The Medical Evaluation Board (MEB) and IDES ( Integrated Disability Evaluation Services)

 

As I was approaching the end of my career, I had decided that I would like to be of service to my country – so, I signed on to serve on the Medical Evaluation Board of the US Army at Ft. Hood. I quickly realized that I had a lot to learn about the military and its operation.  I had to learn about  Military Services Standards of Medical Fitness  contained in  the Army Regulations AR 40-501.  In essence, this is a list of diseases, deformities or malfunctions of the body and how bad they can be with regards to medical fitness to serve in the military.  These standards are used to evaluate prospective candidates who have a medical issue to see if they can join the military.  These same standards are employed when soldiers get sick or injured.  The Army allows one year of treatment for a medical problem and if it has not been resolved, the case is evaluated by the MEB (Medical Evaluation Board) to decide whether the military member is still fit to remain in service or whether they need more care or they should be medically separated from military service.  The MEB is a group of physicians who gather all the information for a case and discuss it and make recommendations for retention in the military or medical separation – these recommendations are forwarded to the PEB ( Physical Evaluation Board).  The PEB is the group which makes the final determination on retention or separation of the individual from the military.

Joining the Army is much like making a career choice.  After taking an aptitude test, potential recruits are assigned a MOS ( Military Occupational Specialty). They sign a contract that they will do their MOS training and provide MOS services as well as basic Army services to the US Government. The US Government signs a contract with the person that they will provide MOS and Army training and will provide training for advancement and careers within the Army. Thus, it is a two-way binding contract.  There are many ways that this contract can be broken but the focus of this article  is on medical standards of fitness for soldiers to remain in the Army.

Injured military personnel receive treatment through their primary care team and are referred  for specialty evaluation/care.  If surgical procedures are required, they are completed.  The goal is to fully restore the injured person to enable them to continue their military career.  The Army allows for one year of care to get the soldier back to normal and back to duty.  If the illness is severe or the repair of any injuries with rehabilitation will not allow them to continue their military duties, then they are referred to the MEB where it is determined whether the soldier has received all the necessary care and whether they might not be able to return to duty.  If the soldier has not received all necessary care and interventions, they are referred back to their primary care team with recommendations.  However, if all possible care has been rendered and the soldier is not able to return to duty, the MEB evaluates them according to the Military Services Standards of Medical Fitness.  If they do not meet fitness standards,  the MEB recommends to the PEB that the soldier be medically separated from the Army.  The PEB has the power to medically separate the solder from the Army or to assign them to a new MOS within the limitations given to them by the MEB.

The focus of the MEB is to serve 3 goals:  1. Protect the soldier; 2. Protect the other soldiers; 3. Protect the interests of the United States Government.

1. Protect the soldier. In some cases of injury or illness, the soldier’s medical or mental health is compromised to the point that continued Army service could be detrimental to their health. They might have difficulty performing some aspect of their MOS or performing basic soldier duties. As an example, an injured soldier may be returned to normal function but may require some special medicines to treat their medical problem. In the case of highly specialized medicines, these might not be available if the soldier is deployed to remote areas.  This has to be considered as the Army goal is to have every soldier immediately deployable to any location at any time.  Should this soldier be deployed and not be able to obtain their needed medication, their medical problem may be significantly aggravated.  Thus, they may be at significant  risk if deployed.
2. Protect other soldiers. We are concerned with protecting everyone. If an injured solder is not able to perform their MOS to their fullest capacity, we do not want other soldiers to be at risk.  For example if a radio technician soldier can’t climb a pole to install an antenna so that the group can radio their location and request needed assistance, the entire group might be at risk.  Thus, it is the MEB’s job to make sure that ill or injured soldiers are accurately evaluated and treated and proper restrictions placed on their activity with Profiles.
3. Protect the interest of the federal government. Since the federal government is the ultimate employer, we must be aware that we not put the federal government at risk by any MEB decisions about soldier suitability for their MOS or soldier responsibilities. Let me give an example.  Lets take an Army cook who is attached to a unit getting ready to deploy for a combat mission.  The cook has a walking boot on their foot for a fracture of the 5th metatarsal bone which is healing very slowly – maybe over 12 months.  The commander’s argument for the soldier to deploy with their unit goes like this: “Joe, our cook, is in the kitchen all the time and does not go outside “the wire” and thus is able to do his duties within the confines of the camp and we need the cook to be deployed on our mission.”  This is a safe argument for the commander  –  until the camp is attacked and they have to quickly mobilize.  Since Joe can’t run, several soldiers have to assist and maybe carry him – they can’t leave him.  This slows down the group and maybe Joe and several other solders get injured or killed.  Looking at the big picture, one asks the question “Why did they let Joe get deployed when he clearly could not run with a leg boot and a foot fracture that has not healed – and several soldiers were injured or killed because of it?”  This is the correct question. It is questions like this which the MEB has to ask and intervene for the soldier so that they are not deployed with a serious ongoing medical problem.  In this scenario, the federal government may be at risk for the decision to deploy Joe and for the injuries and loss of life subsequent to the attack on the camp.

When the MEB finds that the soldier does not meet retention standards after treatment has been rendered, then the solder goes through the IDES process. The MEB report is one component of the IDES process.  The soldier’s packet is then forwarded to the PEB. The PEB makes the final determination on separation or retention.   The IDES process integrates the DoD Disability Process and the VA Disability process. This makes sure that the individual’s medical issues are clearly identified and that they will receive continued care through the VA health care system.