Military service members often suffer injuries while serving our country. When a medical condition develops that a physician believes will not heal enough in order for the service member to be able to perform his or her military duties within one year, the service member is then referred to the Medical Evaluation Board (MEB) for possible out-processing due to the medical condition.
In 2009, the Integrated Disability Evaluation System was established in order to bridge the gap between the Department of Defense (DoD) disability, and the Veterans Affairs (VA) disability procedures. The IDES allows DoD and VA to work together by simplifying the entire military disability process as a whole, and is only utilized for service members who have attained conditions that disallow them to perform their military duties (labelled as “Medically Unfit for Duty”).
What is the Timetable?
Once a service member is referred by their physician to the MEB (usually within 10 days of documented medical condition), he or she is assigned a DoD Physical Evaluation Board Liaison Office (PEBLO) and a VA Military Services Coordinator (MSC) in order to assist them through the IDES process. The MSC assists the service member with submitting a VA disability claim, focusing only on the condition that precludes him or her from returning to full duty.
Within 45 days from submitting the VA disability claim, the VA will schedule a Compensation and Pension (C&P) examination (or examinations, if more than one condition precludes the service member from performing his or her military duties). Once the C&P is completed, the results are sent to the PEBLO, and the service member’s physician submits a written report known as a “Narrative Summary”, or NARSUM. The NARSUM summarizes the etiology of the service member’s medical conditions from its time of onset through the completed C&P examination(s). Once completed, the NARSUM is submitted to the MEB for review of medical acceptability of each of the medical conditions claimed. The MEB makes their determination, and submits their findings to the Physical Evaluation Board (PEB), ending the MEB process.
When the PEB receives the MEB findings (usually within 35 days), the PEB determines which of the medical conditions claimed qualify for DoD disability. Qualifying medical conditions are considered to be service connected, rendering the service member Unfit for Duty. Once PEB makes their determination, the decision is sent to the VA for consideration. If there is at least one unfitting condition listed in the PEB decision, the VA assigns a Military Disability Rating to each service connected condition the service member has; the VA is the official rating authority for both VA disability and DoD disability. If there are no unfitting conditions listed, the service member is then returned to full duty, ending the IDES process.
The VA rating decision is sent back to the PEB for implementing the DoD disability rating for the service member’s unfitting conditions. If the service member does not agree with the VA’s decision, he or she may appeal the decision for reconsideration. The VA will then re-examine the claim and make a final rating determination. In turn, if the service member does not agree with the PEB decision on which conditions are considered unfitting, he or she may file an appeal with the Formal Physical Evaluation Board (FPEB) in order for the case to be reviewed. The FPEB then makes a final determination on the unfitting conditions, ending the PEB process.
Once all decisions are final, the PEB can do one of the following: 1) place the service member on the Temporary Disabled Retired List (TDRL); 2) place the service member on the Permanent Disabled Retired List (PDRL); or 3) separate the service member from military service.
In order to be placed on TDRL, a service member’s condition must be considered unstable, have a Total Combined Military Disability Rating of 30-percent or higher, and there is a chance that either the condition could improve enough for the service member to return to full duty, or seriously worsen within the next five years. While on TDRL, the service member is considered to be medically retired from service for a period of five years. During this retired period, the service member must be occasionally re-evaluated (usually every 18 months) in order to determine any progress of his or her condition, while updating the disability ratings to reflect any changes in the condition. If the condition improves to a point which enables the service member to return to service, he or she may be removed from TDRL and placed back on active duty. By returning to service, all disability benefits received while on TDRL will cease.
What if There is No Improvement in the Condition?
If the condition worsens, or at least does not improve, and becomes relatively stable yet still unfitting for service, the PEB will either medically retire or medically separate the service member with a permanent military disability rating based on the severity of his or her condition at that time. PDRL occurs when a condition is considered unstable, will not improve, and worsens over time. The VA transitions the TDRL determination, along with all re-evaluations and any supporting evidence, and considers the service member “permanently” disabled.
Under TDRL and PDRL (disability rating of 30-percent or higher), the service member is considered medically retired from the military. Additionally, the service member is entitled to all benefits of a regularly retired (20 years plus) service member. These benefits include complete medical care, commissary and exchange privileges, and a monthly disability/retirement payment for five years (under TDRL), or the rest of his or her life (under PDRL).
If a service member is provided a military disability rating of less than 30-percent, he or she is medically separated from the military. Any medically separated service member will receive a single lump-sum severance payment for their DoD disability. The severance payment is equal to two months of basic pay for each year of military service, with a minimum of six years, and a maximum of 19 years. Medically separated service members do not receive any other benefits for their DoD disability; however, they may submit a claim for VA benefits.
 As a medically retired Veteran myself, I cannot stress the importance of the C&P examination, and the service member’s responsibility to 1) attend the scheduled examination, and 2) provide the examiner with any supporting evidence on the condition being examined. Please see my previous blog regarding C&P examinations. – Sal Lo Monaco