1. United States Public Health Service Commission Corps Medical Affairs

2. Purpose To provide an overview of the Medical Affairs and Medical Retirements This briefing is not designed to replace the USPHS Commissioned Corps Retirement Seminar that is located on the Commissioned Corps Learning Management System

3. Medical Affairs

4. Medical Affairs Sections Medical Review Staff and Support Services Review retirement Physicals Medical Evaluations Section Prepare Fitness for Duty (FFD) Evaluations TRICARE Services Point of Contact Medical File Section

5. Healthcare Authorization (TRICARE) Dental Support (TRICARE) Medical Waivers Deployment Eligibility Determinations Medical Records (Physicals) Review Medical Review Boards (FFD Evals.) DEERS Determinations (Incap Depend) Combat-Related Special Compensation Line-of-Duty Determinations (AD death) Medical Affairs Services

6. Active Duty (AD) PHS Officers Retired PHS Officers Beneficiaries of both AD and Retired PHS Officers Clients Supported by Medical Affairs

7. Retirement

8. Report of Medical History –DD Form 2807-1 Report of Medical Exam –DD Form 2808 Report of Dental Examination –PHS 6355 Retirement Documentation

9. CCPM 29.3 INSTR 5: “Medical Examination Requirements” (page 3) –CCMIS Website http://ccmis.usphs.gov/eccis/CCISToc.aspx?Sh owTOC=Y –Book 2, Chapter 2, Section 1 –Instruction 221.02 Retirement Physicals Policy

10. CCPM 29.3 INSTR 5: “Medical Examination Requirements” (page 3) –Section B.3. (page 3) “General Information: Retirement and Separation Physicals” –Section D.3 (page 6) “Medical Examination Requirements: Officers undergoing Retirement” –Exhibit VII (pages 22 – 23) Retirement Physicals Policy

11. Salient Information –DD2807/Med. Hx, DD2808/Med. Eval & PHS6355/Dental Exam submitted within 6 months prior to separation (to be received in Medical Affairs at least 60 days before separation date). Retirement Physicals Policy

12. Salient Information –“An officer may waive this examination by executing the waiver on form PHS-l373, ‘Separation of Commissioned Officer’“ –“the examination not only serves to protect his/her potential right to disability retirement, but it also serves to protect any future entitlements that he/she may have for benefits provided by the Department of Veterans Affairs (VA) after(wards)” Retirement Physicals Policy

13. Salient Information –Benefits disability compensation, medical care, and … survivor benefits for service-connected disease or injury “important -- officer's medical status at retirement be documented in his/her central medical file” Retirement Physicals Policy

14. Recommended Testing –Blood work (CBC, chemistry profile, lipid profile, HIV antibody, prostatic specific antigen for males over age 40); –Resting EKG for males > age 35 and females > age 40; –Chest X-ray for all smokers and for any over age 45 Retirement Physicals Policy

15. Recommended Testing –Screening pulmonary function testing for all smokers; PPD previously negative; –Stool occult blood testing, flexible sigmoidoscopy for > age 40; –Cervical Pap smear for all females, and –Mammography for females > age 40 who have not been recently screened Retirement Physicals Policy

16. Officer plans to retire in one year –Officer undergoes retirement physical Physical examination – colonoscopy reveals colorectal mass (previously asymptomatic) Biopsy of mass reveals malignant neoplasm Additional studies performed, i.e. CT scan of abdomen and additional serological studies Treatment plan: Surgery, followed by adjuvant chemotherapy Will the officer remain on AD until all is done? Retirement Scenario

17. Corps Policy CCPM 23.8 INSTR 6 states: –Section E.4: Requirements for Disability Retirement or Separation with Benefits (Disposition of Cases) “An officer found unfit because of a permanent disability cannot ordinarily be retained on active duty even though further hospitalization may be required. The officer will normally be separated, placed on the temporary disability retired list (TDRL), or permanently retired. “However, with the consent of the officer and the officer's program of assignment, ASH may defer the disposition of the case if the officer can still serve with appropriate assignment limitations and his/her disability is basically stable or only slowly progressive and does not require extensive medical care or jeopardize the officer's health. In no case will an officer who is physically disabled be retained on active duty solely to increase benefits.” Retirement Scenario

18. CCPM 23.8 INSTR 6: –Disability Retirement Policy CCPM 23.8 INSTR 7: –Appeal Policy of Medical Review Board CCPM Pamphlet No. 47: –Disability Evaluation Manual for the Commissioned Corps of the U.S. Public Health Service Fitness For Duty Policy

19. Officer is unable to perform the duties of his/her grade, category, or office because of one or more physical or mental conditions Officer must be decided as unfit-for-duty by Medical Review Board Having a medical condition which could, under certain circumstances, render the individual unfit does not, per se, make him/her unfit. Disability Retirement or Separation

20. Officer Requests His/Her Own FFD Eval. –Having an untreatable terminal illness Duty Station Requests (Program Official’s Initiative) –Decline in performance of assigned tasks Initiated by PHS Headquarters (DCCPR and Medical Affairs) –Example: 90 - more consecutive sick leave days –Example: Written recommendation by Officer’s Healthcare Providers Fitness For Duty Requests

21. Officer’s inability at some later date to meet physical standards Inability to physically qualify for specialized duties requiring a high degree of physical fitness. Inability to physically qualify for transfer to another uniformed service or another component or program within PHS. The Director, DCCPR, in consultation with the Chief, Medical Affairs, ACMB, will make the final determination about the merits of a fitness for duty request. Inappropriate FFD Requests

22. Pending voluntary or involuntary separation or retirement –When an officer is being processed for separation or retirement for reasons other than he/she is scheduled for separation for other purposes creates a presumption that the officer is fit for duty. –The officer shall not be referred for disability evaluation unless his/her physical condition raises substantial doubt that he/she is fit to continue to perform the duties of his/her office and grade or he/she was previously retained on active duty as an exception to policy. Inappropriate FFD Requests

23. QUESTIONS