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A physical or psychological condition that interferes significantly with an individual’s fitness for duty is grounds for discharge. Each Service’s disability evaluation system will determine if a servicemember is unfit for duty due to physical disability. Smaller medical problems may lead to an involuntary discharge such as Other Designated Physical And Mental Conditions.
Processing for a disability discharge must be initiated by a military doctor who, after an initial medical evaluation, can begin processing the member for consideration by the disability evaluation system. The disability evaluation system is composed of a series of medical boards. With conditions such as missing limbs or blindness, a member is obviously unfit for duty due to physical disability and a military doctor usually initiates the necessary procedures. However, not everyone who qualifies for a medical discharge has such obvious medical problems and a servicemember must sometimes take action to initiate the process.
A condition, or series of conditions, may lead to a determination of unfitness due to physical disability if it reduces or prevents an individual’s actual or presumed ability to perform military duties. Criteria for determining a member’s ability to perform his or her duties include:
- Whether the condition represents a decided medical risk to the health of the member or to the welfare of other members….
- Whether the medical condition imposes unreasonable requirements on the military to maintain or protect the member….
- What established duties the member must perform during any remaining period of reserve obligation.
Although military regulations list various physical defects which normally make a person unfit for military duty, [a]ny condition that appears to significantly interfere with performance of duties appropriate to a servicemember’s office, grade, rank, or rating will be considered for referral to the disability evaluation system.
A servicemember is ineligible for physical disability evaluation when the member’s condition is a developmental or constitutional disorder not constituting a physical disability. A servicemember is also ineligible for physical disability evaluation when the member is:
- pending an approved, unsuspended, punitive discharge or dismissal;
- pending separation under provisions that authorize a characterization of service of Under Other Than Honorable.
However, [w]hen the medical impairment or extenuating circumstances may be the cause of the conduct that lead to the above discharges, members should normally be referred to the disability evaluation system.
Documentation for a Disability Discharge
In cases of acute, grave illness or injury, the medical evaluation may stand alone, particularly if medical evidence establishes that continued service would be deleterious to the servicemember’s health or is not in the best interests of the…Service.
However, when a member’s condition is a chronic impairment, evaluation of the member’s performance of duty by supervisors as indicated, for example, by letters, efficiency reports, credential reports, status of physician medical privileges, or personal testimony may provide better evidence than a clinical estimate by a physician of the servicemember’s ability to perform his or her duties. Particularly in cases of chronic illness, these documents may be expected to reflect accurately a member’s capacity to perform.
Adequate job performance may be considered evidence that a servicemember is fit for duty even though medical evidence indicates questionable physical ability. However, inadequate duty performance shall not be considered as evidence of unfitness…unless it is established that there is a cause and effect relationship….
When a disability is suspected, obtain an evaluation from a civilian doctor. The doctor must give a thorough examination and write letters or reports explaining the individual’s disability. (See Supporting Statements from Medical Professionals, below.)
The civilian doctor can use the regulations as a guide for knowing what information to emphasize. Keep in mind that a person may be physically disabled by a condition, or a series of minor conditions, which, while not specifically listed in the regulations, may prevent the member from performing his or her duties. The doctor may want to send for copies of medical records from the family physician, parents, or school because the military will want to know when the condition arose or became worse. Include all lab test results and x-ray findings in the doctor’s report.
If the situation warrants it, the doctor can contact the head of the medical facility and ask to consult with an appropriate specialist. If special tests or hospitalization for treatment or observation is called for, the doctor can suggest them.
Approaching the Command
Even if a person believes he or she is eligible for a disability discharge, the member cannot officially apply. The servicemember’s commanding officer or a medical officer must recommend medical evaluation. Therefore, members should explain the disability to the military doctor or their commanding officer and present doctor’s letters and any other documentation verifying the ailment. This may require some persistence, including repeated visits to medical and military officials if necessary.
If a military doctor feels that further medical evaluation is warranted, the doctor will recommend the case for review by a Medical Evaluation Board. Medical Evaluation Boards are convened by officers in charge of many medical treatment facilities and, in the Navy, may also be convened by commanding officers.
Why Is An Evaluation Needed?
Military personnel may need medical documentation to show the existence of a condition requiring discharge, the severity of the condition of a dependent, or mitigating circumstances for an unexcused absence. Although the military has its own health care system, individual and specialized attention is difficult to find. In many cases, your evaluation may be the only way to ensure that your patient’s needs are considered.
Your evaluation will be used to provide evidence of your patient’s medical or psychiatric condition. However, your evaluation will not be protected by patient/doctor privilege once it has been submitted. Anything you say may be used as evidence against the patient. For example, discussion of illegal drug use or homosexual acts (even before enlistment) could result in criminal prosecution for your client.
Nobody expects you to spend time on legal technicalities. Instead, a knowledgeable counselor or attorney should always review your letter. Submit your evaluation directly to the attorney or counselor, when possible.
It is perfectly legal to medically evaluate a member of the military – even when the member is absent without leave (AWOL). In fact, medical evaluation is a proper step toward return to military jurisdiction. The risk of being pulled away from your practice for hearings or trials is virtually nonexistent.
Contents of the Evaluation
- Opening. Use your letterhead and address the letter To Whom It May Concern, or To the Commanding Officer of ____. Mark your letter Confidential. (Remember, however, this will not stop the military from using your evaluation as evidence against the patient.)
- Military Experience. If you have had military experience, please cite it.
- History. If you have been treating the patient for some time, say so: your letter will be given more weight.
- Test Results. Military personnel favor numbers and pictures. Whenever possible, clinical impressions should be corroborated with objective findings.
- Diagnosis. Try to use the exact words of the military medical regulation (Department of Defense Directive 1332.38 Physical Disability Evaluation, Enclosure 4); for a copy, visit the disability page. The regulation sometimes uses antiquated language, and the military has been known to refuse to recognize a newer name for the same phenomenon. For psychiatric diagnoses, consult the DSM-IV.
- Prescriptions. Emphasize any prescriptions which may be difficult to fill under military conditions, such as special clothing, special diet, or limits on activity.
- Prognoses and Conclusion. Consider providing two prognoses: one if the prescription is followed, and the other if it is not. For example, If the patient scrupulously adheres to a bland diet she may experience few gastrointestinal difficulties. But if the restricted diet cannot be adhered to, acute and painful episodes will continue, probably requiring surgical intervention.
Stress Military Needs Not Patient Welfare
The military wants to know whether the patient can perform their duties without causing trouble, embarrassment, or expense. His or her welfare is distinctly less important. Emphasize the impact of your patient’s condition on job performance. If, however, the patient’s problem may result in death, suicide, or serious disability, stress this fact.
Military authorities do not like civilians to tell them what to do. They often believe that civilians don’t understand military needs. Therefore, it is unwise to offer an opinion of the patient’s ability to adjust to military service.
It is also unwise to directly express criticisms of the military. Instead, offer your opinion of the patient’s ability to adjust to specific factors which may be present in military service. If the patient requires a special adjustment you suspect the military could not provide, state the requirement. The exception to this rule is if you have previous military medical experience. In this case, cite your experience.
Some poor examples of medical evaluations are:
- This person should be discharged.
- This person will not be able to adjust to military life.
Excellent examples of evaluations include:
- This person should not be required to live or work in close quarters.
- This person should only be required to walk moderate distances.
Avoid Documenting Incriminating Evidence
Criminal behavior, drug use and homosexual conduct should not be mentioned without consulting the servicemember’s civilian counselor or attorney first. Remember, your evaluation will not be kept confidential and may be used against the patient.
A servicemember may want a letter stating that they are homosexual to help establish grounds for discharge. Military authorities often like to rely on medical opinions about a person’s homosexual identification. Focus your evaluation on your patient’s sexual desires, interests and feelings. Do not discuss a patient’s sexual acts. Consult with the patient’s counselor or lawyer.
For psychological cases, consult the regulations when possible, and stress the basic question of the patient’s continued ability to serve. Pay special attention to cases with several applicable diagnoses. A diagnosis of personality disorder and neurosis often results in (Honorable) discharge. A diagnosis of adjustment disorder, however, may be considered a disciplinary, nonmedical problem (and will seldom result in treatment or separation from the military), while a diagnosis of psychosis may result in compelled hospitalization or employment problems later.