Care Under Fire — Limited to gear of medic and soldier. Focus is on assessment and stopping major bleeding. Tactical Field Care — Outside of fire decide to triage or evacuate.
Tactical Evacuation Care — During evacuation by vehicle, further medical devices, measurements, and access to medical staff are possible. Casualties are also advised to continue fighting as needed and able through field treatment. Flight duration: 45 minutes Land Journey Length: 3 days. In the Army, unlike the other services, disability proceedings often begin with a referral by the commanding officer, specifically asking that a medical evaluation be conducted AR , Section II, Initiation of Medical Evaluation, paragraph The other services are less concerned about referrals by commands.
Informally, treating physicians, particularly specialists, often initiate the process for medical evaluation boards MEBs. Thus, if doctors fail to act on their own, counsel in Army cases may wish to address a letter to the command, providing documentation of the condition and requesting medical discharge. In other services, this request is better addressed to the treating doctor, the head of the treating facility, or medical headquarters.
Unfortunately, many commands, soldiers and even Army doctors tend to assume that commands have greater authority than the regulations allow, and civilian advocates may need to remind both commands and doctors of the requirements of the regulations.
Members with medical problems have little or no access to legal help through the military in the early stages of their cases. Military counsel is not normally available to soldiers who are having problems gaining access to doctors, feel they have been badly treated in the medical system, or believe that medical evaluation boards should have been prepared long ago.
Under the IDES system, members should be able to consult with military attorneys when MEB proceedings have been initiated or are contemplated. Military counselors or attorneys can play an essential role in the early stages of cases. Members are generally not familiar with the medical standards governing discharge, and may be misled by over-worked corpsmen, medics or doctors, as well as unsympathetic commands.
Few have any idea of the criteria which might make the difference between a medical discharge without disability benefits for a pre-existing condition or medical retirement with disability benefits. In many areas, non-physicians serve as gatekeepers; they and medical officers serving in the field may be the most likely to under-diagnose medical and psychiatric problems that should warrant referral to a specialist or even emergency treatment. Advocates can help members move through this sometimes unfriendly system by bringing pressure on commands, medical treatment facilities or medical headquarters, or by enlisting the assistance of civilian physicians to document problems and urge evaluation and treatment.
The right to medical evaluation and care is not discussed much in military regulations, though it is assumed to be a basic right. Some help can be found in DoD Instruction The Instruction also describes complaint procedures available to patients. With problems that are difficult to measure, including some psychiatric conditions and physical conditions which manifest in such elusive symptoms as back pain or headaches, civilian documentation and pressure from an advocate may be important in ensuring that problems are taken seriously.
Reports from civilian doctors are particularly helpful, making it difficult for commands and military doctors to ignore the condition, and providing documentation for complaints if they do so. Part of this process involves helping soldiers or sailors to be effective patients. Many servicemembers downplay medical problems to avoid ridicule or harassment. They should receive an explanation of the value of full reporting of problems and of repeated visits to sick call or their individual doctors whenever symptoms arise.
Most counselors and attorneys encourage their clients not to present as members wanting their rights or wanting discharge, but rather as patients wanting help with problems. Members also need to be warned that military medical records are not confidential, and that information they provide to military doctors or mental health professionals can be repeated to their commands. If access to physicians is denied, sometimes informal appeal to the commanding officer by members or their advocates will make access easier.
Formal letters from counsel requesting medical evaluation sometimes provide the necessary impetus. Parallel letters and complaints can be made to the commander of the military treatment facility involved and to the surgeon general of the service. Some counselors and attorneys have found ombudsmen and patient advocates at military medical facilities to be helpful, as well. The regulations offer little guidance on time frames for medical evaluation and treatment.
When cases stall, and referrals to MEBs are not forthcoming, counselors or attorneys may need to recommend a reasonable time and demand that the service justify any delay beyond that point. The issue of how long the service can take before responding to certain requests should be judged under a reasonableness standard. Where members have given the military the opportunity to grant the relief requested or to rectify any unwarranted denial of a request for relief, and have submitted appeals to the secretary of the service, administrative remedies have been exhausted for purposes of federal court intervention.
The military should not be able to avoid the consequences of unreasonable delays by transferring members to a war zone and away from the assistance of their attorneys. When in-service remedies have been exhausted, attorneys may go into federal district court to challenge any denial deemed arbitrary and capricious or without basis in fact. GIs may prevail on a writ of habeas corpus or writ of mandamus in such a forum if they have provided a prima facie case warranting medical discharge or retirement, and the military has failed to disprove the existence of the medical condition identified in the prima facie case.
Previously, the VA performed its own medical evaluations after veterans were discharged and then assigned a VA disability rating and processed the VA disability benefits. The integration of the military and veterans disability evaluation systems was meant to streamline the medical evaluation process and reduce the amount of time between discharge from the service and commencement of VA benefits.
There are many factors affecting the length of time needed to get through the entire IDES process including, but not limited to, lack of adequate staffing, training of personnel on the new system, the number of medical conditions of the servicemember, and an increase in the number of servicemembers in the system. Servicemembers should expect the process to take nearly one year and possibly longer.
It should be noted that military disability ratings and VA ratings may differ because there are some conditions the VA considers and rates as disabilities that the military does not consider unfitting. These differences are described in DoD Instruction One example is the physical appearance of scarring or other disfigurement that does not interfere with functioning. The Integrated Disability Evaluation System and the process for medical discharge and retirement are governed by statute.
Be aware that these regulations may or may not already be updated for changes resulting from the implementation of IDES through DTM There are variations between services, so it is important to work with individual service regulations as well as the DoD Instructions and Directive.
In addition, there is a significant body of case law on the disability system and the rights of those considered for medical discharge or retirement; unfortunately, almost all of the cases, like the regulations, deal with individuals who have already entered the system through a medical evaluation board.
This graphic was created by IDES program administrators and includes the target number of days for each step in the process. The dark hexagons identify points in the process where servicemembers may rebut or appeal decisions. Source — DTM, Attachment 9. These include:. MEBs do not formally convene, and they offer members no formal opportunity to testify or present evidence.
The regulations set out detailed requirements for MEB reports, including types of testing required for some specific medical conditions.
The reports include diagnoses, origin and history of the conditions and descriptions of treatment. The reports state whether the conditions are cause for referral into the physical evaluation board PEB , but should not offer opinions on whether or not members are medically fit or unfit for duty.
These boards do not make recommendations for discharge or retirement, or suggest any percentage of disability. Any MEB listing a psychiatric diagnosis must contain a thorough psychiatric evaluation and include the signature of at least one psychiatrist or psychologist with a doctorate degree in psychology. DTM, Appendix 5 to Attachment 4, page DTM, Attachment 10, page This is the only formal role commands have in the process once the disability proceedings have been initiated.
This makes it essential that servicemembers communicate symptoms and their impact on duties to the command while seeking medical attention.
If servicemembers do not let their medical personnel know about symptoms, a condition may be overlooked. The down side is that, the more symptoms servicemembers present, the more medical evaluation needs to be performed and the longer the process takes. Many servicemembers are reticent to say anything that might make the process take longer. It is difficult to come back to the VA later and report symptoms that are not already in the record and claim the symptoms as service connected.
Servicemembers may also fear that signing the VA and DD forms referenced in the above paragraph may be used against them because they include information about the origin, incurrence or aggravation of their disease or injury, which in some cases may reveal conduct in violation of regulations. However, Title 10, Chapter 61, Section of the US Code prohibits the use of such information against the best interests of the servicemember. DTM, Appendix 1 to Attachment 4, page.
Note, though that information contained in unsigned medical records is sometimes used in administrative and disciplinary proceedings. Another opportunity to get symptoms into the record occurs during the physical exam for discharge. If a condition found in a discharge examination is serious enough, the examiner may refer the servicemembers back to the MEB.
This is another area where it is not possible to know what will happen until servicemembers are there. The safest counseling approach is to make sure servicemembers understand it is in their interest to bring all symptoms to the attention of the medical examiner during the IDES process if not earlier.
DoDI In some cases, as when there is concern about misconduct or willful negligence, these may be formal investigations, not simply prepared by commands, but by appointed investigating officers, frequently military attorneys.
Command members may be interviewed as part of formal investigations, and command attitudes may thus affect a basic determinant of eligibility for benefits. However, it is always wisest to have attorneys or counselors review the reports and discuss them with clients before deciding on the value of a rebuttal.
Even small errors regarding symptoms, severity, origin or effect on duties may affect the outcome. If rebuttal is appropriate, it offers an opportunity to provide additional documentation of the medical condition discussed in the report, or other medical conditions omitted from the report. Service members should be counseled to be prepared for pressure from the PEBLO to waive their right to a rebuttal so that they have an appropriate response ready. Servicemembers or their representatives have only 5 days to submit the MEB rebuttal and request an impartial medical review.
Extensions of time may be granted when good cause is shown. If you had a pre-existing injury, and an accident while you were on leave or away from the base made it worse, you can seek compensation for the worsening of your condition. But you will not be compensated if the pre-existing injury got worse of its own accord and not due to your accident. A medical opinion from a doctor will often be needed to prove that the accident made your condition worse than it would have been had it had just continued progressing naturally.
You are eligible for disability compensation even if it took years for an injury to manifest more severely, as long as you can prove the injury resulted from the original accident. Perhaps you were young when the accident occurred, and the symptoms didn't begin bothering you until quite some time after your discharge from service.
You are still eligible for veterans disability benefits. If you have an accident while on leave or at any time during your military service, seek medical attention. Do this even if your injuries seem minor. This will create a paper trail that will make it easier later on to show a future disability stemmed from your accident.
Even if you don't think you have been badly hurt in your accident, obtain all the records you can while you are still in service. This will help you later on if your injuries worsen and you, or your family, want to seek compensation from the VA. Read more about obtaining helpful records while still in the military. For more information, see our article on applying for VA disability benefits. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site.
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