Duty Status Processing and Overseas/Suitability Screening Overview for the Busy Provider

Duty Status Processing and Overseas/ Suitability Screening for Providers Significant Recent Changes Affecting All Providers Goals of Presentation are: To Succinctly Review Changes Provide Overview of Reasons for Change but… Focus on Operational “nuts and bolts” Details Provide Resources for More In-Depth Review/Questions

Definitions Sick in Quarters (SIQ) Light Duty Duty status assigned when service member is hurt/ill to the point that they are unable to perform any aspect of their job. Typically reserved for acute conditions requiring less than 72 hours to recover. Light Duty Duty status assigned when service member is hurt/ill but is able to safely perform some aspects of their job.

Definitions Convalescent Leave (CONLV) Limited Duty (LIMDU) Duty status assigned when service member is hurt/ill to the point that they are unable to perform any aspect of their job. Can be prescribed for longer periods than SIQ, up to 30 days (postpartum – 42 days). Limited Duty (LIMDU) Duty status assigned when service member is hurt/ill but is able to safely perform some aspects of their job. Can be prescribed for periods of time greater than light duty. Affects ability to receive/execute orders and other personnel functions.

Definitions Full Duty Fit For Continued Naval Service Duty Status assigned when, in the provider’s opinion, the service member does not have a medical condition that interferes with successful and safe job performance. Fit For Continued Naval Service Finding of the PEB that a service member does not have a medical condition that constitutes a disability. The member may have duty limitations.

Definitions Unfit Fit for Duty Finding of the PEB that a service member’s condition constitutes a disability and the member should be separated/retired from active service. Fit for Duty Term used by a provider or medical board to describe a service member’s condition that does not meet the definition of disability. Frequently used at the conclusion of a light or limited duty period or to explain why a service member’s case is NOT being referred to the PEB.

Definitions Medical Evaluation Board (Med Board) A group (typically 2) of providers at an MTF that evaluates the medical status of a service member with a serious or protracted illness or injury. Medical Evaluation Board Report The document(s) that a Medical Evaluation Board produces. It may include a “Short Form” or Dictated/Long Form. These may be sent to other groups such as the Physical Evaluation Board or Naval Personnel Command.

Definitions Physical Evaluation Board (PEB) Group of Line Officers and Medical Officers at the Washington Navy Yard that evaluates the medical status of a service member with a serious or protracted illness/injury that appears to permanently limit the member’s ability to do his job. Physical Evaluation Board Report Report issued by PEB that describes the Board’s findings, includes a Naval disability rating.

Definitions Suitability/Overseas Screening Assignment Screening Review of a service member’s (and family’s) medical status to determine if the member CAN EXECUTE a specific set of orders. Member must have “orders in hand.” Assignment Screening Review of a service member’s medical status at the conclusion of a LIMDU or PEB process, conducted BEFORE the member has orders to determine what platform/location limitations might still exist.

Duty Status Processing… the “Old Way” SIQ Up to 72 hours Completely ‘excused’ from work place Convalescent Leave (CONLV) Up to 30 days (42 postpartum) Command had options regarding travel/recuperation at place remote from command Light Duty Service Member reports to work place but with activity restrictions Max 30 days No inclusion of CONLV

Duty Status Processing… the “Old Way” (cont.) Limited Duty (LIMDU) Done when prolonged (more than 30 days will have elapsed) work place activity restrictions were expected. Paperwork initially done by provider with referral to MTF medical board/convening authority. Enlisted and officer LIMDU handled differently at every level.

Duty Status Processing… the “Old Way” (cont.) LIMDU- (Enlisted) Initial report done on ‘short form’ and routed through MTF and PSD Maximum time of 8 months First and second periods of LIMDU could be approved at MTF Additional periods required dictated report (even if first period less than 8 months) So… vast majority of initial board reports prescribed for 8 months Third or more periods routed to NPC for approval Prior to conclusion of LIMDU local PSD responsible for getting the service member a “re-evaluation” appointment at MTF

Duty Status Processing… the “Old Way” (cont.) LIMDU- (Officer) Initial and all subsequent board reports required dictation Require PSD and MTF communication Approval of all LIMDU periods done at NPC Limited to 8 month periods Prior to conclusion of LIMDU local PSD responsible for getting the service member a “re-evaluation” appointment at MTF

Duty Status Processing… the “Old Way” (cont.) PEB referral Done when service member’s condition permanently affects their ability to perform their job Can happen at any time during service member’s care… but condition should be stabilized PRT problems alone NOT appropriate for referral

So Why Change NOW? Make time frames more consistent with known healing/recovery times Get PSD out of the business of making medical appointments Reduce provider paperwork/effort Simplify the process which will improve ownership and accountability throughout the member’s chain of command and MTF

Duty Status Processing… the “New Way” SIQ- no changes Convalescent leave- no changes

Duty Status Processing… the “New Way” Light Duty No change in definition May be used for up to 90 days from the time member first gets ill/hurt, in increments up to 30 days Should only be used if provider reasonably expects member to return to medically unrestricted duty prior to the 90 day maximum CONLV is included in the 90 day limit

Duty Status Processing … the “New Way” (cont.) LIMDU (Enlisted) “Short Form” may be used to document the first and second limited duty periods Maximum time for each period is 6 months Member is placed LIMDU at the same time a provider initiates a PEB referral if not already on LIMDU. (LIMDU paperwork notifies PSD of assignment limitations during PEB processing.) Third (or more) periods require BUPERS approval The third (or more) period of LIMDU in a member’s career requires BUPERS approval and: If related to previous condition – dictation If unrelated to previous condition – short form

Duty Status Processing … the “New Way” (cont.) LIMDU (Officer) Now LIMDU process is the SAME as Enlisted LIMDU EXCEPT: All LIMDU periods require BUPERS approval

LIMDU “Short Form” NAVMED 6100/5

Suitability, Overseas and Assignment Screening These are medical evaluations done to aid NPC in appropriately issuing orders service members (and their families). Ultimately the final decisions regarding assignment are done at the GAINING command in conjunction with NPC/detailing.

Suitability and Overseas Screening … the “Old Way” Screening performed after receipt of orders Provider evaluated member’s ability to safely execute orders to a specific location Provider evaluated family’s ability to safely execute orders to a specific location NAVMED 1300/2 used to document findings If “qualified” no further action, if “not qualified” poorly defined process involving query of gaining command ensued Results sent to BUPERS/PSD for further processing

Suitability and Overseas Screening … the “New Way” Screening performed after receipt of orders Provider evaluates member’s and family’s ability to safely execute orders Results documented on NAVMED 1300/1 If “qualified” no further action necessary… results sent to PSD If “not qualified” BUPERS medical provider (newly created position) will determine where to send member and family Minor changes made to specific testing areas (for example Pap smear timing) but overall screening process largely unchanged

Assignment Screening … the “Old Way” Screening after completion of LIMDU/PEB Performed prior to issuance of orders Provider evaluated member’s residual limitations which might have affected assignability NAVMED 1300/2 required medical input that was impossible to answer without orders in hand Family members not screened Best results were achieved if provider was able to recommend specific and appropriate operational or platform assignments. However, most providers were not knowledgeable enough to make such recommendations.

Assignment Screening … the “New Way” Screening after completion of LIMDU/PEB Performed prior to issuance of orders Provider evaluates member’s residual limitations which might affect assignability NEW form (NAVMED 1300/3) includes only a few questions that any provider can answer easily Screening prompts only the finding of “worldwide assignable” or a list of limitations If “world wide assignable,” no further action necessary… results sent to BUPERS If “not world wide assignable,” BUPERS medical provider will determine where to send member

SUITABILITY/OVERSEAS SCREENING NAVMED 1300/1

ASSIGNMENT SCREENING NAVMED 1300/3

Resources Manual of the Medical Department Chapter 18 effective date 10 Jan 2005 http://www.vnh.org/Admin/MMD/001Contents.html BUMEDINST 1300.2 (series) Disability Evaluation Manual (SECNAVINST 1850.4 series)

SUMMARY The following slides summarize the major changes previously reviewed in greater detail

Changes OLD New Light duty 30 days max LIMDU 8 month increments More than 16 months goes to PEB New Light duty up to 90 days in 30 day increments (including CONLEAVE) LIMDU 6 month increments More than 12 months requires NMPC waiver or PEB

Changes Old Members ending LIMDU get orders then operational screen to see if fit for orders Screener comments on past illness Ship queries MTF, then declines PERS seeks an accepting SMO Member in limbo, billet gapped If no gaining command found, current command ADSEPs New Member ending LIMDU, assignment screening done Report goes to PERS and reviewed by assignment physician PERS finds gaining command before orders written If no gaining command found, current command ADSEPs

Changes Old New Some, not all ships decline PAP smear abnormalities Some ships, not all, decline CPAP CVNs decline history of emotional problems BUT recommend those individuals go to AMPHIBs New Central physician at PERS can negotiate a more consistent screening criteria with Fleets PERS physician will deal with MTF screener and gaining command vice ship and MTF trying to contact each other Currently, often ships will contact the transferring command, find the member has performance issues and then use an unrelated medical excuse to avoid gaining the individual. Single POC for both screeners and gaining commands.

Changes Old LIMDU tracked by PSD which is responsible for getting member back for FU appointment Members lost to follow up after PCSing on LIMDU. New Current command responsible for getting LIMDU member back for timely appointments BUPERS tracks Members to Mast for missing appointments