Appendix G DISABILITY EVALUATION SYSTEM TRAINING TOPICS FOR PRIMARY PARTICIPANT POPULATIONS ACROSS MILITARY DEPARTMENTS As noted in Chapter 5, the suggested purpose of the DES and set of desired outcomes shaped the suggested performance competencies for primary participant populations, which in turn shaped the selection of DES topics for training content. Chapter 5 groups the DES topics into six distinct training packages with each containing a specific body of DES knowledge for the relevant primary participant population clusters. In contrast, Table G.1 presents the raw data that served as the basis for the training packages presented in Chapter 5. Table G.1 contains a comprehensive list of DES topics and our assessment of which primary participant populations require knowledge of a given topic. The topics are listed in the order in which we collected the respective data. This data array informed the organization and development of the content of the six training packages. We gleaned much of what appears in Table G.1 directly from OSD disability policy documents, augmented by existing military department syllabi and policy documents, and through observation of military department training programs and interviews with primary participants. A few of the topics listed in the table—such as “Difference Between VA and DoD DES”—came directly from our analysis and other recommended interventions noted in this report. Note: The full range of information included within some knowledge areas is shown in the table in italics. Not all primary participant populations require knowledge in every DES topic area. 191 Utopia DES Topics References (statutes, directives, instructions) Statutory basis of the DES DoD DES purpose DES desired outcomes DES (process and steps) Eligibility for referral for full disability adjudication, including checklist to determine eligibility Waiver of DES processing Service member rights, benefits, and entitlements Incompetency cases Service member restrictions imposed by the DES Effect of PEB findings and decision Impairment versus disability Unfit versus unsuitable (conditions that do not constitute a physical disability) X X X X X X X X X X Utopia Semibold X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Patient Administrators X PEB Administrative Action Officers X Primary Participants Medical Evaluation PEB Medical Board Members/ EvaluaApproving Approving tion Board AuthorAuthorMembers ities ities X X X X X X X X X X PEBLOs/ Disability Evaluation Counselors X Physicians Who Write Narrative Summaries X X X X X X X X X X X X Post-PEB Appellate Review Board Members X X X X X X X X X X X X X Attorneys Who Represent Service Members X Initial Formulation of Disability Evaluation System Topics for Primary Participant Populations Table G.1 X X X X X X Active Component Unit Commanders X X X X X X X X X X X X Reserve Component Commanders X 192 Improving Performance of the DoD Disability Evaluation System Utopia DES Topics Medical board coordination among service member, MTF, PEB, and military department personnel organizations Role of primary participants in the DES Difference between VA and DoD DES Temporary early retirement authority Waiver of disability retirement pay for Reserve retirement Transfer to the retired Reserve and early qualification for retired pay Service member election of options Standards for determination of fitness X X X X X X X X X X X X X Utopia Semibold X X X X X X X X Patient Administrators PEB Administrative Action Officers X Primary Participants Medical Evaluation PEB Medical Board Members/ EvaluaApproving Approving tion Board AuthorAuthorMembers ities ities X X X PEBLOs/ Disability Evaluation Counselors X Physicians Who Write Narrative Summaries Table G.1—Continued X X X X X X Post-PEB Appellate Review Board Members X X X X X X X Attorneys Who Represent Service Members X X Active Component Unit Commanders X X X X X X Reserve Component Commanders DES Training Topics for Primary Participant Populations Across Military Departments 193 Utopia Permanent limited duty (continuation on active duty or active Reserve status) Compensability Standards Prior service impairments Reserve component performing duty of 30 days or less DES Topics Compensability Criteria 15-year rule for early qualification for retired pay for members of the selected Reserve Proximate result Presumptions of service incurred/aggravated and overcoming presumptions Conditions presumed to be preexisting Noncompliance (refusal of treatment) X X X X X X X X X X X X X Patient Administrators PEB Administrative Action Officers X PEBLOs/ Disability Evaluation Counselors X X X X Physicians Who Write Narrative Summaries Utopia Semibold X X X X X X X X X X X X X X X X Primary Participants Medical Evaluation PEB Medical Board Members/ EvaluaApproving Approving tion Board AuthorAuthorMembers ities ities Table G.1—Continued X X X X X X X X Post-PEB Appellate Review Board Members X X X X X X X X Attorneys Who Represent Service Members X Active Component Unit Commanders X X X X Reserve Component Commanders 194 Improving Performance of the DoD Disability Evaluation System Utopia Adjudication of TDRL reevaluations TDRL Statutory Requirements Retired pay while on TDRL remains constant at 50% to 75% of base pay, although rating may be less TDRL reevaluations DES Topics Range of Disability Dispositions Fit, return to duty Unfit, separate with severance pay Unfit, separate without disability benefits Unfit, permanent disability retirement Unfit, temporary disability retirement list X X X X X X X X X X X X X X X X X X X X X X X Utopia Semibold X X X X X X X X X X X X X X X X X X X X X X PEB Administrative Action Officers Primary Participants Medical Evaluation PEB Medical Board Members/ EvaluaApproving Approving tion Board AuthorAuthorMembers ities ities X X Patient Administrators PEBLOs/ Disability Evaluation Counselors Physicians Who Write Narrative Summaries Table G.1—Continued X X X X X X X X Post-PEB Appellate Review Board Members X X X X X X X X Attorneys Who Represent Service Members X X X X X Active Component Unit Commanders X X X X X X Reserve Component Commanders DES Training Topics for Primary Participant Populations Across Military Departments 195 Utopia Medical evidence in case adjudication Fact versus opinion Purpose of Medical Evaluation Board DES Topics Medical Board Contents Sufficient narrative summaries Appropriate specialty consults Comprehensive Clinical Evaluation Protocol LOD determinations (Notice of Eligibility for Navy Reserves) Complete physical examination (Standard Form 88/93) Appropriate signatures Documents dated within last 90 days X X X X X X X X X X X X X X X X X X X X X X X X X PEB Administrative Action Officers X X X Patient Administrators X X PEBLOs/ Disability Evaluation Counselors X X X X X X X X X Physicians Who Write Narrative Summaries X X Utopia Semibold X X X X X X X X X X X X X X X X X X X X X X X X X Primary Participants Medical Evaluation PEB Medical Board Members/ EvaluaApproving Approving tion Board AuthorAuthorMembers ities ities X X X X X X Table G.1—Continued X X X X X X X X X Post-PEB Appellate Review Board Members X X X X X X X X X X X Attorneys Who Represent Service Members X X X X X Active Component Unit Commanders X X X Reserve Component Commanders 196 Improving Performance of the DoD Disability Evaluation System Utopia How a service member gets to a Medical Evaluation Board Composition (members) of a Medical Evaluation Board Retention standards considered by a Medical Evaluation Board Documentation of rationale supporting Medical Evaluation Board decision DES Topics Necessary Medical Data in Sufficient Detail to Enable PEBs to Adjudicate Cases Migraine headache cases Orthopedic cases (especially backs ) Neurological/Neurosurgical cases (especially backs) Ophthalmologic cases Pulmonary cases Cardiological cases Psychiatric cases (for example, epilepsy, narcolepsy) X X X X X X X X X X X X X X X X X X X X X Patient Administrators X PEBLOs/ Disability Evaluation Counselors X X X X X X X X X X X X PEB Administrative Action Officers X X X X X X X X X X X Physicians Who Write Narrative Summaries X Utopia Semibold X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Primary Participants Medical Evaluation PEB Medical Board Members/ EvaluaApproving Approving tion Board AuthorAuthorMembers ities ities X X X Table G.1—Continued X X X X X X X X X X X Post-PEB Appellate Review Board Members X X X X X X X X X X X X Attorneys Who Represent Service Members X X Active Component Unit Commanders X Reserve Component Commanders DES Training Topics for Primary Participant Populations Across Military Departments 197 Utopia Commander’s Letter or Nonmedical Assessment Timely response Judgment regarding how condition impacts service member’s ability to perform duty When Specialty Consults Are Required for the Following Conditions and the Diagnostic Details That Are Required Fibromyalgia Chronic Fatigue Syndrome Gulf War Syndrome/ SWATO-related CCEP Psychiatric diagnoses/NPT testing for head injury patients HIV DES Topics Medical Evaluation Board range of dispositions Narrative summary template (contents and format) X X X X X X X X X X X X X X X X Patient Administrators X PEBLOs/ Disability Evaluation Counselors X X X X X X X X X PEB Administrative Action Officers X X X X X X X Physicians Who Write Narrative Summaries X Utopia Semibold X X X X X X X X X X X X X X X X X X X X Primary Participants Medical Evaluation PEB Medical Board Members/ EvaluaApproving Approving tion Board AuthorAuthorMembers ities ities X X X Table G.1—Continued X X X X X X X X Post-PEB Appellate Review Board Members X X X X X X X X X Attorneys Who Represent Service Members X X X Active Component Unit Commanders X X X Reserve Component Commanders X 198 Improving Performance of the DoD Disability Evaluation System Utopia Accepted medical principals Assignment limitation codes/physical profiles Appealing Medical Evaluation Board decisions Organization of the VASRD plus supplements (currently 26) and updates Procedure for rating by analogy; use of hyphenated codes in disability adjudication Analogous codes (in DoDI 1332.39 and updates) that supplement the VASRD Military department analogous codes that supplement the VASRD and DoDI DES Topics Judgment regarding service member’s ability to deploy Adverse actions pending X X X Utopia Semibold X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X PEB Administrative Action Officers X Primary Participants Medical Evaluation PEB Medical Board Members/ EvaluaApproving Approving tion Board AuthorAuthorMembers ities ities X X X X X X X X Patient Administrators X PEBLOs/ Disability Evaluation Counselors X Physicians Who Write Narrative Summaries Table G.1—Continued X X X X X X Post-PEB Appellate Review Board Members X X X X X X X X X Attorneys Who Represent Service Members X X X Active Component Unit Commanders X X X Reserve Component Commanders X DES Training Topics for Primary Participant Populations Across Military Departments 199 Utopia DES Topics What it would take to increase percentage of disability determined by the PEB Combined ratings/overall effects Bilateral factor Pyramiding Dual processing cases Adjudication of cases involving mental disorders Administrative determinations for purposes of employment under federal civil service Zero-percent ratings Disability (separation and retirement) compensation computation Documentation of rationale supporting PEB decision Severance pay tax refund Processing Reserve component non-dutyrelated cases Imminent death procedures X Utopia Semibold X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Patient Administrators PEB Administrative Action Officers Primary Participants Medical Evaluation PEB Medical Board Members/ EvaluaApproving Approving tion Board AuthorAuthorMembers ities ities X X PEBLOs/ Disability Evaluation Counselors X Physicians Who Write Narrative Summaries Table G.1—Continued X X X X X X X X X X X X Post-PEB Appellate Review Board Members X X X X X X X X X X X X X Attorneys Who Represent Service Members X X Active Component Unit Commanders X X X Reserve Component Commanders X 200 Improving Performance of the DoD Disability Evaluation System Utopia DES Topics Formal PEB presentation Final administrative disposition of disability separations and retirements Administrative finality Appeal opportunities Abuse of discretion Template for managing disability case appeal Processing physicians and general officers Potential benefits from the VA Calculation of effective date of separation or retirement Survivor benefit plan Acronyms Ready Reserves Non-duty-related impairment (Reserve component) Optimum medical treatment benefits X X Utopia Semibold X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Attorneys Who Represent Service Members X X X X X X Post-PEB Appellate Review Board Members X X X X X X X Primary Participants Medical Evaluation PEB Medical Board Members/ EvaluaApproving Approving tion Board AuthorAuthorMembers ities ities X X X Patient Administrators PEB Administrative Action Officers X X X X X PEBLOs/ Disability Evaluation Counselors X X Physicians Who Write Narrative Summaries Table G.1—Continued X X Active Component Unit Commanders X X X X X Reserve Component Commanders X DES Training Topics for Primary Participant Populations Across Military Departments 201 Utopia DES Topics Preponderance of evidence Administrative determinations for federal tax benefits Natural progression Presumption of fitness rule and overcoming presumptions X X PEBLOs/ Disability Evaluation Counselors X X Patient Administrators X PEB Administrative Action Officers X X Physicians Who Write Narrative Summaries X Utopia Semibold X X X X Primary Participants Medical Evaluation PEB Medical Board Members/ EvaluaApproving Approving tion Board AuthorAuthorMembers ities ities X X X X Table G.1—Continued X X Post-PEB Appellate Review Board Members X X X X Attorneys Who Represent Service Members X X Active Component Unit Commanders Reserve Component Commanders 202 Improving Performance of the DoD Disability Evaluation System