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AR 635-40 Disability Evaluation for Retention, Retirement, or Separation (19 Jan 2017)

Source
AR 635-40 Disability Evaluation for Retention, Retirement, or Separation (19 Jan 2017) (626 KB)

Comments: To view or download the complete regulation, click on the link to it in the box above these comments.

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Chapter 4
Procedures
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Section III
Medical Processing Related to Disability Evaluation

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4-9. Medical examination

The MTF commander having primary medical care responsibility will conduct an examination of a Soldier referred for evaluation. The commander will advise the Soldier's commanding officer of the results of the evaluation and the proposed disposition. If it appears the Soldier is not medically qualified to perform duty, the MTF commander will refer the Soldier to a MEBD.

Comments: "MTF" is Medical Treatment Facility ."MEBD" is Medical Evaluation Board, also referred to as "MEB".

4-10. The medical evaluation board

The MEB are convened to document a Soldier's medical status and duty limitations insofar as duty is affected by the Soldier's status. A decision is made as to the Soldier's medical qualification for retention based on the criteria in AR 40-501, chapter 3. If the MEBD determines the Soldier does not meet retention standards, the board will recommend referral of the Soldier to a PEB.  For  MEB’s  rules  for  documentation,  recommendations,  and  disposition  of  the
evaluated  Soldier,  see  AR  40–400,  chapter  7.

Comments: "PEB" is Physical Evaluation Board.

...
4-12. Counseling Soldiers who have been evaluated by a medical evaluation board

a. The PEBLO will advise the Soldier of the results of the MEBD. The Soldier will be given the opportunity to read and sign the MEB proceedings. If the Soldier does not agree with any item in the medical board report or NARSUM, he or she will be advised of appeal procedures.

Comments: "PEBLO" is Physical Evaluation Board Liaison officer.  "NARSUM" is the The Narrative Summary of the Soldier's condition.

b. The decisions below are exclusively within the province of adjudicative bodies. Neither the PEBLO nor the attending medical personnel will tell the Soldier that

(1) The Soldier is medically or physically unfit for further military service.

(2) The Soldier will be discharged or retired from the Army because of physical disability.

(3) A given percentage rating appears proper.

(4) A LD decision is final (unless final approval has been obtained according to AR 600-8-4).

Comments: "LD" is Line of Duty; an "LD decision" is a decision as to whether the Soldier's condition was incurred in the Line of Duty.

4-13. Referral to a physical evaluation board

a. The MEBD will recommend referral to a PEB those Soldiers who do not meet medical retention standards. Those who apply for COAD under the provisions of chapter 6 will be included. Do not refer Soldiers to a PEB who request discharge under the provisions of chapter 5. A Soldier being processed for nondisability separation will not be referred to a PEB unless the Soldier has medical impairments that raise substantial doubt as to his or her ability to continue to perform the duties of his or her office, grade, rank, or rating. Soldiers previously found unfit and retained in limited assignment duty status under chapter 6, or a previous authority, will be referred to a PEB.

Comments: "COAD" is continuation on active duty.

b. A Soldier may provide additional information to the MTF commander to forward to the PEB. The information may be from the unit commander, supervisor, or other persons who have knowledge regarding the effect the condition has on the Soldier's ability to perform the duties of the office, grade, rank, or rating.

AR 40-501 Standards of Medical Fitness (27 June 2019)

Source
AR 40-501 Standards of Medical Fitness (27 June 2019) (753 KB)

Comments: To view or download the complete regulation, click on the link to it in the box above these comments.

Chapter 2
Physical Standards for Enlistment, Appointment, and Induction

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Chapter 3
Medical Fitness Standards for Retention and Separation, Including Retirement

Comments: This is from the Table of Contents of this 80-page document. Chapter 3 describes the conditions that may qualify a Soldier for a discharge for Disability. To see the detailed description of each condition, click on the link to the regulation in the box above these comments.

Head • 3–5

Eyes • 3–6

Vision • 3–7,

Ears • 3–8

Hearing • 3–9

Nose, sinuses, mouth, and larynx • 3–10

Dental • 3–11

Neck • 3–12

Lungs, chest wall, pleura, and mediastinum • 3–13

Heart • 3–14

Vascular system • 3–15

Abdominal organs and gastrointestinal system • 3–16

Female genital system • 3–17

Male genital system • 3–18

Urinary system • 3–19

Spine and sacroiliac joints • 3–20

Upper extremities • 3–21

Lower extremities • 3–22

Miscellaneous conditions of the extremities • 3–23

Skin and soft tissues • 3–24

Blood and blood-forming tissues • 3–25

Systemic conditions • 3–26

Exertional heat illness • 3–27

Cold injury • 3–28

Endocrine and metabolic • 3–29

Rheumatologic • 3–30

Neurological • 3–31

Sleep disorders • 3–32

Learning, psychiatric, and behavioral health • 3–33

Tumors and malignancies • 3–34

General and miscellaneous conditions and defects • 3–35

Conditions and circumstances not constituting a physical disability • 3–36

Medical examinations • 3–37

Chapter 5 Medical Fitness Standards for Miscellaneous Purposes

Comments: Chapter 5, Section 5-14 describes conditions that may disqualify a soldier for deployment. To see the detailed description of each condition, click on the link to the regulation in the box above these comments.

5–16. Medical fitness standards for certain geographical areas

a. Some Soldiers with certain medical conditions require administrative consideration when assignment to combat areas or certain geographical areas is contemplated. Such consideration of their medical conditions ensures these Soldiers are used within their functional capabilities without undue hazard to their health and well-being as well as ensures they do not produce a hazard to the health or well-being of other Soldiers.

b. Excluding Soldiers affected by paragraph 5–16a, all Soldiers considered medically qualified for continued military service and medically qualified to serve in all or certain CONUS areas are medically qualified to serve in similar or corresponding areas OCONUS in accordance with the AR 635–40 definition of deployability as the minimum standard of fitness for duty.

c. Soldiers who do not meet the medical retention standards in chapter 3 of this regulation must be referred to the DES (see AR 635–40 for fitness determination guidance). However, Soldiers returned to duty by an MAR2, PEB, or Soldiers with temporary medical conditions may still have some assignment/deployment limitations that must be considered before a decision is made to assign to certain geographical areas, such as Korea and other OCONUS areas.

d. Medical Standards for Military Assistance Advisory Groups (MAAGs), military attaches, military missions, and duty in isolated areas where adequate medical or dental care may not be available will consider the following medical conditions and defects to preclude assignments or attachment to duty with MAAGs, military attaches, military missions, or any type of duty in OCONUS isolated areas where adequate medical care is not available:

(1) A history of emotional or behavioral health disorders, including recurrent acute adjustment disorder, of such a de-gree as to have interfered significantly with adjustment or is likely to require treatment during the extent of the tour. For example, a single acute adjustment disorder that resolved with a period of stability of over a year would pose no limitations pending combatant command guidance.

(2) Any medical conditions where maintenance medication is of such toxicity as to require frequent clinical and labor-atory follow up or where the medical condition requires frequent follow up that cannot be delayed for the extent of the tour.

(3) Inherent, latent, or incipient medical or dental conditions that are likely to be aggravated by the climate or general living environment prevailing in the area where the Soldier is expected to reside, to such a degree as to preclude acceptable performance of duty.

(4) Of special consideration are Soldiers with a history of chronic cardiovascular, respiratory, or nervous system disorders that are scheduled for assignment and/or residence in an area 6,000 feet or more above sea level. While such individuals may be completely asymptomatic at the time of examination, hypoxia due to residence at high altitude may aggravate the condition and result in further progression of the disease. Examples of areas where altitude is an important consideration are La Paz, Bolivia; Quito, Ecuador; Bogota, Colombia; and Addis Ababa, Ethiopia.

(5) Medical, dental, or physical conditions or defects that might reasonably be expected to require care during a normal tour of duty in the assigned area are to be corrected prior to departure from CONUS.

AR 135-381 Incapacitation of Reserve Component Soldiers (27 December 2006)

Source
AR 135-381 Incapacitation of Reserve Component Soldiers (73.2 KB)

Comments: To view or download the complete regulation, click on the link to it in the box above these comments.

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1–5. Objective
The objective of the RC Incapacitation System is to compensate, to the extent permitted by law, members of the Reserve Components who are unable to perform military duties and/or who demonstrate a loss in civilian earned income as a result of an injury, illness, or disease incurred or aggravated in the line of duty and to provide the required medical and dental care associated with the incapacitation.

1–6. Entitlement
  
a. A member of the RC incurring or aggravating any injury, illness, or disease in the line of duty is entitled to medical and dental care, incapacitation pay, and travel and transportation incident to medical and/or dental care, in accordance with 37 USC 204 and 37 USC 206. The amount of incapacitation pay for the member will be  determined in accordance with DOD 7000.14–R, Volume 7A.
   b. Members incapacitated in the line of duty are entitled to medical and dental treatment in an MTF for the in-the-line-of-duty condition until qualified for return to military duty. If the resulting incapacitation cannot be materially improved by further hospitalization or treatment, the case will be processed and finalized through the Disability Evaluation System (DES) when eligible for disability processing. Procedures governing physical disability evaluation are provided in DODI 1332.38 and Department of Defense Directive (DODD) 1332.18.
   c. A member on a call or order to active duty specifying a period of 30 days or less who incurs or aggravates an injury, illness, or disease will not have orders terminated solely because of the injury, illness, or disease, unless requested by the member. Upon release from active duty, the member is entitled to benefits provided by this regulation.

   d. Members authorized incapacitation pay under 37 USC 204(g) will not be allowed to attend inactive duty training (IDT) periods or to acquire retirement points for drills. However, a member may earn retirement points in order to satisfy the requirements for a qualifying year of service by completing correspondence courses....

1–8. Members unable to perform military duties
   a. A member who is unable to perform military duties because of incapacitation under the circumstance described in paragraph 1–6 is entitled to full pay and allowances, including all incentive pay to which entitled, less any civilian
earned income for the same period the member receives incapacitation pay (see DOD 7000.14–R, Volume 7A for entitlements).
   b. Incapacitation pay under paragraph 1–8a is adjusted only by the amount of earned income received. The civilian income of the member other than earned income received will not be a consideration in calculating incapacitation pay
under that paragraph.
   c. For establishing fitness, an RC member will be determined to be unable to perform military duties if, under service procedures in AR 40–501 the member would be determined to be medically unfit to perform his or her military duties.
   d. A member authorized incapacitation pay under 37 USC 204(g) of reference will not be allowed to attend IDT or to acquire retirement points for performing IDT. A Soldier attending IDT and performing military duties may be evidence that they are not suffering from a disability that entitles them to incapacitation pay (tier 1 cases). This will not be used as a basis for terminating entitlement to medical treatment.
   e. Return to or acceptance of civilian employment may not terminate entitlement to medical care at Government expense.

1–9. Members able to perform military duties
Members able to perform military duties, but demonstrating a loss of earned income as a result of an in-the-line-of-duty incapacitation, will be compensated for lost earned civilian income. The compensation under this provision will be the lesser of the amount of demonstrated lost civilian income in the amount not to exceed military pay and allowances for which the member would be entitled if serving on active duty. Members will be compensated for loss of earned civilian income in accordance with 37 USC 204(h) and DOD 7000.14–R, Volume 7A, table 57–3....

1–11. Duration of incapacitation pay
  
a. Incapacitation pay will be paid only during the period a member remains unfit for military duty or demonstrates a loss of earned income as a result of the incapacitation.
   b. Payment in any particular case may not be made for more than 6 months without review of the case by appropriate headquarters as outlined in paragraph 3–6.
   c. To insure that continuation of incapacitation pay is warranted under this regulation, a review will be made every 6 months.
   d. Incapacitation pay will continue as long as the conditions warranting the incapacitation pay exist and the approving authority determines that it is in the interest of fairness and equity to continue the payment.
   e. When incapacitation lasts for over a year, the case should be processed through the DES for disability separation or retirement. Incapacitation pay will end upon retirement, separation for physical disability, or determination by military service medical personnel that the member has recovered sufficiently to perform military duties, when actually returned to military duty, whichever occurs first....

1–13. Compensation
   a. Soldiers are entitled to a portion of the same monthly pay and allowances as are provided members of the Active Army with corresponding grade, length of service, marital status, and dependent status for each period the Soldier is unable to perform military duties (tier 1 cases) or can demonstrate loss of compensation from civilian earned income (tier 2 cases). Maximum amount payable for any given period is an amount equivalent to military pay and allowances for the period in question.
   b. Soldiers will not be issued AD orders in place of incapacitation pay as a means of providing benefits to which they might otherwise not be entitled....
 

Army Pamphlet 135-381 Incapacitation of Reserve Component Soldiers Processing Procedures

Source
Army Pamphlet 135-381 Incapacitation of Reserve Component Soldiers Processing Procedures

Comments: To view or download the complete pamphlet, click on the link to it in the box above these comments.

Chapter 1 Introduction

1-1. Purpose
This pamphlet provides procedures regarding incapacitation pay and allowances for Reserve Component (RC) Soldiers.

1-2. References
Required and related publications and prescribed and referenced forms are listed in appendix A.

1-3. Explanation of abbreviations and terms
Abbreviations and special terms used in this publication are listed in the glossary.

AR 600-8-4 Line of Duty Policy, Procedures, and Investigations (15 March 2019)

Source
AR 600-8-4 Line of Duty Policy, Procedures, and Investigations (15 March 2019) (529 KB)

Comments: To view or download the complete regulation, click on the link to it in the box above these comments.

Chapter 1 Introduction

Section I

Information

1–1.Purpose

This regulation prescribes policies and procedures for investigating the circumstances of injury, illness, disease, or death of a Soldier. It provides standards and considerations used in making line of duty (LOD) determinations.

Chapter 2 Program Elements

2–2. Requirements for line of duty investigations

LOD investigations determine: duty status at the time of incident and whether misconduct was involved and, if so, to what degree. Additionally, LOD investigations may be required to determine an EPTS condition, and, if so, determine service aggravation.

a. An LOD investigation will be conducted for all Soldiers, regardless of Component if the Soldier experiences a loss of duty time for a period of more than 24 hours and—

  • (1) The injury, illness, or disease is of lasting significance (to be determined by a physician, physician assistant, or nurse practitioner) (see para 5–4b for other guidance);
  • (2) There is a likelihood that the injury, illness, or disease will result in a permanent disability;
  • (3) If an RC Soldier requires follow-on care for an injury, illness, or disease incurred during a period of active duty.

b. An injury, illness, or disease diagnosed while serving on active duty or in a duty status as outlined in AR 638–8 does not mean that the injury, illness, or disease was incurred while serving on active duty or that an EPTS condition was service aggravated. An expert medical opinion from an appropriate provider is required and must address when the condition was incurred, if the condition existed prior to the current military service and whether the condition was service aggravated (see para 4–8). If an LOD determination has been made during a period of prior military service and the same condition arises in a subsequent period of military service, the prior determination will remain unchanged unless intervening events exist.

c. Depending on the circumstances of the case, an LOD investigation may or may not be required to make this determination. Only AHRC can make a presumptive in line of duty (PILD) finding, with the exception of identifying service connection for RC Soldiers who were previous members of one compo and transfers to another compo for which clear evidence is documented in the active duty medical records….

Comment: AHRC is Army Human Resource Command.

d. In all other cases of injury, illness, disease, or death, except minor injuries that will not result in a permanent disability (for example, sprain, contusion, or minor fracture), an LOD investigation must be conducted.

  • (1) Conduct an informal LOD investigation in cases where no misconduct or gross negligence is suspected.
  • (2) Conduct a formal LOD investigation in the following circumstances:

(a) Injury, illness, disease, or death that occurs under strange or doubtful circumstances or is apparently due to misconduct or gross negligence.

(b) Injury, illness, or death involving the abuse of alcohol or other drugs.

(c) Self-inflicted injuries or suspected suicide.

(d) Injury, illness, or death incurred while AWOL.

(e) Injury or death that occurs while an individual was enroute to final acceptance in the Army.

(f) When a USAR or ARNG Soldier serving on orders for less than 30 days who becomes disabled due to injury, illness, disease, or death.

(g) When directed by higher authority (AHRC, approval authority, or appointing authority).

(h) Conditions that the MTF commander or other medical provider determine EPTS.

(i) Injury or death of a USAR or ARNG Soldier while traveling to or from authorized training or duty.

(j) Death of a USAR or ARNG Soldier while participating in authorized training or duty.

(k) Under any circumstances the commander believes should be fully investigated.

  • (3) Currently a restricted LOD is authorized by the Army for sexual assault related cases: Victims of sexual assault will receive medical care for sexually related assaults through a restricted or unrestricted LOD investigation. Only the unit sexual assault response coordinator (SARC) is authorized to process restricted LODs.

e. At no time will an LOD be initiated, regardless the circumstance(s), for a Soldier not in an authorized duty status at the time of injury, illness, disease, or death. A Soldier must be in an authorized duty status before an LOD can be initiated.

f. Any Soldier, retired or separated from Service and requesting a Line of Duty investigation be initiated and/or adjudicated, must submit a request and proper documentation to the Army Review Boards Agency.

2–3. Benefits affected by line of duty Investigation

The following are possible consequences of an LOD investigation:

a. Extension of enlistment….

b. Longevity and retirement multiplier….

c. Forfeiture of pay….

d. Disability retirement and severance pay….

e. Medical and Dental care for Soldiers on duty other than active duty….

f. Benefits administered by the Department of Veterans Affairs….

2–4. Standards applicable to line of duty determinations

a. A Soldier’s injury, illness, disease, or death is presumed to have occurred ILD unless rebutted by the evidence.

  • (1) Injury, illness, disease, or death proximately caused by the Soldier’s misconduct or gross negligence is “not in line of duty-due to own misconduct (NLD–DOM).”
  • (2) Simple negligence, alone, does not constitute misconduct and is, therefore, still considered to be ILD.

b. Standard of proof. Unless another regulation or directive, or an instruction of the appointing authority, establishes a different standard, the findings of investigations governed by this regulation must be supported by a greater weight of evidence than supports a contrary conclusion (such as, by a preponderance of the evidence). The weight of the evidence is not determined by the number of witnesses or volume of exhibits, but by considering all the evidence and evaluating factors, which as a whole shows that the fact sought to be proved is more probable than not….

2–5. Line of duty determination(s)

One of the following 8 determinations will be applied to the Soldier’s injury, illness, disease, or death….

a. In line of duty. The injury, illness, disease, or death did not occur while the Soldier was AWOL and was not due to the Soldier’s own misconduct or gross negligence. For USAR/ARNG Soldiers, the injury, illness, disease, or death occurred while the Soldier was in a duty status, as defined in AR 638–8 or direct travel status. This finding also applies in suicide cases when Soldiers are AWOL and considered mentally unsound at both the inception of AWOL and at time of death (mental soundness can only be determined by a behavioral Health expert).

b. Not in line of duty-not due to own misconduct (NLD–NDOM). A formal investigation with supporting evidence, that the injury, illness, disease, or death occurred during a period when a Soldier was AWOL, was mentally sound at the inception of AWOL, and which was not directly caused by Soldier’s own misconduct or gross negligence (mental soundness can only be determined by a behavioral Health expert). EPTS conditions typically falls under this determination.

c. Not in line of duty-due to own misconduct (NLD–DOM). A formal investigation determined that the Soldier’s injury, illness, disease, or death was proximately caused by the Soldier’s own misconduct or gross negligence. Mental soundness can only be determined by a behavioral Health expert.

d. In line of duty-existed prior to service-service aggravated (ILD–EPTS–SA). This finding is made when there is clear and unmistakable evidence the Soldier’s injury, illness, or disease existed prior to service and the condition has been service aggravated. Aggravation will be determined by an appropriate provider in accordance with DODI 1332.18. (Annotate in remarks section of DD Form 261, ILD–EPTS–SA). Mental soundness can only be determined by a behavioral Health expert.

e. Not in line of duty-EPTS-not service aggravated (NLD–EPTS–NSA). This finding is made when there is clear and unmistakable evidence the member’s injury, illness, or disease EPTS and the condition has not been service aggravated. Aggravation will be determined by an appropriate military provider in accordance with DODI 1332.18. (Annotate in remarks section of DD Form 261, NLD–EPTS–NSA). Mental soundness can only be determined by a behavioral Health expert.

f. In Line of Duty-This Episode Only (ILD-This Episode Only). This determination relates to a one-time event, where no serious injury or illness has occurred, but warranted the Soldier be attended to by a medical physician. This incident occurred while the Soldier was in an authorized duty status at the time of the episode. Treatment should be limited for this particular episode only. A Reserve Component Soldier is not authorized military treatment if episode occurs while not in an authorized duty status. A Formal LOD should be conducted to determine the cause of episode.

g. Presumptive in line of duty (PILD)-Reserved for AHRC and Reserve Component for purposes of Soldiers transferring components only. AHRC uses this determination in cases of hostile action, death of natural causes, or death of passengers in a commercial carrier or military vehicles (see para 2–2c (1–3)). Specific Reserve Component personnel (specified in the Delegation of Authority memorandum from the TAG) can use this determination in cases of Soldiers transferring between components with the proper medical documentation. (See paragraph 2–2c for eligible RC personnel and who is responsible within the RC and guidelines for issuing a PILD finding).

h. No Finding-Reserved for AHRC purposes only. Used in cases where an LOD investigation was completed but was not required in accordance with paragraph 2–2. If the RC has an LOD case and feels that a No Finding is necessary, the RC can send the case to AHRC–PDC–P, AHRC will review and grant approval/ disapproval on a case-by-case basis.

Chapter 3 The Line of Duty Investigation Process

Section I

Informal Line of Duty Investigations

3–1. General

The unit commander may, if approved by the appointing authority, elect to conduct an informal investigation so long as misconduct or gross negligence is not suspected on the part of the Soldier and a formal investigation is not required in accordance with paragraph 2–2d(2)….

3–2. Timeline

All informal line of duty investigations must be initiated within 5 calendar days of the command’s discovery of the injury, illness, disease, or death. When an informal investigation is not completed within the given time, the reasons the report is late should be included in the remarks section of DA Form 2173 (Statement of Medical Examination and Duty Status). The timeline for completing an informal investigation is no more than 60 days….

3–4. Line of duty determination

a. The final determination of an informal LOD investigation will only result in a determination of “ILD” with the exception of EPTS.

Comment: EPTS stand for existed prior to service.

b. The mere fact that the Soldier was in an “authorized status” (duty, pass, leave, and so forth) does not necessarily support a determination of ILD in and of itself. (Also see para 2–4b)….

Section II Formal Line of Duty Investigations

3–10.Timeline

All formal line of duty investigations must be initiated within 5 calendar days of the command’s discovery of the injury, illness, disease, or death. When a formal investigation is not completed within the given time, the reason(s) the report is late should be included in the remarks section on DD Form 261 (Report of Investigation Line of Duty and Misconduct Status) and as part of the investigating officer’s comments. The timeline for completing a formal investigation; to include the approving authority finding, is no more than 180 days. If evidence required to support a determination is not available within the prescribed time frame, the IO must provide the reason(s) in the 30-day investigative update to the appointing authority, CAC, GCMCA, and Commander, U.S. Army Human Resources Command (AHRC–PDC–C), 1600 Spearhead Division Avenue, Fort Knox, KY 40122–5405. If evidence required to support a determination is not available within the prescribed time frame, the IO must request in writing, a request for an extension from the appointing authority….

Chapter 4 Special Considerations and Other Matters Affecting Line of Duty Investigations

4–1. Relationship to disciplinary actions

An LOD determination is an administrative action and is not to be used for punitive/judicial action. The LOD determination does not prohibit a commander from pursuing disciplinary and/or administrative actions….

4–4. Time limitations for processing and initiating

LOD actions must be completed within the time limits given in paragraphs 3–2 and 3–10.

a. In death cases, significant benefits to the survivors are pending until unit leadership has reviewed the investigation and final action has been taken by HRC.

b. In injury, illness, or disease cases, final action by the medical evaluation board, physical evaluation board, and the U.S. Army Physical Disability Agency (USAPDA) may be pending an LOD determination.

c. In general, an RC Soldier has 180 calendar days from the end of the qualified duty status to request a LOD determination, for the purpose of determining eligibility for medical and dental treatments and incapacitation pay entitlements, absent special circumstances. See DODI 1241.01. Submission of AGR LOD investigations, solely for the purpose of retirement, is not authorized. Exceptions to the 180-day timeline include:

  • (1) A Behavioral Health diagnosis which may occur at some point beyond the 180 day period;
  • (2) A Soldier is currently enrolled in the Integrated Disability Evaluation System (medical evaluation board (MEB)/physical evaluation board (PEB)) and a line of duty is directed by the Physical Disability Agency;
  • (3) The covered condition pre-dated the 180 day period (such as with latent onset symptoms of post-traumatic stress disorder).

d. In general, a Soldier who transfers from RA to RC has 180 calendar days from their separation date from RA to request an LOD determination, for the purpose of determining eligibility for medical and dental treatments and incapacitation pay entitlements, absent special circumstances. The accepting RC will initiate and/or adjudicate an LOD provided the Soldier can provide substantiating medical documentation to support an LOD determination. In RA–RC transfers, the Soldier can seek medical attention directly through the Veterans Administration using all current medical documentation.

e. Sexual assault related incidents. Medical entitlements for Reserve Component Soldiers are dependent on a LOD determination as to whether or not the sexual assault incident occurred in an active service or inactive duty training status (see DODI 6495.02, Encl. 5, Para 5b)….

4–7. Absent without leave

For any injury, illness, disease, or death incurred during a period of AWOL the finding will be NLD unless a behavioral health provider has determined that the Soldier was mentally unsound, such that the Soldier did not possess the ability to form the intent to go AWOL. In cases of suicide or attempted suicide or suspected mental unsoundness, a behavioral health provider will render an opinion of the Soldiers mental soundness at both the inception of AWOL as well as at the time of incident. Any Soldier that is found not mentally sound at the time of inception and at the time of the incident will be handled as ILD. In cases of suicide or attempted suicide, a behavioral health provider assigned to the nearest military treatment facility will render an opinion as to the Soldier’s mental soundness at both the inception of AWOL as well as at the time of incident….

4–17. Appeals

The following information addresses policy and procedures concerning appeals to NLD determinations:

a. The Soldier may appeal, in writing, within 30 days after receipt of the notice of the LOD determination to the approval authority of his or her unit. For appeals not submitted within the 30-day time limit, the reason for delay must be fully explained and a request for exception to the time limit justified. The appeal must be personally signed by the Soldier unless the Soldier is physically unable to sign or is mentally incompetent. In such cases, the appeal will include evidence of the condition that prevented the Soldier from personally signing….

4–21. Limits on use of a line of duty investigation

An LOD determination will not be used for the following purposes:

a. Disciplinary action and other administrative action. A NLD determination is an administrative determination and not a punitive or judicial action. Disciplinary and other administrative actions, if warranted, will be taken independently of any LOD determination. A determination of ILD does not preclude separate disciplinary or administrative actions. An LOD determination is not binding on the issue of guilt or innocence of the Soldier in a separate disciplinary action, the issue of pecuniary liability in a financial liability investigation of property loss, or any other administrative determination.

b. Reimbursement of medical expenses. An LOD determination does not authorize the U.S. Government to recoup the cost of medical care from a Soldier. Soldiers on active duty for a period of more than 30 days cannot be denied treatment based on an LOD determination. However, future access to care may be limited by the LOD determination….

Chapter 5 Line of Duty Determination Procedures for Soldiers of the Army National Guard and U.S. Army Reserve …

5–3. Responsibilities

Commanders, medical officers, S1s, SJAs, unit administrators, noncommissioned officers, and RC Soldiers who learn of a Soldier’s injury, illness, disease, or death that occurred under circumstances that warrant an LOD investigation/determination must take an active role in ensuring that an investigation/determination is initiated, completed, and uploaded into eMMPS in a timely manner.

a. Individual Mobilization Augmentees (IMAs) will be processed by the Regular Army command to which they are assigned or attached….

b. IRR Soldiers are processed by the Regular Army command to which they are assigned or attached when in an active status. The LOD for an injury, illness, or disease incurred while on active duty is the responsibility of the Regular Army command to which the Soldier is assigned to include Warrior Transition Units. The LOD will be initiated and completed before the IRR Soldier REFRADs. An LOD will be completed for any injury, illness, or disease for which the IRR Soldier is receiving treatment while assigned to a Warrior Transition Unit that warrants an LOD. In exceptional cases the AHRC Surgeon General’s office (AHRC–SG) will complete an LOD after REFRAD (for example, post-traumatic stress disorder).

c. For RA Soldiers who have transferred or transitioned to the RC whose medical conditions are reported after the Soldier is a member of the RC, only the named personnel from the Delegation of Authority memorandum signed by the TAG may initiate a PILD memorandum with proper medical documentation and a medical review from a physician, physician assistant, or nurse practitioner from the active duty medical records to support the injury, illness, or disease that may have been diagnosed and/or treated while serving on active duty. This does not include RC Soldiers who are/were mobilized or who are/were in a federalized duty status.

d. The S1 has overall responsibility for the management and processing of LOD’s as outlined in this regulation.

e. For Soldiers assigned to the IRR and ordered to perform muster duty; an LOD will be initiated by the muster officer in charge or authorized representative. DA Form 2173 and all supporting medical documents will be forwarded to: Commander, U.S. Army Human Resources Command (AHRC–SG), 1600 Spearhead Division Avenue, Fort Knox, KY 40122–5405 for processing and completion.

f. For USAR, the Army Reserve Medical Management Center, the MSC or RD surgeon’s office are responsible for assisting commanders in understanding the diagnosis, prognosis, and treatment plan for the Soldier and whether the injury, illness, or disease was caused or aggravated through military service while in a duty status or was EPTS. This responsibility includes making a definitive diagnosis that has not been accomplished by the initial treating MTF, initial civilian treatment facility, or Veterans Administration MTF.

g. For ARNG, the State surgeon’s office is responsible for assisting commanders in understanding the diagnosis, prognosis, and treatment plan for the Soldier and whether the injury, illness, or disease was caused or aggravated through military service while in a duty status or was EPTS. This responsibility includes making a definitive diagnosis that has not been accomplished by the initial treating MTF, initial civilian treatment facility or Veterans Administration MTF. The State health services specialist (HSS) or State administrator has access to forward LOD to the State surgeon’s office through eMMPS. Unit commanders who require assistance will need to forward LOD to the State HSS or State administrator in order to receive a State surgeon opinion….

5–4. Entitlement to medical care, pay and allowances for Soldiers who incur an injury, illness, disease, or incur aggravation in the line of duty

This guidance establishes criteria for initiating and processing LODs to ensure access to care and a timely resolution of their medical condition(s).

a. Soldiers will have up to 180 days following the completion of their qualified duty to request consideration for a line of duty determination, absent special circumstances. Special circumstances are those in which the covered condition predates the 180 day period, for example, latent onset symptoms of post-traumatic stress and unreported Sexual Assault in accordance with AR 600–8–4, paragraph 4–4c.

b. LOD determinations for injury, illness, or disease that have no lasting effect, defined as not requiring follow on care ultimately affecting a Soldier’s overall health or career will not be accepted in accordance with AR 600–8–4, paragraph2–2 (a)(1). LODs where the diagnoses are listed as, abrasions, scratches, pain, headache (not associated with BH), hernia, and pregnancy, are injuries or illness that leave no lasting effect on the Soldier or require hospitalization for further treatment.

c. A Soldier requiring treatment for an emergency medical or dental condition while in a qualified duty status is authorized an interim line of duty determination for initial medical care only. This authorizes emergent care, unless clear and unmistakable evidence shows the condition was the result of the member’s gross negligence or misconduct. An interim LOD must be initiated within 10 days following completion of qualified duty to continue treatment, if indicated, for covered conditions. The appropriate Defense Health Agency (DHA) office will serve as the MMA for approval and authorization of emergency medical and dental treatment with a civilian provider. The interim LOD will be adjudicated within 30 days of completion of the qualified duty status to continue further medical and/or dental treatment.

d. The LOD determination is required to authorize immediate medical and dental treatment for the covered condition(s). Under no circumstances, will care be authorized after one year from diagnosis without being identified for referral to the Disability Evaluation System (DES). A Soldier must be referred to the DES when the criteria for referral is met in accordance with DODI 1332.18.

e. Should the approval authority, at any time, find that the injury, illness, or disease was not incurred or aggravated in a qualified duty status or was the result of gross negligence or misconduct, all authorizations for medical and dental treatment, incapacitation pay, travel and transportation allowances provided related to in line of duty determination must be terminated immediately. The Soldier is financially responsible for all treatment to include emergency treatment for non-covered condition(s), if a finding such as described above is rendered.

5–5. Reserve Component line of duty procedures for sexual assault

Members of the RCs, whether they file a restricted or unrestricted report, shall have access to medical treatment and counseling for injuries, illness, and/or diseases incurred from a sexual assault inflicted upon a Soldier when performing active service, as defined in 10 USC section 101(d)(3), and inactive duty training.

a. Medical entitlements remain dependent on a LOD determination as to whether or not the sexual assault incident occurred in an active service or inactive duty training status. However, regardless of their duty status at the time that the sexual assault incident occurred, or at the time that they are seeking SAPR services, Soldiers can elect either the Restricted or Unrestricted Reporting options and have access to the SAPR services of a SARC and a SAPR VA.

Comment: SAPR stands for sexual assault prevention and response. SARC stands for sexual assault response coordinator.

b. Any alleged collateral misconduct by a Soldier victim associated with the sexual assault incident will be excluded from consideration as intentional misconduct or gross negligence under the analysis required by 10 USC section 1074a(c) in LOD findings for healthcare to ensure sexual assault victims are able to access medical treatment and mental health services.

c. The following LOD procedures shall be followed by Reserve Component commanders.

(1) To safeguard the confidentiality of Restricted Reports, LOD determinations may be made without the victim being identified to Department of Defense law enforcement or command, solely for the purpose of enabling the victim to access medical care and psychological counseling, and without identifying injuries from sexual assault as the cause.

(2) For LOD determinations for sexual assault victims, the Chief, Army National Guard and Chief, Army Reserve shall designate individuals within their respective organizations to process LODs for victims of sexual assault when performing active service, as defined in 10 USC section 101(d)(3) and inactive duty training….

(3) For LOD purposes, the victim’s SARC may provide documentation that substantiates the victim’s duty status as well as the filing of the Restricted Report to the designated official.

(4) If medical or mental healthcare is required beyond initial treatment and follow-up, a licensed medical or mental health provider must recommend a continued treatment plan.

(5) Reserve Component members who are victims of sexual assault may be retained or returned to active duty in accordance with DODI 6495.02, Table 1 and 10 USC Section 12323….

AR 40-502 Medical Readiness (27 JUN 2019)

Source
AR 40-502 Medical Readiness (27 JUN 2019) (418 KB)

Comments: To view or download the complete regulation, click on the link to it in the box above these comments.

Chapter 1

General Provisions

Section I

Overview

1–1.Purpose

This regulation governs individual medical readiness (IMR) requirements and standards; medical readiness processes and policies supporting commander deployability determinations; physical profiles; and medical examinations, periodic health assessments (PHAs), and the Deployment Health Assessment Program (DHAP). In the event provisions or guidance in this regulation conflict with those in AR 40–501, this regulation takes precedence. These conflicts will be addressed in the next revision of AR 40–501….

1–6. Medical readiness classification

a. Medical readiness classification (MRC) is an administrative determination by healthcare providers using a standardized system across the total force. This system enables the commander to measure, achieve, and sustain their Soldiers’ health and ability to perform their wartime requirement in accordance with their military occupational specialty (MOS)/area of concentration (AOC) from induction to separation. Medical readiness is described in chapter 2.

b. Commanders administratively use the medical readiness information to determine if a Soldier is deployable and able to perform the unit’s core designed mission or assigned mission in accordance with readiness reporting guidance in AR 220–1 and DA Pam 220–1. Soldiers are automatically medically deployable in the Medical Readiness System of Record if they are in MRC 1 or 2. This status is automatically uploaded to the readiness reporting system without additional commander action. Commanders can make deployability determinations for readiness reporting on Soldiers who are in MRC 3, with deployment-limiting (DL) 1 and 2, as well as for Soldiers in MRC 4. DL codes 3 to 7 are constrained by policy from deployment, and cannot be overridden by commanders….

1–7.Command application of medical readiness

Commanders will make deployability determinations for all Soldiers authorized by policy for their MRC/DL. In making deployability determinations for readiness reporting, unit commanders should consider the classification categories in paragraph 2–4 and collaborate with a healthcare provider for any questions. Unit commanders will not override duty limitations or instructions on DA Form 3349 (Physical Profile Record). Healthcare providers do not make or engage directly in deployability determinations for readiness reporting. Profiling officers describe and indicate potentially DL conditions for commander review and consideration in their deployment determination. Readiness is a commanders program. Paragraph 3–4 describes the procedure if there is disagreement between the healthcare provider and commander regarding initiating the CCMD waiver process….

Chapter 2

Individual Medical Readiness Key Elements, Standards, Categories, and Goals

...2–4. Individual medical readiness classification

After evaluating the required IMR elements by viewing e-Profile, the Medical Readiness System of Record and the EHR information, the healthcare team will categorize the Soldier into one of four medical readiness categories listed below and depicted in table 2–1.

a. MRC 1: Soldiers in MRC 1 are fully medically ready and deployable if they fulfill the following categories:

  • (1) Soldier meets all medical readiness requirements.
  • (2) Soldier is in Dental Class 1 or Dental Class 2 in accordance with AR 40–35.
  • (3) Soldier may have a transient illness or minor injury with a profile 7 days or less in duration (for example, upper respiratory infection).
  • (4) Permanent duty limiting condition(s) with a 3 or 4 in the physical, upper, lower, hearing, eyes, psychiatric (PULHES) (PULHES is a United States military acronym used in the Military Physical Profile Serial System) series with a completed board and an assigned physical category code of “S, W, or Y”, if no F, V, or X code (see DA Pam 40–502 for physical category codes). Use of certain medications and medical conditions, as established by DOD or CCMD guidance, will require a CCMD waiver for deployment. Upon receipt of an assigned mission, the servicing healthcare providers will evaluate the Soldier to determine the need for CCMD waivers. Each CCMD establishes the specific deployment status guidance and waiver processes for their area of responsibility. Medical readiness, commander deployability determinations, and CCMD waiver requirements are independent of each other.

b. MRC 2: Soldiers in MRC 2 are partially medically ready and deployable. Soldier has one or more of the following deficiencies:

  • (1) Hearing Readiness Class 4 (considered overdue with The Defense Occupational and Environmental Health Readi-ness System – Hearing Conservation hearing test greater than 365 days and all RC table of distribution and allowances Soldiers without an audiogram on file).
  • (2) Vision Readiness Class 4 (considered overdue at 15 months).

(3) Deoxyribonucleic acid (DNA) not on file with the Armed Forces Repository of Specimen Samples for the Identification of Remains.

(4) Human immunodeficiency virus (HIV) not drawn/validated with Armed Forces Repository of Specimen Samples for the Identification of Remains (within 24 months) without a previous diagnosis of HIV.

(5) Routine adult immunization profile immunizations to include hepatitis A; hepatitis B; tetanus-diphtheria or tetanus-diphtheria and acellular pertussis; measles, mumps, and rubella; poliovirus; varicella; influenza (seasonal); and if required, rabies (for personnel as required in accordance with AR 40–562).

(6) A Soldier who requires, but does not possess individual medical equipment (1 mask insert (1MI), 2 pairs of eye-glasses, military combat eye protection inserts (MCEP–I), medical warning tags, and hearing aid with batteries).

(7) A temporary profile 8 to 30 days in duration. Soldiers are deployable with these profiles, however, commanders have the discretion to make a commander’s determination that these Soldiers are non-deployable in the Commander Portal.

c. MRC 3: Soldiers in MRC 3 are not medically ready and will default to non-deployable. Soldiers in MRC 3 will be described by one or more of seven DL codes described below and in table 2–1:

  • (1) DL 1 – Temporary profiles greater than 30 days. Soldier is not medically ready and defaults to non-deployable. The commander can make a commander’s determination that these Soldiers are deployable and change the deployability status for all temporary profile(s) greater than 30 days in duration (total time to include extensions) in the Commander Portal. Soldier deployability remains DL 1 as long as there is an active temporary condition identified. Application of CCMD guidance will determine if a CCMD waiver is required for these conditions upon receipt of the assigned mission.
  • (2) DL 2 – Dental Readiness Class 3 conditions. Soldier is not medically ready and defaults to deployable. The commander has the discretion to make a commander’s determination that these Soldiers are non-deployable in the Commander Portal. The Soldier remains DL 2 as long as they have a Dental Readiness Class (DRC) 3 e-Profile. Dentists will use e-Profile to describe these conditions to the commander and guide the deployability determination. These conditions must be corrected before a Soldier deploys.
  • (3) DL 3 – Soldier is pregnant or post-partum. Soldier is not medically ready and is non-deployable. The commander cannot deem Soldier deployable until authorized by policy.
  • (4) DL 4 – MAR2. Soldier is not medically ready and is non-deployable. Soldier cannot be deemed deployable by the commander. This includes Soldiers with a permanent profile with a 3 or 4 in the PULHES without a completed MAR2 board. Soldiers who meet retention standards are eligible for MAR2 process. Soldier will remain DL 4 from when the condition is identified up to when MAR2 process is complete.
  • (5) DL 5 – Soldier is not medically ready and is non-deployable. Soldier cannot be deemed deployable by the commander. Soldiers with a permanent profile with a 3 or 4 in the PULHES, who do not meet retention standards without a completed medical evaluation board (MEB)/physical evaluation board (PEB). Soldiers who do not meet retention standards must be referred for Disability Evaluation System (DES) processing. MEB/PEB is appropriate for LOD conditions. Soldiers remain DL 5 from when the condition is identified until they are separated or have completed the MEB/PEB process.
  • (6) DL 6 – Soldier is not medically ready and is non-deployable. Permanent profile with a 3 or 4 in the PULHES without a completed non-duty PEB. Soldiers who do not meet retention standards due to a non-duty related condition can request a PEB. The Soldier will be DL 6 from when the condition is identified until they are separated or have completed the non-duty PEB process.
  • (7) DL 7 – Soldier is not medically ready and is non-deployable. Any profile with a physical category code of V, F, X, or Y. Soldiers in this category may be eligible for a CCMD waiver in accordance with the applicable published CCMD policy.d. MRC 4: Soldiers in MRC 4 are not medically ready.
  • (1) Commanders determine deployment status (default is deployable).
  • (2) Status is unknown. Soldier is deficient in one of the following:
  • (a) PHA (current if administered within past 15 months).

(b) Dental Class 4.

...

Chapter 3 Physical Profiling

3–1.General

This chapter prescribes a system, which is further described in DA Pam 40–502, for classifying individuals according to functional abilities; documents key aspects of medical readiness; and outlines the administrative management of Soldiers with duty limiting conditions....

3–2.Application

The physical profile system is applicable to members of any component of the Army throughout their military Service, whether or not the Soldier is on active duty.

3–3. Profiling overview

...

c. The DA Form 3349 contains all of a Soldier’s current duty limiting conditions with built-in communication links between the profiling officer and commander.... Profiling officers will evaluate all Soldiers with duty limiting conditions for Section 4: Functional Activities. Any permanent limitation in the functional activities section will either require a disability evaluation referral or initiate the RC medical disqualification process according to their duty status (see AR 635–40)….

d. The unit commander will review all profiles of Soldiers in their command. After reviewing a profile the unit commander—

  • (1) Addresses any questions or concerns, including when their observations of the Soldier’s performance is inconsistent with the profile, with the profiling officer.
  • (2) If necessary, has the authority to request a fitness for duty evaluation to include a profile review and second opinion from another profiling officer. Input from the original profiling officer will ensure a comprehensive review and informed opinion. The applicable profile delegation authority will implement a consistent process to ensure timely completion of all requested command reviews, minimizing the impact on readiness. If the original profile deemed the Soldier nondeployable, then the Soldier will remain nondeployable until the fitness for duty evaluation or profile review is completed.
  • (3) Makes deployability determinations in the Commander Portal for MRC 4, MRC 3, DL 1 and 2, and when not constrained by policy.
  • (4) Should extend reasonable consideration to profile restrictions even after expiration if the environment or mission has prevented prompt follow up.
  • (5) Should exercise due diligence in requiring Soldiers to take and (sic) APFT following any temporary conditions that have affected the Soldier’s ability to maintain optimal physical fitness and formulate their APFT policy according to command and leadership policy.

Comments: APFT stands for Army Physical Fitness Test.

e. A profiling officer writes a temporary profile to describe temporary duty limitations or a medical condition that needs to be communicated to the commander, or is required per AR 40–501. Profiling officers will describe duty limitations, capabilities, and physical readiness training guidance for each reason for profile affecting the Soldier. Each temporary reason for profile must be written for the full duration of the limitations, up to 90 days. Extensions must be linked to the previous profile to maintain an accurate description of the total length of time the Soldier has had a profile for that reason. Temporary profiles impact MRC by duration only, and there is no PULHES determination.

Comments: MRC stands for medical readiness classification. PULHES stands for physical, upper, lower, hearing, eyes, psychiatric.

Soldiers will be issued a temporary profile when receiving medical or surgical care during or while recovering from illness or injury for the same medical condition. The Medical Retention Determination Point (MRDP) is reached if the medical condition has stabilized or cannot be stabilized in a reasonable period of time for up to 12 months and impacts successful performance of duty. Successful performance of duty is defined as the ability to perform basic soldiering skills required by all military personnel (DA Form 3349, section 4 and passing one aerobic APFT event) and the ability to perform MOS specific duties. Medical evaluation of Soldiers with temporary profiles is required at least once every 90 days, to assess progress, response to treatment, and the currency of the duty limitations. Specific conditions in AR 40–501 will require specialty care and evaluation to determine if a Soldier meets retention standards. Specialty evaluations should start by the 6th month of the profiled period. If no specialty care is required by policy, a Soldier will have a physician evaluation after 6 months on profile for the same condition. These re-evaluations and progression of care are to ensure that the Soldiers who reach MRDP have recovered and rehabilitated to the point that they can transition to a permanent profile or initiate the appropriate DES process.

  • (1) A DD Form 689 or short-term temporary profile can describe conditions (less than or equal to 7 days). A temporary profile should convey more information to the commander, use standardized templates and establish the initiating event in e-Profile in accordance with AR 40–501.
  • (2) When the condition is stable, the profiling officer will communicate the permanent duty limiting conditions to the commander on a permanent profile. If the condition does not meet retention standards, the provider will initiate a referral to DES in accordance with the eligibility provisions of AR 635–40.
  • (3) The profiling officer must review previous profiles before making a decision to extend a temporary profile. Any extension of a temporary profile will be linked and described as a continuation of the same condition on DA Form 3349 in the EHR based on clinical judgment and the history of any other inciting injury.
  • (4) Temporary profiles will specify an expiration date. If no expiration date is specified, the profile will automatically expire at the end of 30 days from issuance of the profile.
  • (5) If a profile is required beyond a 12-month period, the condition will be documented in the form of a permanent profile. If the condition does not meet retention standards, the DES/RC–NDR process will commence. Exceptions to the 12-month temporary physical profile restriction must be approved by the first general officer in the Soldier’s chain of command, in consultation with the Secretary of the Army or the appropriate designee, senior approving authority, and/or senior medical officer….

f. A profile is considered permanent when the Soldier has reached MRDP for the condition(s). Because of the signifi-cance of permanent limitations of duty to medical readiness, all permanent profiles will have two profiling officer signa-tures. A physician approving authority will review all permanent “3” and “4” profiles.

  • (1) If the profile is permanent, the profiling officer must assess if the Soldier meets the medical retention standards located in AR 40–501. Soldiers who do not meet the medical retention standards, or cannot complete an aerobic APFT event, or cannot perform any of the functional activities in section 4 in DA Form 3349, must be referred to DES in accordance with AR 635–40. Soldiers in the RCs who are not on active duty and who do not meet medical retention standards for a non-duty related condition will be processed for medical disqualification in accordance with AR 135–175, AR 135–178, and AR 635–40, unless the Soldier requests a non-duty related PEB.
  • (2) Soldiers who meet retention standards but have a 3 or 4 PULHES serial will be referred to MAR2 in accordance with AR 635–40.
  • Comments: MAR2 is Military Occupational Specialty Administrative Retention Review.

3–4. Physical profile serial system

a. The basis for the physical profile serial system is to identify the function of body systems and their relation to military duties. The functions of the various organs, systems, and integral parts of the body are all considered. Since the analysis of the individual's medical, physical, and mental status plays an important role in assignments and welfare of other Soldiers, not only must the functional grading be executed with great care, but clear and accurate descriptions of medical, physical, and mental deviations from normal are essential.

b. In developing the physical profile serial system, body systems or regions were been divided into six factors designated as PULHES: physical/systemic; upper extremity and spine; lower extremity and spine; hearing; eyes; and psycho-logical. For each factor, a numerical designation (serial) of 1, 2, 3, or 4 indicates the overall functional capacity for that system or region. The functional capacity of a particular system or region of the body, rather than the defect per se, will determine the appropriate serial. DA Pam 40–502 describes the use of the physical profile serial system.

c. Soldiers who are medically ready may have health conditions that do not meet the specific CCMD deployment guidance. If the healthcare provider and commander concur that the Soldier is able to deploy, the CCMD policy will describe the initiation of the CCMD waiver process. When medical healthcare providers and unit commanders disagree on the deployment status of a Soldier, the decision to request a CCMD waiver will be raised to the first O–6 in the Soldier’s chain of command (or higher approving authority) and the hospital commander. Both the first O–6 and hospital commander will review both medical and unit commander recommendations to make the final decision whether to seek a CCMD waiver to deploy the Soldier. CCMD deployment guidance is developed to protect both the Soldier’s health and well being and the mission. Guidance is continually updated and is based on consideration of DODIs. The commander will ensure implementation with these individual medical requirements in accordance with all applicable DODIs, to include DODI 6490.07. To the extent that the information within this chapter is inconsistent with later published DOD guidance, DOD guidance will be followed.

3–5. Representative profile serials and codes

To facilitate the assignment of individuals after they have been given a physical permanent profile serial and for statistical purposes, code designations have been adopted to represent certain combinations of physical limitations or assignment guidance as described in DA Pam 40–502. The alphabetical coding system will be utilized and the appropriate code(s) will be recorded on the DA Form 3349. The profile form will be completed as described in DA Pam 40–502. The numerical designations serials for each profile factor and the code system are presented DA Pam 40–502.

3–6. Profiling officer, approving authority, and commander

a. Profiling officers. MTF commanders, ARNG chief and state surgeons, and the USAR command surgeon and RSC surgeons may designate physicians, dentists, physical therapists, optometrists, podiatrists, audiologists, chiropractors, nurse practitioners, nurse midwives, licensed clinical psychologists, licensed clinical social workers, and physician assistants as profiling officers. Under no circumstances will a special forces medic or independent duty corpsman serve as a profiling officer….

Department of the Army Pamphlet 40-502 Medical Readiness Procedures (27 June 2019)

Source
Department of the Army Pamphlet 40-502 Medical Readiness Procedures (27 June 2019) (802 KB)

Comments: To view or download the complete regulation, click on the link to it in the box above these comments.

Chapter 3

Individual Medical Readiness - Key Elements, Standards, Categories, and Goals

3–1. Overview

Maintaining their readiness is an individual Soldier’s responsibility. Per DODI 1332.45, Soldiers, commanders and healthcare providers must immediately correct all IMR deficits to ensure Service members are medically ready to deploy. IMR is the foundation of a unit’s Armywide medical readiness and deployability determinations. …

3–2. Individual medical readiness

a. General. DODI 6025.19 establishes IMR as a Soldier’s responsibility. There are six measurable elements of IMR for all Services. Senior leaders report IMR data to the DOD. The Army reports IMR as:

  • (1) PHA currency (required by DOD).
  • (2) DL conditions (required by DOD).

Comments: DL stands for deployment-limiting

  • (3) DRC (required by DOD).
  • (4) Immunization status (required by DOD).
  • (5) HIV test and DNA specimen (required by DOD).
  • (6) Individual medical equipment (required by DOD).
  • (7) Hearing readiness (Army-specific requirement).
  • (8) Vision readiness (Army-specific requirement).…

3–4. Commander deployability determinations

a. In making deployability determinations, unit commanders should consider the Soldier’s duties, type of mission, and geographic conditions or concerns. Execution and support for medical readiness both improve when there is close collaboration with supporting (unit or MTF) health care providers. Army leaders needs accurate deployment statuses and readiness assessments to train, man, and equip the force.…

d. Commanders ensure Soldiers are medically ready prior to deployment. During a deployment, the commander assesses changes in a Soldier’s deployment status, whether from injuries, worsening of known medical conditions, or the diagnosis of new medical conditions.…

Chapter 4

Physical Profiles

4–1. General

a. This chapter describes processes for communicating functional abilities, medical instructions and recovery time estimates to commanders, for accurate readiness and duty assignment…. In accordance with AR 40–502, unit commanders may not override duty limitations or instructions on DA Form 3349.

b. Determining individual assignments or duties is a commander’s decision. Limitations such as “no field duty,” or “no overseas duty,” are not proper medical recommendations. Administratively, Soldiers in certain deployment-limiting categories will have these constraints (such as pregnant Soldiers and Soldiers pending medical and administrative boarding action). Profiling providers must provide specific information on the Soldier’s functional limitations, capabilities, and a description of what the Soldier “can do” to enable assignment or duty determination by the nonmedical commander or U.S. Army Human Resources Command. The profiling provider ensures that complete and accurate administrative information is annotated on the DA Form 3349.

Comments: Click on the regulation link above to see examples in the text of appropriate and inappropriate profiling comments.

c. The commander or personnel management officer determines proper assignment and duty, based on knowledge of the Soldier’s profile, assignment limitations, and the duties of the grade and MOS.

d. The commander has the final decision on the deployment of Soldiers in his or her unit. When health care providers and commanders disagree on the medical readiness status of a Soldier, the decision will be raised to the first O–6 in the Soldier's chain of command, who makes the final decision whether to deploy the Soldier in consultation with the appropriate medical officer. Deployment waivers may be required for certain areas of operation.

4–3.Physical profile serial system

a. The basis for the physical profile serial system is the function of body systems and their relation to military duties. Profiling providers will use permanent profiles to describe and rate the function of the extremities, sensory organs, physical capacity, and mental health according to the system described in the following paragraphs….

b. The permanent physical profile has six functional areas “P–U–L–H–E–S” with four numerical designations used to reflect different levels of functional capacity, described in the following paragraph and table 4–2. The determination of the numerical designation 1, 2, 3, or 4 evaluates the functional capacity of a particular organ or system of the body.

c. The functional areas for consideration are:

  • (1) P – Physical capacity or stamina. This is general physical capacity and normally includes conditions of the heart; respiratory system; gastrointestinal system and genitourinary system; nervous system; allergic, endocrine, metabolic, and nutritional diseases; diseases of the blood and blood-forming tissues; oral maxillofacial conditions; dental conditions; dis-eases of the breast, and other organic defects and diseases that do not fall under other specific factors of the system.
  • (2) U – Upper extremities. This is the function and/or diseases of hands, arms, shoulder girdle, and upper spine (cervical and thoracic); as they affect strength, range of motion (ROM), and general efficiency.
  • (3) L– Lower extremities. This is the function and/or diseases of feet, legs, pelvic girdle, lower back musculature, and lower spine (lumbar and sacral) as they affect strength, ROM, and general efficiency.
  • (4) H – Hearing and ears. This is auditory performance.
  • (5) E – Eyes. This is visual acuity and diseases and defects of the eye.
  • (6) S – Psychiatric. This is personality, emotional stability, and psychiatric diseases.

d. There are four numerical designations to describe a Soldier’s functional capacity, in each of the six functional areas of the physical profile serial system, applied to the permanent profiles. Guidance for assigning numerical designators is in table 4–2. Soldiers with a numerical designator of 3 or 4 are non-deployable until they have completed the medical or administrative board process described in AR 635–40. The profile serial and physical category codes described in para 4–5 support and document progress through the medical or administrative board processes.

e. All profiles will describe the Soldier’s functional limitations whether the condition is just presenting or has a thorough evaluation and has reached the Medical Retention Determination Point (MRDP). The MRDP is reached if a medical condition which has been temporarily profiled has stabilized or cannot be stabilized in a reasonable period of time for up to twelve months and impacts successful performance of duty. Successful performance of duty is defined as the ability to perform basic soldiering skills required by all military personnel (section 4 of DA Form 3349 and passing one aerobic AFPT event) and perform the duties required of his or her MOS, grade, or rank. If after reaching MRDP, and transitioning to a permanent profile, the Soldier does not meet the medical retention standards listed in AR 40–501, then the numerical designator must be a 3 or a 4. Any persistent deployment-limiting condition requires inherently significant duty limitation and indicates a numerical designator of 3 or 4….

  • (1) An individual having a numerical designation of “1” describes a high level of medical fitness, deployable.
  • (2) A physical profile designator of “2” under any factors indicates some medical condition or physical defect that requires some minor functional or activity limitations, deployable. (Note, a Soldier may meet medical retention standards but require a permanent 3, thus, requiring referral to MAR2 in accordance with AR 635–40).
  • (3) A profile containing one or more numerical designators of “3” describes one or more medical conditions or physical defects with significant functional or activity limitations and warrant processing through a MAR2 or DES process.
  • (4) A profile containing one or more numerical designators of “4” describes one or more medical conditions or physical defects with severe limitations of military duty performance, requires a DES board evaluation….

4–4.Temporary vs. permanent profiles

There are many electronic requirements for recording profiles. As designated in AR 40–502, profiling provider must complete all profiles for medical conditions lasting greater than 3 days, both temporary and permanent, in e-Profile. The DA Form 689 (Individual Sick Slip) may be used only once for a medical condition limited to acute, minor, self-limited illnesses requiring only 1 to a maximum of 7 days of recovery. DA Form 689 may also be used to write out medical instructions for Service members from other Services, to communicate back to other commanders. Any residual duty limitations and all conditions with functional limitations clinically expected to extend beyond 7 days must be recorded on a temporary profile in accordance with AR 40–502….Temporary profiles are not associated with a PULHES or the physical function capacity; rather they are assessed by duration only….

c. Temporary profiles. Indications for a temporary profile are conditions with limitations that will improve over time. Correction or treatment of temporary conditions is medically advisable, and should usually result in a higher level of function and employment. Profiling providers manage Soldiers receiving medical or surgical care, recovering from illness, injury, or surgery by designating a temporary condition on the Soldier’s DA Form 3349. The addition of the limitations to any previously existing temporary or permanent limitations in the e-Profile system will provide the commander a single source for the Soldier’s medical instructions and duty limitations.

  • (1) Duration: The profiling provider will write the profile for the entire length of the expected recovery up to 90 days (except as directed in paras 4–8d (tuberculosis) and 4–9 (pregnancy)). The profiling provider will extend and modify the profile for the temporary condition, to communicate with the command, until the Soldier reaches the point in their evaluation, recovery, or rehabilitation where they have returned to full duty or the profiling provider determines that the Soldier has achieved the MRDP. MRDP may occur before the 12-month administrative timeline if the condition is stable and no further functional progress is expected. At MRDP, the profiling provider will transition any remaining duty limitations to a permanent profile. All permanent profiles require two profiling provider signatures. The second signature will need to be a physician, or for profiles within their area of expertise, an audiologist or podiatrist are second signature authorities for profiles without deployment limitations. If the profile has deployment limitations, either a 3 or 4 in the PULHES or a deployment-limiting physical-category code, the second signature must be an approval authority. The maximum duration of temporary profiles is 12 months for the same medical condition without an exception, as described in paragraph 4–4c(4)below. At 12 months, the Soldier is administratively defined to have reached MRDP. …
  • (2) Temporary profiles exceeding 6 months’ duration, for the same medical condition, will be referred to a physician or medical specialist if clinically indicated, for that medical condition, or as required by policy. Specific conditions in AR 40–501 require specialty evaluation to determine if the Soldier meets retention standards. These referrals ensure the optimal care and support to help the Soldier return to duty, or ensure documentation of the injury or illness that supports the medical or administrative board process. Reviewing physicians or specialty health care providers will consider one of the following actions:
  • (a) Continuation of a temporary profile, for the same medical condition or injury, up to a maximum of 12 months from the initial profile start date;
  • (b) If the condition has reached MRDP, transition to a permanent profile;
  • (c) Determination of whether the Soldier meets the medical fitness standards for retention in accordance with AR 40–501 and, if not, refer to the DES. Once MRDP is met for one condition which does not meet retention standards, referral into the DES must commence regardless of the status of other co-existing conditions. …
  • (3) Prolonged Soldier review: There are higher authority reviews for profiles lasting over 120 days. Profiles over 120 days in duration will be reviewed by operational profile review boards, above company level, every month….
  • (4) Temporary profiles for conditions with duty limitations beyond 12 months are usually converted to permanent pro-files. For all Soldiers, the application of the second signature for a permanent profile that does not meet retention standards initiates the requirement for DES or appropriate processing….

e. Permanent profiles. Soldiers whose condition(s) have reached MRDP will receive a permanent profile…. Some diagnoses do not meet retention standards by definition and will be referred to DES upon diagnosis, in accordance with AR 40–501….

  • (3) Medical and administrative processes once a Soldier reaches MRDP and does not meet medical retention standards.
  • (a) Duty related processes through one of the three forms of DES: legacy DES, IDES, or expedited DES.
  • (b) Non-duty related physical evaluation board (ND–PEB) processing is for the reserve COMPOs only.
  • Comments: COMPO stands for components.

Soldiers who do not meet retention standards due to a non-duty related condition may request non-duty processing to determine if they may be retained and continue to serve.

  • (c) Administrative processing for Reserve COMPO Soldiers with non-duty related conditions proceeds when the Sol-dier does not request a ND–PEB.
  • (4) Medical and administrative processes once a Soldier reaches MRDP and meets medical retention standards.
  • (a) Transition to a permanent profile describing the permanent duty limitations….
  • (b) The MAR2 is an administrative process to evaluate the Soldier’s ability to serve in their MOS. Outcomes from the MAR2 are to retain the Soldier in their MOS, reclassify them to another MOS, or refer the Soldier for DES processing in accordance with AR 635–40.

4–5.Physical category codes

The physical category codes indicate limitations in personnel and administrative matters and are used in numerous Army systems. The current physical category codes described in tables 4–3 and 4–4 describe a history of an accession waiver, assignment, and deployment limitations, or the completion of medical board or administrative processing. Previously there were medically descriptive codes, but in accordance with AR 40–502, these are rescinded, and the profiling provider will describe these limitations in plain language on the profile to inform the commander’s duty assignments and deployment determinations….

Code F No assignment or deployment to OCONUS areas where definitive medical care for the Soldier’s medical condition is not available

Code V This code identifies a Soldier with deployment restrictions to certain areas

Code X This Soldier is allowed to continue in the military service with a disease, injury, or medical defect that is below medical reten-tion standards, pursuant to a waiver of an unfit finding and con-tinued on active duty or in active reserve status under AR 635–40.

Code S Soldier has been determined to meet medical retention standards of chapter 3 by a Medical Evaluation Board (MEB)

Code T Waiver granted for a disqualifying medical condition, or standard, for initial enlistment or appointment. The disquali-fying medical condition, or standard, for which a waiver was granted will be documented in the Soldier’s accession medical examination

Code W This Soldier has a permanent 3 or 4 profile that has been evaluated by a MAR2 with a recommendation to retain or reclassify and return to duty.

Code Y This Soldier has been found fit for duty through the disability evaluation system (DES) (not entitled to separation or retirement because of physical disability) after complete processing under AR 635–40….