When a wounded, ill, or injured servicemember transitions from active duty to medically retired, separated veteran, or retiree, caregivers are faced with many confusing, interconnected programs that have a direct impact on the lifetime benefits and compensation of the servicemember.
During this transition, ensure your servicemember is provided a complete copy of his or her medical records. The medical records are instrumental in providing a fully developed claim for VA compensation and benefits at discharge and if any disabilities worsen in the future.
The following sections are designed to help caregivers navigate the various phases of the Integrated Disability Evaluation System’s (IDES) critical processes, the Medical Evaluation Board (MEB), and Physical Evaluation Board (PEB), as the servicemember transitions from active duty to veteran status. As you can see in this diagram, the disability system can be overwhelming.
Each service developed specific guides to help caregivers and servicemembers understand the IDES process. They give service-specific timeframes and information to assist families in the IDES process. They also list the rights servicemembers have and to whom a servicemember needs to direct specific questions at specific times. The guides are:
Several avenues for assistance are available to help caregivers navigate the IDES process as well as to assist servicemembers transition from active duty to the VA health care system. Available to help are
Physical Evaluation Board Liaison Officers (PEBLOs): Caregivers and their servicemembers can receive counseling from the PEBLO who is there to provide information and advocacy during the MEB/PEB processes.
Recovery Care Coordinators (RCCs) : RCCs are available to caregivers and severely injured, ill, or wounded servicemembers to help develop and integrate the servicemember’s comprehensive recovery plan with that of the family and recovery medical team.
Federal Recovery Coordinators (FRCs):FRCs are available through the VA to assist in the recovery and reintegration of severely injured, ill, or wounded servicemembers.
VA Liaisons : VA liaisons are available at military treatment facilities (MTFs) to assist servicemembers and their caregivers with the seamless transition from active duty to the VA health care system.
Transition Assistance Advisors (TAAs): TAAs are available to National Guard members and their caregivers to help navigate the various compensation and health care benefits provided through federal and state agencies.
During the MEB, military doctors document the servicemember’s medical conditions that limit his or her ability to perform his or her duties and continue to serve. This list of conditions is called a Narrative Summary, or a NARSUM, and it is used to determine whether the servicemember’s long-term medical condition(s) “meets medical retention standards.”
Keep in mind the MEB process ensures all of the servicemember’s medical conditions are included in the NARSUM. This document determines the servicemember’s outcome at the end of the IDES.
Caregivers, especially in cases involving traumatic brain injury (TBI) and PTSD, should be involved in both the MEB and PEB processes. They have first-hand information regarding the servicemember’s limitations and can provide the doctors important information regarding the servicemember’s conditions and limitations.
The MEB is not a formal board because it does not drive the decision of the service as to whether a servicemember will be retained, separated, or retired. MEB findings, the list of conditions a servicemember has that MAY make him or her unfit for duty, are referred to the PEB, which formally determines fitness for continued service. However, a servicemember may appeal if he or she disagrees with the MEB decision or ask for an Independent Medical Review and/or a review by the local Judge Advocate General (JAG). The JAG is an expert on DoD programs and policies and might have limited knowledge with VA programs. Additional review time may be requested. See your service-specific guide to the IDES process above to determine from whom you request more time to review the findings.
Throughout the MEB/PEB process, caregivers and their servicemembers can receive counseling from the PEBLO.
Please describe the PEB process/issues.
The second step of the medical discharge process is the PEB. The PEB reviews the MEB’s documentation and recommendations to determine whether the servicemember is fit for continued military service.
There is a distinct difference between the two. The MEB is a medical process; the PEB is a personnel process. The PEB looks at the MEB’s NARSUM, the Compensation and Pension exam(s), and the servicemember’s medical records and considers whether the medical condition(s) affect the member’s ability to do his or her job or renders him or her non-deployable or world-wide assignable.
At any time during the process, servicemembers may seek assistance with a veteran service officer.
The PEB is broken into four phases: informal board, member’s review, formal board, and final decision.
Informal Board: Once a PEB board has determined the servicemember is no longer fit for duty, the board assigns a disability rating. The disability rating determines whether the servicemember is retired or separated. If the rating is 20 percent or lower, the servicemember may be discharged with or without severance pay, depending whether the PEB finds a servicemember’s disability existed prior to entry into the armed forces. If the rating is 30 percent or more, the board can place the servicemember into one the following categories:
Member’s Review: The PEBLO will advise the servicemember about the informal board’s findings. If the servicemember agrees with the findings, the PEB recommendation is forwarded to the service for final decision. If the servicemember disagrees with the findings, the servicemember can request a formal board.
Formal Board: The servicemember may appear before a formal PEB in a variety of ways: in person, through a designated representative, or via video teleconferencing media.
An attorney is appointed (by the branch of service for free) to represent the servicemember at the formal board or the servicemember may use his or her own representation (cost to be funded by the servicemember). The servicemember may introduce witnesses, documents, affidavits, or other evidence on his or her behalf. The formal board reexamines the medical evidence, hears testimony, and considers new evidence, before making its recommendation, and it may uphold the informal board’s recommendations or make a new determination.
Final Decision: The informal or formal PEB recommendations are sent to the servicemember’s service for a final decision or an appeal. PEBLOs or other representatives will assist the servicemember and caregiver through the process. It is during this process when a retirement/separation date is set. Find additional information at: DoD Instruction (DoDI) 1332.38, Physical Disability Evaluation, November 1996, Incorporating Change 1, July 2006.
In addition, the services have programs that allow unfit servicemembers to remain in service such as Continuation on Active Duty or Continuation on Active Reserve; however, each service program is different and the policy changes. If your servicemember wishes to remain in service, talk with your PEBLO to get the current eligibility requirements.
Of what special considerations for National Guard and Reserve members should I be aware?
National Guard and Reserve members require special consideration, especially if they are no longer activated. When called onto active duty, reserve component members who are wounded, ill, or injured are treated like active duty servicemembers and have their conditions evaluated by the MEB/PEB. Wounds, injuries, or illnesses occurred in the line of duty should be considered before the member is deactivated.
A problem might occur when a member is deactivated and returns to his or her home unit only to have the medical condition worsen over time. The rights to an MEB/PEB process are the same for active duty servicemembers (as long as the conditions occurred in the line of duty), but the transition process differs. Servicemembers have the right to appeal conditions determined not in the line of duty.
Referral to the MEB generally is voluntary, and the servicemember can request from of his or her command when he or she is notified of a pending separation because of medical disqualification.
The servicemember’s unit/command decides whether to submit a case as “duty-related” or “non-duty-related.” Cases referred under the duty-related process are authorized MEBs.
Each state has a transition assistance advisor to assist servicemembers.