Navy Medicine makes significant changes to LIMDU process

Photo By Chief Petty Officer John Grandin | Graphic associated with: Navy Medicine makes significant changes to LIMDU process.  

UNITED STATES

12.17.2020

Story by BUMED PAO 

U.S. Navy Bureau of Medicine and Surgery

In an effort to improve the Readiness of our warfighters, Navy Medicine has made significant changes to the management of Sailors and Marines placed on Temporary Limited Duty (TLD, or LIMDU) to ensure the focus is on recovery.

When a Sailor or Marine is wounded, ill, or injured, they may be placed on LIMDU status to focus on obtaining the care they need to optimize recovery.

Placement on LIMDU results in the Service member being in a non-deployable status until they are capable of returning to duty, or, if treatment has been optimized but they are unable to meet retention standards, triggering a referral to the Disability Evaluation System (DES) or administrative separation for a condition not amounting to a disability (ADSEP CnD).

Two changes are among the most significant.

The first changed the approach to assignment of LIMDU durations away from a fixed duration of 180 days, and allow for durations of LIMDU based on the recommended recovery period for the specific medical condition limiting the Sailor or Marine. The new process is called condition-based duration LIMDU.

The second created a new position called the Medical Evaluation Board Approval Authority (MEBAA) that Navy Medical Training Commands (NMRTCs) . The MEBAA’s role is to provide focused, informed management of Service members referred to LIMDU or DES. Both initiatives are incorporated into an updated Navy Medicine Instruction, signed by the Navy Deputy Surgeon General, which outlines how the new processes are implemented and executed.

“Navy Medicine exists to support the warfighter,” said Rear Admiral Gayle Shaffer, Navy Deputy Surgeon General. “These changes support and enhance our focus to ensure we are getting our Sailors and Marines the care they need quickly and back to full duty without administrative delay.”

Before the change, as a Sailor or Marine approached the expiration of the first 180-day LIMDU period a disposition determination was initiated to return to full duty or recommend another LIMDU period for up to 180 days. Data from previous years had shown that a majority of Sailors and Marines were being taken off of LIMDU right at the 180 day mark with a smaller but second spike at 360 days following a second period of LIMDU.

Captain Alaric Franzos, Director for Force Medical Readiness, said that this analysis was telling. It’s unlikely Sailors and Marines returned to duty right at 180 days was based on actual recovery, but on providers simply setting the LIMDU period to the maximum of 180 days.

Similarly, if a provider knew a Sailor’s or Marine’s recovery would be longer than 180 days, they couldn’t set a realistic recovery period because of the maximum 180 day limit. This required an extra administrative step to review and extend the LIMDU period at the end of the 180 day limit.

The new process is designed to mitigate both of these instances by allowing a provider to set an estimated timeframe for recovery and return to duty that is based on nationally recognized, evidence based clinical guidelines along with specialty leader recommendations and provider experience.

“The standard LIMDU period of 180 days is no more,” said Franzos. “This is a tremendous shift that will require our providers to change the way they do business. We are putting the care team in the driver’s seat by asking them to thoughtfully set the timeframe of every LIMDU order they write.”

The updated instruction still requires the treatment team to make a duty determination no later than 30 days prior to the end of the Service member’s LIMDU period. The treatment team’s decision then goes to a multidisciplinary team, generally at the medical treatment facility level, for review and recommendations. Incorporating input from the treating provider, the multidisciplinary team can recommend continued LIMDU, case management interventions, early return to duty, referral for ADSEP CnD, or referral to the Physical Evaluation Board (PEB), which makes a determination on fitness for continued naval service.

The newly created MEBAA position will be an experienced physician that is dedicated to Medical Evaluation Board (MEB) activities, which a focus on active LIMDU management and appropriate disposition, including return to duty, referral to the DES, or a recommendation for ADSEP CnD. These providers function as the gatekeepers charged with the comprehensive review of MEB referrals as a primary duty. “The codification of the MEBAA as a full time position will give better fidelity on the proper disposition of cases,” said LT Kunal Shah, Branch head for Navy Medicine LIMDU and Disability Evaluation System.

“Prior to this, providers were performing these duties between patients and on a collateral basis, and so accruing experience, continuity and understanding of changing policies was a major challenge. By shifting from collateral duties to this dedicated MEBAA role, we are easily moving towards a high reliability standard in the active management of ill and injured members and increasing the readiness of the warfighters,” said Shah.

As the program continues to evolve, “Training to all of Navy Medicine will be provided, with particular focus on providers including Independent Duty Corpsmen, on how to administer the changes so that the LIMDU program is more agile and continues to meet Department of Defense 7LIMDU goals,“ said CAPT Franzos.

For example, he said that another position currently in development will be a deployability care coordinator that will help ensure service members on LIMDU are getting to their appointments and not meeting resistance in receiving care.

“Warfighting is a physically and mentally demanding set of professions,” said Franzos. “Although our commanders take great efforts to minimize the risk, some sailors and Marines will experience illness and injuries. When that happens, Navy Medicine will aggressively partner with the individual and the command to ensure that the focus is on recovery. We want to get that individual back on the job and back in the fight. In the rare circumstances when they can’t do the job in a deployable status we’ll help affect a smooth transition from the Navy to a new career with strong support from the Department of Veteran’s Affairs.”

• Date Taken: 12.17.2020
• Date Posted: 12.18.2020 13:58
• Story ID: 385224
• Location: US