Health Services - Medical Boards (PDES)
Background
Like the other military services, the Coast Guard is required by Congress to maintain a disability evaluation system. The fundamental purpose of the system is to support the deployment of a fit armed force by identifying and, ultimately, separating from service members who are not fit. Except for very narrow exceptions, all military members of the Coast Guard must be fit for full duty and worldwide assignment. Members who are not fit for unrestricted world-wide assignment may be subject to separation under the Physical Disability Evaluation System.
Medical Boards
A military member whose physical condition raises reasonable doubt as to his or her ability to perform assigned military duties must be the subject of an Initial Medical Board (IMB). Medical boards are convened typically by Commanding Officers or Medical Officers. Medical board reports consist of a narrative medical summary, member's input (if any), and the command's cover letter. Prepared by a doctor, the narrative summary describes the member's overall physical condition, with primary focus on apparent disabilities and a recommendation as to fitness or unfitness for continued duty. Members are given the opportunity to rebut the doctor's narrative report and fitness recommendation. Commanding Officers prepare a cover letter endorsing the narrative summary and rebuttal, providing certain administrative data, a description of the member's duties, and the CO's opinion as to the member's ability to perform those duties. The now-complete IMB is forwarded to the Central Physical Evaluation Board (CPEB), located at the Coast Guard Personnel Command.
Physical Evaluation Boards
The CPEB, consisting of at least one line officer and one medical officer, reviews the board report, makes fitness findings, and recommends personnel disposition. If the CPEB finds the member unfit, it will then measure the level of unfitness, using a Department of Veterans Affairs standards. A member found unfit for continued duty by reason of physical disability is entitled to reject the findings of the CPEB and appear in person before a Formal Physical Evaluation Board (FPEB). Members appear before a FPEB to assert their fitness for duty, to claim a higher level of disability than rated by the CPEB, or to seek a personnel disposition different than that recommended by the CPEB. Members found Fit for Duty by the CPEB are not entitled to a formal board, and are simply returned to full duty status.
Occasionally, rather than finding a member fit or unfit, a PEB (either CPEB or FPEB) decides that a member's physical condition is not sufficiently clear to make a fitness determination or the member has not reached maximum medical benefit from the treatment plan. In such cases, the PEB orders a follow-up medical board, called a Disposition Medical Board (DMB). A letter from the PEB to the unit orders the DMB and indicates the required specialist consultations and a submission date. On receipt at Personnel Command, the DMB is again processed like an IMB.
Findings and recommended disposition of PEB's, even when accepted by members, are not final until the member's case has been reviewed by the Chief Counsel's office and approved by Commander, Coast Guard Personnel Command or higher authority.
Disability Separation
Military members found unfit for continued duty by reason of physical disability must be separated from the service. (There are some limited exceptions to this policy, particularly when members with relatively minor disabilities and more than 18 years service wish to remain on active duty until they reach 20 years of service.) Any member whose combined percentage of disability is 30% or higher is retired. Unfit members found to be less than 30% disabled, and not otherwise entitled to a longevity retirement, are discharged with severance pay.
Members separated with severance pay receive a lump sum payment on discharge, computed on the basis of base pay and the number of months served. Members permanently retired with a physical disability receive the specified percentage (disability level) of their basic pay, unless their time in service otherwise entitles them to a higher percentage. Members temporarily retired with a disability receive at least 50% of their basic pay; time in service or the specified percentage (disability level) may entitle them to a higher percentage.
Temporary or Permanent Disability Retirement
Members scheduled for disability retirement that is, members with a 30% or higher disability, or retirement-eligible members with any disability are either permanently retired or placed on the Temporary Disability Retirement List (TDRL). Members are placed on the TDRL when their disabilities are judged to be relatively unstable, and might reasonably be expected to change significantly in the next few years. Members are kept on the TDRL for up to 5 years, during which time they are re-evaluated approximately every 18 months. The purpose of the periodic re-evaluations is to determine whether the member's condition has stabilized. The periodic exam can lead to new disability findings and recommended disposition from a Physical Evaluation Board. Disability level and personnel status may be changed only once during a member's tenure on the TDRL; at that time the member's case is permanently resolved. Ultimately, at some point within 5 years of placement on the TDRL, members must be either:
- Found Fit for Duty (termination of CG disability benefits; usually eligible for voluntary return to duty and resumption of military career),
- Permanently retired (at original or a new level of disability), or
- Separated with severance pay (disabilities improve somewhat, but not enough to allow a return to duty).
Key Policy Points
The fundamental finding of a PEB is physical fitness or unfitness for continued Coast Guard duty. The disability system may not be used to effect an administrative separation. Disability evaluation is precluded by a member's misconduct. A member already scheduled or eligible for separation may choose to waive disability evaluation. Every Coast Guard military member must be found physically qualified for separation prior to discharge, or must be the subject of a medical board (unless there is misconduct or the member waives disability review). Members found physically qualified for separation may formally object to the doctor's finding.
Presumption of Fitness
The law that provides for disability separation is intended to compensate a member whose military service is involuntarily ended due to a service-connected injury or illness. Members scheduled for longevity retirement or non-disability separation are presumed fit to perform their duties. No longer scheduled for reassignment, they are no longer required to be deployable worldwide. A medical board should not be convened on such a member unless the presumption of fitness is overcome by a preponderance of evidence. The evidence must show that the member is unable to perform current duties due to disability, or that the member has suffered an acute, grave illness or injury. (Examples of acute, grave illness or injury warranting a medical board at that time are a heart attack, car accident, or diagnosis of cancer.) The vast majority of members ending active duty, even those with chronic painful conditions, have chosen to draw pay and allowances and compete for promotion. While perhaps tolerating physical impairments, they have continued full military service. Occasionally, members ending active duty during which they have suffered a truly debilitating condition are disappointed or even embittered to learn that their clear disabilities are not properly ratable by the Coast Guard. It is important for these members to understand that the military disability evaluation system is not intended by Congress to bestow benefits on members already scheduled for voluntary or mandatory separation. The federal government does, of course, provide specifically for such members to apply for extensive disability benefits, through the dedicated resources of the Department of Veterans Affairs.