Before 2007, all military members faced additional physical evaluations and disability ratings after leaving the military to receive benefits from the Department of Veterans Affairs (VA). While both the DoD and VA use the same rating tool, the VASRD, each had a different physical exam process. Additionally, they came to their own decision on percentages of disability to award as a result of the exam, sometimes leading to differences between VA and the DoD rating of the same injury or illness. The additional requirements led to delays in receiving VA benefits.
The President’s Commission on Care for America’s Returning Wounded Warriors, sometimes called the Dole-Shalala Report, recommended removing this dual-evaluation process and applying one medical exam and one rating determination by VA that the DoD could use for determining fitness at the PEB. In November 2007, the DoD and VA initiated a joint DES Pilot program in the National Capital Region (NCR) to improve the timelines, effectiveness and transparency of the DES review process. The DoD and VA have reviewed the results of the first full year of the DES Pilot and decided the pilot was successful enough in the National Capital Region to justify expanding the program beyond the Washington, D.C., metropolitan area. On June 1, 2009; the DES Pilot Program was expanded to Fort Carson.
The pilot program allows military members to file a VA disability claim when they are referred to the DES. In the pilot program, the DoD relies on VA to perform the full medical exam used by the MEB and PEB to determine if the member meets service retention standards and, later, by the PEB to determine if the member is fit to remain in the service. VA provides a disability rating for each condition found during the medical exam, and the PEB uses these ratings to determine the type of separation or retirement for which the member is eligible.
Although the DoD and VA expect the pilot program to be faster and fairer, you should understand that, even in the pilot program, there are still differences in the final, combined DoD and VA disability percentage. The DoD, by law, can only consider conditions that are unfitting when determining disability ratings, while VA determines disability ratings for all service-connected conditions, even the ones that would not result in a finding of unfit for continued military service. The DoD uses the VA disability percentages for each condition, but may have a different combined disability rating than VA awards because conditions that are not unfitting are not considered in the DoD calculations.
Fort Carson DES Pilot "A Unique Process"
Here at Evans Army Community Hospital, we are proud of our unique DES Pilot Program Setup. We are the only Military Treatment Facility with collocated
Department of Veteran's Affairs Evaluation Providers. The VA
has embedded Medical Personnel into our facility.
Approximately 95% of all VA DES Examinations are conducted
here on Fort Carson. Evans Army Community Hospital is proud to
say that we carry more DES Pilot Cases (As opposed traditional
cases) than any other Military Installation.
What To Expect
Our Fort Carson process is near full streamline after 6 months of
thorough debugging. Upon recognition of a potentially
unfitting condition, a Military Treatment Facility (MTF)
Provider will write a TEMPORARY Profile (DA 3349) with a recommendation for a
Medical Evaluation Board (MEB). In the traditional process,
only the Primary Care Manager (PCM) could write a Permanent profile
suggesting MEB. Under the DES Pilot, any provider may write a
profile recommending MEB. However, under the DES Pilot, a
permanent or temporary profile is not the document which initiates
the MEB. A Soldier is only considered "in the MEB process" when that
temporary profile is reviewed by MEB Clinical Staff and "referred" into the
MEB System via a "VA/DES Referral Form". Only MEB Staff may actually determine if the case has been
worked up properly and initiate the MEB.
Upon referral into the system, the hospital Administrative
Collection Point (ACP) will order a complete copy of the Soldier's medical records.
Upon receipt of this copy from the Hospital Release of Information
(ROI) Section, a Soldier is then assigned to a Physical Evaluation
Board Liaison Officer (PEBLO) or commonly known as an MEB Counselor.
The PEBLO is responsible for collecting/compiling the administrative
evidence for the MEB and Physical Evaluation Board (PEB) as well as
counseling the Soldier on the DES Pilot process.
As part of the DES Pilot process the PEBLO will refer the case over to the VA
Military Service Coordinator (MSC). The MSC will arrange for
an appointment with the Soldier to fill out the "VA/DOD Joint
Disability Evaluation Board" (VA 21-0819) claim form. During this
phase, the Soldier will file a VA claim for all conditions which
they believe may be disabling. The Soldier may claim any and
all medical conditions within their records that they feel are
affecting their health. This claim is not limited to the
conditions which have been identified on the Army Profile.
In order to properly evaluate all claimed conditions, a series of referrals
with VA Specialists will be coordinated. These Specialist
referrals will encompass not only the Soldier's claimed conditions,
but also all conditions on the Army Profile. This is where the
copy of your records is transferred to the VA Specialists in order
to properly evaluate all conditions. This transfer of medical
records is legal under HIPAA in accordance with the 2005 Memorandum
of Understanding between DOD and VA for evaluation for VA Benefits.
Upon completion of all specialist consults, all reports will be forwarded
to the MEB Physician handling the "Narrative Summary" (NARSUM)
appointment. Due to most all of the physical evaluation portion
being completed by the VA Providers, the MEB Physician basically
conducts an interview and creates a NARSUM.
Upon compilation of all administrative and medical documents into
the DES Pilot case file by the PEBLO, the case will "go around for
signatures". This is a process where the Deputy Commander of
Clinical Services (DCCS), MEB Physicians, and Specialists (pertinent
to conditions falling below retention standards) make a final review
of the case and all supporting documentation. The Soldier also has
the opportunity to review and sign the MEB findings at this point. Once all reviews are completed and all documents are signed, the
case will be transferred to the PEB and the VA examinations to the
Disability Rating Active Site. (DRAS)
PEB will only determine whether a Soldier is fit or unfit for
continued military service and forward their finding back to this
facility. If the Soldier is found unfit they will be afforded
the opportunity to request to see their VA rating decision prior to
making a decision as to appealing the finding of unfit. In the case
that the soldier is found fit by the PEB, the DRAS will not
determine a rating for any conditions. Upon receiving the rating, to
Soldier is afforded one opportunity (while on active duty) to request a
"second look" at the
VA rating by the DRAS. This does not prevent further VA
ratings appeals after the Soldier is discharged.
Upon completion of the case and discharge, the Soldier will start to
receive the determined disability percentage of compensation at the
end of the first full month after discharge .