medical
Evaluation Board Report
(MEBR) is a multi-page
detailed document that is
submitted to a PEB.
44
Navy/USMC MEBR Template
45
US Coast Guard PDES
46
US Coast Guard Resources
 Coast Guard Physical Disability Evaluation
System (PDES)
 http://www.uscg.mil/directives/cim/1000-
1999/CIM_1850_2D.pdf
 Coast Guard MEB Checklist
 Coast Guard Medical Manual
 http://www.uscg.mil/directives/cim/60006999/CIM_6000_1f.pdf
47
USCG PDES Boards
• USCG PDES Indications are detailed in Additional Slides
• Medical Evaluation Board (MEB) conducts a thorough
•
•
•
•
•
exam of member’s physical or BH condition.
MEB document is sent to the unit for endorsement by
the command
• Commander’s observations of the impact of the
condition on ability to perform required military duties.
• Include aspects such as motivation and ability to adapt.
SM gets to comment on findings.
Commanding Officer forwards entire packet to
Commander (CGPC-adm-1) for review and referral to PEB.
PEB reviews case for fitness and disability.
PEB findings are sent to the SM who may elect counsel to
challenge the findings.
48
USCG PDES for Reservists
 CG Reservists with Line of Duty (LOD)
injuries/illness/disease may be continued on either
Medical Hold orders, Active Duty for Health Care (ADHC)
orders or Notices of Eligibility (NOE) while going through
the PDES process.
 Notice of Eligibility (NOE): Authorizes medical
treatment for a specific time period for a reservist’s LODcondition. A Reservist on a NOE is not in, or does not
remain, an active duty status.
 CG Reservist with a NOT line of duty condition is entitled
to the PED.
49
USCG PDES Narrative Summary
50
The Veteran’s Administration
51
The VA’s Role
 VBA -Veterans Benefits Administration
 Military Services Coordinator (MSC)
 D-RAS --Disability Rating Activity Site


Rhode Island
Seattle
 Contracted Examination Providers (QTC Services)
 VHA –Veterans Health Administration
 Compensation and Pension Examiners

VA C&P Exam is the Exam of record for the Army MEB (Per
Annex O)
52
VA Compensation and Pension Exam
 Disability Benefits Questionnaire (DBQ)
 Medical examination form used to capture essential
information for evaluating disability compensation
and/or pension claims.
 http://www.benefits.va.gov/COMPENSATION/dbq_List
ByDBQFormName.asp
53
Disability Ratings
 After the MEB/PEB process is complete, SM will
receive two ratings.
 Service-specific rating
 VA rating
 30% or higher = disability retired pay (lifetime)

Access to healthcare through MTF and VA.
 <30% = severance pay (single payment)


(2 months base pay) x (years of active duty up to 12) =
severance pay
Access to healthcare through VA.
54
Service-Specific Ratings
 PEB determines Military compensation for




loss of military career
By law, (Title 10 U.S.C., chapter 61), the PEB assigns ratings
from the Department of Veterans' Affairs (VAs') Schedule
for Rating Disabilities (VASRD).
VASRD ratings are applied to unfit conditions only.
Unfit conditions existing prior to service (EPTS) and not
permanently aggravated by service (PABS) will NOT receive
benefits.
Conditions not constituting a disability (conditions NOT
on the VASRD) will not be rated.
 Example: “Intellectual disability (intellectual developmental
disorder [EPTS such as ADHD]) and personality disorders are
not diseases or injuries for compensation purposes.” –VASRD
55
VASRD- VA Schedule for Rating Disabilities
 VA system used to rate service-connected disability for
loss of civilian employability.
 Each condition (not just unfit conditions) is assigned
a specific rating depending on severity, loss of
function.
 Formula used to determine final disability rating
 10 conditions each rated at 10% do NOT add up to 100%!
 Ratings can change with improvement or aggravation of
condition (SM can request VA re-evaluation after MEB
complete).
 http://www.benefits.va.gov/warms/bookc.asp
56
Ratings Notes
 PTSD (mental disorders due to traumatic stress):





Usually starts at 50%, then is re-evaluated by the VA in
six months.
TBI is rated based on Cognitive,
Emotional/Behavioral, and Physical impairments.
Eating Disorders are now ratable.
Chronic Adjustment Disorder is now a ratable
condition.
Obstructive Sleep Apnea with CPAP = 50%
Below the Knee Amputation = 40%
57
Special Situations
 Presumed Fit for Duty: SM may be presumed fit for duty
if SM is pending retirement at the time they are referred for
disability evaluation (unless they have already had an MEB
for the same condition; other stipulations may also apply).*
 Dual Processing: SM is pending either administrative or
disciplinary proceedings along with MEB.
 MEB/PEB continues
 Convening Authority for General Court Martial (CAGCM)
makes final determination whether to pursue medical
retirement or administrative/disciplinary separation. *
 A SM with a terminal or catastrophic condition (i.e. cancer)
can receive an expedited MEB. ALS is also now being
expedited by the VA.
* DODI 1332.18
58
TDRL: Temporary Disability Retirement List
 “A Service member will be placed on the TDRL
when the member meets the requirements for
permanent disability retirement except that the
disability is not determined to be stable but
may be permanent.” (DODI 1332.18)
 PTSD is the most common condition
 Back and knee conditions are also common
59
TDRL: Temporary Disability Retirement List
 Service Member is re-evaluated by an MTF
provider at least once every 18 months to
determine whether there has been a change in the
disability for which the member was temporarily
retired.
 If the condition has resolved or improved to
functional level, SM may RTD
 If the condition is stable or has deteriorated, SM
may be permanently retired.
60
TDRL: Temporary Disability Retirement List
 Can be difficult to track down these service members
for periodic reevaluation.
 Disability ratings can change with improvement or
aggravation of condition.
 < 2% of
TDRL soldiers are RTD.
 As of 31 Dec 2014, there were 698 service members on
TDRL throughout the DoD. (IDES Performance Report Dec 2014—Defense
Health Agency)
 TDRL program is mandated by Congress; not going
away anytime soon.
61
Take Away Pearls
 Keep MEB in the back of your mind for all service member
visits.
 If seeing a SM at the time of initial injury/onset/incident
(esp. TBI):
 document all positive AND negative findings.
 Document any inconsistencies between clinical testing
(ROM, strength) and observed capabilities.
 Know where your MEB Regs are (you don’t have to
memorize them, just know where to look things up).
62
Should all services use the same DES?
 Should every service have a




separate MEB Department?
Same profile form?
Use only electronic profiles?
Same MEB report/Narrative Summary format?
Same PEB or service-specific PEB?
What’s the best way forward?
63
Want to learn more?
 MHS Learn has a series of IDES training Modules.
 Review test cases to determine if MEB indicated.
 Geared towards Army IDES, compares Army approach
to other services
64
Questions?
65
Additional Slides
66
67
68
69
New Medical Records Tool: JLV
70
JLV: Joint Legacy Viewer
 Pilot program to access both AHLTA/DoD and VA
Electronic Health Records
 Read-only viewing






Outpatient encounters/progress notes
Lab results
Radiology studies
Medications
Problem list
Pending orders, and much more!
 Can also access Essentris inpatient records
71
72
US Air Force PDES
73
USAF DES
 MEB documentation includes:
 Narrative Summary of care describing, at minimum:
 the member’s course of medical treatment since injury
 current condition
 description of the treatment plan
 prognosis.
 Narrative summary must be signed by the senior
attending physician.
 LOD
 Written statement from the member's immediate
commanding officer or supervisor describing the
impact of the member’s medical condition on normal
military duties and ability to deploy or mobilize, as
applicable
74
USAF IPEB Documents
 IPEB AF Form 1180 or - statement of concurrence/nonconcurrence documents that pertain to this area such as rebuttals, mail receipts, etc. - pay
estimate
 IPEB AF Form 356 (and/or RRF - with latest date first), and, if applicable, summary statement - dissenting report
 Orders appointing board
 AF Form 618 w/attachments (including commander’s letter) or report of TDRL
reexamination
 Approved AF Form 348, Line of Duty Determinations, or DD Form 261, Report
of Investigation Line of Duty and Misconduct Status (not on TDRL cases)
 Memo for Record of a call or orders covering non-EAD service, if applicable
 If applicable, - AF Form 1172, Certificate of Medical Officer, or - prior medical
board report relating to mental competency (AFI 48-123)
 As attachments and not part of proceedings, if applicable: - historical
documents of case - clinical records - AF Form 125, Application for Extended
Active Duty With the USAF - statement Relative to Appointment or Enlistment
After Removal From TDRL - retention in Limited Assignment Status
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AF Form 469
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US Navy/US Marine Corps DES
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Does this Sailor need an LIMDU?
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USN/USMC DES
 An MEB is a panel of providers attached to one of the
MTFs whose commander or commanding officer (CO)
has been expressly designated to hold “convening
authority” (CA) for MEBs. (MANMED article 18-3 describes CA in
detail; article 18-6 details MEB composition.)
 The Navy distinguishes the
 MEB (group of providers evaluating the SM)
from the
 MEBR (the document/report generated by the MEB).
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USN/USMC PDES
 Distinguishing “Fit for Duty” from “Fitness for
Continued Naval Service”
 “Fit for Duty” --- decision by a physician or by an
MEB that a patient previously on light or LIMDU has
healed from the injury or illness that necessitated the
member’s serving in a medically restricted duty status.
 “Fitness for Continued Naval Service” ---finding
made exclusively by the Department of the Navy PEB
in determining an ADSM’s ability to continue serving in
the Navy or Marine Corps.
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US Coast Guard PDES
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USCG PDES Indications
 Existence of one or more of the following situations
requires convening an MEB:
 Detection of a physical impairment preexisting enlistment or
appointment in the Coast Guard.
 Refusal of medical or dental treatment or diagnostic procedure (see
article 2.C.8.).
 After 60 continuous days of hospitalization (Saturdays, Sundays, and
holidays included), or intermittent admission to an inpatient facility for
the same diagnosis for 60 out of any 90 consecutive days
 Failure to meet physical standards at the following times:


required periodic physical examination (except for those
conditions set forth in Military Separations, COMDTINST
M1000.4; e.g., obesity, motion sickness)
aviation physical examination when the disqualification may
lead to permanent removal from aviation.
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USCG PDES Indications
 After maximum hospital benefits have been attained and
the member remains in a Not Fit For Duty status; after
outpatient treatment in a hospital or a clinic when the total
of all visits in a 1-year period exceeds 30 visits for other than
treatment for traumatic conditions.
 For members retained on active duty under the authority of
Military Separations, COMDTINST M1000.4 (series), at
least 6 months prior to expiration of the period of
retention. There is no requirement for a reevaluation of the
disability when a member is retained for less than 6
months.
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USCG PDES Indications
 A member who is being processed for separation or for
retirement by reason of age or length of service shall not
normally be referred for physical disability evaluation.
Unless previously retained on active duty under the
provisions of chapter 17, Personnel Manual, COMDTINST
M1000.6 (series), absence of a significant decrease in the
level of a member’s continued performance up to the time
of separation or retirement satisfies the presumption that
the member is fit to perform the duties of his or her office,
grade, rank or rating (see article 2.C.2.).
 In any situation where fitness for continuation of active
duty is in question.
 Expiration of TLD designation and a prognosis of AFLD
(see article 2.C.12.).
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USCG MEB CHECKLIST
Chapter 3, PDES Manual, COMDTINST M1850.2 (series),
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TDRL: Temporary Disability Retirement List
 When a Service member on the TDRL refuses or
fails to report for a required periodic physical
examination or provide his or her medical
records, disability retired pay will be
suspended.
 If the Service member later reports for the physical
examination, retired pay will be resumed effective on the
date the examination was actually performed.
 If the Service member subsequently shows just cause for
failure to report, disability retired pay may be paid
retroactively for a period not to exceed 1 year prior to the
actual performance of the physical examination.
 If the Service member does not undergo a periodic physical
examination after disability retired pay has been suspended,
he or she will be administratively removed from the TDRL on
the fifth anniversary of the original placement on the list.
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