Directive-Type Memorandum – Integrated Disability Evaluation System (IDES)

December 19, 2011 MEMORANDUM FOR: SEE DISTRIBUTION SUBJECT: Directive-Type Memorandum (DTM) 11-015 – Integrated Disability Evaluation System (IDES)References: See Attachment 1 Purpose. This DTM: • In accordance with the authority in DoD Directive 5124.02 (Reference (a)), establishes policy, assigns responsibilities, and prescribes procedures for the IDES, which is superseding the legacy Disability Evaluation System (DES). This DTM shall be used in conjunction with References (b) through (k). • Supersedes and cancels Under Secretary of Defense for Personnel and Readiness (USD(P&R)) memorandums (References (l) through (n)). • Is effective upon its publication to the DoD Issuances Website; it shall be incorporated into DoD Instruction 1332.38 (Reference (b)). This DTM shall expire effective June 27, 2012. Applicability. This DTM applies to OSD, the Military Departments, the Office of the Chairman of the Joint Chiefs of Staff and the Joint Staff, the Combatant Commands, the Office of the Inspector General of the DoD, the Defense Agencies, the DoD Field Activities, and all other organizational entities within DoD (hereinafter referred to collectively as the “DoD Components”). Definitions. See Glossary. Policy. It is DoD policy that: • Unless otherwise stated in this DTM, DoD will follow the existing policies and procedures requirements promulgated in Reference (b) and DoD Directive 1332.18 (Reference (c)); and the Under Secretary of Defense for Personnel and Readiness Memorandums (References (d) through (g)). • All newly initiated, duty-related physical disability cases from the Departments of the Army, Air Force, and Navy at operating IDES sites will be processed in accordance with this DTM and follow the process described in DTM-11-015, December 19, 2011 2 this DTM unless the Military Department concerned approves the exclusion of the Service member due to special circumstances. Service members whose cases were initiated under the legacy DES process (see Glossary) will not enter the IDES. • IDES medical examinations will include a general medical examination and any other applicable medical examinations performed to Department of Veterans Affairs (VA) compensation and pension (C&P) standards. Collectively, the examinations will be sufficient to assess the member’s referred and claimed condition(s) and assist VA in ratings determinations and assist military departments with unfit determinations. • Medical information used to substantiate the existence or severity of unfitting conditions will generally be no older than 6 months from the date of the medical exam. Information exceeding that time frame may be used if more current information would not substantially affect the existence or severity of unfitting conditions. Responsibilities. IDES responsibilities are assigned in Attachment 2. Procedures. The IDES process is described in Attachment 3. Attachment 4 contains procedures for IDES entities. Temporary Disability Retired List procedures are given in Attachment 5. IDES case tracking procedures are listed in Attachment 6. IDES timeliness goals are provided in Attachment 7. IDES separation program designator (SPD) codes are listed in Attachment 8. The Figure in Attachment 9 provides the IDES timeline. IDES Medical Evaluation Board (MEB) case file minimum contents are listed in Attachment 10. Releasability. UNLIMITED. This DTM is approved for public release and is available on the DoD Issuances Website at http://www.dtic.mil/whs/directives. Attachments: As stated DTM-11-015, December 19, 2011 DISTRIBUTION: SECRETARIES OF THE MILITARY DEPARTMENTS CHAIRMAN OF THE JOINT CHIEFS OF STAFF UNDER SECRETARIES OF DEFENSE DEPUTY CHIEF MANAGEMENT OFFICER DIRECTOR, COST ASSESSMENT AND PROGRAM EVALUATION DIRECTOR, OPERATIONAL TEST AND EVALUATION GENERAL COUNSEL OF THE DEPARTMENT OF DEFENSE INSPECTOR GENERAL OF THE DEPARTMENT OF DEFENSE ASSISTANT SECRETARIES OF DEFENSE ASSISTANTS TO THE SECRETARY OF DEFENSE DIRECTOR, ADMINISTRATION AND MANAGEMENT DIRECTOR, NET ASSESSMENT DIRECTORS OF THE DEFENSE AGENCIES DIRECTORS OF THE DoD FIELD ACTIVITIES DEPUTY ASSISTANT SECRETARY OF DEFENSE FOR MILITARY PERSONNEL POLICY CHIEF OF STAFF TO THE UNDER SECRETARY OF DEFENSE FOR POLICY UNDER SECRETARY FOR BENEFITS, DEPARTMENT OF VETERANS AFFAIRS UNDER SECRETARY FOR HEALTH, DEPARTMENT OF VETERANS AFFAIRS 3 DTM-11-015, December 19, 2011 ATTACHMENT 1 REFERENCES (a) DoD Directive 5124.02, “Under Secretary of Defense for Personnel and Readiness (USD(P&R)),” June 23, 2008 (b) DoD Instruction 1332.38, “Physical Disability Evaluation,” November 14, 1996 (c) DoD Directive 1332.18, “Separation or Retirement for Physical Disability,” November 4, 1996 (d) Under Secretary of Defense for Personnel and Readiness Memorandum, “Policy Guidance for the Disability Evaluation System and Establishment of Recurring Directive-Type Memoranda,” May 3, 20071 (e) Under Secretary of Defense for Personnel and Readiness Memorandum, “Implementing Disability-Related Provisions of the National Defense Authorization Act of 2008 (Pub. L. 110-181),” March 13, 20081 (f) Under Secretary of Defense for Personnel and Readiness Memorandum, “Implementing Disability-Related Provisions of the National Defense Authorization Act of 2008 (Pub. L. 110-181),” October 14, 20081 (g) Under Secretary of Defense for Personnel and Readiness Memorandum, “Standards for Determining Unfitness Due to Medical Impairment (Deployability),” December 19, 20071 (h) Parts 3, 4, and 14 of title 38, Code of Federal Regulations (i) Section 8111, title 38, United States Code (j) Chapter 61 and section 12643 of title 10, United States Code (k) Sections 5104, 5110, and 7105, title 38, United States Code (l) Under Secretary of Defense for Personnel and Readiness Memorandum, “Policy and Procedural Memorandum for the DES Pilot Program,” November 21, 2007 (hereby cancelled) (m) Under Secretary of Defense for Personnel and Readiness Memorandum “Policy and Procedural Update for the Disability Evaluation System (DES) Pilot Program,” December 11, 2008 (hereby cancelled) (n) Under Secretary of Defense for Personnel and Readiness Memorandum, “Cross Service Support and Service Organization Role at Disability Evaluation System (DES) Pilot Locations,” March 29, 2010 (hereby cancelled) (o) Public Law 106-475, “Veterans Claims Assistance Act of 2000 (VCAA),” November 9, 2000 (p) Section 1646 of Public Law 110-181, “National Defense Authorization Act for Fiscal Year 2008,” January 28, 2008 1 Available at http://prhome.defense.gov/WWCTP/Reports.aspx 4 Attachment 1 DTM-11-015, December 19, 2011 ATTACHMENT 2 RESPONSIBILITIES 1. ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS (ASD(HA)). The ASD(HA), under the authority, direction, and control of the USD(P&R), shall: a. In coordination with the Deputy Assistant Secretary of Defense, Wounded Warrior Care and Transition Policy (DASD(WWCTP)), the Secretaries of the Military Departments, the Under Secretary for Benefits, Veterans Benefits Administration (VBA), and the Under Secretary for Health, Veterans Health Administration (VHA) recommend policy that ensures Service members referred to the IDES receive a single set of medical examinations using VA C&P standards, by qualified medical examiners. The examinations will include a VA general medical examination plus any other applicable VA C&P medical examinations required to assess the member’s referred and claimed condition(s). b. In coordination with the Military Departments and VA, determine IDES disability examination funding requirements and track IDES disability examination funding expenditures. c. Provide medical and health management-related advice and program support to the DASD(WWCTP). d. In coordination with the Military Departments Information Technology (IT) offices, ensure IT support and access to programs used at the military treatment facilities (MTFs) for medical record input and retrieval are available to the DoD Physical Evaluation Board (PEB). 2. ASSISTANT SECRETARY OF DEFENSE FOR RESERVE AFFAIRS (ASD(RA)). The ASD(RA), under the authority, direction, and control of the USD(P&R), shall, in coordination with the DASD(WWCTP), the Secretaries of the Military Departments, the VBA, and the VHA, ensure that IDES policies and procedures reflect the needs of Reserve Component Service members. 3. DASD(WWCTP). The DASD(WWCTP), under the authority, direction, and control of the USD(P&R), shall: a. In coordination with the ASD(HA), the Secretaries of the Military Departments, the VBA, and the VHA, conduct oversight of their respective activities, assess, and report the performance of the IDES and recommend to the USD(P&R) changes in policy, IT requirements and agreements, procedure, or resources to improve IDES performance. b. Establish requirements to oversee and report to the USD(P&R) the results of Military Department IDES quality control programs. 5 Attachment 2 DTM-11-015, December 19, 2011 c. In coordination with the Assistant Secretary of Defense for Public Affairs, the Secretaries of the Military Departments, and the VBA, and the VHA, develop and execute a strategic communications plan for the IDES. 4. SECRETARIES OF THE MILITARY DEPARTMENTS. The Secretaries of the Military Departments shall: a. Establish procedures for their respective Military Departments to ensure IDES site MEBs and Military Department PEBs are staffed and resourced to meet IDES timeliness goals. b. Establish procedures for their respective Military Departments to ensure strategic and tactical communications plans for the IDES are developed and executed consistent with the overall DoD-VA plan to inform Service members who enter the IDES and IDES administrators of the features and anticipated benefits of participation in the IDES. c. Establish procedures for their respective Military Departments to ensure the proposed VA disability ratings for each of the military unfitting conditions are used to determine the individual and combined DoD disability rating for all military unfitting conditions. Military Departments will follow the guidance in Reference (f) and applicable DoD policy memorandums regarding application of the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD). d. Establish Department policy to ensure Service members requiring disability evaluations are referred, processed, and counseled in a manner similar to their Service peers. e. Establish procedures for their respective Military Departments to ensure Service members who are hospitalized or receiving treatment at a VA poly-trauma center or a non-governmental facility are referred, processed, and counseled in a manner similar to their peers. f. Establish procedures for their respective Military Departments to ensure Service members who are hospitalized or receiving treatment at the MTFs of another uniformed Service are not transferred from the facility merely to complete IDES processing. g. Establish procedures for their respective Military Departments to coordinate cross-Service referrals into the IDES and support and ensure the conduct of VA medical examinations and MEBs in accordance with IDES disability examination agreements. h. Establish procedures for their respective Military Departments necessary to ensure MEB and PEB determinations and notifications to the Service member are provided to the host Department and that Military Department MEBs and PEBs are authorized to communicate directly with the host MTF to clarify or obtain additional IDES case information. i. Establish procedures for their respective Military Departments necessary to ensure Service members are referred to the IDES in accordance with this DTM, using VA Form 21- 6 Attachment 2 DTM-11-015, December 19, 2011 0819, “VA/DoD Joint Physical Disability Evaluation Board Claim,” available at http://www.va.gov/vaforms/. j. Establish procedures for their respective Military Departments to inform Service members upon referral to the IDES that they may seek assistance during the IDES process from Government legal counsel provided by the Military Departments, private counsel retained at their own expense, or from a VA-accredited representative of a service organization recognized by the Secretary of Veterans Affairs, using VA Form 21-22, “Appointment of Veterans Service Organizations as Claimant’s Representative,” or from a VA-accredited claims agent or attorney using VA Form 21-22a, “Appointment of Individual as Claimant’s Representative.” Both forms are available at http://www.va.gov/vaforms. k. Establish procedures for their respective Military Departments to ensure legal counsel is available to the Service member during the IDES in accordance with the standards for legal support in Reference (f). In accordance with Military Department regulations, uniformed or civilian legal counsel of the Military Department concerned may, at no cost to a member, represent the member before DoD at all steps of the PEB determinations. Uniformed or civilian legal counsel of the Military Department concerned may represent a member before the VA during the pre-separation portion of the IDES process if the representative complies with part 14 of title 38, Code of Federal Regulations (Reference (h)). l. In coordination with the ASD(HA), the VBA and the VHA establish procedures for their respective Military Departments to ensure Service members referred to the IDES receive a single set of disability examinations in accordance with this DTM. m. Establish procedures for their respective Military Departments to recommend changes, in coordination with the USD(P&R), to VA C&P worksheets to VA through the VA-DoD Joint Executive Council structure. n. Establish procedures for their respective Military Departments to identify to the responsible VA Military Service coordinator (MSC) Service members with such serious physical or mental impairments that they are unable to attend a disability examination so that the C&P assessment may be based on a review of medical records in lieu of an examination. o. Establish procedures for their respective Military Departments to ensure DoD providers complete VA’s General Certification Course as well as the specific training course for the requested exam prior to performing VA C&P examinations. p. Establish procedures for their respective Military Departments to track and ensure the expeditious completion of the cases of Service members in the IDES. q. Establish procedures for their respective Military Departments to ensure Service members in the IDES meet all DES appointments, particularly during the MEB phase of the IDES process during which critical case management briefings, medical examinations, and Military Department MEBs are completed. Commanders may grant exceptions to this 7 Attachment 2 DTM-11-015, December 19, 2011 requirement for the welfare or morale of a Service member as long as those exceptions do not prevent timely completion of IDES appointments. r. Establish procedures for their respective Military Departments to clarify and amend medical examinations performed by DoD providers that are insufficient for assignment of DoD and VA disability rating. s. Establish procedures for their respective Military Departments to develop and implement standardized training for Military Department personnel who administer the IDES. t. Develop Department procedures to ensure the results of VA C&P medical examinations are utilized to aid in fitness determinations. Additionally, procedures shall ensure that the whole body system is reviewed for unfitting conditions. u. Provide to VA, for rating purposes, the results of medical examinations generated by DoD examiners (Reference (i)). v. Establish procedures for their respective Military Departments to ensure all IDES case files include an assessment of whether each unfitting disabling condition is temporary or permanent in nature based on accepted medical principles. Accept the proposed disability rating(s) of the compensable unfitting condition(s), as determined by the Military Department concerned, rendered by the Disability Evaluation System Rating Activity Site (D-RAS) under Part 4 of Reference (h) in determining separation and other administrative matters including final disposition from the Temporary Disability Retirement List (TDRL). w. Establish procedures for their respective Military Departments to ensure Service members have the opportunity and assistance to request reconsideration of VA disability ratings assigned for unfitting conditions prior to separation in accordance with the procedures in Appendix 4 (PEBLO) and Appendix 11 (D-RAS) to Attachment 4 of this DTM. x. Establish procedures for their respective Military Departments to ensure the use of the appropriate IDES SPD codes, as specified in the Table at Attachment 8 of this DTM, in the permanent records of Service members separated from active military service through the IDES. Reserve Component members not on active duty, separating through the IDES, who do not receive a DD Form 214/5 Series, “Certificate of Release” or “Discharge from Active Duty,” will receive a letter indicating the date of separation with the appropriate SPD code. y. Establish Department procedures to ensure that upon application by a former Service member who has successfully appealed an IDES disability rating determination for unfitting conditions to the VA, the correction of records, is made to the former Service member’s records, when appropriate. This includes the records of former Service members who are temporarily retired through the IDES who appeal ratings that affect unfitting conditions for which the retiree was placed on the TDRL. z. Establish procedures for their respective Military Departments to ensure IDES administrators: maintain timely, complete, and accurate data in the IDES module of VTA; 8 Attachment 2 DTM-11-015, December 19, 2011 9 Attachment 2 maintain the association between the VTA unique case identifier and the Service member’s personal identification number; and execute IDES procedures in accordance with standards for the protection of personal and health information. aa. Establish procedures for their respective Military Departments to ensure adherence to the IDES processing timeliness goals in this DTM without reducing Service members’ due process time provided by DoD regulations. ab. Establish procedures for their respective Military Departments to ensure Military Department compliance with sections 1210 and 1222, Chapter 61 of title 10, United States Code (Reference (j)) responsibilities regarding the TDRL, to include performing TDRL re-examinations and re-ratings when necessary. ac. Establish an agreement jointly with the VBA, and the VHA, to implement the electronic sharing of IDES data to enable the Departments to obtain the most current military service data, medical evidence and VA disability rating data. DTM-11-015, December 19, 2011 ATTACHMENT 3 IDES PROCESS 1. GENERAL. The IDES is the joint DoD-VA process by which DoD determines whether wounded, ill, or injured Service members are fit for continued military service and by which DoD and VA determine appropriate benefits for Service members who are separated or retired for a Service-connected disability. The IDES features a single set of disability medical examinations appropriate for fitness determination by the Military Departments and a single set of disability ratings provided by VA for appropriate use by both departments. Although the IDES includes medical examinations, IDES processes are administrative in nature and are independent of clinical care and treatment. a. The IDES scope includes all medical examinations and all administrative activities associated with IDES case management from the point of referral by a military medical care provider to the point of return to duty or completion of VA’s benefits decision letter, including the management of Service members who are temporarily retired for disability through the IDES. b. Administrative requirements include, but are not limited to, creating a DES case file, educating the Service member on the process, advising the Service member of the results of the MEB and PEB and their options, rights, benefits, and entitlements; assisting the Service member as the case progresses through the IDES process; and reevaluating Service members who were temporarily retired for disability through the IDES or who have an approved record correction requiring an examination. All IDES timelines in this DTM refer to calendar days. 2. PROCESS STEPS. This section describes the high-level IDES process. Appendix 3 to Attachment 4 contains the detailed procedures for process participants. a. In consultation with the Service member’s commander and on approval by the MEB convening authority, a military medical care provider refers a Service member to the IDES and provides the referral to an MTF patient administrator. b. The MTF patient administrator assigns a DoD physical evaluation board liaison officer (PEBLO) to the Service member. c. The PEBLO informs the Service member of the IDES process, assembles the DES case file, enrolls the Service member in the Veterans Tracking Application (VTA), and refers the Service member to a VA MSC case manager. d. The VA MSC informs the Service member of the IDES process and requests that qualified medical examiners perform the medical examinations required to adjudicate the Service member’s disability claim. 10 Attachment 3 DTM-11-015, December 19, 2011 11 Attachment 3 e. Qualified medical examiners perform the medical examinations required to adjudicate the fitness for duty determination and rating determinations. f. The VA MSC provides the completed medical examination results to the Service member’s PEBLO and the VA D-RAS of jurisdiction. g. The PEBLO incorporates the medical examination results in the IDES case file and provides it to the MEB convening authority. h. The MEB convening authority (MTF commander or senior physician(s) designated by the commander for this purpose) conducts an MEB and provides the results to the PEBLO, including the results of the MEB’s response to the Service member’s rebuttal of the MEB findings. i. The PEBLO provides a copy of the MEB findings, to include the completed VA medical examination results, to the Service member and, if the MEB did not return the Service member to duty, forwards their case to the PEB administrator. j. The PEB administrator prepares and provides the Service member’s case to the informal PEB (IPEB). k. The IPEB adjudicates the case and requests the D-RAS provide proposed ratings for Service member conditions that the IPEB determines to be unfit. l. The D-RAS prepares and provides the Service member’s proposed disability ratings, and reconsideration of the proposed ratings (if the Service member requested reconsideration) to the IPEB. m. The IPEB provides its findings to the Service member. n. If the Service member requests a formal PEB (FPEB), the FPEB convenes, adjudicates the case, and provides its findings to the Service member. o. If the Service member appeals the FPEB findings, the Military Department considers the appeal and returns to duty, separates, retires, or assists the Service member to complete an inter-Service transfer, if appropriate and approved. p. The Military Department concerned and VA provides Service members, separated or retired for disability through the IDES, with disability benefits and compensation at the earliest time allowed by law after separation. q. After separation, the Military Department periodically reexamines and readjudicates the cases of Service members who are temporarily retired for disability. DTM-11-015, December 19, 2011 ATTACHMENT 4 IDES ENTITY PROCEDURES Individuals perform specific procedures within the IDES. Each entity’s procedures are detailed in appendixes to Attachment 4. a. Service Member. Service member procedures are outlined in Appendix 1. b. MTF Medical Care Provider. MTF medical care provider procedures are outlined in Appendix 2. c. Patient Administrator. Patient administrator procedures are outlined in Appendix 3. d. PEBLO. PEBLO procedures are outlined in Appendix 4. e. MEB Convening Authority. MEB convening authority procedures are outlined in Appendix 5. f. MSC. MSC procedures are outlined in Appendix 6. g. Commander. Commander procedures are outlined in Appendix 7. h. IDES Qualified Medical Examiner. IDES qualified medical examiner procedures are outlined in Appendix 8. i. Physical Evaluation Board (PEB) Administrator. PEB administrator procedures are outlined in Appendix 9. j. IPEB or FPEB. IPEB or FPEB procedures are outlined in Appendix 10. k. D-RAS Administrator. D-RAS administrator procedures are outlined in Appendix 11. l. Military Departments. Military Department procedures are outlined in Appendix 12. m. VA Regional Office of Jurisdiction. VA regional offices of jurisdiction procedures are outlined in Appendix 13. n. Disability Advisory Council (DAC). DAC procedures are outlined in Appendix 14. 12 Attachment 4 DTM-11-015, December 19, 2011 APPENDIX 1 TO ATTACHMENT 4 SERVICE MEMBER PROCEDURES 1. The Service member (or his or her designated representative) may: a. If desired, seek assistance from Government legal counsel provided by the Military Departments, private counsel retained at their own expense, or from a VA-accredited representative of a service organization recognized by the Secretary of Veterans Affairs, using VA Form 21-22. Additionally, the Service member may request assistance from a VA-accredited claims agent or attorney, using VA Form 21-22a. Provide the completed VA Form 21-22 or 21-22a to the PEBLO. b. Claim conditions not otherwise referred by the Military Department concerned, that the Service member believes are disabling and service connected by completing section 2 of VA Form 21-0819. In accordance with section 1219 of Reference (j), a Service member shall not be required to submit DD Form 2807-1, “Report of Medical History,” since it may relate to the origin, incurrence, or aggravation of a Service member’s disease or injury. DD Form 2807-1 is available at www.dtic.mil/whs/directives/infomgt/forms/eforms/dd2807-1.pdf. In accordance with section 1219 of Reference (j), a Service member shall not be required to submit VA Form 21-0819 or DoD Form 2807-1 since they contain information that may relate to the origin, incurrence, or aggravation of a Service member’s disease or injury. Submission of these forms is entirely voluntary. Information provided on those forms relating to the origin, incurrence, or aggravation of a disease or injury will not be used by DoD in any manner against the interest of the Service member. c. Upon receiving notice from the MSC as required by Public Law 106-475 (Reference (o)): (1) Waive the opportunity to submit information and evidence consistent with Reference (o). (2) While not waiving the opportunity to submit evidence consistent with the guidelines of Reference (o), submit any information or evidence to substantiate the claim. d. Within 5 days of being informed about the VA disability process by the MSC, submit VA Form 21-0819 to the MSC with sections 2, 4 (if applicable), and 5 completed. e. Within 5 days of receiving the completed and signed MEB results, to include completed VA disability evaluation results, submit to the PEBLO, if desired, request(s) for an impartial medical review (IMR) or MEB rebuttal. The Service member or representative may request an extension of time to prepare the IMR or MEB rebuttal, which shall be granted by the MEB convening authority when good cause is shown. 2. Service members (or his or her designated representative) may, if found unfit by the IPEB: 13 Appendix 1 to Attachment 4 DTM-11-015, December 19, 2011 a. After receiving their proposed VA disability rating may accept or rebut the IPEB unfit determination and request an FPEB by notifying their PEBLO, in writing, within 10 days of receiving their IPEB determination and preliminary disability ratings. The request should include a clear statement on the reason for rebuttal and the remedy sought. A Service member’s right to a full and fair hearing will not be denied based on the lack of a statement or a determination that any such statement is insufficient, unclear, or otherwise objectionable. Retained counsel may petition the PEB for an extension with good cause shown. b. May request a one-time reconsideration of their disability rating(s) for unfitting conditions only by notifying their PEBLO, in writing, within 10 days of receiving their preliminary disability ratings. The request must include new medical evidence or sufficient justification of an error to warrant reconsideration. 3. The Service member (or his or her designated representative) may, if found fit for continued service by the IPEB,: a. Accept the findings by notifying his or her PEBLO, in writing, within 10 days of receiving the proposed disability ratings. b. Rebut the findings by notifying his or her PEBLO, in writing, within 10 days of receiving the proposed disability ratings and providing new information that the IPEB did not previously consider. c. Rebut the fit findings of the IPEB and if the Service member is then found unfit by an FPEB or Military Department disability disposition approval authority may request a one-time reconsideration of his or her disability rating(s) for unfitting conditions by notifying the PEBLO, in writing, within 10 days of receiving the VA disability rating. Retained counsel may petition the PEB for an extension with good cause shown. 4. The Service member (or his or her designated representative) may appeal their FPEB findings regarding fitness for duty to all subsequent levels allowed by the Military Department concerned, such as the Department of the Navy Council of Review Boards and the Department of the Air Force Personnel Council. 5. After the Service member (or his or her designated representative) submits VA Form 21-0819 to the MSC, the Service member may claim additional conditions, but VA will not evaluate the added claimed conditions until after separation from service. 6. In the event the Service member desires to transfer to another branch of the U. S. Military, he or she may apply to the appropriate Service headquarters to determine if he or she meets Service standards. 7. Upon separation from military service for medical disability and consistent with BCMR procedures of the Military Department concerned, the former Service member (or his or her designated representative) may request correction of his or her military records through his or her respective Military Department BCMR if new information regarding his or her service or 14 Appendix 1 to Attachment 4 DTM-11-015, December 19, 2011 15 Appendix 1 to Attachment 4 condition during service is made available that may result in a different disposition. For example, a veteran appeals VA’s disability rating of an unfitting condition based on a portion of his or her service treatment record that was missing during the IDES process. If VA changes the disability rating for the unfitting condition based on a portion of his or her service treatment record that was missing during the IDES process and the change to the disability rating may result in a different disposition, the Service member may request correction of his or her military records through his or her respective Military Department BCMR. 8. If, after separation from service and attaining veteran status, the former Service member (or his or her designated representative) desires to appeal a determination from the rating decision, the veteran (or his or her designated representative) has 1 year from the date of mailing of notice of the VA decision to submit a written notice of disagreement with the decision to the VA regional office of jurisdiction. 9. The Service member has either 60 days from the date of the statement of the case provided by the VA regional office of jurisdiction or the remainder of the 1 year from the date of mailing of notification of the VA decision, whichever is longer, to file a VA Form 9, “Appeal to the Board of Veterans Appeals,” available at http://www.va.gov/vaforms/. DTM-11-015, December 19, 2011 APPENDIX 2 TO ATTACHMENT 4 MTF MEDICAL CARE PROVIDER PROCEDURES A qualified MTF medical care provider, as authorized by the MTF commander, shall initiate the IDES process and: a. In consultation with the Service member’s commander, refer Service members to the IDES process in accordance with Attachment 3 of this DTM. b. Complete section 1 of VA Form 21-0819 and provide it to the PEBLO. c. Notify the Service member of his or her referral to the IDES and direct the Service member to MTF patient administration. d. Notify MTF patient administrator of a Service member’s referral to the IDES. e. Construct an abbreviated narrative summary and MEB report, meeting all the necessary requirements from the IPEB to render a fitness decision. 16 Appendix 2 to Attachment 4 DTM-11-015, December 19, 2011 APPENDIX 3 TO ATTACHMENT 4 PATIENT ADMINISTRATION PROCEDURES The Director, Patient Administration, shall: a. Assign a PEBLO and forward the MEB case file to the PEBLO within 3 days of the date the MTF medical care provider refers the Service member to an MEB. b. Receive the VA C&P disability examination results from the VA C&P qualified medical examiner through the PEBLO and ensure the examination results are recorded in the Service member’s service treatment record. c. Provide the Service member’s service treatment record and disability examination results to the provider who will construct the narrative summary and MEB report. d. Forward the DES case file to the PEBLO and a copy of the case file to the MSC within 3 days of the date the MTF medical care provider signs the narrative summary. e. Assist Service members who request to consult with an impartial medical reviewer or legal counsel or rebut MEB findings in accordance with Reference (f). 17 Appendix 3 to Attachment 4 DTM-11-015, December 19, 2011 APPENDIX 4 TO ATTACHMENT 4 PEBLO PROCEDURES 1. GENERAL. The PEBLO is one of the most important contacts for the Service member, and their family member(s) throughout the DES process. Immediately after the case is referred to the IDES, the MTF patient administrator assigns the PEBLO to the case. The PEBLO provides the link between the Service member, the member’s commander, VA, and the IDES. The PEBLO will notify the Service member’s commander once a Service member is referred into the IDES; it is the PEBLO’s responsibility to coordinate all necessary appointments for the Service member in conjunction with the MSC. The PEBLO remains an integral part of the process from the point of MEB referral to the Service member’s return to duty or separation from military service. Additional PEBLO responsibilities are outlined in Reference (e). To accommodate Service differences, other staff members may complete these procedures. 2. PEBLO PROCEDURES. The PEBLO shall: a. Within 3 days of the date the MTF medical care provider referred the case to an MEB or, for Reserve Component Service members, not later than the first drill after referral to an MEB by the MTF medical care provider: (1) Build the IDES case file. (2) Inform the Service member of the DoD IDES process and that they may seek assistance during the IDES process from Government legal counsel provided by the Military Departments, private counsel retained at their own expense, or from a VA-accredited representative of a service organization recognized by the Secretary of Veterans Affairs, using VA Form 21-22. Additionally, the Service member may request assistance from a VA-accredited claims agent or attorney, using VA Form 21-22a. (3) Provide Service members who are referred to the IDES: (a) A brochure or handout detailing the benefits, expectations, right to legal counsel, and possible decisions at each step of the IDES. (b) The link to the Compensation and Benefits Handbook for Seriously Ill and Injured Members of the Armed Forces, http://turbotap.org/register.tpp. (c) A copy of VA Form 21-22 and ensure the word “veteran” in Block 1 is deleted and replaced with “Service member.” (4) Notify the MSC that the Service member is referred to the IDES. 18 Appendix 4 to Attachment 4 DTM-11-015, December 19, 2011 (5) Inform the Service member of the requirement of providing all service treatment records to include civilian records to the PEBLO for inclusion in the DES case file during the claims development phase of the IDES. b. Within 5 days of the date the MTF medical care provider referred the case to the IDES: (1) Request a non-medical assessment from the Service member’s commander. (2) If necessary, request the Service member’s commander conduct and provide a complete line of duty investigation and determination. c. Within 10 days of the date the MTF medical care provider referred the case to the IDES, for Active Component Service members, or within 30 days of the referral date for Reserve Component Service members: (1) Provide the MSC a copy of the member’s IDES case file and service treatment record, including entrance physical, mental health records, and records from the Armed Forces Health Longitudinal Technology Application (AHLTA) and the Composite Health Care System. (2) When a Service member’s complete service treatment record is not available, provide the MSC a memorandum describing the actions taken to locate the missing records and the determination that the medical records are not available. d. Within 3 days following receipt of the IDES case file and VA C&P disability examination requirements from the MSC or not later than the next Reserve drill, inform the Service member and the Service member’s commander of all scheduled VA C&P medical examinations. e. Monitor the Service member’s completion of IDES appointments, including VA C&P medical examinations. (1) Approve and coordinate the Service member’s requests for rescheduling of VA examination appointments by contacting the MSC. Within 3 days of receipt of rescheduled VA examination appointments, inform the Service member and Service member’s commander of new appointments. (2) Upon receipt of notification from an MSC or VA examination facility that a member failed to report for scheduled examination appointment(s), inform member’s command. Coordinate rescheduling of VA examination appointments by contacting the MSC. Within 3 days of receipt of rescheduled VA examination appointments, inform the Service member and Service member’s commander of new appointments, and if necessary, request for the command to provide an escort. 19 Appendix 4 to Attachment 4 DTM-11-015, December 19, 2011 f. Assemble the DES case file to include all medical and non-medical information to be considered by the MEB. g. Inform the Service member that his/her case is being forwarded to the MEB. h. Forward the Service member’s case file to the MEB. i. Within 3 days of receipt of the MEB results or not later than the next Reserve drill, provide a copy of the MEB findings to the MSC and notify the Service member of the MEB results, including the conditions that caused the Service member to fail to meet retention standards and the date of PEB referral. j. While undergoing consideration by the MEB, inform the Service member of his or her right to an IMR, when requested, to serve as an independent source for review of the findings and recommendations of the MEB, and provide medical advice and counsel regarding the findings and recommendations of the MEB. k. Forward the results of the IMR or MEB rebuttal to the MEB, as required. l. If the MEB finds the Service member does not meet medical retention standards, assemble the MEB case file with all attachments and forward the complete MEB case file to the PEB. m. Inform the MSC of the date of referral to the IPEB. n. Within 3 days of receiving the IPEB findings from the PEB administration or at the next Reserve drill, provide a copy and inform the Service member of the IPEB findings, the VA proposed ratings and benefits estimate letter, and his or her options, including consultation with legal counsel. If the PEB finds the member fit, notify the MSC of that finding and provide a copy of the PEB findings to the MSC. Advise the Service member of their right to legal counsel regarding the preparation of a rebuttal of his or her fitness decision or disability rating, if applicable. o. Within 10 days after the Service member receives his or her IPEB findings or not later than the next Reserve drill: (1) Assist the Service member with the administrative portion of preparing a rebuttal to his or her IPEB Unfit for duty finding, if applicable. Although the PEBLO may assist with the administrative portion of Service member rebuttals and appeals, they are not Service member legal advocates, and shall not provide advice, legal counsel, or other assistance regarding substantive aspects of the rebuttal. (2) On request and with consent of the Service member, forward the Service member’s legal counsel a copy of the Service member’s IDES case file, including a complete paper or scanned copy of the member’s service treatment record, all non-medical information 20 Appendix 4 to Attachment 4 DTM-11-015, December 19, 2011 reviewed by the MEB and PEB, narrative summary, all VA C&P disability examination reports, and the proposed VA rating determination. (3) If applicable, administratively assist the Service member in preparing a request to reconsider the proposed VA disability ratings of unfitting conditions and provide the Service member’s request for reconsideration to the PEB and MSC within 10 days of the date the Service member received the IPEB findings. Additionally, inform the Service member of his or her right to consult with and be represented by government counsel from the Military Department concerned, private counsel retained at member’s expense, as well as the opportunity to be represented before VA by a VA-accredited attorney, agent, or representative of a VA-recognized Service organization. (4) If applicable, inform the Service member of VA’s decision to propose a finding of incompetency and record the date and name of the person who provides the letter to the Service member. (5) Provide the Service member’s request for an FPEB to PEB administration. (6) Inform the MSC and Service member’s commander of the Service member’s acceptance of findings, request for reconsideration, or request for an FPEB. p. Notify the Service member and his or her commander of the FPEB date. q. Monitor case progress and resolve complications related to the FPEB. r. Within 3 days after receiving the FPEB findings from PEB administration or not later than the next Reserve drill: (1) Inform the Service member of the FPEB findings and right to appeal the findings to the Military Department review authority or ensure a Military Department representative such as a PEB official informs the Service member. (2) Advise the Service member of his or her right to legal counsel for assistance in the preparation of an appeal or ensure a Military Department representative, such as a PEB official, informs the Service member of their right to legal counsel. s. Within 3 days of receiving the approval authority’s decision or at the next Reserve drill, inform the Service member of the Military Department’s final fitness disposition or ensure a Military Department representative, such as a PEB official, informs the Service member. t. Enter IDES cases into the IDES module of VTA within 3 days of the date the medical care provider referred the case to the MEB. Enter or update the case data required in the VTA IDES module within 3 days of the data becoming available. u. Notify and provide documentation of the reason for disenrollment to the MSC and PEB when Service members are disenrolled from the IDES. 21 Appendix 4 to Attachment 4 DTM-11-015, December 19, 2011 22 Appendix 4 to Attachment 4 v. Inform the Service member (or his or her designated representative) to schedule and attend an exit interview with the MSC prior to exiting the IDES process. DTM-11-015, December 19, 2011 APPENDIX 5 TO ATTACHMENT 4 MEB CONVENING AUTHORITY PROCEDURES The MEB convening authority shall: a. Assemble an MEB in accordance with Military Department regulations, using the information provided by the PEBLO in the DES case file. MEB members will consult and render a decision on whether the Service member’s fitness for continued military service is questionable because of physical or mental impairment. Any MEB listing a psychiatric diagnosis must contain a thorough psychiatric evaluation and include the signature of at least one psychiatrist or psychologist with a doctorate degree in psychology. b. Ensure that, within 30 days of receipt of the complete DES case file, the MEB completes their deliberations and documents their decision, which shall include the specific conditions that cause the Service member to fail retention standards. The MEB returns the case file, with completed findings, to the PEBLO. c. Ensure that MEB rebuttal procedures meet the guidelines outlined in References (b) and (e). 23 Appendix 5 to Attachment 4 DTM-11-015, December 19, 2011 APPENDIX 6 TO ATTACHMENT 4 MSC PROCEDURES 1. GENERAL. The MSC is a critical contact for the Service member or veteran throughout the IDES. Assigned immediately after the PEBLO is assigned to assist the Service member, MSCs provide the link between the Service member and VA by keeping the Service member, veteran, and the PEBLO informed of VA processes. 2. MSC PROCEDURES. The MSC shall: a. Within 10 days of receiving a Service member’s IDES case file, including a complete copy of the service treatment record, either paper or electronic (scanned to CD-ROM), from the PEBLO: (1) Inform the Service member of his or her rights and VA actions in the IDES, including: (a) The criteria that must be met to receive VA disability compensation, noting that a claim can be filed with VA for any condition. (b) The opportunity to be represented before VA by any attorney, agent, or officer of a Service organization providing representation to Service members who has complied with part 14 of Reference (h). (2) Provide the Service member with the notice required by Reference (o). The MSC may solicit a waiver from the Service member or veteran of the 30-day period in which to submit any information or evidence to substantiate the claim. (3) Assist the member in completing VA Form 21-0819. b. Upon completion of section 2 of VA Form 21-0819, enter the information from the form into the VA claims processing system. If the Service member declines to claim additional conditions during the initial education session or does not claim additional conditions beyond those noted in part 1 of VA Form 21-0819, within 3 working days of their initial MSC session, the MSC seeks annotation from the Service member that he or she does not desire to file a claim for VA disability benefits or does not want to claim any additional disabilities. If the Service member refuses to complete VA Form 21-0819, the MSC annotates on the form that the Service member declined to claim additional conditions and the MSC documents the information in VTA. c. Within 10 days of receiving the Service member’s DES case file from the PEBLO, request a VA C&P disability examination using the VA Compensation and Pension Record 24 Appendix 6 to Attachment 4 DTM-11-015, December 19, 2011 Interchange (CAPRI), the Veterans Examination Request Information System (VERIS), or other appropriate systems as required and agreed to by the ASD(HA) and VBA. d. Concurrently, gather additional information and evidence required to substantiate the claim, such as service medical records and other pertinent records from previous periods of service, private medical treatment records, and additional information for the Service member. The MSC may request examinations required by the case as developed to date and forward the case to the next step while continuing to gather additional information and evidence required to substantiate the claim. If the MSC is unable to obtain all of the relevant records, the MSC notifies the Service member of the inability to obtain the records, identifies the records, explains the efforts made by VA, and describes any further action VA will take with respect to the records. Through the course of routine care and treatment or as found by the examiner, should the member present new medical issues for consideration, the MSC requests the additional examinations in coordination with the PEBLO and MTF liaisons. e. Inform the Service member of the case development results prior to the MEB. f. When all examinations have been completed: (1) Provide the PEBLO the completed VA C&P disability examination results. (2) Forward the VA claim folder to the D-RAS of jurisdiction. g. Track the Service member’s case status. The MSC conducts an exit interview with the Service member before the member departs the installation. The MSC gathers any additional required information in order to expedite payment of VA benefits after separation. h. Within 3 days of receiving notification of the Service member’s separation date, advise the Service member on his or her appeal rights for disability ratings and other post-separation VA processes. i. Forward the veteran’s DD Form 214 Part 3 or Letter of Separation or Retirement (Reserve Component only) to the D-RAS by overnight mail for processing within 3 days of receiving it from the Military Department. (1) The Department of the Navy will forward all IDES case information to: U.S. Department of Veterans Affairs Providence VA Regional Office ATTN: DES 380 Westminster Street Providence, RI 02903 E-mail: des.vbapro@va.gov (2) The Army PEB in the Washington, D.C., area and the Air Force PEB at Randolph AFB, Texas, forward all IDES case information to: 25 Appendix 6 to Attachment 4 DTM-11-015, December 19, 2011 26 Appendix 6 to Attachment 4 U.S. Department of Veterans Affairs Baltimore DES Rating Activity Room 1200 31 Hopkins Plaza Baltimore, MD 21201 E-mail: des.vbabal@va.gov (3) The Army PEB in Joint Base Lewis-McChord, Washington, and Fort Sam Houston, Texas, forward all IDES case information to: U.S. Department of Veterans Affairs Auburn Processing Center (DES) 1901 C Street SW Auburn, WA 98001 E-mail: des.vbasea@va.gov j. Maintain timely, complete, and accurate data in the IDES module of VTA. DTM-11-015, December 19, 2011 APPENDIX 7 TO ATTACHMENT 4 COMMANDER PROCEDURES Commanders shall: a. Provide the PEBLO a non-medical assessment of the Service member’s ability to perform their current job within 5 calendar days of the request date. b. If a line of duty determination is required, provide the PEBLO a complete line of duty investigation and determination within 5 days of the request date. c. Ensure Service members attend all IDES appointments and VA medical examination appointments, particularly during the MEB phase of the IDES process during which critical case management briefings, medical examinations, and Military Department MEB are completed. Commanders may grant exceptions to this requirement for the welfare or morale of a Service member as long as those exceptions do not prevent timely completion of IDES appointments. Commanders may discuss the contents of the non-medical assessment with the Service member before submission to the PEB. d. Inform the PEBLO of any scheduling conflicts with IDES appointments. e. Ensure IDES referred Service members are assigned military duties appropriate to their condition or have a recovery care plan established. 27 Appendix 7 to Attachment 4 DTM-11-015, December 19, 2011 APPENDIX 8 TO ATTACHMENT 4 IDES QUALIFIED MEDICAL EXAMINER PROCEDURES The IDES qualified medical examiner shall: a. Complete the general medical and specialty examinations for Service members being considered for separation through the IDES within 45 days of receiving an IDES VA C&P disability examination request and service treatment record. The 45-day timeframe will include 40 days for the completion of the examination and 5 days for the completion of the administrative requirements. VA will supplement this DTM with operational instructions for scheduling VA C&P medical examinations. b. Perform VA C&P medical examinations. VA C&P medical examinations will be performed by providers who meet VA C&P examination certification requirements. Qualified medical examiners may come from a variety of sources (e.g., DoD, VA, TRICARE, contractor). While not prohibited, it is highly discouraged for the treating provider to perform a VA C&P disability examination. This allows the treating provider to concentrate on medical care and the IDES qualified medical examiner to focus on quantifying impairment. The IDES qualified medical examiner will review the member’s complete service treatment record in conjunction with the examination, and prior to issuing the final examination report(s). Medical examinations for seriously or very seriously injured Service members who are not able to leave their bed, or otherwise attend an examination may consist of a review of the medical records developed as part of the Service member’s treatment. c. Ensure all C&P medical examinations include a complete review of systems and a comprehensive evaluation of medical conditions identified and referred to the IDES by a military medical provider. C&P medical examinations will include an evaluation of medical conditions identified and claimed by the member as having been incurred in, or aggravated by, military service. To the extent feasible, C&P medical examinations will be documented on VA C&P general medical examination worksheets plus any applicable VA Automated Medical Information Exchange examination worksheets or templates. C&P medical examinations will serve as the separation physical should separation from military service occur through the IDES. d. Notify the MSC and PEBLO of additional examination requirements when conditions are identified that cannot be examined during the course of the current exam. For newly identified conditions, the medical examiner must also receive from the MTF physician a statement as to whether these newly identified conditions meet the Service’s medical retention standards or are otherwise cause for referral to the PEB as established by Reference (b) or Military Department regulations. e. Perform TDRL re-examinations when necessary. 28 Appendix 8 to Attachment 4 DTM-11-015, December 19, 2011 APPENDIX 9 TO ATTACHMENT 4 PEB ADMINISTRATION PROCEDURES 1. GENERAL. PEB administration ensures the IDES case file that was received from the PEBLO is processed through the IPEB or FPEB. PEB administration also supports the IDES quality control review process. a. Upon receiving the complete and correct MEB case file from the PEBLO, the PEB administrator prepares the case for the PEB. b. The PEB administrator notifies the PEBLO of the IPEB fit findings within 3 days of receiving the fit findings from an IPEB. c. For all unfit findings from the IPEB, the PEB administrator forwards a copy of the request for rating with the documentation upon which that assessment was made and the pertinent findings of the PEB to the D-RAS for rating of the claimed disabilities by encrypted electronic transfer or overnight mail for processing. d. The Department of the Navy will forward all IDES case information to: U.S. Department of Veterans Affairs Providence VA Regional Office ATTN: DES 380 Westminster Street Providence, RI 02903 E-mail: des.vbapro@va.gov e. The Army PEB in the Washington, D.C., area and the Air Force PEB at Randolph AFB, Texas, forward all IDES case information to: U.S. Department of Veterans Affairs Baltimore DES Rating Activity Room 1200 31 Hopkins Plaza Baltimore, MD 21201 E-mail: des.vbabal@va.gov f. The Army PEB at Joint Base Lewis-McChord, Washington, and Fort Sam Houston, Texas, forward all IDES case information to: U.S. Department of Veterans Affairs Auburn Processing Center (DES) 1901 C Street SW Auburn, WA 98001 E-mail: des.vbasea@va.gov 29 Appendix 9 to Attachment 4 DTM-11-015, December 19, 2011 30 Appendix 9 to Attachment 4 2. REBUTTAL. Within 3 days of receiving the Service member’s request to rebut the IPEB fitness decision, PEB administration: a. Schedules a FPEB. Provides Service members or the designated representative a minimum of 10 days advance notice of the formal hearing before the FPEB. This 10-day requirement may be waived by the Service member in writing. At a minimum, assigned Government legal counsel will consult with the Service member in accordance with guidance in Reference (f), prior to the scheduled formal hearing. Affords Service members traveling to an FPEB sufficient time to arrive (more than 1 day) in advance of the scheduled hearings to confer with Government legal counsel. b. Notifies the PEBLO of the FPEB date. c. Provides a copy of the DES case file to the Service member’s Government legal counsel. 3. FINDINGS. Within 3 days of receiving findings from an IPEB or FPEB that is not rebutted or appealed, PEB administration: a. Processes the IPEB or FPEB findings. b. Notifies the Service Headquarters, PEBLO and MSC of the FPEB findings. 4. PEB COMPOSITION. The IPEB may be comprised of at least two members, military personnel at the level of major or lieutenant commander or civilian personnel whose level is equivalent or higher. In cases of a split opinion, a third voting member will be assigned to provide the majority vote. a. The FPEB shall be comprised of at least three members and may have military and civilian personnel representatives. PEB organization will be promulgated in regulations and policies of the Military Department. Therefore, specific board composition may differ among the Military Department and is governed by appropriate departmental regulations. The board will minimally consist of a president, who should be a colonel, naval captain, or civilian equivalent; a medical officer; and a line officer (or non-commissioned officer at the E-9 level for enlisted cases) familiar with duty assignments. b. Secretaries of the Military Departments may adjust this composition, if desired, to enhance the adjudication process. In the case of Reserve Component members, Secretaries of the Military Departments shall ensure Reserve Component representation on the PEBs is consistent with section 12643 of Reference (j) and related policies. DTM-11-015, December 19, 2011 APPENDIX 10 TO ATTACHMENT 4 IPEB AND FPEB PROCEDURES 1. GENERAL. The IPEB and FPEB determines a Service member’s fitness in accordance with existing policy but does not assign disability ratings to conditions. The IPEB and FPEB supports IDES quality control review processes. 2. IPEB PROCEDURES. The IPEB members shall: a. Within 15 days of receiving the complete and correct MEB case file from the PEB administrator, adjudicate the Service member’s case and forward the findings and recommendations to the PEB administration staff. b. Within 15 days of receiving proposed disability ratings from the D-RAS, apply the ratings using the diagnostic code(s) provided by the D-RAS to the Service member’s unfitting conditions and publish the disposition recommendation. For example, if the PEB identifies a condition to the D-RAS as schizophreniform disorder but the D-RAS rates the condition as psychotic disorder not otherwise specified (VASRD 9210), the PEB will apply the rating as “schizophreniform disorder rated as psychotic disorder not otherwise specified (VASRD 9210).” c. Evaluate the Service member’s request for FPEB. If a Service member requests a FPEB when the decision of the IPEB is fit for all conditions, the PEB President or FPEB (or as specified by Military Department regulations) may grant the Service member’s request. If the request is granted, the PEB administrator prepares the case for a FPEB. 3. FPEB PROCEDURES. The FPEB members shall: a. Consider Service member rebuttals of issues pertaining to the fitness of conditions for service and the ratings assigned to unfitting conditions. b. Render a recommendation within 30 days from the date the Service member elects to rebut the IPEB decision. The decision will be formally prepared by the PEB for the Service member. c. Coordinate recommendations to change the status of conditions between fit and unfit with the D-RAS to ensure VA’s proposed rating accurately reflects the PEB’s final recommendation of unfitting conditions. 31 Appendix 10 to Attachment 4 DTM-11-015, December 19, 2011 APPENDIX 11 TO ATTACHMENT 4 D-RAS PROCEDURES 1. Upon receipt of the case files (request for rating and service treatment record) of unfit Service members from PEB administration, the D-RAS determines whether the VA C&P disability examination report is adequate for disability rating purposes. Within 3 days of receiving the case files of unfit Service members, the D-RAS will return case files with inadequate VA C&P medical examinations to the examining facility for correction via next day mail or electronically. The D-RAS also notifies the referring Service PEB administration, PEBLO, and MSC when a case file is being returned for additional required information. 2. The D-RAS will rate the Service member’s referred and claimed Service-connected disabilities and provide a proposed rating decision, with rationale, to the PEB within 15 days of notification by the PEB administration staff that a Service member is unfit. If the D-RAS determines that the disability examination report(s) are insufficient for rating purposes, the PEB will return the VA C&P disability examination report to the appropriate examining facility for correction or completion. Once the D-RAS has rated all unfitting conditions, the D-RAS will provide their proposed rating decision to the PEB. The D-RAS will defer rating all other conditions that require additional claim development in accordance with VA business practices and regulations. 3. Within 15 days of receipt from the PEB of a Service member’s written request for a one-time reconsideration of a proposed disability evaluation assigned for unfitting conditions by VA, the VA decision review officer will consider any new documentation or information from the Service member and provide the PEB updated proposed ratings, if any. The VA decision review officer will only reconsider ratings if new medical evidence is received or the Service member is able to provide sufficient justification, such as error, to warrant the reconsideration. The D-RAS will determine if the request for D-RAS reconsideration is based upon appropriate grounds. This is a one-time “request for reconsideration” of the rating(s) from the D-RAS. Subsequent appeals of ratings to VA must occur when the Service member has separated, attained veteran status, and has been formally notified of the rating decision. 4. The D-RAS will enter or update the case data required in the VTA within 3 days of the data becoming available. 5. The responsibilities assigned in this appendix are related to veteran or Service members placed on the TDRL. For all Service members found unfit for continued service and separated via the IDES model and placed on the TDRL, VA will establish future examinations in accordance with existing laws and regulations. VA will prepare rating decisions on all future examinations in accordance with existing laws and regulations. The IDES goal is for the D-RAS to complete the proposed rating decision not later than 30 days after the D-RAS receives the completed examination report. VA will provide the TDRL Service member and the designated VA-accredited representative with notification of all VA rating decisions at the same time that the rating is made available to the Military Department concerned. VA will notify the veteran in 32 Appendix 11 to Attachment 4 DTM-11-015, December 19, 2011 33 Appendix 11 to Attachment 4 accordance with part 3 of Reference (h) and section 5104 of title 38, United States Code (Reference (k)) of all decisions made by VA to include procedural due process and appellate rights. Uniformed or civilian attorneys of the Military Departments, private counsel retained by the member at the member’s expense VA-accredited representative, are authorized to assist TDRL members with requests for reconsideration of VA rating determinations on medical conditions determined to be unfitting and that affect Military Department decisions on their military benefits. 6. The Military Department concerned will use the Veterans Health Information Systems and Technology (VISTA), Veterans Service Network (VETSNET), Virtual VA, or VA’s SHARE system to obtain a copy of the most current rating and the medical evidence upon which the most current rating is based. If the PEB is unable to obtain documentation from the VA IT systems, the PEB will contact the D-RAS to request the results of the re-evaluation and subsequent rating decision documents of Service members be sent directly to the PEB. DTM-11-015, December 19, 2011 APPENDIX 12 TO ATTACHMENT 4 MILITARY DEPARTMENT PROCEDURES 1. The staff of the Military Department will: a. Place Reserve Component Service members on orders as needed to meet all IDES requirements. b. Process IDES decisions in accordance with their respective regulations except as required by this DTM. c. Return to duty, separate, retire, or assist the Service member to complete an inter-Service transfer. d. Inform the PEBLO and D-RAS of the Service member’s final out-processing date and provides VA a copy of the Service member’s DD Form 214 or separation letter. e. Within 5 days of receiving the approval authority’s decision to separate the Service member, establish a separation date in accordance with their respective regulations except that the separation date should generally be in 45 days from the date of approval of the disposition for Active Component Service members. The 45-day goal may be exceeded to allow the Service member to take authorized leave and permissive temporary duty (TDY). f. Notify the MSC of the member’s separation date and either deliver the DD Form 214, Copy 3, or the letter of separation or retirement to the MSC or VA by secure email if the DD Form 214 was digitally signed or forward to VA by overnight mail for processing as listed in paragraphs 1.d. and 1.e. of Appendix 9 to Attachment 4 of this DTM. g. Advise Active Component Service members that it may be in their financial best interest to separate prior to, but as close to, the last day of the month as possible. In accordance with section 5110 of Reference (k) and part 3 of Reference (h), payment of VA disability compensation may not be made for any period prior to the first day of the calendar month following the month in which the award became effective. The effective date of an award of disability compensation to a veteran is the day following the date of the veteran’s release or discharge if a claim is received within 1 year from discharge. Military Departments will provide VA formal notification via the DD Form 214 that the Service member has been separated from service to enable VA to finalize the award of disability benefits. In the case of Reserve Component Service members, entitlement to VA compensation begins when the Service member’s period of active service ends and the Service member becomes a veteran. h. If a determination is made that a Service member’s records warrant a correction, necessary procedures are implemented to ensure compensation and benefits are adjusted as appropriate, and the Service member’s corrected DD Form 214 is forwarded to the responsible VA Regional Office. 34 Appendix 12 of Attachment 4 DTM-11-015, December 19, 2011 35 Appendix 12 of Attachment 4 2. The staff of the Military Department concerned will: a. Review DAC reports and other reports and data from the IDES and, in coordination with DASD(WWCTP) and VA, adjusts their IDES process to ensure a fair and equitable process for all Service members in the IDES. b. Using course content supplied by VA, provide VA C&P medical examination training for DoD providers who are required to conduct C&P exams. c. Using VA certification processes, document the qualifications of DoD personnel who conduct IDES medical examinations. d. Provide PEBLOs training on the overall IDES process, including educating Service members on their options, rights, benefits, and entitlements and the timeliness goals associated with the IDES process. DTM-11-015, December 19, 2011 APPENDIX 13 TO ATTACHMENT 4 VA REGIONAL OFFICE OF JURISDICTION PROCEDURES If, after separation from Service and attaining veteran status, the veteran desires to appeal a determination from the rating decision, the veteran has 1 year from the date of mailing of notice of the VA decision to submit a written notice of disagreement with the decision per part 3 of Reference (h) and section 7105 of Reference (k). a. Upon receipt of the notice of disagreement from the veteran, the VA reviews the notice of disagreement, and issues a statement of the case or revised rating decision. The veteran has either 60 days from the date of the statement of the case, or the remainder of the 1 year from date of mailing of original notification of decision, whichever is longer, to file a VA Form 9. b. Once the VA Form 9 is received, forwards the appeal to the Board of Veterans’ Appeals for decision. The Board may grant the VA the relief sought on appeal, deny the relief sought on appeal, or remand the case to the VA regional office for development or re-adjudication before returning it to the Board. 36 Appendix 13 of Attachment 4 DTM-11-015, December 19, 2011 APPENDIX 14 TO ATTACHMENT 4 DAC PROCEDURES The DAC shall: a. Ensure that policy is established for a fair and equitable determination of a Service member’s fitness for continued duty is implemented and, if a Service member is found unfit, that the policy guarantees disability ratings are applied in a uniform manner. b. Administer the IDES policy for Service members to process through the IDES expeditiously, be informed about the process, know the status of their case, and understand that due process rules are followed. c. Evaluate the results of the IDES. d. Recommend adjustments to the DASD(WWCTP) to improve and standardize IDES processes. 37 Appendix 14 of Attachment 4 DTM-11-015, December 19, 2011 ATTACHMENT 5 TDRL PROCEDURES 1. INITIAL PLACEMENT ON TDRL a. PEB Initial Adjudication. IPEBs will forward the cases of unfit Service members to the D-RAS and will include a medical assessment prepared by a DoD clinician of whether each unfitting condition will most likely improve, remain stable, or worsen based on accepted medical principles and the clinician’s findings. b. D-RAS Adjudication. The D-RAS will rate all conditions, claimed as well as unfitting conditions, referred by the Service PEB. The D-RAS will determine if a future examination is required for any of the service-connected disabilities based upon part 3 of Reference (h) for future examinations, a review of the existing medical evidence of record, and existing VA policies and procedures in effect at the time of the rating determination. Future examinations will be scheduled in accordance with part 3 of Reference (h). If the D-RAS does not schedule or does not conduct a future examination or rating for an unfitting condition for a Service member placed on TDRL, the Military Department concerned will execute TDRL examination and rating requirements in accordance with chapter 61 of Reference (j). VA will make the reports of future examinations and any rating decisions prepared after the member’s initial separation from service available to the Service PEB. c. IPEB Disposition. The Military Departments’ PEBs will use the future examination requirements set by the D-RAS as an indicator of stability when making the PEB’s recommendations of stability determinations and case disposition to the Military Department Secretary. If the D-RAS finds there is no requirement for a future examination in accordance with part 3 of Reference (j) or VA regulations and current policies, the D-RAS will not schedule a future examination. If the Service PEB decides to temporarily retire a Service member for disability for whom the D-RAS has not scheduled a future examination, the Military Department concerned will execute required TDRL examinations and ratings in accordance with chapter 61 of Reference (h). d. Service Member Counseling. The Military Department will inform the Service member, prior to placement on the temporary retirement list, of the TDRL process and the requirement for re-examination. 2. RE-EXAMINATION AND RE-RATING OF TDRL MEMBERS a. Initiating the TDRL Re-Evaluation Process. No later than 16 months after temporarily retiring a Service member for disability or after the Service member’s previous re-evaluation, the Military Department will use DoD medical treatment documentation and VA corporate databases, including VISTA, VETSNET, CAPRI, SHARE, Virtual VA, or follow-on systems, or veteran-provided medical records to obtain available medical treatment and disability 38 Attachment 5 DTM-11-015, December 19, 2011 examination documentation. The Military Department PEB will review the available medical evidence to determine if the documentation is sufficient to conduct the TDRL re-evaluation of all diagnoses present during the period of TDRL evaluation without the requirement for additional physical examination of the Service member. b. Conduct of Disability Re-Examinations. VA will schedule and conduct future examinations in accordance with part 3 of Reference (h) for Service members placed on TDRL via the IDES process if the D-RAS has established a need for a future examination. The Military Department concerned will use VA’s VISTA, VETSNET, Virtual VA, and SHARE applications to determine if VA cancelled (or rescheduled to a later date) a future examination for a service-connected disability. If VA cancels a future examination, VA will not schedule additional future examinations and will not prepare additional rating decisions. The Military Department concerned will obtain a copy of the most current rating and medical evidence upon which the most current rating was based using the VISTA, VETSNET, Virtual VA, and SHARE applications. If the existing medical treatment documentation and examination reports are not sufficient for the Military Department concerned to conduct the re-evaluation process, the Military Department concerned will comply with their responsibilities in chapter 61 of Reference (j) regarding the TDRL, to include performing TDRL examinations and ratings when necessary. c. Cases on VA Appeal. When a Service member, temporarily retired for disability, has filed an appeal of a VA decision and the appeal resides with the Board of Veterans Appeals or Court of Appeals for Veterans’ Claims, the Military Department concerned will obtain, via VISTA, VETSNET, Virtual VA, and SHARE, a copy of the most current rating and medical evidence available. The Military Department concerned will use DoD medical treatment documentation and VA corporate databases, including VISTA, VETSNET, CAPRI, SHARE, and Virtual VA, or follow-on systems, to obtain all available medical treatment and disability examination documentation. The Military Department PEB concerned will review the available medical evidence to determine if the documentation is sufficient to conduct the TDRL re-evaluation process without the requirement for a physical examination of the veteran. If the PEB determines that the veteran requires a medical re-examination the PEB will coordinate the Military Department concerned actions needed to meet the statutory, 18-month examination requirement in chapter 61 of Reference (j). Upon receipt of all medical evidence, the PEB will adjudicate the case. d. Re-Rating by VA. VA will prepare subsequent ratings decisions for IDES TDRL re-examinations that meet the requirements of paragraph 1.b of Attachment 5 of this DTM. e. Notification of VA Rating Decisions. VA will provide the Service member who is temporarily retired for disability and their designated representative with notification of all VA rating decisions. VA will notify the Service member in accordance with part 3 of Reference (h) and section 5104 of Reference (k) of all decisions made by VA to include procedural due process and appellate rights. f. PEB Re-Adjudication. If the D-RAS schedules a second or subsequent future examination for a service-connected disability, the D-RAS will notify the Military Department concerned. The Military Department will use VISTA, VETSNET, Virtual VA, or SHARE to 39 Attachment 5 DTM-11-015, December 19, 2011 40 Attachment 5 obtain a copy of the most current rating and the medical evidence upon which the most current rating is based. The rating decision will inform the Military Department of the future examination date. The Military Departments’ PEBs will use the future examination requirements set by the D-RAS as an indicator of stability when making the PEB’s recommendations of stability determinations and case disposition to the Military Department Secretary. If the D-RAS determines there is no requirement for a future examination in accordance with part 3 of Reference (h) or VA regulations and current policies, the D-RAS will not schedule any further future examinations. If the Service PEB decides to continue a Service member on temporary retirement for disability for which the D-RAS has not scheduled a future examination, the Military Department concerned will execute required TDRL examinations and ratings in accordance with chapter 61 of Reference (j). g. PEB Disposition. If the PEB finds the TDRL Service member fit for duty for the condition(s) for which they were placed on the TDRL, that the condition(s) is now stable, and the TDRL Service member wishes to return to active duty, the Military Department concerned will administer any additional examinations required to evaluate whether the Service member is otherwise fit for duty according to the Military Department’s regulations and the guidance in Reference (b). The Military Department will administer other dispositions in accordance with the guidance in Reference (b). DTM-11-015, December 19, 2011 ATTACHMENT 6 IDES CASE TRACKING PROCEDURES 1. Upon referral of a Service member to the IDES, the PEBLO assigned to the Service member’s case will initiate the case in the IDES module of VTA. 2. If at any point, the Service member is disenrolled from the IDES, the PEBLO or PEB will notify the MSC and the D-RAS of case disenrollment using an encrypted e-mail or commercial delivery service. a. The Department of the Navy will forward all IDES case information to: U.S. Department of Veterans Affairs Providence VA Regional Office ATTN: DES 380 Westminster Street Providence, RI 02903 E-mail: des.vbapro@va.gov b. The Army PEB in the Washington, D.C., area and the Air Force PEB at Randolph AFB, Texas, forward all IDES case information to: U.S. Department of Veterans Affairs Baltimore DES Rating Activity Room 1200 31 Hopkins Plaza Baltimore, MD 21201 E-mail: des.vbasea@va.gov c. The Army PEBs in Joint Base Lewis-McChord, Washington, and Fort Sam Houston, Texas, forward IDES case information to: U.S. Department of Veterans Affairs Auburn Processing Center (IDES) 1901 C Street SW Auburn, WA 98001 E-mail: des.vbadea@va.gov 41 Attachment 6 DTM-11-015, December 19, 2011 ATTACHMENT 7 IDES TIMELINESS GOALS 1. GENERAL. Unless otherwise noted, all actions that specify timeliness requirements are measured in calendar days. Case processing timeliness goals for major portions of the IDES are described in this attachment. The goals are stated as numeric averages across IDES cases that each echelon should strive to achieve. For IDES purposes, Active Component members include Service members ordered to active duty for more than 30 days. 2. ACTIVE COMPONENT a. Overall IDES Process. The IDES goal is for DoD and VA to complete the cases of Active Component Service members in no more than 295 days from the date of referral to the IDES to the date of return to duty or disability separation and notification of the VA benefits decision. b. MEB Phase. The MEB phase of the IDES includes activities from the point of referral to the DES to the transfer of a completed MEB case file to the Military Department’s PEB administration function. The IDES goal is to complete the MEB portion of the cases of Active Component Service members in no more than 100 days from the date of referral to an MEB by an MTF medical care provider to the date of receipt of the complete MEB case file by the PEB administration. The MEB phase includes: (1) Referral Stage. The IDES goal is to complete the referral stage of the cases of Active Component Service members in no more than 10 days. The referral stage is measured from the date of referral to an MEB by an MTF medical care provider to the date the PEBLO provides the Service member’s complete service treatment record, including the Service member’s entrance physical and VA Form 21-0819, to the VA MSC. (2) Claim Development Stage. The IDES goal is to complete the claim development stage of the cases of Active Component Service members in no more than 10 days from the date the PEBLO provides the Service member’s complete service treatment record and VA Form 21-0819 to the VA MSC to the date the MSC requests the Service member’s medical evaluation. (3) VA C&P Disability Examination Stage. The IDES goal is to complete the VA C&P disability examination stage of the cases of Active Component Service members, including all VA C&P general and other medical examinations, in no more than 45 days from the date the MSC requests the Service member’s medical examinations appointments to the date the MSC provides the completed disability evaluation results to the PEBLO. The 45-day timeframe will include 40 days for the completion of the examination and 5 days for the completion of the administrative requirements. 42 Attachment 7 DTM-11-015, December 19, 2011 (4) MEB Stage. The IDES goal is to complete the MEB stage of the cases of Active Component Service members in no more than 35 days from the date the PEBLO receives the completed VA C&P disability examination results from the MSC to the date the Military Department’s MEB returns the Service member to duty without referring them to an IPEB, or forwards their DES case file to PEB administration to begin processing for an IPEB. (5) IMR and MEB Rebuttal Stage. The IDES goal is to complete the IMR and MEB rebuttal stage consistent with the requirements in Reference (e) (i.e., no more than 20 days from the date the PEBLO receives Service member’s request for IMR). c. PEB Phase. The IDES goal is to complete the PEB phase of the IDES process of the cases of Active Component Service members, including the VA disability rating stage, in no more than 120 days from the date of receipt of the complete MEB case file by the PEB administration to the date the Military Department’s approval authority approves the final results of the disposition decision. The PEB phase includes 15 days for administrative processing tasks, such as copying and mailing case files. The PEB phase includes: (1) IPEB Stage. The IDES goal is to complete the IPEB stage for Active Component Service members in no more than 65 days from the date the PEB receives the Service member’s DES case file from the PEBLO to the date either the Service member requests an FPEB or (if Service member concurs with IPEB findings) when the Military Department’s approval authority approves the final results of the disposition decision. This time frame includes the time allotted for the D-RAS to complete rating decisions and reconsidered proposed rating decisions to the PEB, which is part of the disposition. (2) FPEB Stage. The IDES goal is to complete the FPEB stage for Active Component Service members in no more than 55 days from the date the PEB receives the Service member’s DES case file from the PEBLO to the date either the Service member requests an FPEB appeal or (if Service member concurs with FPEB findings) when the Military Department’s approval authority approves the final results of the disposition decision. For cases found fit by an IPEB but unfit by an FPEB, this time frame includes the time allotted for the D-RAS to complete rating decisions and reconsidered rating decisions to the PEB, which is part of the disposition. For cases found unfit by an IPEB, this time frame includes the time allotted for the D-RAS re-consideration and Military Department appeal processes. (3) Initial Proposed Ratings Stage. The IDES goal is to complete the initial proposed ratings stage of the cases of Active Component Service members in no more than 15 days from the date the VA D-RAS receives the request for rating and service treatment record from the PEB administration to the date the D-RAS sends the proposed rating to the PEB administration. (4) Rating Reconsideration Stage. The IDES goal is to complete the rating reconsideration stage of the cases of Active Component Service members in no more than 15 days from the date the VA D-RAS receives the rating reconsideration request from the PEB administration to the date the D-RAS sends the reconsideration findings to the PEB administration. 43 Attachment 7 DTM-11-015, December 19, 2011 (5) Military Department Appeal Process and Secretarial Review Stage. The IDES goal is to complete the Military Department appeal process and secretarial review stage of the cases of Active Component Service members in no more than 30 days, including secretarial review from the date the Service member appeals the FPEB disposition to the date the Military Department’s approval authority approves the final results of the disposition decision. d. Service Member Transition Phase. The Service Member transition phase of the IDES includes processing the Service member for a return to duty or to VA care. The IDES goal is to complete the Service member transition phase of the IDES process of the cases of Active Component Service members in 45 days (plus any amount of leave and permissive temporary assigned duty the Service member is authorized to take) from the date of approval of the final disability disposition decision to the date of the Service member’s separation from military service. e. VA Disability Compensation Delivery Phase. The IDES goal is to complete the VA disability compensation delivery phase of the IDES process of the cases of Service members who were Active Component Service members in no more than 30 days from the date of the Service member’s separation from military service to the date VA issues the Service member his or her disability benefits decision letter. 3. RESERVE COMPONENTS a. Overall IDES Process. Because of unique medical documentation and orders requirements, the IDES goal is for DoD and VA to complete the cases of Reserve and National Guard Component Service members in no more than 305 days from the time of referral to the DES to the point of return to duty or disability separation and notification of VA benefits decision. (1) MEB Phase. The IDES goal is to complete the MEB portion of the cases of Reserve and National Guard Component Service members in no more than 140 days from the date of referral to the IDES by an MTF medical care provider to the date of receipt of the complete MEB case file by the PEB administration. (2) Referral Stage. The IDES goal is to complete the referral stage of the cases of Reserve and National Guard Component Service members in no more than 30 days from the date of referral to the IDES by an MTF medical care provider to the date the PEBLO provides the Service member’s complete service treatment record and VA Form 21-0819 to the VA MSC. (3) Claim Development Stage. The IDES goal is to complete the claim development stage of the cases of Reserve and National Guard Component Service members in no more than 30 days from the date the PEBLO provides the Service member’s complete service treatment record, including the Service member’s entrance physical, and VA Form 21-0819 to the VA MSC to the date the MSC requests the Service member’s medical evaluation. 44 Attachment 7 DTM-11-015, December 19, 2011 (4) Disability Examination Stage. The IDES goal is to complete the disability examination stage of the cases of Reserve and National Guard Component Service members, including all VA C&P general and other required medical examinations, in no more than 45 days from the date the MSC requests the Service member’s VA C&P disability examination(s) to the date the MSC provides the completed results to the PEBLO. (5) MEB Stage. The IDES goal is to complete the MEB stage of the cases of Reserve and National Guard Component Service members within 35 days from the date the MSC provides the disability examination results to the PEBLO to the date the Military Department’s MEB returns the Service member to duty without referring them to an IPEB or forwards their DES case file to PEB administration to begin processing for an IPEB. (6) Impartial Medical Review and MEB Rebuttal Stage. The IDES goal is to complete the impartial medical review and MEB rebuttal consistent with the requirements in Reference (e) (i.e., no more than 20 days from the date the PEBLO receives Service member’s request for IMR). b. PEB Phase. The IDES goal is to complete the PEB phase of the IDES process of the cases of Reserve and National Guard Component Service members, including the VA disability rating stage, in no more than 120 days from the date of receipt of the complete MEB case file by the PEB administration to the date the Military Department’s approval authority approves the final results of the disposition decision. The PEB phase includes: (1) IPEB Stage. The IDES goal is to complete the IPEB stage for Reserve and National Guard Component Service members in no more than 65 days from the date the PEB receives the Service member’s DES case file from the PEBLO to the date either the Service member requests a FPEB or (if Service member concurs with IPEB findings) when the Military Department’s approval authority approves the final results of the disposition decision. This time frame includes the time allotted for the D-RAS to complete rating decisions and reconsidered rating decisions to the PEB, which is part of the disposition. (2) FPEB Stage. The IDES goal is to complete the FPEB stage for Reserve and National Guard Component Service members in no more than 55 days from the date the PEB receives the Service member’s DES case file from the PEBLO to the date either the Service member requests a FPEB Appeal or (if Service member concurs with FPEB findings) when the Military Department’s approval authority approves the final results of the disposition decision. This time frame includes the time allotted for the D-RAS to provide completed rating decisions and reconsidered proposed rating decisions for the PEB. (3) Initial Proposed Ratings Stage. The IDES goal is to complete the initial proposed ratings stage of the cases of Reserve and National Guard Component Service members in no more than 15 days from the date the VA D-RAS receives the request for rating and service treatment record from the PEB administration to the date the D-RAS sends the rating determination to the PEB administration. 45 Attachment 7 DTM-11-015, December 19, 2011 (4) Rating Reconsideration Stage. The IDES goal is to complete the rating reconsideration stage of the cases of Reserve and National Guard Component Service members in no more than 15 days from the date the VA D-RAS receives the rating reconsideration request from the PEB administration to the date the D-RAS sends the reconsidered proposed rating determination to the PEB administration. (5) Military Department Appeal Process Stage. The IDES goal is to complete the Military Department appeal process stage of the cases of Reserve and National Guard Component Service members in no more than 30 days, including Secretarial review from the date the Service member appeals the FPEB disposition to the date the Military Department Secretary’s approval authority approves the final results of the disposition decision. c. Service Member Transition Phase. The Service member transition phase of the IDES includes processing the Service member for a return to duty or to VA care. The IDES goal is to complete the Service member transition phase of the IDES process of the cases of Reserve and National Guard Component Service members in 45 days from the date the Military Department informs the Service member of the approved, final disability disposition decision to the date of the Service member’s separation from military service through a retirement or separation order or letter. d. VA Disability Compensation Delivery. The IDES goal is to complete the VA disability compensation delivery phase of the IDES process of the cases of Service members who were Reserve and National Guard Component members in no more than 30 days from the date of the Service member’s separation from military service to the date VA issues the Service member his or her disability benefits decision letter. For Reserve Component Service members, eligibility for disability compensation begins immediately upon separation. For Reserve Component Service members not on active duty orders, who meet the definition of a veteran in accordance with part 3 of Reference (h), the proposed rating will also serve as the actual rating, and VA will notify the veteran of the VA decision at that time. 4. TDRL TIMELINE GOALS a. Overall TDRL Process. The overall processing time for TDRL cases from the point of placement on the TDRL to the point of final disposition from the TDRL depends on the pace at which the unfitting conditions for which the veteran was placed on the TDRL become stable for rating purposes. Therefore, there is no overall IDES TDRL processing timeliness goal. Timeliness goals for cases remain the same for all portions of the IDES process up to the point at which the member is notified of placement on the TDRL and VA notifies the Service member of the initial VA benefits decision at the completion of the VA benefits stage. The following timeliness goals are established for the remainder of the TDRL process. (1) Initiation. The IDES goal is to initiate the TDRL re-evaluation process within 16 months after placing a Service member on the TDRL or after the Service member’s previous re-evaluation. Within that time, the Military Department will obtain all available medical treatment documentation from DoD (AHLTA) and VA corporate databases (including VISTA, 46 Attachment 7 DTM-11-015, December 19, 2011 47 Attachment 7 VETSNET, CAPRI, SHARE, Virtual VA, or follow-on systems). If the PEB is unable to obtain documentation from VA, the PEB will contact the D-RAS to request the results of any re-evaluation and subsequent rating decision documents of veterans or Service members on the TDRL. The PEB will evaluate all current medical treatment documentation, examination reports, and any subsequent VA rating decisions to determine whether the evidence is sufficient to conduct the re-evaluation without the need for a physical examination. (2) Examination. The IDES goal is to complete the re-evaluations for unstable unfitting conditions not later than 18 months after placing a Service member on the TDRL or after the Service member’s previous re-evaluation. (3) Ratings. The D-RAS will prepare rating decisions on future examinations conducted for IDES in accordance with part 3 of Reference (h). The IDES goal is for the D-RAS to complete the proposed rating decision not later than 30 days after the D-RAS receives a completed examination report. The Military Department will use VISTA, VETSNET, Virtual VA, or SHARE to obtain a copy of the most current rating and the medical evidence upon which the most current rating is based. If the PEB is unable to obtain documentation from the VA IT systems, the PEB will contact the D-RAS to request the results of the re-evaluation and subsequent rating decision documents of Service members be sent directly to the PEB. (4) PEB. The IDES goal is to complete each PEB re-adjudication phase of TDRL cases, including IPEB and FPEB adjudications, administrative processing, and Military Department appeals, no more than 90 days from the date the PEB receives the medical and rating documentation, previously described in this policy, for the unfitting conditions for which the TDRL Service member was placed on the TDRL to the date the Military Department informs the TDRL Service member of his or her TDRL disposition. b. TDRL Termination. No Service member may remain on the TDRL for more than 5 years. The disposition of veteran or Service members placed on the TDRL rests solely with the Military Department concerned. DTM-11-015, December 19, 2011 48 Attachment 8 ATTACHMENT 8 IDES SPD CODES Table. IDES SPD Codes FAMILY1 CODE2 REASON (BLOCK 28 DD Form 214/5) EXPLANATION EJ EJ DISABILITY, PERMANENT (IDES) Permanent physical disability. (IDES) EJ SEJ DISABILITY, PERMANENT (IDES) Mandatory retirement resulting from permanent physical disability. (IDES) EJ VEJ DISABILITY, PERMANENT (IDES) Reversion of recalled retiree to retired list resulting from permanent physical disability. (IDES) EJ WEJ DISABILITY, PERMANENT (IDES) Applies to Service members previously retired and recalled to active duty, who upon subsequent release, are entitled to disability retired pay based on permanent disability. (Integrated Disability Evaluation System) EK EK DISABILITY, TEMPORARY (IDES) Temporary physical disability. (IDES) EK SEK DISABILITY, TEMPORARY (IDES) Mandatory transfer to temporary disability retired list required by law due to temporary physical disability. (IDES) EK VEK DISABILITY, TEMPORARY (IDES) Reversion of recalled retiree to retired list due to temporary physical disability. (IDES) EK WEK DISABILITY, TEMPORARY (IDES) Applies to Service members previously retired and recalled to active duty, who upon subsequent release, are entitled to disability retired pay based on temporary disability. (IDES) DTM-11-015, December 19, 2011 49 Attachment 8 Table. IDES SPD Codes, Continued FAMILY1 CODE2 REASON (BLOCK 28) EXPLANATION EE EE DISABILITY, EXISTED PRIOR TO SERVICE, PEB (IDES) Physical disability which existed prior to entry on active duty and was established by a Physical Disability Evaluation Board. (IDES) EE JEE DISABILITY, EXISTED PRIOR TO SERVICE, PEB (IDES) Service initiated discharge directed by established directive for physical disability which existed prior to entry on active duty and was established by a Physical Disability Evaluation Board. (IDES) EE KEE DISABILITY, EXISTED PRIOR TO SERVICE, PEB (IDES) Discharge allowed by established directive for a physical disability which existed prior to entry on active duty and was established by a Physical Disability Evaluation Board. (IDES) EN EN DISABILITY, EXISTED PRIOR TO SERVICE, MED BOARD (IDES) Physical disability which existed prior to entry on active duty and was established by a medical evaluation board. (Integrated Disability Evaluation System) EN JEN DISABILITY, EXISTED PRIOR TO SERVICE, MED BOARD (IDES) Service initiated discharge directed by established directive for physical disability which existed prior to entry on active duty and was established by a disability evaluation board. (IDES) EN KEN DISABILITY, EXISTED PRIOR TO SERVICE, MED BOARD (IDES) Service initiated discharge allowed by established directive for physical disability which existed prior to entry on active duty and was established by a disability evaluation board. (IDES) EP EP DISABILITY, NOT IN LINE OF DUTY (IDES) Physical disability which resulted from intentional misconduct, willful neglect, or incurred during a period of unauthorized absence – not entitled to severance pay. (IDES) EP JEP DISABILITY, NOT IN LINE OF DUTY (IDES) Service initiated discharge directed by established directive when physical disability resulted from intentional misconduct, willful neglect, or incurred during a period of unauthorized absence – not entitled to severance pay. (IDES) EQ EQ DISABILITY, AGGRAVATION (IDES) Aggravation of former disability for which previously separated. (IDES) DTM-11-015, December 19, 2011 50 Attachment 8 Table. IDES SPD Codes, Continued FAMILY1 CODE2 REASON (BLOCK 28) EXPLANATION EQ JEQ DISABILITY, AGGRAVATION (IDES) Service initiated discharge directed by established directive when aggravation of former disability for which previously separated. (IDES) EQ WEQ DISABILITY, AGGRAVATION (IDES) Service member previously retired and recalled to active duty who, upon subsequent release, is entitled to disability retired pay based on aggravation of previous physical disability. (IDES) ER ER DISABILITY, OTHER (IDES) Physical disability not otherwise covered. (IDES) ER JER DISABILITY, OTHER (IDES) Service initiated discharge directed by established directive for physical disability not otherwise covered. (IDES) ER LER DISABILITY, OTHER (IDES) Service initiated release from active duty and transfer to Service component Standby Reserve inactive status list in lieu of discharge with severance pay. This rule applies to Service members found unfit while on active duty and having at least 15 qualifying years of service for retirement as required by section 1222 of Reference (j), when disability is less than 30 percent as required by section 1210 of Reference (j)), and is eligible for retired pay at age 60 in accordance with Reference (j)). (IDES) FI FI DISABILITY, COMBAT Physical disability evaluation (IDES, COMBAT) FI JFI DISABILITY, SEVERANCE PAY, COMBAT RELATED Service initiated discharge, resulting from physical disability incurred in a combat zone or as a direct result of armed conflict with combat related severance pay and entitlement, authorized by section 1646 of Public Law 110-181 (Reference (p)) – retirement not authorized. (IDES, COMBAT) FO FO DISABILITY, NON-COMBAT Physical disability evaluation (IDES. NON-COMBAT) FO JFO DISABILITY, SEVERANCE PAY, NON-COMBAT RELATED Service initiated discharge, resulting from physical disability with non-combat related severance pay and entitlement, authorized by Reference (p) – retirement not authorized. (IDES, NON-COMBAT) DTM-11-015, December 19, 2011 51 Attachment 8 Table. IDES SPD Codes, Continued FAMILY1 CODE2 REASON (BLOCK 28) EXPLANATION EA EA DISABILITY, COMBAT (IDES) Physical disability evaluation (IDES, COMBAT) EA JEA DISABILITY, SEVERANCE PAY, COMBAT RELATED (IDES) Service initiated discharge, resulting from physical disability incurred in a combat zone or as a direct result of armed conflict with combat related severance pay and entitlement, authorized by section 1646 of Reference (p) – retirement not authorized. (IDES, COMBAT) EB EB DISABILITY, NON COMBAT, ENHANCED Physical disability evaluation (IDES, NON-COMBAT) EB JEB DISABILITY, SEVERANCE PAY, NON-COMBAT (IDES) Service initiated discharge, resulting from physical disability with non-combat related severance pay and entitlement, authorized by Reference (p) – retirement not authorized. (IDES, NON-COMBAT) 1Family codes are explained under the Reason column of the Table. 2Separation codes are explained under the Explanation column of the Table. Service members are referred within 1 year of being diagnosed with a medical condition that does not appear to meet medical retention standards. ATTACHMENT 9 IDES TIMELINE Figure. IDES Timeline DTM-11-015, December 19, 2011 1Reserve Component member entitlement to VA disability begins upon release from active duty or separation 52Attachment 9 DTM-11-015, December 19, 2011 ATTACHMENT 10 IDES MEB CASE FILE MINIMUM CONTENTS 1. Cover sheet with convening authority signature and MEB decision (added after the MEB). 2. Narrative summary. 3. All VA C&P examination results. 4. Complete medical record (to include medical profile, appropriate ancillary test and evaluation results). 5. Commander’s non-medical assessment letter. 6. MEB addendums. 7. Line of duty determinations/investigations when required by Military Department regulations. 8. Service member rebuttal and surrebuttal (surrebuttal required if the member submits a rebuttal). 9. Competency statement if psychiatric consideration exists. 10. Service-specific documentation, if required (e.g., Air Force or Army: promotion or demotion documentation). 53 Attachment 10 DTM-11-015, December 19, 2011 GLOSSARY ABBREVIATIONS AND ACRONYMS AHLTA Armed Forces Health Longitudinal Technology Application ASD(HA) Assistant Secretary of Defense for Health Affairs ASD(RA) Assistant Secretary of Defense for Reserve Affairs BCMR board of correction of military records C&P compensation and pension CAPRI compensation and pension record interchange DAC disability advisory council DASD(WWCTP) Deputy Assistance Secretary of Defense (Wounded Warrior Care and Transition Policy) DD Form Department of Defense Form DES disability evaluation system DoD Department of Defense D-RAS disability evaluation system rating activity site DTM directive-type memorandum FPEB formal physical evaluation board IDES integrated disability evaluation system IMR impartial medical review IPEB informal physical evaluation board IT information technology MEB medical evaluation board MSC military service coordinator MTF military treatment facility PEB physical evaluation board PEBLO physical evaluation board liaison officer SPD separation program designator TDRL temporary disability retirement list TDY temporary duty TRICARE military medical managed care system 54 Glossary DTM-11-015, December 19, 2011 55 Glossary USD(P&R) Under Secretary of Defense for Personnel and Readiness VA Department of Veterans Affairs VASRD veterans affairs schedule for rating disabilities VERIS veterans examination request information system VETSNET veterans service network VISTA veterans health information systems and technology architecture VTA veterans tracking application WWCTP wounded warrior care and transition policy PART II. DEFINITIONS legacy DES: For the purpose of this DTM, the name of the DES before the IDES was implemented. statement of the case: The document VA sends the Service member or veteran if they cannot grant all or any part of the appeal.

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