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Medical Program Division, Disability Retirements, Separation and Limited Duty (PERS-82)

Medical Program Division, Disability Retirements, Separation and Limited Duty (PERS-82). Pay / Personnel Conference. 17 -18 SEP 2012, Millington, TN. Purpose of brief. Who we are What we do (define roles/responsibilities) Challenges / Special cases Common references

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Medical Program Division, Disability Retirements, Separation and Limited Duty (PERS-82)

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  1. Medical Program Division, Disability Retirements, Separation and Limited Duty (PERS-82) Pay / Personnel Conference 17 -18 SEP 2012, Millington, TN

  2. Purpose of brief • Who we are • What we do (define roles/responsibilities) • Challenges / Special cases • Common references • Summary / Questions 2

  3. Who we are 3 Commander, Navy Personnel Command located in Millington, TN. • Medical Programs Division (PERS-82), Disability Retirements, Separations and Limited Duty • Human Immunodeficiency Virus (HIV) Program

  4. PERS-82 Leadership • (901) 874-XXXX / DSN: 882 • Fax: 901-874-2072 • Division Director / Senior Medical Advisor CAPT James “Doc” Radike, 4-3201 James.Radike@navy.mil • Asst Division Director LCDR Jared McKendall, 4-3279 Jared.McKendall@navy.mil • Assistant Branch Head YNC(SW/AW) Nathaniel Trice, 4-3230 Nathaniel.Trice@navy.mil 4

  5. PERS-82 Staff – Limited Duty • (901) 874-XXXX / DSN: 882 • Fax: 901-874-2072 • Limited Duty (Last names M-Z) / Officer Separations (all) Mr. Vincent Balla, 4-3203 Vincent.Balla@navy.mil • Limited Duty (Last names A-L) / Return to Duty (RTDs) Clerk Mrs. Marion Gates, 4-4437 Marion.Gates@navy.mil • Permanent Limited Duty (PLD) - both officer/enlisted YNC(SW/AW) Nathaniel Trice, 4-3230 Nathaniel.Trice@navy.mil 5

  6. Others Key Players • Operational Medical Screening (Assignment limited authority) Mr. Detrick Harmon, 4-3523 (PERS-40MM) Detrick.Harmon@navy.mil • LIMDU and Pregnancy Placement / TPP & H Branch (PERS-4013C) - Lead Supervisor, Mr. Jim Gosnell, 4-4403 Jim.Gosnell@navy.mil - Branch Sr Enlisted Leader (SEL), PSCS(AW) Tom Palmer, 4-4475 Thomas.Palmer@navy.mil - Medical Advisor, HMC(SW/AW/FMF) Amy Smith, 4-4358 Amy.M.Smith2@navy.mil • Humanitarian (HUMS) Reassignments / Early Return Program Manager Mrs. Patsy Moore, 4-3542 (PERS-40HH) Patsy.Moore@navy.mil 6

  7. What we do 7 PERS-82 is responsible for: Setting policy and authorizing Temporary Limited Duty (LIMDU) May direct MTFs to submit a medical board to the PEB Managing Navy’s HIV Program SECNAV’s administrative authority for disability decisions including: disability retirements (TDRL/PDRL), separation (severance pay) Approving authority for determining Permanent Limited Duty (PLD)

  8. Limited Duty (LIMDU) 8 LIMDU is appropriate for those Sailors who will be returned to full duty (RTD), medically unrestricted. MEDHOLD (a RC program) is not the same as limited duty. Expectation is that member will be returned to full duty after completion of LIMDU. Allows for treatment, recovery, and rehabilitation. 12 months (6 month increments) max per career, regardless of condition; approved by the MTF. PERS-82 is the approving authority (via a department review) for ALL officer LIMDU and 3rd period or more for enlisted.

  9. LIMDU Myths….. 9 Being on limited duty will keep me on active duty past my EAOS/directed separation/HYT/FLTRES; PSD will just “extend me”. I recently had surgery and the doctor/physician put me on LIMDU…… I have a valid Perform to Serve (PTS) quota; I can be extended. The ECM said that they will “work with me” once I’m cleared by medical. I have 18 YOS in the Navy. I am “untouchable” and will be allowed to complete 20 years and retire. I’ve only been on 1 period of limited duty, I get 2! I have 3 PFA failures/was found not WWA and subsequently have been directed to ADSEP; however I’ve been put on LIMDU.

  10. LIMDU Movement / Orders 10 Enlisted at operational command (Type 2 and 4): MTF directs member to move based on the medical board Member transfers to TPU/Others via STO orders Member awaits orders/assignment via “YH” avail to PERS-4013C Enlisted at shore command (Type 1, 3, and 6): Normal shore rotation – member stays. Exception: Member must move for medical treatment; 4013C determines placement via avail or member is directed TEMDU (MPM 1306-1600) to TPU/Others activity nearest treatment/family support location for appropriate processing.

  11. LIMDU Reevaluations 11 Member is informed of LIMDU requirements…. Members should make every attempt to return to full duty, medically unrestricted. PSD informs commands (weekly message) that LIMDU will expire within 30 days or has already expired. PERS-4013C monitors. Reevaluation may determine member to: - Needs more LIMDU; locally; provided Sailor has time remaining prior to expiration of “valid” contract (EAOS) - Have medical board referred to PEB for fitness/disability - Be found return to full duty, medically unrestricted

  12. Mbr is RTD, then what? 12 Sailors may be returned to full duty, medically unrestricted at any time during LIMDU by a physician with Navy Medical Convening Authority (CA) approval. A RTD determination triggers a medical assignment screening. Must be completed within 15 days. - Exception: If mbr is at normal shore tour and PRD is > 9 months. - Exception: If member has retirement/separation authority. - Exception: As listed in MPM 1306-1208.

  13. Return To Duty continued…. 13 Medical assignment screening results: - World-wide assignable (WWA) - PSD sends YJ avail indicating WWA - Detailer issue and release orders - Assignment limited - PSD sends YJ avail showing limitations - Cmd sends msg to PERS-40BB/officer detailer (MPM 1306-801) - 40MM makes decision after consulting w/detailer; sends message to command - Member most likely directed to separate/retire Mr. Detrick Harmon (PERS-40MM – enlisted only) is the Program Manager.

  14. Areas to improve in….. 14 Local communication! (Sailor, cmd leadership, MTF, servicing PSD) Req for LIMDU for Sailors that are w/i 12 months of EAOS/HYT/FLTRES & for Sailors that are non-rentention (no PTS quota/final denial). ACC 105 Sailors with multiple PFA failures, etc. Way too many multiple PFA failing Sailors on LIMDU….CFLs/cmd leadership need your engagement!! Member not be re-evaluated in a timely manner. MTF not directing TEMDU for treatment when needed. MTF, PSD, Command Coordinators not discussing issues “early rather than later.” (monthly/qtrly CPC/LIMDU mtgs at PSD/MTF) Sailors not being “prepared” to separate/retire on time.

  15. LIMDU and Retention 15 In order for Sailors to be retained on active duty beyond SEAOS, their treatment/condition must meet the criteria in MANMED 18-25/SECNAVINST 1850.4E or they must have an accepted medical board submitted to the Physical Evaluation Board (PEB) for a fitness/disability determination. A common misconception is that placement on LIMDU overrules a directed separation or retirement. Member may voluntarily separate at EAOS waiving LIMDU and medical care via Page 13 (MPM 1160-040). Any separation or retirement authority takes precedence over LIMDU, includes HYT (MPM 1910-216/218, 1160-120). Hospitalization takes precedence over separation or retirement authority, except misconduct.

  16. PEBs and Retention 16 An accepted case by PEB for disability determination takes precedence over non-misconduct separation or retirement (SECNAVINST 1850.4E, MPM 1910-216). An UNFIT PEB decision takes precedence over a non-misconduct separation or retirement (Title 10, Ch 61). Misconduct (legal) separation takes precedence over PEB decisions or any separation/retirement authority (SECNAVINST 1850.4E). Manual of Medicine (P-117), Chap 18-25 directs physicians to adhere to NPC’s separation or retirement authority and not launch a member in a treatment plan that cannot be finished.

  17. LIMDU vs Pregnancy 17 LIMDU member is pregnant. What happens now? - LIMDU ends….ACC code is change to 100. (DNEC 0054/0055) - PSD submits DP (pregnancy) avail report if required (1306-1200) - Usually always required for members LIMDU since most PRDs for LIMDU personnel are within 9 months. - Member’s treatment does not end….we just do not track them as LIMDU anymore. - LIMDU determined again 60 days post delivery.

  18. PEB Findings…possibilities? 18 Member may be found: FIT for continued Naval service UNFIT for continued Naval service * Presumed FIT (P-FIT) * Means the evidence does not support conditions to shortened member’s career. - Decision does not mean the member is FIT. - Rendered in cases where member has an approved retirement date in system or within 12 months of statutory retirement. Member can accept, appeal (once), or request a formal hearing (introduce new medical evidence).

  19. “FIT for continued service” 19 • Member gets assignment screening • If assignment screening places limitations of potential duty stations, message goes to PERS-40MM to try to find a suitable assignment.

  20. “UNFIT for continued service” 20 • Member has disability rating, and may be transferred to Temporary or Permanent Disabled Retired List (TDRL/PDRL), or be medically separated (severance pay). • If member is found disabled (unfit), may request Permanent Limited Duty (PLD) to complete service obligation, reach career milestone, retain critical skills (SECNAVINST 1850.4E, Encl 6). • Enlisted members not worldwide assignable may be administratively separated (MPM 1910-120). • No mechanism to admin sep officers for non-worldwide assignability, but may fail to promote, or be separated as a result of force shaping (See OCM for guidance).

  21. Permanent Limited Duty (PLD) 21 • Only available to Sailors found UNFIT by PEB. - Detailer and ECM/OCM gets a chop. - PERS-82 weigh in on policy compliance. PLD determination is made and message is released. - L5 indicator, PRD, and record updated. - Most cases are at the end of a career. - Separating Sailors w/18+ YOS requires approval from CNP (3-star). - The default is that members will be retained to reach 20 years of service. Each case is individually considered. - PLD population is small…less than 35 (officers and enlisted).

  22. ACC Codes 22 • 100 – FULL DUTY – PERMANENT ASSIGNMENT FOR DUTY • 104 – HUMANITARIAN ASSIGNMENT (6+ MONTHS) • 105 – LIMITED DUTY (ASSIGNMENT RESTRICTED FOR MEDICAL REASONS) • 320 – TEMPORARY DUTY FOR FURTHER ASSIGNMENT • 330 – TEMPORARY DUTY FOR FURTHER TRANSFER • 355 – TEMPORARY DUTY AWAITING MEDICAL BOARD (MEB)/PHYSICAL EVALUATION BOARD (PEB) PROCEEDINGS

  23. …and more ACC Codes 23 • 370 – TEMPORARY DUTY UNDER TREATMENT (INPATIENT AT NAVAL MEDICAL FACILITY) • 371 – TEMPORARY DUTY UNDER TREATMENT (MEDICAL HOLDING COMPANY) • 372 – TEMPORARY DUTY UNDER TREATMENT (INPATIENT AT NON-MILITARY MEDICAL FACILITY) • 374 – TREATMENT AT VA AND OTHER FACILITIES FOR EXTENDED OUTPATIENT TREATMENT • 380 – TEMPORARY DUTY PENDING SEPARATION, DISCHARGE, RELEASE

  24. Challenges/concerns 24 3090 personnel currently on limited duty (2850 enl / 240 off). - 910 (789/121) have been on limited duty more than 12 months. - Not accurate due to those awaiting PEB decision (ACC 355). Limited duty personnel counting towards command’s manning. - Contact PERS-4013B (Enlisted Readiness Support Branch) 2899 expired PRDs / 258 expired EAOS - What actions are being taken? Communication?

  25. Challenges/concerns 25 Integrated Disability Evaluation System (IDES) Program - member’s filling a billet while awaiting PEB decision (Goal: apprx. 295 days; averaging (365 days) Responsibility of LIMDU members must rest mostly on parent command leadership; not solely on PSD, MTF (physicians, Pat Admin/Medical Board sect), TPU, Sailor. All hands effort!! Seems to be event driven vice medical driven (e.g.: PFA cycle, deployment cycle, orders to operational unit)

  26. Scenarios 26 • Administrative proceedings take precedence over medical actions. - Member to be admin separated for serial PFA failures - Physician refers member to PEB for bad back - Member gets admin separated without PEB decision • Legal proceedings takes precedence over medical actions. - Member being separated for misconduct. - Physician refers mbr to PEB for depression - Member gets separated without PEB decision, UNLESS misconduct directly resulted from medical diagnosis (i.e. PTSD, TBI, etc.)

  27. Examples (1 of 4) 27 • E6 to separate at 20 year point (HYT…mandatory separation/retirement) - Diagnosed with ACL tear on separation physical, 30 days prior to separation date - Physician schedules surgery, and places member on LIMDU for 6 months for treatment, recovery and rehab - Extension on AD denied by PERS-82, member goes home on previously determined date with or without surgery - Treatment defined as elective under MANMED 18-25

  28. Example 2 28 • O5 to retire at 28 years of service (mandatory separation) - Diagnosed with colon CA 6 months prior to separation date - Physician contacts PERS-82 for extension on AD for surgery, chemo and referral to PEB - Member is retained on AD until initial treatment is complete and PEB decision is rendered…retirement orders are held in abeyance - Treatment defined as non-elective

  29. Example 3 29 • E8 to transfer to Fleet Reserve at 21 years (can stay on AD until 26 years) - Diagnosed with non-Hodgkin’s lymphoma - Physician contacts PERS-82 requesting extension on AD for treatment and PEB referral - Fleet Reserve date held in abeyance - Member issued a new FLTRES date or MEBR directed to PEB for disability determination - Treatment defined as non-elective

  30. Example 4 30 • E8 to transfer to Fleet Reserve at 26 years gets bit on nose by dog while on terminal leave. - Physician contacts PERS-82 requesting 18 months extension for stages reconstruction surgeries. (Mbr’s physical appearance will not be conducive to job interviews or employment) - Request to remain on AD denied. Member eligible and accepted for care as retiree in MTF Plastic Surgery clinic - Treatment does not meet criteria for non-elective care, and no compromise of care after retirement. - May have been different if member separating without benefits

  31. Exceptions 31 • Care at the end of active service - Specifically addressed in NAVMED 18-25 - Treatment must be “non-elective” & approved by PERS-82 to retain member. - Elective vice non-elective decision made by PERS-82’s Sr Medical Advisor in consultation with primary physician and specialists - Members will not be retained for elective surgery or treatment - Expectation is that condition will result in PEB referral - PERS-82’s approval is REQUIRED for any extension past approved separation, FLTRES or retirement date - BASELINE ASSUMPTION: PLAN TO SEPARATE/RETIRE ON SCHEDULE!

  32. Exceptions – cont’d 32 • Member cannot be retained for financial gain - Selling back excess leave (common inquiry) - Inability to take all leave on the books - Inability to use full permissive TAD for house hunting/job hunting

  33. What NPC can’t do 33 • Member cannot be retained for financial gain • Preserve medical benefits for family members • Overrule the PEB (governed by Title 10) • Separate officers for non-worldwide assignability (force shaping)

  34. What NPC can do 34 • Direct referrals to the PEB • Retain members past HYT for non-elective medical care • Hold retirement orders in abeyance to permit non-elective care • Hold FLTRES transfers in abeyance • Direct separation of enlisted members to non-worldwide assignability (PERS-40MM)

  35. References….. 35 • SECNAVINST 1850.4E – Disability Evaluation Manual • MANMED, Chapter 18 – Medical Board Process • MILPERSMAN - 1306-1200 section: Limited Duty / 1301-225: Officer LIMDU - 1910-120 (Separation) • Navy Personnel Command (NPC) - PERS-82: Disability Retirement, Separation and LIMDU - PERS-8353: Officer Retirements (formerly 822) - PERS-8354: Enlisted Retirements/Fleet Reserve/HYT (formerly 823) - PERS-8352: Enlisted Separations (Favorable and Unfavorable) - PERS-834: Officer Separations / Resignations - PERS-4013C: (Pregnancy and LIMDU Placement) - PERS-40BB: (Medical Assignment Screening Manager)

  36. In summary…. 36 • PERS-82 has final authority on LIMDU exceeding 12 months for enlisted and all officers. • No elective surgery w/i 12 months of EAOS/HYT/FLTRES… • Enlisted members can be involuntarily separated for non-worldwide assignability. • Leadership MUST get us in the loop early, especially if a member is approaching (within 12 months) of EAOS/HYT/retirement eligibility. • Non-retention Sailors (no PTS approval), must plan to separate on time!! Limited duty is NOT a “dumping ground” to keep Sailors on Navy’s payroll past their EAOS/directed separation date….PERIOD.

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