Policy Guidance for Activated Reservists (IRR/IMA/SMCR) and Retirees Who Have Incurred or Aggravated Medical Conditions While on Active Duty

1.  PURPOSE.  THIS MARADMIN PROVIDES CLARIFICATION
ON REFS A THRU G AND AMPLIFYING GUIDANCE AS IT RELATES TO ACTIVATED
MARINES, RESERVE AND RETIRED, WHO HAVE INCURRED OR AGGRAVATED
MEDICAL CONDITIONS SUBSEQUENT TO BEING ACTIVATED.  BUPERS SENIOR
MEDICAL OFFICER (SMO BUPERS) IS THE SOLE AUTHORITY FOR GRANTING
EXTENSIONS OR RETAINING ON ACTIVE DUTY THOSE MARINES REQUIRING
FURTHER MEDICAL OR DENTAL TREATMENT.
2.  DEFINITIONS.
A.  LIGHT DUTY.  A DUTY STATUS THAT A MARINE MAY BE ASSIGNED FOR A
PERIOD UP TO 30 DAYS, WHEN COMPETENT MEDICAL AUTHORITY (PHYSICIAN)
DETERMINES THAT A MEDICAL CONDITION EXISTS AND INTERFERES WITH THE
PERFORMANCE OF DUTY.  A MARINE MAY BE RECOMMENDED FOR LIGHT DUTY IF
EXPECTED TO RETURN TO FULL DUTY WITHIN 30 DAYS.
B.  TEMPORARY LIMITED DUTY (TLD).  A SPECIFIED PERIOD OF LIMITED
DUTY, NORMALLY UP TO 8 MONTHS, RECOMMENDED BY A MEDICAL EVALUATION
BOARD (MEB), OR A QUALIFIED MILITARY DOCTOR WHEN THE PROGNOSIS IS
THAT THE MARINE CAN BE RESTORED TO FULL DUTY WITHIN THE SPECIFIED
PERIOD, NO LONGER THAN 8 MONTHS.
C.  MEDICAL HOLD.  CONVENIENCE OF THE GOVERNMENT MEDICAL (COFGM)
HOLD IS A TEMPORARY STATUS IN WHICH A MARINE IS PLACED WHEN REQUIRED
TO REMAIN ON ACTIVE DUTY BEYOND THE MARINES EAS/ECC TO COMPLETE
MEDICAL TREATMENT, OR PREPARE FOR A MEB OR PHYSICAL EVALUATION BOARD
(PEB).  MARINES ARE PLACED ON MEDICAL HOLD IAW PAR 30305 OF REF A.
D.  MEDICAL EVALUATION BOARD (MEB).  AN EVALUATION BOARD CONVENED AT
A MILITARY TREATMENT FACILITY (MTF) TO REPORT ON:  A MARINES
DIAGNOSIS; PROGNOSIS; FOR RETURN TO DUTY; PLAN FOR TREATMENT; AND,
MEDICAL RECOMMENDATIONS.  A MEB OR A PHYSICIANS DISPOSITON MUST BE
CONDUCTED OR RENDERED WITHIN 60 DAYS OF THE MARINE BEING PLACED IN A
LIGHT DUTY STATUS.  UNDER NO CIRCUMSTANCES CAN A MARINE REMAIN IN A
LIGHT DUTY STATUS GREATER THAN 60 DAYS WITHOUT INITIATING A MEB.
E.  PHYSICAL EVALUATION BOARD (PEB).  ESTABLISHED TO ACT ON BEHALF
OF THE SECRETARY OF THE NAVY (SECNAV) TO MAKE DETERMINATIONS OF
FITNESS TO CONTINUE NAVAL SERVICE, ENTITLEMENT TO BENEFITS,
DISABILITY RATINGS, AND FINAL DISPOSITION OF MARINES REFERRED FOR
DISABILITY EVALUATION.  SMO BUPERS MUST BE INFORMED OF A MARINE'S
STATUS PRIOR TO THE SCHEDULING OF A MEB/PEB.
F.  PHYSICAL DISABILITY.  ANY IMPAIRMENT DUE TO DISEASE OR INJURY,
REGARDLESS OF DEGREE, WHICH REDUCES A MARINE'S ABILITY TO PERFORM
ASSIGNED DUTIES.  THE TERM PHYSICAL DISABILITY INCLUDES MENTAL
DISEASE, BUT NOT SUCH INHERENT CONDITIONS AS BEHAVIORAL DISORDERS,
PERSONALITY DISORDERS, AND PRIMARY MENTAL DEFICIENCY.
G.  UNFIT.  A FINDING BY THE PEB, THAT A MARINE IS UNFIT TO
CONTINUE ACTIVE SERVICE BASED ON EVIDENCE WHICH ESTABLISHES THAT
THE MARINE IS UNABLE TO PERFORM ASSIGNED DUTIES, TO INCLUDE ALL
RESERVE OBLIGATIONS.
H.  FIT.  A FINDING BY THE PEB, THAT A MARINE IS ABLE TO PERFORM ALL
DUTIES REQUISITE TO THE BILLET ASSIGNMENT WITHOUT PHYSICAL
IMPAIRMENT.
I.  DISABILITY EVALUATION SYSTEM (DES).  A SYSTEM ESTABLISHED TO
CONDUCT PHYSICAL DISABILITY EVALUATIONS IN A CONSISTENT AND TIMELY
MANNER.
3.  THE FOLLOWING GUIDANCE IS PROVIDED WHEN AN ACTIVATED MARINE
BECOMES SICK, INJURED, OR AGGRAVATES AN EXISTING MEDICAL CONDITION.
WHEN THE MARINE REPORTS TO THE LOCAL MTF FOR SCREENING, THE
PHYSICIAN HAS THREE OPTIONS:
A.  RETURN THE MARINE TO FULL DUTY UPON INITIAL EXAMINATION;
B.  RECOMMEND ASSIGNMENT TO LIGHT DUTY IF THE PHYSICIAN ANTICIPATES
THAT THE MARINE WILL RETURN TO FULL DUTY WITHIN 30 DAYS; OR,
C.  DETERMINE IF THE MARINE WILL NOT BE ABLE TO RETURN TO FULL DUTY
WITHIN 30 DAYS AND INITIATE A MEB (SEE REF E) FOR ASSIGNMENT OF TLD
AND/OR REFERRAL TO THE PEB FOR DISPOSITION.  THE MTF WILL PROVIDE
NOTIFICATION OF THE MARINE'S MEDICAL STATUS TO THE CMC (MPP-60) OR
MARFORRES, GAINING FORCE COMMAND (GFC), AND PARENT COMMAND.
D.  MARINES ACTIVATED FOR A PERIOD OF MORE THAN 30 DAYS SHALL BE
TREATED IN THE SAME MANNER AS ACTIVE COMPONENT MARINES.  THEY WILL
BE RETAINED ON ACTIVE DUTY UNTIL THEY ARE FIT FOR DUTY, OR HAD THEIR
MEDICAL STATUS REVIEWED BY THE SMO BUPERS FOR DISPOSITION (EXTENDED
FOR MEDICAL TREATEMENT, RELEASED AND RECOMMENDED FOR DRILLING NOTICE
OF ELIGIBILITY (NOE) BENEFITS AND/OR PROCESSED THROUGH THE DES AS
STATED IN REFS B THROUGH D.
4.  WHEN A MARINE'S MEDICAL STATUS CHANGES TO OTHER THAN "FULL
DUTY," THE MARINE'S COMMAND WILL ENTER IN MCTFS A DUTY LIMITATION
CODE OF "Q" (TTC 157 006).  WHEN A MARINE IS PLACED ON LIMITED DUTY
OR ANY OTHER STATUS THAT RENDERS THE MARINE UNFIT FOR FULL DUTY:
A.  A STATEMENT FROM THE ATTENDING PHYSICIAN WILL BE THE SOURCE
DOCUMENT FOR THIS ENTRY.  THE DATE "Q" IS ENTERED INTO MCTFS IS
RECORDED AS THE "FROM" DATE.  IF THE MARINE IS SUBSEQUENTLY FOUND
FIT FOR DUTY PRIOR TO THE TERMINATION DATE OF HIS OR HER ACTIVATION
ORDERS (EAS/ECC), THE MARINE'S COMMAND WILL ENTER IN MCTFS A DUTY
LIMITATION CODE OF "0" (TTC 157 005).  THE "TO" DATE WILL RECORD IN
MCTFS THE DATE THE MARINE WAS FOUND MEDICALLY FIT FOR DUTY.
B.  THE GFC WILL ENSURE THAT THE MCTFS AND IAMMS ARE UPDATED TO
PROPERLY REFLECT THOSE MARINES IN MEDICAL STATUS, TO INCLUDE THE MOB
STATUS CODE.
C.  ONLY WHEN A MARINE IS HELD BEYOND THE ORIGINAL TERMINATION DATE
OF HIS/HER ORDERS (EAS/ECC) WILL THE COFGM ENTRY BE REPORTED ON THE
UNIT DIARY.
5.  MARINES HAVING INCURRED OR AGGRAVATED A MEDICAL CONDITION WHILE
ACTIVATED MAY ELECT DEACTIVATION, UPON REACHING THEIR EAS/ECC.
IMMEDIATELY FOLLOWING THE MARINE'S DEACTIVATION, THE COMMAND (CG
MOBCOM FOR IRR/IMA AND RTC FOR SMCR) WILL SUBMIT THE MARINE'S
REQUEST FOR NOE BENEFITS, THROUGH THE MARINE CORPS MEDICAL
ENTITLEMENTS DETERMINATION SYSTEM (MCMEDS), FOR FOLLOW-ON CARE IF
NECESSARY.  TO INSURE CONTINUITY OF CARE, IT IS IMPERATIVE THAT THE
DEPLOYMENT PROCESSING CENTER (DPC) COORDINATE CLOSELY WITH THE
MOBILIZATION COMMAND (MOBCOM) FOR IRR AND IMA MARINES AND RESERVE
TRAINING CENTER (RTC) COORDINATE CLOSELY FOR SMCR MARINES WHEN AN
ACTIVATED MARINE IS RECOMMENDED FOR DRILLING NOE BENEFITS.  TIMELY
REPORTING OF UNIT DIARY ENTRIES AND IMMEDIATE SUBMISSION OF NOE
REQUESTS IN MCMEDS IS IMPERATIVE.  ADDITIONALY, THE MARINE CAN APPLY
FOR TRICARE COVERAGE OFFERED UNDER THE TRANSITIONAL ASSISTANCE
MEDICAL PROGRAM (TAMP).  TAMP BENEFITS HAVE BEEN INCREASED TO 180
DAYS FOR THOSE MARINES ACTIVATED IN SUPPORT OF A CONTINGENCY
OPERATION.  THE PERIOD OF COVERAGE BEGINS ON THE MARINE'S
DEACTIVATION DATE.  UNLESS EXTENDED BY LAW, THE PERIOD FOR
TRANSITIONAL HEALTH CARE BENEFITS WILL REVERT BACK TO THE STANDARD
60 OR 120 DAYS BEGINNING ON 1 JAN 2005.
6.  EXTENSION OF IRR/IMA MARINES.
A.  TO REQUEST AN EXTENSION OF AN IRR/IMA MARINES ORDERS FOR THE
PURPOSES OF MED HOLD, THE LIMITED DUTY COORDINATOR AT THE GFC, MUST
SUBMIT A COMPLETED "SMO BUPERS MEDICAL EXTENSION CHECKLIST" AND FAX
IT TO SMO BUPERS AT (202) 762-3490, ENSURING THE MARINE SIGNS THE
PRIVACY ACT STATEMENT.  SMO BUPERS WILL MAKE A RECOMMENDATION BASED
UPON THE MEDICAL EVALUATION OF THE MARINE.  BASED ON THIS GUIDANCE,
CMC (MPP-60) WILL PROCESS THE RECOMMENDATION.
B.  TO REQUEST AN EXTENSION FOR SMCR PERSONNEL FOR THE PURPOSES OF
MED HOLD, THE GFC (FOR MARINES ATTACHED TO THE GFC) OR RTC (FOR
MARINES AT THE RTC) MUST SUBMIT A COMPLETED "SMO BUPERS MEDICAL
EXTENSION CHECKLIST" AND FAX IT TO SMO BUPERS AT (202) 762-3490,
ENSURING THE MARINE SIGNS THE PRIVACY ACT STATEMENT.  SMO BUPERS
WILL MAKE A RECOMMENDATION BASED UPON THE MEDICAL EVALUATION OF THE
MARINE.  BASED UPON THE SMO'S RECOMMENDATION, ORDERS MODIFICATIONS
FOR MED HOLD PURPOSES WILL BE COORDINATED BETWEEN THE GFC AND THE
PARENT SMCR UNIT ORIGINALLY INITIATING THE ACTIVATION ORDERS.
EXTENSIONS ARE REQUIRED TO ENSURE THAT THE MARINE'S ENTITLEMENTS
REMAIN IN EFFECT.  SMCR UNITS OBTAIN A COPY OF THE "SMO BUPERS
MEDICAL EXTENSION CHECKLIST" DIRECTLY FROM SMO BUPERS.
C.  BUPERS IS THE SOLE AUTHORITY FOR GRANTING EXTENSIONS (SEE REF C)
FOR MED HOLD PURPOSES.
D.  UPON THE RECOMMENDATION OF SMO BUPERS TO EXTEND THE MARINE, THE
MARINE MUST SIGN THE FOLLOWING PG 11 ENTRY: "(DATE), I AGREE TO
REMAIN ON ACTIVE DUTY BEYOND MY EAS/ECC IN A MEDICAL HOLD STATUS TO
RECEIVE CARE FOR AN INJURY/ILLNESS I INCURRED/AGGRAVATED WHILE ON
ACTIVE DUTY" PER REF C.  THE MARINE WILL BE COUNSELED PER REF E.
THE MARINE'S MEDICAL CONDITION MUST BE FULLY DOCUMENTED IN HIS OR
HER MEDICAL RECORD PRIOR TO RELEASE FROM ACTIVE DUTY.  MARINES MAY
REQUEST AN EXTENSION FROM THE CAREER MANAGEMENT TEAM (CMT) AT
RESERVE AFFAIRS TO BE PLACED ON MEDICAL HOLD BEYOND THE EAS/ECC.
7.  IF THE PHYSICIAN RECOMMENDS ASSIGNMENT TO LIGHT DUTY AND THE
COMMAND CONCURS, THE PHYSICIAN MAY SUBSEQUENTLY RETURN THE MARINE TO
FULL DUTY AT ANY TIME WHILE ASSIGNED TO LIGHT DUTY; OR DETERMINE
THAT THE SITUATION HAS NOT IMPROVED; OR HAS BEEN AGGRAVATED; AND,
THAT A MEB IS REQUIRED FOR EITHER TLD OR REFERRAL TO THE PEB FOR
FITNESS FOR DUTY DETERMINATION.  IF, AT ANY TIME DURING THE PROCESS,
THE PHYSICIAN DETERMINES THAT A MEB IS REQUIRED, ONE WILL BE
INITIATED.  THE SMO BUPERS MUST BE CONTACTED TO RENDER A
DISPOSITION.  SUBMIT A COMPLETED "SMO BUMED EXTENSION REQUEST
CHECKLIST AS DIRECTED ABOVE.  OFFICIAL FINDINGS OF THE MEB PROCESS
ARE LISTED BELOW:
A.  RETURN MARINE TO FULL DUTY.
B.  RECOMMEND A PERIOD OF TLD.
C.  FORWARD TO PEB.
8.  THE MTF IS AUTHORIZED TO APPROVE UP TO AN INITIAL 8 MONTHS OF
TLD FOR ENLISTED MARINES ONLY, BASED UPON THE EVALUATION OF THE
INFORMATION SUBMITTED TO SMO BUPERS.  MEBS THAT RECOMMEND SUBSEQUENT
PERIODS OF TLD, OR INITIAL PERIODS OF TLD GREATER THAN 8 MONTHS FOR
ENLISTED MARINES MUST BE FORWARDED TO SMO BUPERS.  IN ALL CASES, A
MEB MUST BE COMPLETED OR THE SNM STATUS MUST BE REVIEWED BY THE SMO
BUPERS IF A MARINE IS NOT IN A FULL DUTY STATUS FOR A PERIOD OF 60
OR MORE CONSECUTIVE DAYS.  UNDER NO CIRCUMSTANCES WILL A MARINE BE
REMOVED FROM A FULL DUTY STATUS IN EXCESS OF 60 DAYS WITHOUT
COMPLETING A MEB.  THESE 60 DAYS INCLUDE LIGHT DUTY FOR 30 DAYS AND
30 DAYS FOR THE MTF TO COMPLETE A MEB.
9.  UPON REVIEW OF A MEB, THE SMO BUPERS AND CMC (MPP-60) OR
MARFORRES MAY:
A.  APPROVE A PERIOD OF TLD, OR
B.  ENDORSE AND FORWARD THE MEB TO THE PEB FOR A DETERMINATION OF
FITNESS FOR CONTINUED NAVAL SERVICE.
10.  WHEN A MEB IS FORWARDED TO THE PEB, THE PEB WILL EITHER FIND
THAT THE MARINE IS:
A.  FIT FOR CONTINUED NAVAL SERVICE, OR
B.  UNFIT FOR DUTY WITH A RATABLE DISABILITY.  LESS THAN 30 PERCENT
DISABILITY RATING WITH LESS THAN 20 YEARS ACTIVE SERVICE RESULTS IN
A MEDICAL DISCHARGE WITH DISABILITY SEVERANCE PAY.  A DISABILITY
RATING OF 30 PERCENT OR MORE RESULTS IN A MEDICAL RETIREMENT
(TEMPORARY OR PERMANENT) (SEE REF E).
C.  UNFIT FOR DUTY, BUT NOT RATABLE WITH A DISABILITY PERCENTAGE
RATING BECAUSE THE PHYSICAL DISABILITY WAS FOUND TO BE THE RESULT OF
INTENTIONAL MISCONDUCT, WILLFUL NEGLECT, INCURRED DURING AN
UNAUTHORIZED ABSENCE, OR WAS A CONDITION THAT EXISTED PRIOR TO
SERVICE (EPTS).
11.  ONCE THE DISABILITY PROCESS IS INITATED, INCLUDING THE
COMPLETION OF AUTHORIZED HEARINGS AND PETITIONS FOR RELIEF, THE
MARINE IS:
A.  RETURNED TO FULL DUTY,
B.  SEPARATED/RETIRED, OR
C.  AUTHORIZED A PERIOD OF PERMANENT LIMITED DUTY (PLD), PROVIDED
THE CRITERIA ARE MET.
12.  MARINES PROJECTED TO REACH THEIR RESERVE ECC WHILE ON MED
HOLD MUST REQUEST AN EXTENSION VIA THE RELM PROCESS THROUGH THEIR
CAREER RETENTION SPECIALIST.  REQUESTS WILL BE SUBMITTED IAW PAR
5303.1A OF REF F.  REQUESTS WILL BE SUBMITTED NO EARLIER THAN 3
MONTHS PRIOR TO THE MARINES RESERVE EXPIRATION OF CURRENT CONTRACT
(RECC).
13.  MARINES ON LIGHT DUTY OR TLD MUST MAINTAIN PROPER MILITARY
APPEARANCE AND WEIGHT STANDARDS PER THE CURRENT EDITION OF REF G.
14.  INDIVIDUAL AUGMENTEE (IA) MARINES MAY BE TRANSFERRED TO THE DPC
CLOSEST TO THEIR HOME IF IT IS WITHIN COMMUTING DISTANCE OF A MTF
CAPABLE OF PROVIDING THE REQUIRED TREATMENT.  THE DECISION TO
TRANSFER A MARINE WILL BE MADE BY THE SMO BUPERS AND CMC (MPP-60)
AND COORDINATED WITH THE GFC AND DPC.  SMCR MARINES CAN BE RELEASED
BY THE GFC MTF AND RETURNED TO THE RTC.  THE SMCR MARINE MAY THEN
REQUEST NOE BENEFITS ONCE RETURNED TO THE RTC.
15.  ALL COMMANDS (GFC'S AS WELL AS RTC'S) ARE REQUIRED TO ASSIGN A
LIMITED DUTY COOORDINATOR (LDC).  LDC'S ARE ESSENTIAL TO A
COMMANDER'S ABILITY TO TRACK AND MANAGE MARINES WITH MEDICAL ISSUES
AND ALSO PROVIDE A KNOWLEDGEABLE LIAISON BETWEEN MARINE UNITS AND
NAVY MEDICAL CARE.  EACH UNIT SHOULD IDENTIFY AND EMPLOY A QUALIFIED
NCO OR SNCO TO OVERSEE THIS IMPORTANT COLLATERAL DUTY.  RESULTS OF
PAST INSPECTOR GENERAL (IG) INSPECTIONS IDENTIFY A COMPELLING NEED
TO ESTABLISH A LDC AT THE BATTALION/SQUADRON LEVEL.  REQUIREMENTS OF
THIS COLLATERAL ASSIGNMENT WOULD INCLUDE THE IDENTIFICATION,
TRACKING, AND PROPER ADMINISTRATION OF LIGHT DUTY, LIMITED DUTY, AND
DISABILITY EVALUATION PROCESSING, PER REF C AND IN CHAP 8 OF REF D.
CMC (MPP-60) EXPECTS COMMANDS TO TRACK AND MANAGE THEIR PERSONNEL.
CMC (MPP-60) WILL REVIEW THE INTEGRITY OF REPORTS SUBMITTED BY
COMMANDS.  THE MOST COMMON DEFICIENCIES IDENTIFIED WITH TRACKING AND
MANAGEMENT OF ACTIVATED MARINES INCLUDE:
A.  MARINES NOT IN A FULL DUTY STATUS FOR PERIODS IN EXCESS OF 24
MONTHS WITHOUT REQUIRED MEB DOCUMENTATION;
B.  MARINES INAPPROPRIATELY HELD IN A COFGM STATUS FOR MONTHS
WITHOUT REQUIRED MEB'S;
C.  MARINES SENT HOME AWAITING FINAL PEB DISPOSITION, PER CHAP 8 OF
REF D, WITHOUT PROPER AUTHORITY OR ACCOUNTABILITY; AND,
D.  MARINES CONTINUING TO RECEIVE PAY AND BENEFITS WHILE HOME
AWAITING RESULTS OF PEB WITHOUT PROPER AUTHORIZATION OR
ACCOUNTABILITY.