U.S. Army photo by Staff Sgt. Lasonya Morales/Released

The Integrated Disability Evaluation System (IDES) features a single set of disability medical examinations appropriate for determining both fitness and disability.¹ By transitioning from the disability evaluation system (DES) to the IDES, evaluation of a service members’ fitness for duty runs concurrently with a Department of Veterans Affairs’ (VA) determination of a disability rating. Wounded, ill or injured service members receive disability evaluations by VA-certified doctors using VA guidelines, while the Defense Department uses these same exams to determine if the service member is fit for duty. This article details the roles and responsibilities for medical providers associated with the IDES, as well as important training courses available to providers on learning their decision-making responsibilities.

Medical Provider Roles in the IDES

Within the IDES, medical providers fulfill four primary roles:

1. Treating physicians forward cases to DES-trained medical providers if recovery within a year is considered questionable
2. DES-trained medical providers evaluate cases, i.e. degree of injury or illness, impact on ability to serve, to determine if further referral is necessary.
   • Once the treating physician refers a service member to a DES-trained provider, the DES-trained provider must determine if the case should be referred to the Medical Evaluation Board (MEB), comprised of at least two physicians.
3. An MEB Narrative Summary is prepared from information in the case files of service members referred into the DES
4. MEB members review case files and the Narrative Summaries to determine whether cases should be forwarded to the Physical Evaluation Board (PEB), or if the service members should be returned to duty.

DES-trained providers only refer a service member to the MEB when:

• The ability to perform military duties is questionable and is unlikely to resolve within a year
• The service member has an illness or injury that requires referral

MEB Narrative Summary

The purpose of the MEB Narrative Summary is to summarize medical and occupational documentation included in service members’ DES case files and to describe the impact of these medical conditions on the service members’ ability to perform their military duties. Medical providers responsible for writing MEB Narrative Summaries perform the following tasks:

• Review medical and occupational documentation in the DES case file
• Review service-specific medical and occupational standards
• Identify any documentation missing from DES case files

For each active medical condition, the MEB Narrative Summary writer must consider:

• Clinical stability and prognosis for improvement
• Impact on performance of military duties
• Application of the service medical standards

A MEB is convened to review the cases of service members' referred to the IDES. The MEB reviews all of the documentation relevant to the service member's case in the MEB Narrative Summary to determine if return to regular duties within a year after diagnosis really is questionable. If a MEB determines that a return to duty is questionable, the service member’s case is forwarded to the PEB.

Medical Evaluation Board (MEB)

Relying largely on the MEB Narrative Summary, the PEB determines whether a service member is fit or unfit for continued military service. The PEB also uses the information in the MEB Narrative Summary to determine the appropriate benefit amount based on the VA Schedule for Rating Disabilities (VASRD) for eligible service members. The steps in the PEB process include the following:

Physical Evaluation Board (PEB)

The purpose of the MEB Narrative Summary is to summarize medical and occupational documentation included in service members’ DES case files and to describe the impact of these medical conditions on the service members’ ability to perform their military duties. Medical providers responsible for writing MEB Narrative Summaries perform the following tasks:

1. The PEB establishes an Informal Physical Evaluation Board (IPEB), made up of the PEB President, personnel or HR officer and a doctor, to review the service member’s case file. IPEBs are not conducted in-person and the service member does not interact directly with the IPEB.
2. The IPEB renders a fit or unfit finding and, when appropriate, determines a disability rating, which the service member receives for review.
3. If the service member disagrees with the IPEB findings, a Formal Physical Evaluation Board (FPEB) is convened at his/her request. A service member found unfit has the right to a FPEB, while the service member who is found fit may only request an FPEB from the PEB president. The service member may appear before the Board, present evidence, testify or not, and is usually represented by legal counsel. Military legal counsel is also available to the service member at no cost throughout the process.²
4. The FPEB renders a fit or unfit finding and, when appropriate, determines a disability rating. The service member is transitioned out of the service when found unfit or reintegrated into the unit when found fit.

In the last phase of the IDES process, service members are either transitioned to civilian life or reintegrated into military service. Service members who are able to continue to serve can receive their benefits letter from the VA one month after separation. While service members will receive ongoing medical care during transition and reintegration, medical providers are normally not tasked with any IDES-related roles during this phase.

Training for Medical Providers

It is critical that all military medical providers understand the indications for referral, the information needed by the PEB to make equitable and timely decisions, and the regulatory basis for the system. The Defense Department and VA collaborated to offer online IDES training courses for health professionals through the Military Health Learning Portal. The courses support the services in training medical providers to make appropriate clinical and administrative decisions related to the IDES. The courses cover the range of pre-PEB IDES decisions, including:

• Decision to refer to MEB
• Functional impact of the condition
• Reference to the retention standards
• Content of the MEB Narrative Summary

The courses were designed to meet the educational needs of a wide range of medical providers, whether experienced sub-specialists, dedicated MEB providers, primary care providers, or physicians-in-training. The courses can also be used for just-in-time training for newly assigned MEB clinic providers.

This online training should provide a useful supplement to training already offered by the military departments by offering practice in referral decision-making, MEB Narrative Summary preparation and correction, case file (simulated) review, and MEB decision-making. This training also provides exposure to each service branches’ regulations and approaches, which should be helpful to MEB clinicians evaluating service members from other services.

You can locate these courses directly by logging onto MHS Learn, selecting “MHS Staff Training”, then selecting “Browse Catalogue” and searching for the IDES course series.

In addition to your understanding of the IDES as a provider, service members' active participation is also critical to both themselves and the success of the system. The educational materials available help assure that service members can fully participate.

Additional Resources

• MHS Learn
• Deployment Health Clinical Center

Sources

¹Walton, Breanna. "Integrated Disability Evaluation System Helps Separating Soldiers," U.S. Army. Published March 17, 2011.
²375^th Medical Group. "Integrated DoD/VA Disability Evaluation System Now in Place for Servicemembers”, Scott Air Force Base. Published June 29, 2011.
³Taylor, Sharon Renee. "New Disability Evaluation System Benefits Soldiers,” U.S. Army. Published June 28, 2011.