may 2008 peblo/pad conference pers-821 901-874-3230 / 3229 patient administration department...

May 2008May 2008PEBLO/PAD ConferencePEBLO/PAD Conference

PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

Patient AdministrationPatient AdministrationDepartmentDepartment

(Personnel Matters)(Personnel Matters)

Briefed byBriefed by

YNC(AW) Robert S. Brooks, Jr.YNC(AW) Robert S. Brooks, [email protected]@navy.mil

(901) 874-3230(901) 874-3230

mailto:[email protected]


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

Patient AdministrationPatient Administration Most information in this brief is based on MANMED, Most information in this brief is based on MANMED,

MILPERSMAN, SECNAVINST 1850.4E, and other related MILPERSMAN, SECNAVINST 1850.4E, and other related instructions and laws.instructions and laws.

Some information is provided as recommendations with Some information is provided as recommendations with valid points and interests of the member in mind.valid points and interests of the member in mind.

This brief was made for the PAD officer and staff to have an This brief was made for the PAD officer and staff to have an understanding of the overall “personnel” picture in relation understanding of the overall “personnel” picture in relation to the member, family, non-medical case management, and to the member, family, non-medical case management, and communication and not the “medical” aspects of the communication and not the “medical” aspects of the patient.patient.

Information will help you make correct decisions.Information will help you make correct decisions.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

Duty Type CodesDuty Type Codes Five types of duty designations identify Five types of duty designations identify

commands:commands: May require TEMDU if member must be geo relocated for May require TEMDU if member must be geo relocated for

medical care or member is geo relocated > 90 days. medical care or member is geo relocated > 90 days. Members in these type commands normally go through an Members in these type commands normally go through an MEB then YH avail for LIMDU movement vice TEMDU MEB then YH avail for LIMDU movement vice TEMDU direction, MEB, and YH avail:direction, MEB, and YH avail:

Type Duty Code “Type Duty Code “11”: Shore Duty (CONUS) – in the U.S., ”: Shore Duty (CONUS) – in the U.S., including Hawaii and Alaskaincluding Hawaii and Alaska

Type Duty Code “Type Duty Code “33”: Overseas Remote Land-based. ”: Overseas Remote Land-based. Credited as sea duty for rotational purposes only due to the Credited as sea duty for rotational purposes only due to the relative undesirability of the geographic area.relative undesirability of the geographic area.

Type Duty Code “Type Duty Code “66”: Shore Duty (OCONUS) – overseas.”: Shore Duty (OCONUS) – overseas. Must require TEMDU direction if treatment plan > 60 daysMust require TEMDU direction if treatment plan > 60 days

Type Duty Code “Type Duty Code “22”: Vessels and deployable squadrons ”: Vessels and deployable squadrons home ported in the U.S. including Hawaii and Alaska.home ported in the U.S. including Hawaii and Alaska.

Type Duty Code “Type Duty Code “44”: Vessels and deployable squadrons ”: Vessels and deployable squadrons home ported overseas.home ported overseas.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

Types of OrdersTypes of Orders BUPERS PCSBUPERS PCS

In transit (ACC 400)?In transit (ACC 400)? Hospitalized? If so, gain member (both enlisted or officer).Hospitalized? If so, gain member (both enlisted or officer). Walk in-not hospitalized? Most likely No Gain required.Walk in-not hospitalized? Most likely No Gain required.

LIMDU orders come from the member’s detailer. PERS-4013 provides LIMDU orders come from the member’s detailer. PERS-4013 provides input via YH avail.input via YH avail.

GWOT Support Assignments (GSA)GWOT Support Assignments (GSA) Gained at ECRC of NMPS, receives funded TEMADD orders to go in Gained at ECRC of NMPS, receives funded TEMADD orders to go in

theater. GSA is the new IA. GSA is given to those avail in between theater. GSA is the new IA. GSA is given to those avail in between rotation PCS.rotation PCS.

GSA orders come out of PERS-4GGSA orders come out of PERS-4G TEMADD for outpatient care.TEMADD for outpatient care.

When should it be funded? 50 miles from the MTF is keyWhen should it be funded? 50 miles from the MTF is key Who funds? Parent Command. See the P-1000.Who funds? Parent Command. See the P-1000.

Standard Transfer Orders or STO. Funding data - BUPERSINST 7040.6Standard Transfer Orders or STO. Funding data - BUPERSINST 7040.6 Enlisted disability separations, EPTS, and TDRL/PDRL orders are funded Enlisted disability separations, EPTS, and TDRL/PDRL orders are funded

using same instruction. These orders are generated by the PSD.using same instruction. These orders are generated by the PSD. Individual Augmentation (IA) orders. IA orders come out of PERS-4G.Individual Augmentation (IA) orders. IA orders come out of PERS-4G.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

Accounting CodesAccounting Codes Five authorized Accounting Codes (ACC) for Five authorized Accounting Codes (ACC) for

Navy MTF inpatient UIC use: Navy MTF inpatient UIC use: ACC “ACC “370370”: TEMDU – hospitalized in Navy MTF”: TEMDU – hospitalized in Navy MTF ACC “ACC “371371”: TEMDU – Medical Holding Company”: TEMDU – Medical Holding Company ACC “ACC “372372”: TEMDU – hospitalized in Non-MTF”: TEMDU – hospitalized in Non-MTF ACC “ACC “373373”: TEMDU – hospitalized in Other ”: TEMDU – hospitalized in Other

Service Service MTF MTF ACC “ACC “374374”: TEMDU – Extended Outpatient ”: TEMDU – Extended Outpatient

Treatment (avail Sept Treatment (avail Sept 2008)2008)

Direct the use of these ACCs for Direct the use of these ACCs for Active and Active and Reserve componentReserve component Navy personnel. Navy personnel.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

Accounting CodesAccounting Codes Other ACCs you may see:Other ACCs you may see:

ACC “ACC “103103”: Temporary Active Duty”: Temporary Active Duty Reserve component on ADSW or MEDHOLDReserve component on ADSW or MEDHOLD

ACC “ACC “105105”: Limited Duty”: Limited Duty Active ComponentActive Component

ACC “ACC “107107”: Mobilization”: Mobilization Reserve component on mobilization or at the NMPS Reserve component on mobilization or at the NMPS

receiving light duty care up to 90 days before receiving light duty care up to 90 days before demobilization or transfer to ACC 103 to MEDHOLD.demobilization or transfer to ACC 103 to MEDHOLD.

ACC “ACC “320320”: TEMDU – For Further Assignment – ”: TEMDU – For Further Assignment – Not for OfficersNot for Officers

Personnel at TPU awaiting for LIMDU orders Personnel at TPU awaiting for LIMDU orders


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

Accounting CodesAccounting Codes Other ACCs you may see:Other ACCs you may see:

ACC “ACC “355355”: TEMDU – Awaiting PEB decision – ”: TEMDU – Awaiting PEB decision – Not for OfficersNot for Officers

Personnel are always moved to TPU from type duty 2 or Personnel are always moved to TPU from type duty 2 or 4.4.

Personnel at type duty 1, 3, or 6 will stay or change to Personnel at type duty 1, 3, or 6 will stay or change to ACC 105 and stay in the parent command if not moved ACC 105 and stay in the parent command if not moved to the TPU.to the TPU.

Use this code if member is at TPU/Others activity and Use this code if member is at TPU/Others activity and an MEB is not completed yet.an MEB is not completed yet.

ACC “ACC “400400”: In Transit ”: In Transit Member was a loss to a command, but not gained yet Member was a loss to a command, but not gained yet

by prospective command.by prospective command.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

TEMADD FUNDINGTEMADD FUNDING Member should always have funded TEMADD Member should always have funded TEMADD

orders from parent command if member is 50 miles orders from parent command if member is 50 miles away from treatment location.away from treatment location.

Navy Financial Manual P-1000 directs parent Navy Financial Manual P-1000 directs parent commands to provide funded orders to members commands to provide funded orders to members receiving outpatient care.receiving outpatient care.

BUMED M8 provides annual message as well. BUMED M8 provides annual message as well. DoD matrix showing who is responsible for all DoD matrix showing who is responsible for all

Services. Services. Rule is member must be funded “one round trip.” Rule is member must be funded “one round trip.”

Not “one way” trip. Not “one way” trip. Direct that the funded TEMADD orders have POC Direct that the funded TEMADD orders have POC

information, so you may contact the command.information, so you may contact the command.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

TEMADD to TEMDUTEMADD to TEMDU Navy MTF shall direct change of status from TEMADD to Navy MTF shall direct change of status from TEMADD to

TEMDU by message no later than the next work day to TEMDU by message no later than the next work day to parent command and servicing PSD if one of the following parent command and servicing PSD if one of the following occurs:occurs: A determination is made that member is no longer fit for full A determination is made that member is no longer fit for full

duty and member will not return to a type 2 or 4 duty within 60 duty and member will not return to a type 2 or 4 duty within 60 days. days.

Member will be processed by an outpatient MEB and member Member will be processed by an outpatient MEB and member is of a type 2 or 4 command.is of a type 2 or 4 command.

The period of hospitalization or treatment will exceed 90 days The period of hospitalization or treatment will exceed 90 days and type 1, 3, or 6 duty location is not in the area of treatment and type 1, 3, or 6 duty location is not in the area of treatment site. Only do this if you must. Preferred process is member’s site. Only do this if you must. Preferred process is member’s MTF initiates and approves an MEB for YH availability report MTF initiates and approves an MEB for YH availability report submission.submission.

In most cases, do not direct TEMDU from your MTF if member is In most cases, do not direct TEMDU from your MTF if member is from a 1, 3, or 6 duty from another geo location requiring LIMDU. from a 1, 3, or 6 duty from another geo location requiring LIMDU. Member’s MTF should complete the AMEBR/MEBR and direct Member’s MTF should complete the AMEBR/MEBR and direct member’s servicing PSD to submit a YH Availability Report if member’s servicing PSD to submit a YH Availability Report if member must be moved to your MTF area. Member will receive member must be moved to your MTF area. Member will receive LIMDU PCS orders. LIMDU PCS orders.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

TEMDUTEMDU What happens if member is TEMDU transferred?What happens if member is TEMDU transferred?

Member is a loss to PDS, and a gain to new Member is a loss to PDS, and a gain to new TEMDU station.TEMDU station.

BAH changes BAH changes Member’s family does not have to move. It is optional; a Member’s family does not have to move. It is optional; a

family decision.family decision. Family is recommended to wait until LIMDU orders are Family is recommended to wait until LIMDU orders are

provided or upon knowing member will be treated in the area provided or upon knowing member will be treated in the area of TEMDU.of TEMDU.

BAH waivers are authorized via PERS-451. Send Secretarial BAH waivers are authorized via PERS-451. Send Secretarial BAH Waiver requests for members to continue to receive BAH BAH Waiver requests for members to continue to receive BAH at the dependent location if member is hospitalized or in at the dependent location if member is hospitalized or in extended outpatient, and dependents didn’t move, and the extended outpatient, and dependents didn’t move, and the dependents location BAH is greater than the member’s current dependents location BAH is greater than the member’s current BAH entitlement. Send to BAH entitlement. Send to [email protected]@navy.mil..



PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

TEMDU continuedTEMDU continued What happens if member is TEMDU transferred?What happens if member is TEMDU transferred?

A Standard Transfer Order (STO) allows all benefits of A Standard Transfer Order (STO) allows all benefits of a normal PCS order if the medical treatment at the a normal PCS order if the medical treatment at the location shown on the STO is prolonged.location shown on the STO is prolonged.

A combination of medical input on treatment length A combination of medical input on treatment length and STO will allow HHG shipment per the JFTR.and STO will allow HHG shipment per the JFTR.

Specifically, U5372.3.C.1.B of the JFTR allows HHG Specifically, U5372.3.C.1.B of the JFTR allows HHG movement to a place INCONUS for an injured/ill movement to a place INCONUS for an injured/ill member receiving prolonged treatment.member receiving prolonged treatment.

See U5372 paragraph 4 of the JFTR for storage See U5372 paragraph 4 of the JFTR for storage authorization anywhere INCONUS. authorization anywhere INCONUS.

U5372 of JFTR pertain to HHG movement.U5372 of JFTR pertain to HHG movement.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

INPATIENT (not theater)INPATIENT (not theater) InpatientInpatient

NOT FROM THEATER OPERATIONS NOT FROM THEATER OPERATIONS Hospitalization MessageHospitalization Message Is hospitalization based on the medical condition member Is hospitalization based on the medical condition member

incurred in theater? If so, ensure Pay and Personnel incurred in theater? If so, ensure Pay and Personnel Review/Action with PSD/CSD. There are entitlements.Review/Action with PSD/CSD. There are entitlements.

Type of Orders? PCS? GSA? TEMADD funded? IA? Type of Orders? PCS? GSA? TEMADD funded? IA? Nothing?Nothing?

Type 2 or 4 Duty? GSA tour is type 2.Type 2 or 4 Duty? GSA tour is type 2. Treatment plan > 60 days and member from type 2 or 4?Treatment plan > 60 days and member from type 2 or 4?

PAD Direct TEMDU to your inpatient UIC if treatment PAD Direct TEMDU to your inpatient UIC if treatment plan (not hospitalization) is greater than 60 days.plan (not hospitalization) is greater than 60 days.

Treatment plan > 90 days and member from type 1, 3, or 6?Treatment plan > 90 days and member from type 1, 3, or 6? PAD Direct TEMDU to your inpatient UIC if member is PAD Direct TEMDU to your inpatient UIC if member is

geo dislocated greater than 90 days..geo dislocated greater than 90 days.. Inpatient UIC (do you know yours?)Inpatient UIC (do you know yours?)


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

INPATIENT (coming from INPATIENT (coming from theater)theater)

InpatientInpatient FROM “IN THEATER” OPERATIONS FROM “IN THEATER” OPERATIONS

Hospitalization MessageHospitalization Message Ensure Pay and Personnel Review/Action at PSD/CSDEnsure Pay and Personnel Review/Action at PSD/CSD Type of Orders? GSA? TEMADD funded? IA? Nothing?Type of Orders? GSA? TEMADD funded? IA? Nothing? Is member from a shore or sea (operational) command?Is member from a shore or sea (operational) command? Did you know…GSA are fm ECRC within NMPS Norfolk/SDDid you know…GSA are fm ECRC within NMPS Norfolk/SD Type 2 or 4 Duty? GSA tour is type 2, too.Type 2 or 4 Duty? GSA tour is type 2, too. Treatment plan > 60 days and member from type 2 or 4?Treatment plan > 60 days and member from type 2 or 4?

PAD Direct TEMDUPAD Direct TEMDU Treatment plan > 90 days and member from type 1, 3, or Treatment plan > 90 days and member from type 1, 3, or

6?6? PAD Direct TEMDU if member must be geo relocatedPAD Direct TEMDU if member must be geo relocated

Inpatient UIC (do you know yours?)Inpatient UIC (do you know yours?)


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

INPATIENT TRANSFERSINPATIENT TRANSFERS

Inpatient TransfersInpatient Transfers Physician determines treatment plan/locationPhysician determines treatment plan/location Medical Case Manager Involvement Medical Case Manager Involvement Follow-up and discuss status of member with PAD Follow-up and discuss status of member with PAD Changing MTF responsibility? Changing MTF responsibility?

Communication of Clinical Communication of Clinical Communication of non-clinical to PAD to inform/direct/request from Communication of non-clinical to PAD to inform/direct/request from

parent command/PSDparent command/PSD PSD to PSD communication and transfer of pay UIC account based PSD to PSD communication and transfer of pay UIC account based

on PAD to PSD communication.on PAD to PSD communication. Transfer of TEMDU to new MTF inpatient UIC if already Transfer of TEMDU to new MTF inpatient UIC if already

assigned to current MTF inpatient UICassigned to current MTF inpatient UIC Physician needs to determine if treatment plan is greater than Physician needs to determine if treatment plan is greater than

60 (sea) or 90 (shore & geo dislocated) if not done so at this 60 (sea) or 90 (shore & geo dislocated) if not done so at this point at the same time clinical transfer is determined.point at the same time clinical transfer is determined.

PAD Directs parent command to TEMDU member to the MTF PAD Directs parent command to TEMDU member to the MTF inpatient UIC responsible.inpatient UIC responsible.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

How did member get to you?How did member get to you?(TAD in area – Example 1)(TAD in area – Example 1)

Member is TEMADD for duty/training etc. away from parent command in Member is TEMADD for duty/training etc. away from parent command in your MTF’s area and member gets injured.your MTF’s area and member gets injured.

contact command for more TEMADD funding for treatment and provide status of contact command for more TEMADD funding for treatment and provide status of member appropriatelymember appropriately

If an officer, remember to submit BUPERS 1301-13 per If an officer, remember to submit BUPERS 1301-13 per [email protected]@navy.mil and and the PERS-821 officer LIMDU POC…currently the PERS-821 officer LIMDU POC…currently [email protected]@navy.mil..

If outpatient basis, and after the level of treatment is completed, can the major If outpatient basis, and after the level of treatment is completed, can the major MTF that services member’s parent command treat member? If so, MTF that services member’s parent command treat member? If so, communicate with that MTF, setup appointment for member, and refer member communicate with that MTF, setup appointment for member, and refer member appropriately. Member’s local MTF will provide continued treatment, complete appropriately. Member’s local MTF will provide continued treatment, complete the MEB, and direct case as applicable.the MEB, and direct case as applicable.

If the member’s MTF cannot service member at member’s command location, If the member’s MTF cannot service member at member’s command location, then complete the MEB appropriately, allow member to return to command for then complete the MEB appropriately, allow member to return to command for preparation of move (if possible), direct member’s servicing PSD upon preparation of move (if possible), direct member’s servicing PSD upon completion of the MEB to move member via YH availability report to location completion of the MEB to move member via YH availability report to location determined by physician. Member will be moved via LIMDU orders.determined by physician. Member will be moved via LIMDU orders.

Exception of above…if member is of a type 2 or 4 duty…then to TPU as the MTF Exception of above…if member is of a type 2 or 4 duty…then to TPU as the MTF treating directs, but if at all possible, to the TPU/TPD/Others activity closest to treating directs, but if at all possible, to the TPU/TPD/Others activity closest to the member’s PDS.the member’s PDS.

If an officer, PERS-821 will determine LIMDU once MEB is submitted to allow If an officer, PERS-821 will determine LIMDU once MEB is submitted to allow detailer to provide LIMDU orders vice PSD submitting YH avail.detailer to provide LIMDU orders vice PSD submitting YH avail.

If member is hospitalized based on injury, follow TEMDU/TEMADD requirements.If member is hospitalized based on injury, follow TEMDU/TEMADD requirements.




PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

How did member get to you?How did member get to you?(TAD referral – Example 2)(TAD referral – Example 2)

Member is TEMADD for treatment to your MTF as a referral from another Member is TEMADD for treatment to your MTF as a referral from another MTF. MTF.

Example…NH Lemoore to NMC San Diego.Example…NH Lemoore to NMC San Diego. Ensure member has funded TEMADD orders. If not, direct appropriately to Ensure member has funded TEMADD orders. If not, direct appropriately to

document required entitlements. document required entitlements. If outpatient basis, can the major MTF that services member’s parent command If outpatient basis, can the major MTF that services member’s parent command

treat member appropriately after review/initial treatment? If so, communicate treat member appropriately after review/initial treatment? If so, communicate with that MTF, setup appointment for member, and refer member back to the with that MTF, setup appointment for member, and refer member back to the MTF appropriately. Member’s local MTF will provide continued treatment, MTF appropriately. Member’s local MTF will provide continued treatment, complete the MEB, and direct TEMDU as applicable.complete the MEB, and direct TEMDU as applicable.

If the MTF cannot service member at command location, then:If the MTF cannot service member at command location, then: Provide referral information back to the member’s MTF for initiation of an MEB, orProvide referral information back to the member’s MTF for initiation of an MEB, or Complete the MEB, allow member to return to command for preparation of move, direct Complete the MEB, allow member to return to command for preparation of move, direct

member’s servicing PSD upon completion of the MEB to move member via YH availability member’s servicing PSD upon completion of the MEB to move member via YH availability report to location determined by physician. Member will be moved via LIMDU orders at report to location determined by physician. Member will be moved via LIMDU orders at the recommended treatment area, orthe recommended treatment area, or

If member is from a type 2 or 4 duty…TEMDU required to the TPU/TPD/Others activity the If member is from a type 2 or 4 duty…TEMDU required to the TPU/TPD/Others activity the MTF approving the MEB directs, but preferably to the TPU/TPD/Others activity closest to MTF approving the MEB directs, but preferably to the TPU/TPD/Others activity closest to the member’s PDS, if able.the member’s PDS, if able.

If an officer, PERS-821 will determine LIMDU once the MEB is submitted to allow If an officer, PERS-821 will determine LIMDU once the MEB is submitted to allow detailer to provide LIMDU orders vice PSD submitting YH avail. detailer to provide LIMDU orders vice PSD submitting YH avail.

If member is hospitalized based on injury, follow TEMDU/TEMADD requirements.If member is hospitalized based on injury, follow TEMDU/TEMADD requirements.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

How did member get to you?How did member get to you?(GSA – Example 3)(GSA – Example 3)

Member received and member’s parent command is ECRC within Member received and member’s parent command is ECRC within the NMPS on GSA orders (regardless if in-theater operations or the NMPS on GSA orders (regardless if in-theater operations or not)not)

This is a type 2 command. Treat the case as such.This is a type 2 command. Treat the case as such. Ensure member has funded TEMADD orders. If not, direct Ensure member has funded TEMADD orders. If not, direct

appropriately to document required entitlements. Member should be appropriately to document required entitlements. Member should be funded under the orders provided for GSA assignment. There may be funded under the orders provided for GSA assignment. There may be no action on this…but verify.no action on this…but verify.

If member cannot return to full duty within 60 days regardless of If member cannot return to full duty within 60 days regardless of combination of inpatient/outpatient, follow TEMDU direction. If an combination of inpatient/outpatient, follow TEMDU direction. If an officer, follow TEMADD direction. officer, follow TEMADD direction.

ECRC is the parent command for all personnel on GSA tour. There is ECRC is the parent command for all personnel on GSA tour. There is only two ECRC commands. One in NMPS San Diego, and the other at only two ECRC commands. One in NMPS San Diego, and the other at NMPS Norfolk. NMPS Norfolk.

When you direct ECRC to TEMDU member…ECRC and PERS-4G/detailer When you direct ECRC to TEMDU member…ECRC and PERS-4G/detailer will follow member for new assignment, or if an MEB is pending, a YH will follow member for new assignment, or if an MEB is pending, a YH availability report will be submitted by TPU/PSD once MEB is completed availability report will be submitted by TPU/PSD once MEB is completed for LIMDU orders or stay at TPU for PEB processing. If an officer, the for LIMDU orders or stay at TPU for PEB processing. If an officer, the MEB will be submitted to PERS-821 for disposition.MEB will be submitted to PERS-821 for disposition.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

How did member get to you?How did member get to you?(IA – Example 4)(IA – Example 4)

Member received and member is on Individual Augmentation (IA) Member received and member is on Individual Augmentation (IA) orders.orders. Member’s parent command is the command member went on IA from.Member’s parent command is the command member went on IA from. Parent command could be any type duty. Verify UIC for type of duty.Parent command could be any type duty. Verify UIC for type of duty. Ensure member has funded TEMADD orders. If not, direct appropriately Ensure member has funded TEMADD orders. If not, direct appropriately

to document required entitlements. Member should be funded under to document required entitlements. Member should be funded under the orders provided for on IA. There may be no action on this…but the orders provided for on IA. There may be no action on this…but verify availability of funds.verify availability of funds.

If member cannot return to full duty within 60 days regardless of If member cannot return to full duty within 60 days regardless of combination of inpatient/outpatient, and member is type 2 or 4 duty, combination of inpatient/outpatient, and member is type 2 or 4 duty, follow TEMDU direction. If an officer, follow TEMADD direction. follow TEMDU direction. If an officer, follow TEMADD direction.

If member is from a type 1 command, follow example 2.If member is from a type 1 command, follow example 2. If member is from a type 3 or 6 command, follow example 2 and If member is from a type 3 or 6 command, follow example 2 and

determine further if the overseas MTF may be able to treat member. determine further if the overseas MTF may be able to treat member. Report status of member via message to parent command and PERS-Report status of member via message to parent command and PERS-

4G. Parent command to know status of member, and PERS-4G to 4G. Parent command to know status of member, and PERS-4G to indicate member will or will not return to IA assignment.indicate member will or will not return to IA assignment.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

How did member get to you?How did member get to you?(No Notice – Example 5)(No Notice – Example 5)

Member received at Other Services MTF (i.e. BAMC), VA hospital, Member received at Other Services MTF (i.e. BAMC), VA hospital, or other civilian hospital as an inpatient (not transferred from an or other civilian hospital as an inpatient (not transferred from an MTF). MTF).

Ensure your level 4 and 5 hospitals in your area know how to contact Ensure your level 4 and 5 hospitals in your area know how to contact you.you.

Member could be any type duty command including an in transit. Member could be any type duty command including an in transit. Verify UIC for type of duty and ACC code. Verify UIC for type of duty and ACC code.

Was member on regular leave? If so, ensure you notify parent Was member on regular leave? If so, ensure you notify parent command of member’s hospitalization.command of member’s hospitalization.

Was member on separation or retirement leave? If so, notify losing Was member on separation or retirement leave? If so, notify losing command. Additionally, determine if member needs an extension of command. Additionally, determine if member needs an extension of retirement/separation for hospitalization or PEB referral to separating retirement/separation for hospitalization or PEB referral to separating or retirement authority. or retirement authority.

If member cannot return to full duty within 60 days regardless of If member cannot return to full duty within 60 days regardless of combination of inpatient/outpatient, and member is type 2 or 4 duty, combination of inpatient/outpatient, and member is type 2 or 4 duty, follow TEMDU direction. If an officer, follow officer TEMADD direction. follow TEMDU direction. If an officer, follow officer TEMADD direction.

If member is from a type 1 command, follow example 2.If member is from a type 1 command, follow example 2. If member is from a type 3 or 6 command, follow example 2 and If member is from a type 3 or 6 command, follow example 2 and

determine further if the overseas MTF may be able to treat member. determine further if the overseas MTF may be able to treat member.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

How did member get to you?How did member get to you?(Inpatient – Example 6)(Inpatient – Example 6)

Member received at Other Services MTF (i.e. BAMC), VA hospital, Member received at Other Services MTF (i.e. BAMC), VA hospital, or other civilian hospital as an inpatient from another MTF. or other civilian hospital as an inpatient from another MTF.

The Navy MTF’s medical case manager and PAD should have already The Navy MTF’s medical case manager and PAD should have already communicated the clinical/non-clinical transfer information to the new communicated the clinical/non-clinical transfer information to the new MTF.MTF.

The losing MTF should have directed TEMDU if member was a type 2 or The losing MTF should have directed TEMDU if member was a type 2 or 4 duty and gained in that MTF’s inpatient UIC prior to transfer, if 4 duty and gained in that MTF’s inpatient UIC prior to transfer, if applicable. applicable.

If TEMDU did not occur, ensure the losing MTF directs the TEMDU to be If TEMDU did not occur, ensure the losing MTF directs the TEMDU to be gained to your MTF inpatient UIC now; your MTF shouldn’t be directing gained to your MTF inpatient UIC now; your MTF shouldn’t be directing TEMDU if member’s case was already determined to be prolonged by TEMDU if member’s case was already determined to be prolonged by the other MTF, but may be necessary if not already completed. the other MTF, but may be necessary if not already completed.

Waiting to direct TEMDU may be appropriate if the MTF knows member Waiting to direct TEMDU may be appropriate if the MTF knows member will be farmed out for other Navy MTF responsibility. Knowledge of this will be farmed out for other Navy MTF responsibility. Knowledge of this should come from attending physician, but never wait longer than 60 should come from attending physician, but never wait longer than 60 days to direct TEMDU by any combination.days to direct TEMDU by any combination.

Do not go over 60 days without directing TEMDU. Key is “as soon as it Do not go over 60 days without directing TEMDU. Key is “as soon as it is known” member will not return to operational unit within 60 days full is known” member will not return to operational unit within 60 days full up.up.

Be proactive. Communication is key to medical, personnel, and pay. Be proactive. Communication is key to medical, personnel, and pay.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

How did member get to you?How did member get to you?(MEB referral – Example 7)(MEB referral – Example 7)

Member received at your MTF for your MTF to do MEB action.Member received at your MTF for your MTF to do MEB action. Does the other MTF have convening authority? If so, then the other Does the other MTF have convening authority? If so, then the other

MTF should have completed the MEB, and:MTF should have completed the MEB, and: If member is shore duty (1, 3 or 6), directed servicing PSD to submit YH If member is shore duty (1, 3 or 6), directed servicing PSD to submit YH

availability report for member to be transferred to new MTF area for availability report for member to be transferred to new MTF area for treatment. If an officer, submit MEBR to PERS-821 for disposition. treatment. If an officer, submit MEBR to PERS-821 for disposition.

If member is sea duty (2 or 4), directed parent command to TEMDU member If member is sea duty (2 or 4), directed parent command to TEMDU member to TPU/Others activity for LIMDU/PEB processing to their own servicing to TPU/Others activity for LIMDU/PEB processing to their own servicing TPU/TPD/Others activity.TPU/TPD/Others activity.

If gaining MTF determines to do the MEB, then note the following.If gaining MTF determines to do the MEB, then note the following. A member’s transfer to other MTF location for outpatient treatment may be A member’s transfer to other MTF location for outpatient treatment may be

delayed until the new MTF can direct appropriately. delayed until the new MTF can direct appropriately. Member may still have to return to parent command for personal property Member may still have to return to parent command for personal property

movement, etc. which will cause stress to member and family.movement, etc. which will cause stress to member and family. The other MTF directs member’s TEMDU, etc. The other MTF directs member’s TEMDU, etc.

Simply put…if diagnosis cannot be treated by major MTF in member’s Simply put…if diagnosis cannot be treated by major MTF in member’s area…then the MTF does an MEB writing in treatment plan area that area…then the MTF does an MEB writing in treatment plan area that member must be moved to the new MTF area for treatment. Don’t member must be moved to the new MTF area for treatment. Don’t make the other MTF do your MTF’s MEB and coordination. make the other MTF do your MTF’s MEB and coordination.

Any DoD physician should know approx how long member may be medically Any DoD physician should know approx how long member may be medically restricted without the specialty clinic and without the proper equipment. restricted without the specialty clinic and without the proper equipment.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

INPATIENT to OUTPATIENT INPATIENT to OUTPATIENT (For LIMDU)(For LIMDU)

Will member ever be returned to duty? Will member ever be returned to duty? No? Why LIMDU then. No? Why LIMDU then. Yes? Continue with LIMDU plan.Yes? Continue with LIMDU plan. Surgery? Qualifies for LIMDU for healing time.Surgery? Qualifies for LIMDU for healing time. Career ending? Retirement, separation, or HYT within 1 year? Career ending? Retirement, separation, or HYT within 1 year?

Within 6 months? Within 3 months? Now?Within 6 months? Within 3 months? Now? Punitive separation pending?Punitive separation pending?

Type duty 2 or 4? Type duty 2 or 4? Direct TEMDU to TPU/Others Direct TEMDU to TPU/Others Medical Holding Company available? Medical Holding Company available? Transfer to TPU/Others if assigned inpatient UIC alreadyTransfer to TPU/Others if assigned inpatient UIC already Type duty 1, 3 or 6? The MTF at duty location sufficient to Type duty 1, 3 or 6? The MTF at duty location sufficient to

treat member? treat member? Yes, stay at current command. Communicate clinical.Yes, stay at current command. Communicate clinical. No, direct member’s servicing PSD to submit YH availability No, direct member’s servicing PSD to submit YH availability

report, after MEB is completed; provide:report, after MEB is completed; provide: Geo location member should be transferred for medical care Geo location member should be transferred for medical care

based on physician direction if not on the MEBRbased on physician direction if not on the MEBR All other data needed is on the MEBR already provided to PSDAll other data needed is on the MEBR already provided to PSD


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

INPATIENT to OUTPATIENTINPATIENT to OUTPATIENT(For PEB)(For PEB)

Physician dictates MEBRPhysician dictates MEBR Is there final punitive separation authority? Cancel PEB.Is there final punitive separation authority? Cancel PEB.

Pending? Suspend it.Pending? Suspend it. Is there approved retirement or member is HYT? Is there approved retirement or member is HYT?

Presumption of Fitness?Presumption of Fitness? Need more time? Send message to PERS-823 (enlisted retirements Need more time? Send message to PERS-823 (enlisted retirements

& HYT) or 822 (officer retirements)& HYT) or 822 (officer retirements) Current email and numbers for more time:Current email and numbers for more time:

PERS-823: Mr. Mike Lynn, PERS-823: Mr. Mike Lynn, [email protected]@navy.mil, 901-874-3246, 901-874-3246 PERS-822: Ms. Kim Riddle, PERS-822: Ms. Kim Riddle, [email protected]@navy.mil, 901-874-3180, 901-874-3180 Submit message requesting 60 days extension to submit to PEB. Add Submit message requesting 60 days extension to submit to PEB. Add

message to the email.message to the email. Type duty 2 or 4? Type duty 2 or 4? Direct TEMDU to TPU/Others Direct TEMDU to TPU/Others Transfer to TPU/Others if assigned inpatient UIC alreadyTransfer to TPU/Others if assigned inpatient UIC already Type duty 1, 3 or 6? Type duty 1, 3 or 6? Stay on type 1, 3, or 6 station if Stay on type 1, 3, or 6 station if

possible…but may need to be moved if applicable.possible…but may need to be moved if applicable.




PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

INPATIENT to OUTPATIENTINPATIENT to OUTPATIENT(Extended Outpatient)(Extended Outpatient)

MEB not required or desiredMEB not required or desired These patients are SVI or SI or equivalent if not reported.These patients are SVI or SI or equivalent if not reported. Physician determines treatment plan/location.Physician determines treatment plan/location. If not assigned to your inpatient UIC in error, then do it now.If not assigned to your inpatient UIC in error, then do it now. Change of MTF responsibility? Change of MTF responsibility?

Communicate clinical transfer to new MTF responsible for the case.Communicate clinical transfer to new MTF responsible for the case. Have your servicing PSD do the loss endorsement and send records and new STO Have your servicing PSD do the loss endorsement and send records and new STO

etc. to gaining MTF’s servicing PSD.etc. to gaining MTF’s servicing PSD. Member should already be assigned to your inpatient UIC…change ACC to Member should already be assigned to your inpatient UIC…change ACC to

374. 374. ACC-374 will be available in September 2008.ACC-374 will be available in September 2008. Use ACC-374 for patients who are not in a hospital in a bed, and patients are Use ACC-374 for patients who are not in a hospital in a bed, and patients are

not able to work in LIMDU status in a workspace. not able to work in LIMDU status in a workspace. ACC-374 is for patients in nursing facilities, VA rehabilitation facilities, home ACC-374 is for patients in nursing facilities, VA rehabilitation facilities, home

in a bed with nursing care, etc., 90 day convalescent plans (cannot legally in a bed with nursing care, etc., 90 day convalescent plans (cannot legally allow 90 days conv)…but, accounting member as ACC-374 may be allow 90 days conv)…but, accounting member as ACC-374 may be authorized. authorized.

Specific reasons to use ACC-374 will be determined by PERS-821 and M3.Specific reasons to use ACC-374 will be determined by PERS-821 and M3. ACC-374 is equivalent to being hospitalized. Member is unable to work, but ACC-374 is equivalent to being hospitalized. Member is unable to work, but

the treatment is extended or extensive to the fact member still cannot work. the treatment is extended or extensive to the fact member still cannot work. It’s the grey area between hospitalization and LIMDU. It’s the grey area between hospitalization and LIMDU.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229


Actual case #1Actual case #1 Member was an inpatient from theater routed to an MTF CONUS, further Member was an inpatient from theater routed to an MTF CONUS, further

sent to PALO ALTO for treatment.sent to PALO ALTO for treatment. Clinical transfer discussed, but not the non-clinical (the STO).Clinical transfer discussed, but not the non-clinical (the STO). Member transitioned to extended outpatient treatment to continue PALO Member transitioned to extended outpatient treatment to continue PALO

ALTO treatment; member started having pay complications.ALTO treatment; member started having pay complications. STO direction completed very late after PERS-821 intervention, and a STO direction completed very late after PERS-821 intervention, and a

different MTF had to coordinate the non-clinical transfer.different MTF had to coordinate the non-clinical transfer. Member was gained at an MTF inpatient UIC.Member was gained at an MTF inpatient UIC. Impact of not directing the STO.Impact of not directing the STO.

Member’s military wife separated for the basis of HM3 injury…but could not ship Member’s military wife separated for the basis of HM3 injury…but could not ship HHG to desired location.HHG to desired location.

Member was receiving incorrect BAH entitlements. Living in Palo Alto is very Member was receiving incorrect BAH entitlements. Living in Palo Alto is very expensive.expensive.

Accounting code for hospitalization was not captured for historical purposes.Accounting code for hospitalization was not captured for historical purposes. Member was not getting additional entitlements since he was not accounted Member was not getting additional entitlements since he was not accounted

correctly.correctly. Parent command was an operational command…without a replacement.Parent command was an operational command…without a replacement. Spouse could elect to travel to HM3 and store HHG anywhere in CONUS.Spouse could elect to travel to HM3 and store HHG anywhere in CONUS. Above actions could have been resolved by simply directing TEMDU.Above actions could have been resolved by simply directing TEMDU.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229


Actual case #2Actual case #2 Member was an inpatient at a Navy MTF, further sent to VA MEDICAL in Member was an inpatient at a Navy MTF, further sent to VA MEDICAL in

TAMPA FL for treatment.TAMPA FL for treatment. Clinical transfer discussed, and non-clinical directed as well (the STO). Clinical transfer discussed, and non-clinical directed as well (the STO).

Member was onboard the LABOON. However, the PSD Afloat was not Member was onboard the LABOON. However, the PSD Afloat was not informed.informed.

Member was in extended outpatient treatment to continue TAMPA treatment; Member was in extended outpatient treatment to continue TAMPA treatment; member started having pay complications.member started having pay complications.

STO direction completed on time, but the command didn’t forward the STO direction completed on time, but the command didn’t forward the message to the servicing PSD Afloat.message to the servicing PSD Afloat.

Member was gained after PERS-821 provided TDRL authority. Impact of not Member was gained after PERS-821 provided TDRL authority. Impact of not following STO direction.following STO direction.

Member is single and continued to pay comrats on a ship.Member is single and continued to pay comrats on a ship. Member not receiving BAH (since he is occupying gov’t housing…the ship) + being Member not receiving BAH (since he is occupying gov’t housing…the ship) + being

single.single. Could not move personal property or store it.Could not move personal property or store it. Member was paying out of pocket expenses. Member was paying out of pocket expenses. Accounting code for hospitalization was not captured for historical purposes.Accounting code for hospitalization was not captured for historical purposes. Parent command was an operational command…without a replacement. –Their Parent command was an operational command…without a replacement. –Their

fault.fault. Above actions could have been resolved if LABOON simply did what the MTF Above actions could have been resolved if LABOON simply did what the MTF

directed. On top of that…member would have received BAH because he was not directed. On top of that…member would have received BAH because he was not occupying gov’t quarters.occupying gov’t quarters.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229


Actual case #3 Actual case #3 Members were sent to BAMC from GUAM. Members were sent to BAMC from GUAM. Clinical transfer discussed, and non-clinical not directed (the STO). Clinical transfer discussed, and non-clinical not directed (the STO). Navy MTF finally directed STO after many conversations. Navy MTF finally directed STO after many conversations. BAMC at the time was receiving Navy liaison support. BAMC at the time was receiving Navy liaison support. FRANK CABLE wouldn’t complete the STOs. FRANK CABLE was spending 30K FRANK CABLE wouldn’t complete the STOs. FRANK CABLE was spending 30K

+ a month for per diem. Command felt member’s OHA was the problem.+ a month for per diem. Command felt member’s OHA was the problem. FRANK CABLE thought if member’s were transferred that family could not FRANK CABLE thought if member’s were transferred that family could not

continue OHA. Not true.continue OHA. Not true. Members injured were a combination of hospitalization, extended outpatient Members injured were a combination of hospitalization, extended outpatient

treatment, and LIMDU. treatment, and LIMDU. Members were finally gained at BAMC. BAH waivers for dependent location Members were finally gained at BAMC. BAH waivers for dependent location

submitted and approved, TSGLI packages submitted, etc.submitted and approved, TSGLI packages submitted, etc. Impact of not following STO direction. Impact of not following STO direction.

Family not receiving bedside orders had to pay out of pocket expenses. Family not receiving bedside orders had to pay out of pocket expenses. Family had no option to move HHG or even have funding to move.Family had no option to move HHG or even have funding to move. Accounting code for hospitalization was not captured for historical purposes.Accounting code for hospitalization was not captured for historical purposes. Parent command was an operational command…without a replacement. –Their Parent command was an operational command…without a replacement. –Their

fault.fault. Above actions could have been resolved if FRANK CABLE simply did what the MTF Above actions could have been resolved if FRANK CABLE simply did what the MTF

directed. directed.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229


Actual case #4Actual case #4 This is a Grey area…not LIMDU capable, and also not hospitalized.This is a Grey area…not LIMDU capable, and also not hospitalized. Member was at a Navy MTF area on 2 LIMDU periods.Member was at a Navy MTF area on 2 LIMDU periods. PERS-821 received 3PERS-821 received 3rdrd LIMDU request for treatment plan not entirely matching LIMDU request for treatment plan not entirely matching

member’s actual treatment plan (later discovered).member’s actual treatment plan (later discovered). YH availability submitted to move member to KY/TN area near family for LIMDU and YH availability submitted to move member to KY/TN area near family for LIMDU and

treatment at KY clinic.treatment at KY clinic. Clinical transfer discussed, and non-clinical transfer approved via LIMDU PCS orders Clinical transfer discussed, and non-clinical transfer approved via LIMDU PCS orders

to CNRC.to CNRC. CNRC refused to accept member since member was not reporting to command for CNRC refused to accept member since member was not reporting to command for

LIMDU.LIMDU. Further review determined that the MTF directed a combination of Further review determined that the MTF directed a combination of

inpatient/outpatient.inpatient/outpatient. Member would not be able to work in a work space per the MTF.Member would not be able to work in a work space per the MTF. A YH availability report to move member on LIMDU PCS orders should have never A YH availability report to move member on LIMDU PCS orders should have never

been submitted.been submitted. Member should have been non-clinically coordinated to NH Pensacola to be gained in Member should have been non-clinically coordinated to NH Pensacola to be gained in

its inpatient UIC for tracking by its medical case manager or kept in the current MTF’s its inpatient UIC for tracking by its medical case manager or kept in the current MTF’s patient UIC and tracked.patient UIC and tracked.

This member would be perfect for ACC 374 since member is not an inpatient and not This member would be perfect for ACC 374 since member is not an inpatient and not able for LIMDU.able for LIMDU.

Current MANMED directs the MTF to do an MEB to properly restrict a member once Current MANMED directs the MTF to do an MEB to properly restrict a member once becoming an outpatient. ACC-374 will alleviate this action since ACC-374 is a becoming an outpatient. ACC-374 will alleviate this action since ACC-374 is a medical restriction by default.medical restriction by default.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

Enlisted in-transit between Enlisted in-transit between stationsstations

ENLISTED:ENLISTED: Get PCS orders from member/family any possible way (fax, etc.). Member may Get PCS orders from member/family any possible way (fax, etc.). Member may

be hospitalized hundreds of miles from your MTF.be hospitalized hundreds of miles from your MTF. MILPERSMAN 1306-1600 directs that closest Navy MTF to gain member in transit.MILPERSMAN 1306-1600 directs that closest Navy MTF to gain member in transit. Direct your servicing PSD to gain member in your inpatient UIC in appropriate Direct your servicing PSD to gain member in your inpatient UIC in appropriate

37x code.37x code. Reason for gain: Reason for gain:

Member doesn’t use leaveMember doesn’t use leave Provide status of member to losing/gaining/detailer via message using all PLADs listed on Provide status of member to losing/gaining/detailer via message using all PLADs listed on

the PCS orders the PCS orders Physician determines if member can continue on orders or NAVPERS should cancel orders Physician determines if member can continue on orders or NAVPERS should cancel orders

based on medical restriction. based on medical restriction. If orders must be cancelled due to medical restriction or unsuitability ensure member If orders must be cancelled due to medical restriction or unsuitability ensure member

liquidates used portion of the PCS.liquidates used portion of the PCS. Have member or guardian discuss with qualified person on how to stop HHG movement, Have member or guardian discuss with qualified person on how to stop HHG movement,

etc. if orders are cancelled.etc. if orders are cancelled. Physician initiates MEB for LIMDU/PEB and orders cancelled. Send member to TPU/Others Physician initiates MEB for LIMDU/PEB and orders cancelled. Send member to TPU/Others

once outpatient.once outpatient. LODI if needed: Always go to losing command or local installation.LODI if needed: Always go to losing command or local installation. Does your MTF have a relationship with those level 4 and 5 hospitals in your area Does your MTF have a relationship with those level 4 and 5 hospitals in your area

of responsibility? of responsibility? Do they know how to contact you? Do they know how to contact you?


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

Officer in-transit between Officer in-transit between stationsstations

OFFICERS:OFFICERS: Get PCS orders from member/family any possible way (fax, etc.). Member may be Get PCS orders from member/family any possible way (fax, etc.). Member may be

hospitalized hundreds of miles from your MTF.hospitalized hundreds of miles from your MTF. MILPERSMAN 1301-010 directs that the closest Navy MTF to gain member in MILPERSMAN 1301-010 directs that the closest Navy MTF to gain member in

transit.transit. Direct PSD to gain member in your inpatient UIC in appropriate 37x code.Direct PSD to gain member in your inpatient UIC in appropriate 37x code. Reason for gain: Reason for gain:

Member doesn’t use leaveMember doesn’t use leave Officer orders are not cancelled…just modified.Officer orders are not cancelled…just modified. Provide Report Control Symbol BUPERS 1301-13 report (format in MILPERSMAN) to Provide Report Control Symbol BUPERS 1301-13 report (format in MILPERSMAN) to

losing/gaining/detailer via message using all PLADs listed on the PCS orders.losing/gaining/detailer via message using all PLADs listed on the PCS orders. Email or FAX above message to PERS-821 officer LIMDU coordinator and PERS-451 for faster Email or FAX above message to PERS-821 officer LIMDU coordinator and PERS-451 for faster

service and coordination. PERS-821 POC is service and coordination. PERS-821 POC is [email protected]@navy.mil and and [email protected]@navy.mil..

Physician determines if member can continue on orders or NAVPERS should modify orders Physician determines if member can continue on orders or NAVPERS should modify orders based on medical restriction. based on medical restriction.

Have member or guardian discuss with qualified persons on HHG movement change, etc. if Have member or guardian discuss with qualified persons on HHG movement change, etc. if orders are modified.orders are modified.

Physician initiates MEB for LIMDU/PEB or allows convalescent leave before continuing on Physician initiates MEB for LIMDU/PEB or allows convalescent leave before continuing on orders, etc. orders, etc.

If orders are to be modified since member is outpatient, TAD (unfunded) officer appropriately If orders are to be modified since member is outpatient, TAD (unfunded) officer appropriately in local area to await for new orders. Member uses current orders combined with gaining in local area to await for new orders. Member uses current orders combined with gaining endorsement to your inpatient UIC as the I-stop.endorsement to your inpatient UIC as the I-stop.

LODI if needed: Always go to losing command or local installation.LODI if needed: Always go to losing command or local installation. Does your MTF have a relationship with those level 4 and 5 hospitals in your area of Does your MTF have a relationship with those level 4 and 5 hospitals in your area of

responsibility? Do they know how to contact you? responsibility? Do they know how to contact you?




PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

MEB action for LIMDUMEB action for LIMDU Physician determines diagnosisPhysician determines diagnosis Physician further determines restriction by indicating Physician further determines restriction by indicating

limitations and treatment plan.limitations and treatment plan. Who initiates an MEB?Who initiates an MEB?

Any certified DoD physician.Any certified DoD physician. Who can approve an MEB?Who can approve an MEB?

The Navy MTF Convening AuthorityThe Navy MTF Convening Authority Who initiates the MEB if a specialty physician/clinic is not Who initiates the MEB if a specialty physician/clinic is not

available at the current MTF?available at the current MTF? The current MTF if at all possible.The current MTF if at all possible. Directs the treatment plan via referrals.Directs the treatment plan via referrals. Allows YH availability report submission to move member rather Allows YH availability report submission to move member rather

than allowing the other MTF to direct TEMDU in its TPU/Others than allowing the other MTF to direct TEMDU in its TPU/Others activity.activity.

Doing your own MEBs, directing your own TEMDU, and allowing Doing your own MEBs, directing your own TEMDU, and allowing your own PSDs to submit availability reports is needed for the your own PSDs to submit availability reports is needed for the member, the family, and allows less manpower, money, and member, the family, and allows less manpower, money, and confusion. confusion.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

MEB action for LIMDUMEB action for LIMDU If your MTF’s physician provides a referral to another MTF for If your MTF’s physician provides a referral to another MTF for

review…why allow the other MTF initiate the MEB…who will also review…why allow the other MTF initiate the MEB…who will also direct the TEMDU.direct the TEMDU.

Recommend that the receiving MTF provide clinical report back to Recommend that the receiving MTF provide clinical report back to the referring physician.the referring physician.

Recommend the referring physician initiate the MEB and not the Recommend the referring physician initiate the MEB and not the referred physician.referred physician.

This will allow your MTF to hold the ace cards and not the other MTF This will allow your MTF to hold the ace cards and not the other MTF staff. staff.

If you allow the other MTF to do the MEB, then don’t gripe and fuss If you allow the other MTF to do the MEB, then don’t gripe and fuss that they are directing your patients to a different geo located that they are directing your patients to a different geo located TPU/Other activity from member’s current PDS. That MTF is doing TPU/Other activity from member’s current PDS. That MTF is doing nothing wrong by instruction.nothing wrong by instruction.

It is best to request action in the member in mind. I.e., where is your It is best to request action in the member in mind. I.e., where is your PDS. In severe medical cases, where is your spouse? PDS. In severe medical cases, where is your spouse?

Your MTF should do the MEB and direct appropriately…don’t allow Your MTF should do the MEB and direct appropriately…don’t allow others to do your cleaning. Member will suffer, the PSD will get others to do your cleaning. Member will suffer, the PSD will get upset, the command will be in the middle figuring why it is upset, the command will be in the middle figuring why it is happening, immediate family is impacted on daily living, and so happening, immediate family is impacted on daily living, and so forth…forth…


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

WHO CAN INITIATE AN MEBWHO CAN INITIATE AN MEB Per MANMED 18-6(2), MEBs will be composed of physicians who are Per MANMED 18-6(2), MEBs will be composed of physicians who are

properly credentialed and actively engaged in clinical practice on the properly credentialed and actively engaged in clinical practice on the staff of a DoD MTF.staff of a DoD MTF.

There are a minimum of 2 members required on an MEB.There are a minimum of 2 members required on an MEB. A junior member and a senior member.A junior member and a senior member.

A CA may name a 3A CA may name a 3rdrd member to an MEB. member to an MEB. A 3A 3rdrd member is mandatory. Specifically, if MEB is convened for adjudicating member is mandatory. Specifically, if MEB is convened for adjudicating

mental incapacitation, and must be a psychiatrist as defined by MANMED article mental incapacitation, and must be a psychiatrist as defined by MANMED article 18-6(8).18-6(8).

The CA cannot be both be a member of the MEB and the final The CA cannot be both be a member of the MEB and the final reviewer…which is the CA signatory responsibility.reviewer…which is the CA signatory responsibility.

The CA must be a Navy MTF CA for a Navy member, but the MEB The CA must be a Navy MTF CA for a Navy member, but the MEB members may be any Service.members may be any Service.

If an MEB is convened for a member needing specialty care not If an MEB is convened for a member needing specialty care not provided at the current MTF, then per MANMED 18-6(7), the MEBR provided at the current MTF, then per MANMED 18-6(7), the MEBR must expressly indicate that key clinical information in the MEBR is must expressly indicate that key clinical information in the MEBR is predicated on specialty consultation by providers other than those predicated on specialty consultation by providers other than those comprising the MEB. comprising the MEB.

Note: just because your MTF doesn’t have a specialty clinic for the injured Note: just because your MTF doesn’t have a specialty clinic for the injured or ill member doesn’t mean the MTF cannot approve an MEB for referral of or ill member doesn’t mean the MTF cannot approve an MEB for referral of treatment…get member moved through personnel systems on the treatment…get member moved through personnel systems on the approved MEBR, and physician refers member appropriately for approved MEBR, and physician refers member appropriately for treatment. treatment.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

LODD/ILODD/I Line of Duty Determination/Investigations (LODD/I)Line of Duty Determination/Investigations (LODD/I)

See Article 18-16 for more info on LODD/I.See Article 18-16 for more info on LODD/I. LODD/I maybe required if a member is placed on Light Duty if LODD/I maybe required if a member is placed on Light Duty if

light duty was related to an injury.light duty was related to an injury. Do not decline PEB processing if the LODD/LODI indicates a Do not decline PEB processing if the LODD/LODI indicates a

member’s condition was incurred outside the line of duty and/or member’s condition was incurred outside the line of duty and/or due to the member’s misconduct. The final decision is the PEB.due to the member’s misconduct. The final decision is the PEB.

JAGINST 5800.7C (JAGMAN), Chapter II, outlines policies and JAGINST 5800.7C (JAGMAN), Chapter II, outlines policies and procedures for making LOD/M determinations. procedures for making LOD/M determinations.

If a member incurs a disease/injury that may result in a If a member incurs a disease/injury that may result in a disability or results in the member’s physical inability to disability or results in the member’s physical inability to perform duty > 24 hours, as determined by medical, then perform duty > 24 hours, as determined by medical, then LOD/M determination is required.LOD/M determination is required.

At a minimum, per JAGMAN 0220d, a PDS must convene an At a minimum, per JAGMAN 0220d, a PDS must convene an investigation and make findings concerning misconduct and investigation and make findings concerning misconduct and LOD if:LOD if:


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

More on LODD/IMore on LODD/I At a minimum, per JAGMAN 0220d, a PDS must convene an At a minimum, per JAGMAN 0220d, a PDS must convene an

investigation and make findings concerning misconduct and investigation and make findings concerning misconduct and LOD if:LOD if: The injury was incurred that suggest a finding of misconduct The injury was incurred that suggest a finding of misconduct

(i.e., injury related to DUI incident), or(i.e., injury related to DUI incident), or An injury was incurred that suggest “not in LOD,” orAn injury was incurred that suggest “not in LOD,” or Reasonable chance of disability decision, orReasonable chance of disability decision, or CO considers an investigation to make official record of the CO considers an investigation to make official record of the

circumstance.circumstance. Except for medical defects and physical disabilities noted Except for medical defects and physical disabilities noted

and recorded at the time of entrance, any injury or disease and recorded at the time of entrance, any injury or disease discovered after a service member enters active duty, with discovered after a service member enters active duty, with the exception of congenital and hereditary conditions, is the exception of congenital and hereditary conditions, is presumed to have been incurred in the line of duty.presumed to have been incurred in the line of duty.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

More on LODD/IMore on LODD/I Process cases that fail to contain a required LOD/M as Process cases that fail to contain a required LOD/M as

follows:follows: If the date of injury was > 2 years prior to date of MEB.If the date of injury was > 2 years prior to date of MEB.

Consistent with JAGMAN, the MEB will presume a finding of “in the Consistent with JAGMAN, the MEB will presume a finding of “in the LOD and not due to the member’s own misconduct.”LOD and not due to the member’s own misconduct.”

If the date of injury was < 2 years prior to date of MEB.If the date of injury was < 2 years prior to date of MEB. Provide statement from GCMCA indicating that an LOD/M Provide statement from GCMCA indicating that an LOD/M

determination was not required per JAGMAN article 0221 or was not determination was not required per JAGMAN article 0221 or was not able to be obtained (i.e., diligent efforts, witness unavailability).able to be obtained (i.e., diligent efforts, witness unavailability).

Always request LOD/M if you have to think about asking for one. Always request LOD/M if you have to think about asking for one. This will allow you time to complete the MEBR per timeline This will allow you time to complete the MEBR per timeline allowed. allowed.

LOD/M is one of the most time-consuming steps.LOD/M is one of the most time-consuming steps. LOD/M is required though to determine if member is eligible for LOD/M is required though to determine if member is eligible for

disability compensation while on active duty. disability compensation while on active duty.


PERS-821PERS-821901-874-3230 / 3229901-874-3230 / 3229

Early ReturnEarly Return

A member injured/ill from an overseas duty location IS NOT A member injured/ill from an overseas duty location IS NOT an “early return” request by the parent command (in an “early return” request by the parent command (in regards to treatment), if:regards to treatment), if: The member was screened suitable and member was injured/ill The member was screened suitable and member was injured/ill

after reporting to the command.after reporting to the command. The member needs treatment at a CONUS MTF because local The member needs treatment at a CONUS MTF because local

MTF is not capable of treating the member for a new or MTF is not capable of treating the member for a new or aggravated condition.aggravated condition.

The command doesn’t want the member at the TYPE 3 or 6 The command doesn’t want the member at the TYPE 3 or 6 command on LIMDU.command on LIMDU.

Member is inpatient to inpatient transfer, and TYPE 3 or 6 Member is inpatient to inpatient transfer, and TYPE 3 or 6 command requests movement.command requests movement.

ALL of the above must be an MTF input via MEB action or ALL of the above must be an MTF input via MEB action or TEMDU request.TEMDU request.

may 2008 peblo/pad conference pers-821 901-874-3230 / 3229 patient administration department...

Documents