duty status processing and overseas/suitability screening overview for the busy provider

Duty Status Processing Duty Status Processing and Overseas/Suitability and Overseas/Suitability

ScreeningScreening

Overview for the Busy Overview for the Busy ProviderProvider

Duty Status Processing and Duty Status Processing and Overseas/ Suitability Screening Overseas/ Suitability Screening

for Providersfor Providers Significant Recent Changes Affecting All Significant Recent Changes Affecting All

ProvidersProviders Goals of Presentation are:Goals of Presentation are:

To Succinctly Review ChangesTo Succinctly Review Changes Provide Overview of Reasons for Change but…Provide Overview of Reasons for Change but… Focus on Operational “nuts and bolts” DetailsFocus on Operational “nuts and bolts” Details Provide Resources for More In-Depth Provide Resources for More In-Depth

Review/QuestionsReview/Questions

DefinitionsDefinitions

Sick in Quarters (SIQ)Sick in Quarters (SIQ) Duty status assigned when service member is Duty status assigned when service member is

hurt/ill to the point that they are unable to hurt/ill to the point that they are unable to perform any aspect of their job. Typically perform any aspect of their job. Typically reserved for acute conditions requiring less reserved for acute conditions requiring less than 72 hours to recover. than 72 hours to recover.

Light DutyLight Duty Duty status assigned when service member is Duty status assigned when service member is

hurt/ill but is able to safely perform some hurt/ill but is able to safely perform some aspects of their job.aspects of their job.


Convalescent Leave (CONLV)Convalescent Leave (CONLV) Duty status assigned when service member is Duty status assigned when service member is

hurt/ill to the point that they are unable to hurt/ill to the point that they are unable to perform any aspect of their job. Can be perform any aspect of their job. Can be prescribed for longer periods than SIQ, up to prescribed for longer periods than SIQ, up to 30 days (postpartum – 42 days).30 days (postpartum – 42 days).

Limited Duty (LIMDU)Limited Duty (LIMDU) Duty status assigned when service member is Duty status assigned when service member is

hurt/ill but is able to safely perform some hurt/ill but is able to safely perform some aspects of their job. Can be prescribed for aspects of their job. Can be prescribed for periods of time greater than light duty. Affects periods of time greater than light duty. Affects ability to receive/execute orders and other ability to receive/execute orders and other personnel functions. personnel functions.


Full DutyFull Duty Duty Status assigned when, in the Duty Status assigned when, in the provider’s provider’s

opinion, the service member does not have a opinion, the service member does not have a medical condition that interferes with medical condition that interferes with successful and safe job performance.successful and safe job performance.

Fit For Continued Naval ServiceFit For Continued Naval Service Finding of the Finding of the PEBPEB that a service member does that a service member does

not have a medical condition that constitutes a not have a medical condition that constitutes a disability. The member may have duty disability. The member may have duty limitations.limitations.


UnfitUnfit Finding of the Finding of the PEBPEB that a service member’s that a service member’s

condition constitutes a disability and the condition constitutes a disability and the member should be separated/retired from active member should be separated/retired from active service.service.

Fit for DutyFit for Duty Term used by a Term used by a provider or medical boardprovider or medical board to to

describe a service member’s condition that does describe a service member’s condition that does not meet the definition of disability. Frequently not meet the definition of disability. Frequently used at the conclusion of a light or limited duty used at the conclusion of a light or limited duty period or to explain why a service member’s period or to explain why a service member’s case is NOT being referred to the PEB.case is NOT being referred to the PEB.


Medical Evaluation Board (Med Board)Medical Evaluation Board (Med Board) A group (typically 2) of providers at an MTF that A group (typically 2) of providers at an MTF that

evaluates the medical status of a service member evaluates the medical status of a service member with a serious or protracted illness or injury.with a serious or protracted illness or injury.

Medical Evaluation Board ReportMedical Evaluation Board Report The document(s) that a Medical Evaluation Board The document(s) that a Medical Evaluation Board

produces. It may include a “Short Form” or produces. It may include a “Short Form” or Dictated/Long Form. These may be sent to other Dictated/Long Form. These may be sent to other groups such as the Physical Evaluation Board or groups such as the Physical Evaluation Board or Naval Personnel Command.Naval Personnel Command.


Physical Evaluation Board (PEB)Physical Evaluation Board (PEB) Group of Line Officers and Medical Officers at Group of Line Officers and Medical Officers at

the Washington Navy Yard that evaluates the the Washington Navy Yard that evaluates the medical status of a service member with a medical status of a service member with a serious or protracted illness/injury that appears serious or protracted illness/injury that appears to permanently limit the member’s ability to do to permanently limit the member’s ability to do his job. his job.

Physical Evaluation Board ReportPhysical Evaluation Board Report Report issued by PEB that describes the Board’s Report issued by PEB that describes the Board’s

findings, includes a Naval disability rating.findings, includes a Naval disability rating.


Suitability/Overseas ScreeningSuitability/Overseas Screening Review of a service member’s (and family’s) Review of a service member’s (and family’s)

medical status to determine if the member CAN medical status to determine if the member CAN EXECUTE a specific set of orders. Member must EXECUTE a specific set of orders. Member must have have “orders in hand.”“orders in hand.”

Assignment ScreeningAssignment Screening Review of a service member’s medical status at Review of a service member’s medical status at

the conclusion of a LIMDU or PEB process, the conclusion of a LIMDU or PEB process, conducted conducted BEFOREBEFORE the member has orders to the member has orders to determine what platform/location limitations might determine what platform/location limitations might still exist.still exist.

Duty Status Processing… Duty Status Processing… the the “Old Way”“Old Way”

SIQSIQ Up to 72 hoursUp to 72 hours Completely ‘excused’ from work placeCompletely ‘excused’ from work place

Convalescent Leave (CONLV)Convalescent Leave (CONLV) Up to 30 days (42 postpartum)Up to 30 days (42 postpartum) Completely ‘excused’ from work placeCompletely ‘excused’ from work place Command had options regarding travel/recuperation at Command had options regarding travel/recuperation at

place remote from commandplace remote from command Light DutyLight Duty

Service Member reports to work place but with activity Service Member reports to work place but with activity restrictionsrestrictions

Max 30 daysMax 30 days No inclusion of CONLVNo inclusion of CONLV

Duty Status Processing… Duty Status Processing… the the “Old Way” “Old Way” (cont.)(cont.)

Limited Duty (LIMDU) Limited Duty (LIMDU) Done when prolonged (more than 30 Done when prolonged (more than 30

days will have elapsed) work place days will have elapsed) work place activity restrictions were expected.activity restrictions were expected.

Paperwork initially done by provider with Paperwork initially done by provider with referral to MTF medical board/convening referral to MTF medical board/convening authority.authority.

Enlisted and officer LIMDU handled Enlisted and officer LIMDU handled differently at every level.differently at every level.


LIMDU- LIMDU- (Enlisted)(Enlisted) Initial report done on ‘short form’ and routed through MTF Initial report done on ‘short form’ and routed through MTF

and PSDand PSD Maximum time of 8 monthsMaximum time of 8 months First and second periods of LIMDU could be approved at First and second periods of LIMDU could be approved at

MTFMTF Additional periods required dictated report (even if first Additional periods required dictated report (even if first

period less than 8 months)period less than 8 months) So… vast majority of initial board reports prescribed for 8 So… vast majority of initial board reports prescribed for 8

months months Third or more periods routed to NPC for approvalThird or more periods routed to NPC for approval Prior to conclusion of LIMDU local PSD responsible for Prior to conclusion of LIMDU local PSD responsible for

getting the service member a “re-evaluation” appointment getting the service member a “re-evaluation” appointment at MTFat MTF


LIMDU- LIMDU- (Officer)(Officer) Initial and all subsequent board reports Initial and all subsequent board reports

required dictationrequired dictation Require PSD and MTF communicationRequire PSD and MTF communication Approval of all LIMDU periods done at NPCApproval of all LIMDU periods done at NPC Limited to 8 month periodsLimited to 8 month periods Prior to conclusion of LIMDU local PSD Prior to conclusion of LIMDU local PSD

responsible for getting the service responsible for getting the service member a “re-evaluation” appointment at member a “re-evaluation” appointment at MTFMTF


PEB referralPEB referral Done when service member’s condition Done when service member’s condition

permanently affects their ability to permanently affects their ability to perform their jobperform their job

Can happen at any time during service Can happen at any time during service member’s care… but condition should member’s care… but condition should be stabilizedbe stabilized

PRT problems alone NOT appropriate for PRT problems alone NOT appropriate for referralreferral

So Why Change NOW?So Why Change NOW?

Make time frames more consistent with Make time frames more consistent with known healing/recovery timesknown healing/recovery times

Get PSD out of the business of making Get PSD out of the business of making medical appointmentsmedical appointments

Reduce provider paperwork/effortReduce provider paperwork/effort Simplify the process which will improve Simplify the process which will improve

ownership and accountability ownership and accountability throughout the member’s chain of throughout the member’s chain of command and MTFcommand and MTF

Duty Status Processing… Duty Status Processing… the the “New Way”“New Way”

SIQ- no changesSIQ- no changes Convalescent leave- no changesConvalescent leave- no changes

Duty Status Processing…Duty Status Processing…the the “New Way”“New Way”

Light DutyLight Duty No change in definitionNo change in definition May be used for up to 90 days from the time May be used for up to 90 days from the time

member first gets ill/hurt, in increments up to member first gets ill/hurt, in increments up to 30 days 30 days

Should only be used if provider reasonably Should only be used if provider reasonably expects member to return to medically expects member to return to medically unrestricted duty prior to the 90 day maximum unrestricted duty prior to the 90 day maximum

CONLV is included in the 90 day limitCONLV is included in the 90 day limit

Duty Status ProcessingDuty Status Processing… the … the “New Way”“New Way” (cont.) (cont.)

LIMDU LIMDU (Enlisted)(Enlisted) ““Short Form” may be used to document the first Short Form” may be used to document the first

and second limited duty periodsand second limited duty periods Maximum time for each period is 6 monthsMaximum time for each period is 6 months Member is placed LIMDU at the same time a Member is placed LIMDU at the same time a

provider initiates a PEB referral if not already on provider initiates a PEB referral if not already on LIMDU. (LIMDU paperwork notifies PSD of LIMDU. (LIMDU paperwork notifies PSD of assignment limitations during PEB processing.)assignment limitations during PEB processing.)

Third (or more) periods require BUPERS approval Third (or more) periods require BUPERS approval The third (or more) period of LIMDU in a The third (or more) period of LIMDU in a

member’s career requires BUPERS approval and:member’s career requires BUPERS approval and: If If relatedrelated to previous condition – dictation to previous condition – dictation If If unrelatedunrelated to previous condition – short form to previous condition – short form

Duty Status ProcessingDuty Status Processing… the … the “New Way”“New Way” (cont.) (cont.)

LIMDU LIMDU (Officer)(Officer) Now LIMDU process is the SAME as Now LIMDU process is the SAME as

Enlisted LIMDU EXCEPT:Enlisted LIMDU EXCEPT: All LIMDU periods require BUPERS approvalAll LIMDU periods require BUPERS approval

LIMDU “Short Form”LIMDU “Short Form”NAVMED 6100/5NAVMED 6100/5

Suitability, Overseas and Suitability, Overseas and Assignment ScreeningAssignment Screening

These are medical evaluations done These are medical evaluations done to aid NPC in appropriately issuing to aid NPC in appropriately issuing orders service members (and their orders service members (and their families).families).

Ultimately the final decisions Ultimately the final decisions regarding assignment are done at regarding assignment are done at the GAINING command in the GAINING command in conjunction with NPC/detailing.conjunction with NPC/detailing.

Suitability and Overseas Suitability and Overseas Screening Screening

… the … the “Old Way”“Old Way” Screening performed after receipt of ordersScreening performed after receipt of orders

Provider evaluated member’s ability to safely Provider evaluated member’s ability to safely execute orders to a specific locationexecute orders to a specific location

Provider evaluated family’s ability to safely Provider evaluated family’s ability to safely execute orders to a specific locationexecute orders to a specific location

NAVMED 1300/2 used to document findingsNAVMED 1300/2 used to document findings If “qualified” no further action, if “not qualified” If “qualified” no further action, if “not qualified”

poorly defined process involving query of gaining poorly defined process involving query of gaining command ensuedcommand ensued

Results sent to BUPERS/PSD for further processingResults sent to BUPERS/PSD for further processing

Suitability and Overseas Suitability and Overseas ScreeningScreening

… the … the “New Way”“New Way” Screening performed after receipt of ordersScreening performed after receipt of orders

Provider evaluates member’s and family’s Provider evaluates member’s and family’s ability to safely execute ordersability to safely execute orders

Results documented on NAVMED 1300/1Results documented on NAVMED 1300/1 If “qualified” no further action necessary… If “qualified” no further action necessary…

results sent to PSDresults sent to PSD If “not qualified” BUPERS medical provider If “not qualified” BUPERS medical provider

(newly created position)(newly created position) will determine where will determine where to send member and familyto send member and family

Minor changes made to specific testing areas Minor changes made to specific testing areas (for example Pap smear timing) but overall (for example Pap smear timing) but overall screening process largely unchangedscreening process largely unchanged

Assignment Screening Assignment Screening … the … the “Old Way”“Old Way”

Screening after completion of LIMDU/PEB Screening after completion of LIMDU/PEB Performed prior to issuance of ordersPerformed prior to issuance of orders Provider evaluated member’s residual Provider evaluated member’s residual

limitations which might have affected limitations which might have affected assignabilityassignability

NAVMED 1300/2 required medical input that NAVMED 1300/2 required medical input that was impossible to answer without orders in handwas impossible to answer without orders in hand

Family members not screenedFamily members not screened Best results were achieved if provider was able Best results were achieved if provider was able

to recommend specific and appropriate to recommend specific and appropriate operational or platform assignments. However, operational or platform assignments. However, most providers were not knowledgeable enough most providers were not knowledgeable enough to make such recommendations. to make such recommendations.

Assignment Screening Assignment Screening … the … the “New Way”“New Way”

Screening after completion of LIMDU/PEBScreening after completion of LIMDU/PEB Performed Performed priorprior to issuance of orders to issuance of orders Provider evaluates member’s residual Provider evaluates member’s residual

limitations which might affect assignabilitylimitations which might affect assignability NEW NEW form (NAVMED 1300/3) includes only a few form (NAVMED 1300/3) includes only a few

questions that any provider can answer easilyquestions that any provider can answer easily Screening prompts only the finding of Screening prompts only the finding of

“worldwide assignable” or a list of limitations “worldwide assignable” or a list of limitations If “world wide assignable,” no further action If “world wide assignable,” no further action

necessary… results sent to BUPERSnecessary… results sent to BUPERS If “not world wide assignable,” BUPERS medical If “not world wide assignable,” BUPERS medical

provider will determine where to send member provider will determine where to send member

SUITABILITY/OVERSEAS SUITABILITY/OVERSEAS SCREENINGSCREENING

NAVMED 1300/1NAVMED 1300/1

ASSIGNMENT SCREENINGASSIGNMENT SCREENINGNAVMED 1300/3NAVMED 1300/3

ResourcesResources

Manual of the Medical Department Manual of the Medical Department Chapter 18 effective date 10 Jan Chapter 18 effective date 10 Jan 20052005 http://www.vnh.org/Admin/MMD/http://www.vnh.org/Admin/MMD/

001Contents.html001Contents.html

BUMEDINST 1300.2 (series) BUMEDINST 1300.2 (series) Disability Evaluation Manual Disability Evaluation Manual

(SECNAVINST 1850.4 series)(SECNAVINST 1850.4 series)

SUMMARYSUMMARY

The following slides summarize The following slides summarize the major changes previously the major changes previously

reviewed in greater detailreviewed in greater detail

ChangesChanges

OLDOLD Light duty 30 days Light duty 30 days

maxmax

LIMDU 8 month LIMDU 8 month incrementsincrements

More than 16 More than 16 months goes to PEB months goes to PEB

NewNew Light duty up to 90 Light duty up to 90

days in 30 day days in 30 day increments (including increments (including CONLEAVE)CONLEAVE)

LIMDU 6 month LIMDU 6 month incrementsincrements

More than 12 months More than 12 months requires NMPC waiver requires NMPC waiver or PEBor PEB

ChangesChanges OldOld

Members ending LIMDU Members ending LIMDU get orders then get orders then operational screen to operational screen to see if fit for orderssee if fit for orders

Screener comments on Screener comments on past illnesspast illness

Ship queries MTF, then Ship queries MTF, then declinesdeclines

PERS seeks an PERS seeks an accepting SMOaccepting SMO

Member in limbo, billet Member in limbo, billet gappedgapped

If no gaining command If no gaining command found, current found, current command ADSEPscommand ADSEPs

NewNew Member ending LIMDU, Member ending LIMDU,

assignment screening assignment screening donedone

Report goes to PERS Report goes to PERS and reviewed by and reviewed by assignment physicianassignment physician

PERS finds gaining PERS finds gaining command before orders command before orders written written

If no gaining command If no gaining command found, current found, current command ADSEPscommand ADSEPs

ChangesChanges

OldOld Some, not all ships Some, not all ships

decline PAP smear decline PAP smear abnormalitiesabnormalities

Some ships, not all, Some ships, not all, decline CPAPdecline CPAP

CVNs decline history CVNs decline history of emotional of emotional problems BUT problems BUT recommend those recommend those individuals go to individuals go to AMPHIBsAMPHIBs

NewNew Central physician at Central physician at

PERS can negotiate PERS can negotiate a more consistent a more consistent screening criteria screening criteria with Fleetswith Fleets

PERS physician will PERS physician will deal with MTF deal with MTF screener and gaining screener and gaining command vice ship command vice ship and MTF trying to and MTF trying to contact each othercontact each other

ChangesChanges

OldOld LIMDU tracked by LIMDU tracked by

PSD which is PSD which is responsible for responsible for getting member getting member back for FU back for FU appointmentappointment

Members lost to Members lost to follow up after follow up after PCSing on LIMDU.PCSing on LIMDU.

NewNew Current command Current command

responsible for responsible for getting LIMDU getting LIMDU member back for member back for timely appointmentstimely appointments

BUPERS tracksBUPERS tracks Members to Mast for Members to Mast for

missing missing appointmentsappointments

duty status processing and overseas/suitability screening overview for the busy provider

Documents