1. DoD-DVA Disability Evaluation System (DES) Pilot & Army Application and Overview
COL Joyce Hamel, Judge Advocate, USAR
Staff Judge Advocate (DIMA)
Uniform Services University of Health Sciences
* * *
Chief, Office of Soldiers’ Counsel & Legal Assistance
Office of the Center Judge Advocate
Walter Reed Army Medical

2. References Title 10 U.S.C., Chapter 61
National Defense Authorization Act for FY 08 & FY 09
Directive-Type Memorandum (DTM) for the Disability
Evaluation System (DES) Pilot Program, signed 21 NOV 07
- DoD Action Memo for DES Expansion dated 25 SEPT 08
DoD Policy & Procedural Update for DES Pilot Program
dated 11 DEC 08
DoDI AR

3. DES Reform Chronology
April 2006 – GAO Report on the Disability Evaluation System
Fall 2006 – BPR on DES (facilitated by P&R IM/BAH)
December 2006 – Disability Advisory Council (DAC) charter update
February 2007 – Washington Post headlines
March 2007 – Senior Oversight Committee chartered and Lines of Action initiated
May 2007 – Published P&R DES Report and Directive Type Memorandum (DTM) on DAC, reporting & timeliness
August 2007 – Devised and tested alternative DES processes in joint DoD-VA Table Top exercise
November 2007 – Published DES Pilot DTM and initiated Pilot in National Capital Region
December 2007 – Published DES DTM on deployability standards
March 2008 – Published initial DES Pilot report to Congress and first DTM on 2008 National Defense Authorization Act (NDAA)
September 2008 – Published Disability Advisory Council Charter update
October 2008 – Published second DTM on 2008 NDAA, expanded Pilot
November 2008 – Published interim DES Pilot report to Congress, expanded Pilot
As an historical overview, one thing to recall from this slide is that the Departments were already engaged in evaluating and improving the DES process prior to the series of articles published in February 2007.
As the Pilot has grown (in participants and locations), the Departments have updated the procedural guides in place to regulate the process to take better advantage of observations and needs identified by participants, providers, and stakeholders. Throughout, the Departments have sought to ensure that senior oversight (DAC, SOC) input is current and reflected in the day-to-day procedures of the Pilot.
Additionally, as outlined on the next slide, the Departments have formally reported to Congress on two occasions, providing an analysis and status of the overall practicality, impact, and effectiveness of the DES Pilot.

4. DES Pilot Justification
The following reviews all recommended a single medical examination:
The Dole-Shalala Commission
SECDEF’s Independent Review Group (IRG)
VA Secretary’s Global War on Terrorism Returning Heroes Task Force
Veterans’ Disability Commission
UNCLASSIFIED/FOUO

5. DES Pilot Justification
With the exception of Dole-Shalala, all groups recommended that the DVA shall assign disability percentages
Dole-Shalala recommended that all unfit Service Members receive DoD annuity payments, the dollar value of which would be based solely on rank and length of service.
UNCLASSIFIED/FOUO

6. DES Pilot Vision / Goals
VISION: A seamless and transparent DES, administered jointly by DoD & VA
GOALS:
Less complex and adversarial
Faster, more consistent evaluations & compensation
Single medical exam & single-source disability rating
Seamless transition to Veteran status
A continuum of care - advocacy & expectation management
The Washington Post stories on conditions at Walter Reed Army Medical Center accelerated DoD’s efforts to reform the system by which wounded, ill, or injured service members are evaluated for disabilities and returned to duty or separated, compensated, and passed to the care of the VA. In response to the Washington Post series and informed by the various Congressional, Presidential, and Departmental commissions and study groups, the DoD and VA formed a senior oversight committee chaired by the Department Deputies with targeted subordinate lines of action to address the findings and recommendations of their own internal studies as well as the other major commissions, including those chaired by Senator Dole and Secretary Shalala and General Scott.
The SOC and Line of Action dedicated to improving the Departments’ disability systems set the vision and goals you see here. The key elements of the vision are that the new process must be joint and seamless to prevent service members and new veterans from falling through the cracks as they transit the DoD system and transition to the care of the VA. The Departments set these goals based on the commission recommendations.
A business process reengineering effort in summer, 2007, led DoD and VA to begin Piloting an integrated disability process in November, 2007 that implemented the recommendations of the commissions as closely as possible within current law. As you know, later that year, the Congress, through the 2008 NDAA, authorized the Departments to execute a joint Pilot program. The major element of the commission recommendations the current Pilot does not implement is the recommendation of the Dole-Shalala commission to divide the process so the DoD determines the fitness of the service member to serve and the VA executes all responsibilities for disability evaluation and compensation. The Departments support that recommendation and the VA is leading an legislative initiative to implement that recommendation.

7. DES Pilot Concept
One Integrated & Comprehensive Medical Evaluation Report
Must Meet DoD & DVA Requirements for Adjudication
Military Departments Retain Authority to Determine Service Member’s Fitness for Duty & Compensability
Single-Sourced Rating Determination from the DVA
DoD Adopts Rating for those Conditions Determined “Unfitting”
UNCLASSIFIED/FOUO

8. Joint DoD/DVA DES Pilot
Initially only a NCR pilot program starting with the MEB process on or after 26 NOV 07:
Walter Reed Army Medical Center (WRAMC)
NMC Bethesda &
Malcolm Grow Medical Center at Andrews AFB

9. Expansion Schedule
The Departments approved the expansion schedule and sites shown here, subject to their operational readiness. The expansion sites include small, large, and remote installations. Training at each site includes education on both the current DES and the DES Pilot. Training is conducted by each Service, augmented by the DES Pilot Support Team. The training session provides policy guidance as well as a hands on tutorial on the DES Pilot database to ensure consistent reporting of case processing data. Training for Camp Pendleton was conducted in conjunction with the standup of NMC San Diego in November.
Training at February 2009 IOC sites is as follows:
Vance AFB, January 14 & 15
NMC Bremerton, February 10 & 11
Fort Polk, February 17 & 18
The presence of a previously operating Benefits Delivery at Discharge program at all but one of these sites mean that the VA has prepositioned resources it can apply to the DES Pilot. Many of these VA employees are already hosted at the military treatment facility, know the DoD personnel involved, and have established IT connections back to the VA. These things make the transition to the DES Pilot much easier.
The Navy requested the expansion to Jacksonville be delayed to allow hospital construction project to wrap up before launching the Pilot. We anticipate approving their request.

10. DES Pilot Process
The bar at the top of the graphic depicts the current DES process wherein an individual must complete the entire DoD DES process prior to engaging with the VA. Typical durations are shown, with complex or disputed cases taking even longer.
The lower portion of the graphic presents the DES Pilot process. This process combines the VA and DoD processes, eliminating the duplicate disability examinations and ratings. One of the primary improvements of the Pilot process is that Service member interaction with the VA immediately follows their referral into the DES. Once a DoD physician refers a service member in the disability system of the respective military service, DoD and VA case workers counsel the service member and the VA takes their disability claim and schedules them for the VA general medical exam and any specialty exams required by the service member’s referred and claimed conditions. A board of DoD physicians evaluates the results of the exam and determines whether to return the service member to duty or send the case on to a Physical Evaluation Board. If the informal board, which consists of a review of the case files by a DoD board, finds the service member unfit, VA disability experts rate the severity of the disabilities and the member receives the results before they decide whether to request a formal board that affords them legal representation, personal appearance before the board and the ability to present evidence on their behalf. The service member has the right to appeal the results of the formal board and to ask that the VA reconsider the ratings they determined for unfitting conditions.
Reservists are provided more time in the Medical Evaluation Board phase because (typically) it can take much longer to consolidate the entire medical record, particularly if periods of treatment were provided at civilian facilities.
The Reserve Component timeline ends with transition because a reservist is considered a veteran (and is eligible for benefits) at the point of separation.
The Active Component timeline continues, accounting for the period of time necessary for the VA to receive proof of veteran status (DD Form 214) and initiate delivery of compensation and benefits. In each case, the expected duration is much shorter than the current DES process.
After all appeals, if the Military Secretary concerned determines the member is not fit for continued service, they direct their personnel apparatus to discharge the service member. During this transition to veteran status, the VA and DoD case workers continue to interact with an support the service member. And, because they have been engaged from the beginning of the process, the VA is prepared to provide the new veteran disability compensation one month after discharge, which is the earliest point allowed by law.

11. Currently Enrolled in Pilot
DES Pilot Enrollment
DEPARTMENT
PILOT
NCR FY07
DES FY2007
COMMENT
Army
811
(51%)
450
(39%)
10,400
(52%)
Navy
555
(35%)
519
(45%)
4,931
(25%)
Air Force
210
(14%)
184
(16%)
4,591
(23%)
Overall
1,576
1,153
19,922
Completed
- 301
Includes members returned to duty, separated from military service with or w/o benefits, and those placed on the TDRL/PDRL and issued their VA benefits letter
Removed from the Pilot
- 59
Includes members removed for miscellaneous reasons (e.g. departed the NCR, administratively discharged)
Currently Enrolled in Pilot
1,216
In this slide we compare service member enrollment in the Pilot with enrollment in the National Capital Region and in the entire DES in 2007 before the Pilot started. It shows that enrollment is reasonably representative of the NCR but also that NCR cases are a small portion (about 5%) of all the cases that transit the DES in a year.
Completed (206) indicates those individuals who have finished the DES process and (if applicable) have received their VA benefits letter:
89 were returned to duty
117 separated or were retired
Removed from Pilot (45):
Transferred outside the National Capital Region – 15
Involuntary non-disability separation – 11
Voluntary non-disability separation/retirement – 5
Medical (pregnancy, additional recovery required) – 10
MEB Terminated at direction of referring physician – 1
Terminated by PEB – 1
Best Interest of the Service member – 1
SM passed away – 1
As of March 15, 2009

12. DES Pilot Enrollment as of April 19, 2009
Thru 19 APR 09.
Eighty Service members (43 at expansion sites) entered the DES Pilot from fourteen Military Treatment Facilities (MTFs) during the reporting week. A total of 1,929 Service members, 762 at expansion sites, have been enrolled since November 26, Of those, 344 Service members (3 at expansion sites) completed the DES Pilot via returning to duty, separation, or retirement and 70 Service members (1 at an expansion site) were removed from the DES Pilot for other reasons (additional medical treatment needed, case terminated pending administrative discharge processing, etc.). One thousand five-hundred fifteen Service members remain enrolled in the DES Pilot.
Active Component Service members who completed the DES Pilot averaged 271 days from Pilot entry to VA benefits decision, excluding pre-separation leave. Including pre-separation leave, Active Component Service members completed the DES Pilot in an average 286 days. This is 47 percent faster than the current DES and VA Claim process, and 3 percent faster than the 295 day projection for the Pilot. Reserve Component / National Guard Service members who completed the DES Pilot averaged 249 days from Pilot entry to issuance of the VA Benefits Letter, which is 18 percent faster than the projected 305 day timeline.
UNCLASSIFIED/FOUO

13. DES Pilot Process: MEB
The MTF determines and directs if the SM requires an MEB (Permanent P3 & Maximum Medical Benefit)
The MEB will determine what conditions fall below retention standards according to the Service’s regulations
Soldiers are encouraged to consult with Solders Counsel upon entry and at any point during the DES Pilot process
UNCLASSIFIED/FOUO

14. DES Pilot Process: MEB
A PEBLO coordinates the DoD action on the case and the MSC (Military Services Coordinator) coordinates the VA action on the case
Both the PEBLO and MSC complete the Joint DES Pilot Claim Form (VA Form ) with the Service Member highlighting all of his/her conditions
Provide a Form sample
UNCLASSIFIED/FOUO

15. DES Pilot Process: MEB
In coordination with the MSC and PEBLO, the Service Member attends all required general and specialty medical examinations conducted by the VA
The examinations will be performed to dual specifications:
DoD specifications to determine fitness
VA specifications to determine appropriate disability rating
UNCLASSIFIED/FOUO

16. DES Pilot Process: MEB
MTF Physician reviews the DVA exams for adequacy and dictates a NARSUM (“Narrative Summary”)
A Medical Evaluation Board is then convened at the MTF to determine:
If Service Member meets retention standards: SM is returned to duty
If SM fails to meet retention standards: case forwarded to the PEB for fitness determination
UNCLASSIFIED/FOUO

17. DES Pilot Process: MEB PEBLO informs the SM of the MEB’s determination
SM has 7 working days to file an election, indicating agreement or disagreement
Written rebuttals with non-concurrences are not mandatory
Soldiers Counsel can assist Soldiers with rebuttals
UNCLASSIFIED/FOUO

18. DES Pilot Process: MEB
SMs must include all medical conditions on claims form
Problematic for SMs who want to be found fit
New medical conditions claimed by SM after completion of MEB process
Only considered in Pilot if PEB re-refers case to DVA for examination
If not, pursue compensation after separation
UNCLASSIFIED/FOUO

19. DES Pilot Process: IPEB
The Military Departments use their PEBs for purposes of this Pilot
The PEB answers 4 questions for each medically unacceptable condition:
Fit or Unfit?
Military Compensability?
Combat related or incurred in a combat zone?
Stability?
UNCLASSIFIED/FOUO

20. DES Pilot Process: IPEB
Possible PEB Actions:
Return for additional evidence
Informal Decisions (“IPEB”)
Revised Informal Reconsiderations after Written Rebuttals to IPEB
Formal Hearing Decision (“FPEB”) (if SM non-concurs)
UNCLASSIFIED/FOUO

21. DES Pilot Process: IPEB
As soon as an informal PEB decision is issued, a DVA Rating Board in Baltimore, MD, or Seattle, WA, begins to rate all of the SM’s service-connected medical conditions.
Copy of case earlier forwarded to DVA Rating Board at completion of MEB
UNCLASSIFIED/FOUO

22. DES Pilot Process: IPEB
Ultimately, the Service PEB must adopt the DVA rating for military disposition for each unfitting condition unless:
EPTS
Misconduct
Non-Compliance
The PEB will note on their informal decision if military compensation will be adjusted or denied.
UNCLASSIFIED/FOUO

23. DES Pilot Process: IPEB
3 options upon receipt of their Informal PEB Decision (10 day election period)
Concur;
Do not concur and request a formal PEB hearing; or
Delay their election until receipt of the VA rating results (this prevents gaming the system and unnecessary PEB appeals)
UNCLASSIFIED/FOUO

24. DES Pilot Process: IPEB
If the SM opted to receive the DVA results prior to election, 3 options upon receipt of DVA Rating (10 day election period):
Concur with both IPEB & DVA Rating;
Do not concur with IPEB and request an FPEB hearing; or
Concur with IPEB and request DVA rating reconsideration
UNCLASSIFIED/FOUO

25. DES Pilot Process: FPEB
The PEB will hold a de novo formal hearing answering the 4 core questions:
Fit or Unfit?
Military Compensability?
Combat related or incurred in a combat zone?
Stability?
SMs are afforded right to appointed Counsel at FPEBs
UNCLASSIFIED/FOUO

26. DES Pilot Process: FPEB
After formal proceedings, the FPEB releases their final determinations together with the VA Rating Board’s determination
The PDA serves in an administrative role in the Pilot
No PDA review of PEB decisions
UNCLASSIFIED/FOUO

27. DES Pilot Process: FPEB
Open question: Review under NDAA 08 by DoD Physical Disability Board of Review (PDBR) for Warriors separated with
0-20% ratings
Under the Pilot, unfit Soldiers can still submit requests for Continuation on Active Duty (COAD) or Continuation on Active Reserves (COAR) if eligible:
Combat-related injuries; 15 or more years; or critical/shortage MOS
UNCLASSIFIED/FOUO

28. DES Pilot Process: VA Rating
SMs have 10 days to request a one-time reconsideration of their VA disability rating that will be used to determine military disposition prior to separation/retirement
Right to appointed Counsel
Paper review: no in-person hearing before DVA Rating Board
UNCLASSIFIED/FOUO

29. DES Pilot Process: VA Rating
DVA Rating Board will only reevaluate ratings if:
New medical evidence is received; or
VA mistake/error to warrant reconsideration
Subsequent appeals only after separation and attainment of veteran status
UNCLASSIFIED/FOUO

30. DES Pilot Process: DVA Rating
If the PEB denies or reduces compensability due (EPTS, Misconduct or Non-Compliance), the DVA can still fully compensate the Service Member for that condition for DVA purposes.
The PEB is only determining compensability according to their own rules that affect military disposition.
The PEB is not dictating DVA compensability.

31. DES Pilot Process: DVA Rating
Under the DES Pilot’s Directive Type Memorandum, Judge Advocates and DoD civilian attorneys can assist Service Members with requests for rating reconsiderations with the DVA for all conditions, both fitting and unfitting, while the Service Member is on active duty.

32. Post-Separation Appeals Process
After separation, veterans have one year to file Notice of Disagreement (NOD) with a DVA regional office.
The BCMRs can use this post-separation appeal to warrant a change in military disposition from separation to disability retirement.
UNCLASSIFIED/FOUO

33. Due Process Concerns Right to an In-Person Hearing
Legacy System: Fitness and Rating
DES Pilot: Fitness only
UNCLASSIFIED/FOUO

34. Due Process Concerns
Essential to have a right to an in-person hearing with DVA rating determinations
Impacts military disposition (severance vs. retirement)
Majority of legacy cases did not contest unfit determinations, rather only contested ratings
UNCLASSIFIED/FOUO

35. Questions?
(202) 35

36. Co-located at 18 Brigade & Battalion Sized WTUs
Bonus Slides
Co-located at 18 Brigade & Battalion Sized WTUs
(Alignment w/ OSC)
Walter Reed AMC (WRAMC)
Ft. Drum (WRAMC)
Ft. Polk (Ft. Sam)
Ft. Bragg (WRAMC)
Tripler AMC (Ft. Lewis)
Ft. Sam Houston (Ft. Sam)
Ft. Gordon (Ft. Sam)
Ft. Hood (Ft. Sam)
Ft. Benning (Ft. Sam)
Ft. Bliss (Ft. Lewis)
Ft. Stewart (Ft. Sam)
Ft. Lewis (Ft. Lewis)
Ft. Riley (Ft. Lewis)
Heidelberg (WRAMC)
Ft. Campbell (Ft. Sam)
Ft. Richardson (Ft. Lewis)
Ft. Knox (Ft. Lewis)

37. Legend MEB Other Similar to old process New process Based on:
•Medical evidence/ Occupational Medicine review
•DoD Instruction Guidance
•Military Department Regulations
War Injuries/ Conditions
Member is treated or being treated for a medically limiting injury or condition
Has member reached a point where it is unlikely they will meet medical retention standards?
Refer for Disability Evaluation/ Transition Exam
Yes
Does the member meet medical retention standard? No
Other No
Yes
Continue Medical Treatment
Legend
Return to duty
Similar to old process
New process
MEB
Injury and Treatment
“Permanent” Limitation?
Qualified for Military Job?
Initiate Exam

38. All medical records and current diagnostic results forwarded for use by VA qualified provider
Member’s Medical Evaluation Package Completed (complete narrative summary of all potentially unfitting conditions) +
Other required documentation
Service Medical Experts perform final review, deliver final medical retention decision
Does member meet medical retention standards?
Member receives VA General Medical Exam & comprehensive evaluation of both potentially unfitting conditions & other conditions claimed by member as having been incurred in or aggravated by military service. P E B No
Yes
Results of VA Exam
Return to duty
VA Template
NARSUM& LOD
MEB
PEB
Exam

39. Review of the MEB process under the DES Pilot
UNCLASSIFIED/FOUO

40. Member can have any item or % reconsidered by VA DRO – one time only while on active duty
Veteran relationship with VA system already established.
Processing for compensation can immediately begin.
Veteran retains the right to appeal in VA.
PEB applies VA rating to unfitting conditions.
VA Rating Panel:
Receives case file from PEB & rates all qualified conditions
Is the member fit for duty? P E B
No (Unfit)
What is the applied disability rating?
30% or higher
Dispositions:
0-20% No
Placed on the Temporary Disability Retired List (TDRL)
Yes (Fit)
Disability is stable
Member may elect Formal PEB after unfitness determination
Member’s years of active duty or equivalent service
Placed on Permanent Disability Retirement
≥ 20 years
Yes
DD214
Separated with lump sum disability severance
< 20 years
Return to duty
Necessitates Formal PEB Proceedings
Various Appeal levels maintained per Military Department Regulations
PEB
Rating
Panel

41. Post-Separation Actions by VA
VA Receives DD 214/ Verification of Separation
DD214
Promulgate the Rating Decision and Issue Payment to the Veteran
Yes
Appeal Process:
Notice of Disagreement Received Within 1 Year of Rating Decision?
Statement of the Case issued
VA Form 9
Substantive Appeal Received? No No
No Further Action
Yes
No Further Action
Certify to the Board of Veterans Appeals (BVA) No
Note: Pre-discharge ratings used, concurrent process.
decreases post separation processing time
for award processing by VA.
No Further Action
Yes
Appeal Granted
Promulgate the Decision and Issue Payment to the Veteran
Refer to BCMR for adjustment of the DoD disposition under 10 USC, Chapter 61. VA
Appeals
BCMRs