By Reginald Rogers, ParaglideFebruary 15, 2013
FORT BRAGG, N.C. (Feb. 15, 2013) -- In 2007, and in the wake of abuse allegations at the former Walter Reed Army Medical Center, then President George W. Bush called for a commission to ensure of the proper care and processing of the nation's wounded veterans.
The commission led to the analysis and revamping of veteran's healthcare system and included a closer look and integration between the Department of Defense and the U.S. Department of Veterans' Affairs to create the Integrated Disability Evaluation System, or IDES. The system streamlined the process of treatment and transitioning for wounded veterans.
According to Lt. Col. Arthur I. Campbell, chief, Department of Deployment Health at Womack Army Medical Center, and director of IDES at Fort Bragg, the system differs from the DOD, and particularly the Army's, way of doing business in the past.
"IDES is a presidentially mandated process created in 2007 following issues which emerged at WRAMC, which combines the medical evaluation board/physical evaluation board, or MEB, with the Veteran's Administration Compensation and Pension and Disability Rating Activity Site in order to evaluate (and rate/compensate as applicable) every medical condition a Soldier has had during their entire length of service," Campbell explained.
"In the legacy MEB system (pre-IDES), Soldiers would be evaluated and compensated by DOD only for their service-disqualifying medical conditions," he continued. "They would then separate and file a claim with the VA in order to be evaluated and compensated as applicable, for all other (non-service-disqualifying) medical conditions. This process could take one to two years to accomplish."
Campbell said that by integrating the VA with DOD, which means housing and supporting VA medical providers and administrative staff within the medical treatment facilities, Soldiers are rated for all conditions and receive appropriate compensation and benefits within 30 days of separation from service.
"Additionally, this allows us to arrange follow-up appointments with the VA at the location where the veteran will live after separation in order to ensure continuity of care," Campbell added, pointing out the benefits to the Soldier. "While hugely beneficial to the Soldier, this process has caused the IDES process to be extended significantly. If completed to standard throughout, from the time of identification of service-disqualifying medical condition to separation from service, (it) is 295 days."
The IDES mandates that the DOD and VA work together for the benefit and convenience of veterans during and after their transitional process.
"DOD and local VA are co-located for the purposes of IDES only to provide the most convenience and efficiency of the process for Soldiers, so they are not traveling to VA medical centers any more than absolutely necessary. DOD has no operational control or authority over the VAMCs, which function precisely as they always have and follow all their own policies and procedures," Campbell said.
There is, however, extensive coordination and synchronization locally between the DOD and VA in order to ensure the process is as efficient and Soldier-centered as possible. Family members are strongly encouraged to attend as many of their Soldier's appointments and briefings as they would like, he added.
The medical evaluation board, which is the local phase of IDES, determines only if a Soldier's condition is or is not disqualifying for service, based on Army Regulation 40-501, Standards of Medical Fitness. The determination as to "fitness" (whether or not the Soldier will be medically separated from the service) occurs at the National Capital Region Physical Evaluation Board, or PEB.
Campbell pointed out that if a Soldier is found to be "unfit," the Soldier's case is then routed to Seattle to the disability rating activity site, where compensation is determined. The Seattle D-RAS is a purely DVA activity and is the same site where all veterans' disabilities are determined.
Whatever the decision, Campbell said there is an appeals process that Soldiers can take if they disagree with the D-RAS ruling.
"Locally, Soldiers may request an impartial medical review and/or appeal. At the PEB level, there are appeals to both the PEB Physical Disability Agency, and with the VA, Soldiers may submit VA rating reconsideration. This ensures all possible due process for the Soldier. Womack has two attorneys, the Soldier's MEB counsel, whose sole responsibility is to advise Soldiers and file the necessary documents for all these processes. All Soldiers are required to attend a briefing with these attorneys at the start of the IDES process," he explained.
Campbell also pointed out that once Soldiers are marked for medical separation, and if they concur with the PEB findings, separation orders will be issued and will generally be no later than 90 days after that date. Soldiers are able to take any and all accumulated leave and will out-process the installation.
"Soldiers undergoing MEB will complete all Army Career Alumni Program activities, are referred to the Army Wounded Warrior Program, have access to Soldier and Family assistance centers and are also put in contact with a VA liaison at the [military treatment facility] who will arrange the necessary follow up closest to the VA where the Soldier or veteran will reside after separation," Campbell said.
He said local units also have a responsibility of helping Soldiers during their transitional process.
"Commanders and senior NCOs (noncommissioned officers) at all levels are required to attend classes, which educate them on the IDES process as part of the Company Commander and First Sergeant Course and Pre-Command Course. Units are asked to ensure Soldiers are available for all MEB and VA appointments and to help manage the transition process for Soldiers," Campbell explained.
Fort Bragg, which is one of the Army's premier posts, continues to lead the way in ensuring that Soldiers' and veterans' needs are met during their medical evaluation board and the transition that often follows the MEB findings.
In the past year, the post has:
-- doubled the number of MEB providers and VA examiners dedicated to IDES
-- more than quadrupled the number of administrative staff in support of IDES
-- co-located all IDES personnel (MEB, VA, admin, AW2 and MEB counsel) at the Soldier Support Center in order to better serve Soldiers
-- developed and implemented the "Complexity-Based MEB Program," or CBMP, which is now in the process of being implemented across the Army
This program streamlines the first 100 days of the MEB process to less than 30 days. However, it is not for all cases. Soldiers with complex or multiple medical problems would not be best served by this program, so they continue in the routine IDES process.
The CBMP was specifically designed in order to preserve every step and all due process for Soldiers. It simply condenses appointments into a very short period of time. Fort Bragg has had more than 400 Soldiers complete this process in the 12 months since its implementation and Soldiers seem pleased with the program.
"Fort Bragg continues to meet or exceed all standards set by the Army and DOD for IDES. More than 90 percent of Soldiers complete the local portion of the IDES process (the "MEB Phase") in less than 100 days, which is the DOD standard. The average time for completion on Fort Bragg is 65 days," Campbell said.
"Most importantly, this has been accomplished while continuing to allow every Soldier complete due process and while maintaining quality, as less than one percent of all cases are returned from the PEB for us to perform any additional studies or provide any clarification," he added.
Currently, Fort Bragg has 1,647 Soldiers undergoing the medical evaluation board.