1. Secretary of the Navy Physical 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.
Overall Purpose: 1) Maintain fit fighting force to enable DON to fight battles and win wars; 2) compensate service members where a disability caused military career termination. SECNAVINST § 3101.

3. Member Can Accept or Appeal
IDES Process
Separate:
PDRL
TDRL
w/ or w/out severance
MEB
PEB & VA Rating
Service Headquarters
MEB & VA C&P Exam
Member with questionable fitness for continued service
PEB Informal Board (15 days)
Formal Board (30 days)
VA Rating Reconsideration (15 days) OR
Return to Duty
Admin and Record transfer (15 days)
VA Proposed Rating (15 days)
Appeal (30 days)
100 days
Separate/VA benefits
BCNR and/or VA Appeal
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
The National Defense Authorization Act for Fiscal Year 2008 (NDAA), provides for specific changes and enhancements to the disability processing of “recovering Service members” as defined by the NDAA (i.e., wounded, ill, and injured referred into the DES). Undersecretary of Defense for Personnel and Readiness Directive type Memorandum dtd 14 Oct 08.
120 days
75 days 3

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.
Overall Purpose: 1) Maintain fit fighting force to enable DON to fight battles and win wars; 2) compensate service members where a disability caused military career termination. SECNAVINST § 3101.
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.

6. DOD IDES Phases Service HQ PEB MEB Member - 1 Location (Washington DC)
- 9% Fit for Duty
31% Separated
36% TDRL
23% PDRL
1% Other
MEB
Member
Injury/condition
The DES shall consist of four elements: medical evaluation; physical disability evaluation, to include appellate review; counseling; and final disposition. Paragraph 3.2 DoD Directive (Separation or Retirement for Disability).
- 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. Leadership and Advocacy
PART II.
Leadership and Advocacy

8. Decisional Points/Seams w/in IDES
Appellate
MTF
FPEB
The DES shall consist of four elements: medical evaluation; physical disability evaluation, to include appellate review; counseling; and final disposition. Paragraph 3.2 DoD Directive (Separation or Retirement for Disability).
NDAA 08 - Section 1612 requires DOD to establish “uniform standards and procedures among the military departments for the provision of legal counsel to recovering service members while undergoing evaluation by a physical disability evaluation board, … uniform standards among the military departments on the roles and responsibilities of … judge advocates assigned to recovering service members undergoing evaluation by a physical disability board, and uniform standards on the maximum number of cases involving such service members that are to be assigned to judge advocates at any one time.”
OUSD (P&R) DTM (14 OCT 08)
“Government legal counsel shall be available to consult (by telephone or otherwise) with a Service member regarding the Service member’s rights and elections following the Service member’s receipt of the decision of an Informal Physical Evaluation Board (IPEB). Military Departments may make legal counsel available to respond to inquiries by Service members earlier than receipt of the IPEB decision.”
“Government legal counsel shall be assigned to represent Service members upon their election to proceed to a formal hearing before the PEB. Representation shall continue through the respective Military Department’s appellate process, if elected, until the Service member’s discharge from active duty.”
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 strength 1991 – 2013 (TDRL not included)
Strong correlation between Service end strength drawdown and increasing DES population/adjudications s DON end strength average 750k; 2011 end strength is 550k.

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. PEB Performance & Metrics
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)
The President of the PEB should notify the Secretary of the Military Department concerned if it is determined that the lack of legal counsel becomes a limiting factor to timely adjudication of the PEB caseload. Undersecretary of Defense for Personnel and Readiness Directive type Memorandum dtd 14 Oct 08, E.3.P
October 2010 PEB Process time was 120 days; 58% reduction in case processing times.

18. DoN Breakdown for FY13: New TDRL Periodic Navy 2478 515
Marine
Total =
Active
Reserve
Total =
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
These cases are Adjudications not mere cases received. Of the adjudications: 27% of USMC Cases are CR(AC); 7% of USN are CR; 27% of Reserves are CR. Of all DES cases 16% are CR.

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
See also OUSD IDES Operations Guide dtd September 2010. 20

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
See also OUSD IDES Operations Guide dtd September 2010. 22

23. Physical Evaluation Boards:
Process and Appeals
Appeals
IDES Appeal: Formal motion for reconsideration / Formal Hearing
One time VA reconsideration for rating
See also OUSD IDES Operations Guide dtd September 2010. 23

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
See also OUSD IDES Operations Guide dtd September 2010. 24

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
See also OUSD IDES Operations Guide dtd September 2010. 25

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
See also OUSD IDES Operations Guide dtd September 2010. 26

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
See also OUSD IDES Operations Guide dtd September 2010. 27

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 E (Who, What, Where, When, How)
See also OUSD IDES Operations Guide dtd September 2010.
NMA is a key document in making fitness for duty determinations - need to make them count 28

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
See also OUSD IDES Operations Guide dtd September 2010. 29

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
See also OUSD IDES Operations Guide dtd September 2010. 30

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
See also OUSD IDES Operations Guide dtd September 2010. 32

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)
See also OUSD IDES Operations Guide dtd September 2010. 33

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)
See also OUSD IDES Operations Guide dtd September 2010. 34

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
See also OUSD IDES Operations Guide dtd September 2010. 35

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
See also OUSD IDES Operations Guide dtd September 2010. 36

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
See also OUSD IDES Operations Guide dtd September 2010. 39

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?