Col Robert Desko The purpose of the LOD is to determine if the condition was incurred or aggravated during current military service. This includes the who, what, when ,where and why. LOD determinations can impact ANG members’ entitlements and benefits. It is imperative LODs are accomplished within established timeframes and AFI 36-2910 to alleviate any possible delays. LODs cannot be re-used to claim additional benefits or entitlements once the member has been returned to duty. If a re-aggravation of the medical condition happened in a duty status, then a new LOD must be initiated. If the re-aggravation of the condition did not happen on a duty status, the member is not entitled to a new LOD or entitled to MEDCON or INCAP. The member may receive their care and treatment at the VA. AFI 36-2910 is the Line of Duty Determination Regulation. It is important to read and understand this AFI. › This AFI is under re-write. We hope that it will be “on the street” in October 2013. There will be MAJOR changes to the LOD form and process once the new regulation comes out. More to follow in the future….. Not every condition disclosed on a military status is “In the Line of Duty”. IAW AFI 36-2910 para 3.4.1. Existed Prior to Service (EPTS). The military medical officer must determine whether the illness, injury, or disease or the underlying condition causing it, existed prior to the period of service in which the member exhibited symptoms. › 18.104.22.168. A clear distinction between the symptoms and the actual medical condition causing the symptoms is crucial in making an EPTS determination. An LOD determination is based upon the onset of the disease, illness or injury process, not the existence of symptoms. EPTS conditions include chronic disease, illnesses, injuries and illnesses or disease with an incubation period that would rule out a finding that they were incurred during periods of active duty (AD), active duty for training (ADT), or IDT. IAW DoDI 1332.38 E3.P4.5.4. Conditions Presumed to be Pre-Existing. Occurrence of disease as described in paragraphs E3.P22.214.171.124. and E3.P126.96.36.199., below, shall be presumed to have existed prior to entry into Military Service. › E3.P188.8.131.52. Signs or symptoms of chronic disease identified so soon after the day of entry on Military Service (usually within 180 days) that the disease could not have originated in that short a period will be accepted as proof that the disease manifested prior to entrance into active Military Service. › E3.P184.108.40.206. Signs or symptoms of communicable disease within less than the medically recognized minimum incubation period after entry on active Service will be accepted as evidence that the disease existed prior to Military Service. Per SAF/MR policy dated 21 April 2010: › Informal LODs will be finalized within 50 days from initiation to include NGB process. › Formal LODs will be finalized with 70 days from initiation to include NGB process. There are three types of LODs. 1. Administrative 2. Informal 3. Formal Members must be on a military status to qualify for an LOD determination. This includes travel directly to and from the place where member performs duty (or UTA) and/or remaining overnight between those periods of service. An administrative LOD is accomplished on an SF600 for the following situations: Minor injuries such as a sprain, contusion or minor fracture. If a member, who has had prior service in another branch of the military, who incur an injury, illness or disease during their service to that branch only require an administrative LOD unless the condition is aggravated by their current service. If there is no likelihood of permanent disability, hospitalization, continuing medical treatment or the need for MEDCON/INCAP. The medical provider makes an administrative determination by finding the member’s condition to be “In the Line of Duty” (ILOD) and noting this with an entry in the member’s medical record. No further action is required. An informal LOD will be accomplished on an AF 348 when the administrative process is not appropriate. The list below are some examples of when an informal LOD must be accomplished. This list is not inclusive: • All death cases • Any injury resulting from misconduct and/or neglect. • Any unauthorized absences. • When a request for INCAP or MEDCON is applicable. • Requires hospitalization (except pregnancy) • Any “questionable circumstances” • Self-inflicted injury, suicide attempt • Injury involving alcohol and /or drugs • Requires medical care or treatment beyond period of duty during which the injury, illness incurred or aggravated. Some informal LODs REQUIRE finalization from NGB. These cases include, but are not limited to: • All Death cases • All Formal LODs • Any LOD with “Questionable Circumstances” that include alcohol or drug related incidents, death, sexual assault. • Any medical condition that involve a disease process (i.e. cancer, cardiac conditions, diabetes, all mental health etc.) • Any LOD condition that Existed Prior to Service (EPTS) with Service Aggravation (SA). • Any LOD due to the member’s misconduct or willful neglect. • Any LOD that the member was absent without authority. Refer to AFI 36-2910 chapter 3 para. 220.127.116.11. FORMAL LOD- The Formal LOD will be initiated on the AF 348. The Formal LOD will be required for all cases listed below: • Cases involving misconduct (to include alcohol/drug related incidents, etc.) members absent without authority and any circumstance the commander believes needs an investigation. • The Formal LOD is initiated on DD Form 261 and is based upon a thorough investigation conducted by a specially appointed Investigating Officer (IO). The IO should be a disinterested officer in the grade of captain or above and senior to the member being investigated. • All Formal LODs must be submitted for finalization to NGB/SG. INTERIM LODS- Interim LODs can be used when a request for MEDCON/INCAP is made. Interim LOD must be signed through immediate commander. Do not make an interim LOD if there is clear and convincing evidence showing an EPTS condition or it appears that misconduct was the proximate cause of the illness, injury or disease. The interim LOD is comprised of the completed medical portion of AF Form 348 which must contain a description of the member’s illness, injury or disease, and the date it occurred. The commander will annotate that the LOD is Interim, along with a preliminary finding of the member’s military status at the time the medical condition occurred and sign block 16. Providers are responsible for filling out sections 1-12 on the AF 348. Some common errors from Medical Providers on the AF 348: Block 6 -indicate injury, illness, disease or death. PTSD, cancer, diabetes or heart disease is not an injury. Ensure this box is filled out correctly. Block 11- annotate specific details regarding the injury, illness, disease or history or disease or death. A separate LOD must be accomplished for each medical condition, unless the multiple conditions are linked to a single event. The next couple of slides have examples of good LODs and bad LODs. What’s wrong with this LOD? No investigation was accomplished. How can SJA and Wing CC concur with this? What's wrong with this LOD? What is going on with this member? How can anyone make a determination with this information? Detailed explanation of condition. The LOD is an important tool in determining if a condition is ILOD or not. Not everyone condition that is disclosed while in a military status is deemed in the line of duty. Details of the circumstances are essential in making determinations. LOD determinations will greatly impact a member’s benefits and entitlements.