How do I get access to E-profile as a provider at Walter Reed?

1. Log into Joint Knowledge Online (JKO)
2. Search for the Medical Readiness Healthcare Portal Training
   • Course number DHA-US298
   • Time requirement: 2hrs.
3. Request access to the Medical Readiness Health Care Portal via the MODS User Management website.
   • This is on Page 8 of user guide.
4. Select the "Medical Readiness Health Care Portal" for Program Selection. NOT E-PROFILE.
5. Select Provider-Physician for user Role Selection
6. Add comment about your duties for Access Reason
7. Under Role Property Assignment Selection: Click Active Duty-> RHC ATLANTIC (RHCA)-> Bethesda-PDMIS
8. Request access to the system from Mr. Donnie Nieves (Office: 301-295-2666) by emailing your 1) Full Name and 2) DOD ID to Donnie.nieves.ctr@mail.mil.

How do I actually place an E-profile?

Watch this tutorial: https://youtu.be/V28UXnXisdM Courtesy of Dr. Rohul Amin!

What is the Army E-Profile system?

US Army’s electronic system for documentation of medical or psychiatric diagnoses, duty limitations, deployability and medical readiness. Providers communicate their recommendations regarding duty limitations to the Commanding Officer (CO). Commands will generally follow a provider's recommendation, however, the CO has the final authority to make the final decision regarding duty limitations.

What guidelines do I follow to place an E-profile?

Army Regulations

• AR 40-501 Ch. 3-33 (Behavioral Health)
• AR 40-502

What are the different types of E-profiles?

• Temporary: limitations up to 12 months, with 30-90 days being the most common
• Permanent: limitations lasting more than 12 months.
  • Requires two provider signatures.
  • Profiles affect deployability. A permanent profile may require a referral to the medical board or an administrative separation (more details in the medical board and administrative separation tabs).

When should I consider if a Service Member needs an E-Profile?

At every behavioral health encounter! Consider placing a profile for:

• Initating new psychiatric medications
• Changing doses of psychiatric medications
• Psychiatric hospitalization

Who needs access to E-Profile?

Every behavioral health provider! If you are seeing patients for mental health concerns, you need access.

How do I log on to the E-profile website?

1) Log in directly via https://medpros.mods.army.mil/portal/#/ or 2) Log in with AHLTA:

• Go to the tabs on the left side of the screen
• Select "Army Readiness" > "eProfile"

What are some examples of appropriate limitations?

• "No deployment to an austere environment"
• "Requires 8 consecutive hours of sleep in a 24 hour period"
• "No alcohol"
• "No weapons/ammunition"
• “SM should remain near an MTF where definitive specialty care is available"

What are some examples of inappropriate limitations?

• "No 24 hour duty indefinitely"
• "No rotating shifts”
• "No formations"
• "No uniforms"
• "SM can only work from 0900-1700 hours"
• "SM cannot present to work until 1000 hours"

What is the Army Medical Evaluation Board (MEB)?

A panel of at least two physicians who review Service member's cases to determine the impact of medical conditions on a Service member's ability to perform the duties of his or her office, grade, rank, or rating. The Board consists of a minimum of two or more physicians trained in the Disability Evaluation System (DES). If the board is related to a psychiatric condition, one physician must be a psychiatrist.

Where do the MEB guidelines come from?

Army Regulations:

• AR 40-501 Chapter 3-33
• MEDCOM Policy 19-001

How does a Service member get placed into the MEB process?

A referral by you (a DoD provider)!

If a Service Member enters into the MEB, does this mean they will be discharged from the military?

No. Simply being entered into the MEB process does NOT necessarily mean that a soldier will be discharged from the Army. Service members may be found fit for duty and subsequently returned to duty.

What happens if the MEB decides that the Service member does NOT meet retention standards and/or will be unable to return to duty within one year?

The Soldier will be referred to the Physical Evaluation Board (PEB).

What happens if the MEB decides that the service member DOES meet retention standards & will be able to return to duty within one year?

The soldier will be returned to full duty.

What if the Service member disagrees with the decision made by the MEB?

The Soldier may accept or appeal the MEB's assessment. They may also ask for an independent medical review.

When should I consider placing a Service member into the MEB process?

DoD medical providers MUST refer Service members who have at least one of the following:

• One or more medical conditions that may, individually or collectively, prevent the Service member from reasonably performing the duties of their office, grade, rank, or rating, including those duties remaining on a Reserve obligation for more than one year after diagnosis
• A medical condition that presents an obvious medical risk fo the health of the member or to the health/safety of other members
• A medical condition that imposes unreasonable requirements on the military to maintain or protect the Service member and/or other members.

If a soldier is unable to complete their duty due to a behavioral health condition and their behavioral health condition is eligible per the AR & MEDCOM guidelines then a referral to the MEB is appropriate.

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Where can I learn more about the MEB process?

Complete these JKO trainings: a. DHA-US021: Referral of SM into the DES b. DHA-US022: Documentation of the MEB Results c. DHA-US024: Evaluation of Disability Cases All behavioral health providers should complete these three JKO trainings to become more familiar with the process and to ensure that it is followed correctly. Another source includes this AMSUS presentation by Dr. Rohul Amin and Dr. Lee Hirt: https://youtu.be/p7smEXq5sHo

How do I make a referral to the MEB at Walter Reed?

Place a PERMANENT E-Profile (see E-profile tab for more details). If a patient already has a temporary E-profile, you may convert the temporary E-profile to a permanent E-profile.

What are the basic steps of the Disability Evaluation System (DES) process?

1. Referral
2. VA Claim Development and Disability Examinations
3. Medical Evaluation Board (MEB)
4. Physical Evaluation Board (PEB)
5. VA Rating
6. Appeals
7. Final Disposition

What is ADSEP?

ADSEP stands for Administrative Separation. It is the process of separation from the military for enlisted Army soldiers who do not conform to required standards of conduct, discipline, and performance despite efforts to counsel, retrain, and rehabilitate.

Where do the ADSEP guidelines come from?

AR 635-200: General guidance on ADSEP procedures MEDCOM Policies 19-001 Army ADSEP / DA FORM 3822 guidance for behavioral health providers.

When should I consider placing a Service member into the ADSEP process?

When - Service member has a behavioral health condition that interferes with performance of military duties & - the Behavioral health condition is eligible for ADSEP (per MEDCOM Policy 19-001) & - the Soldier has poor prognosis of recovery & has had ample opportunity for treatment to overcome their symptoms.

How do I make a referral for ADSEP?

1) Inform Commander of diagnosis, poor prognosis and recommendation for ADSEP IF THE COMMANDER AGREES, BH Prodiver will: 2) Inform soldier (explain ADSEP process, perform risk assessment) 3) Use DA Form 3822 & select appropriate chapter based on diagnosis 4) Submit BHAR packet and inform BHAR reviewer of case 3) Provide a copy of DA Form 3822 to the Commander.

What behavioral health conditions qualify for ADSEP?

If a service member enters the ADSEP process, does this mean they will be discharged from the Army?

Not necessarily. BHAR will use the information from the DA Form 3822 to make final decision regarding Soldier’s future military outcome.

If a service member is discharged from the Army via the ADSEP process, does this mean they will receive a dishonorable discharge?

No. In fact, most behavioral health ADSEPs are generally “honorable” unless misconduct is also present.

Who can fill out and complete a DA Form 3822?

a)Psychiatrist b)Clinical Psychologist c)Licensed Clinical Social Workers d)Psychiatric Advanced Practice Registered Nurses e)Trainees (i.e. Psychiatry residents, psychology externs) •The trainee’s supervisor must endorse the plan (i.e. “agree with diagnosis and plan”), cosign AHLTA note, and cosign DA FORM 3822.

What should be included in an ADSEP evaluation?

Records review (i.e. AHLTA and HAIMS) Clinical interview (within 3 months of recommending ADSEP) PLUS Review of required screenings for: - PTSD, - TBI (provider can refer positive screens to physician/TBI service) - Depressive disorder - Sexual assault (that occurred during military service), and - any other Behavioral Health condition requiring a MEB referral.

What screening tools need to be used in the ADSEP packet process?

As BHDP is linked to the BHAR website, screening for PTSD, TBI & Depressive disorder are automatically uploaded into BHAR. However, sexual assault screening is not linked to the BHDP website and there is a three-question screener found in MEDCOM Policy 19-001 that must be asked & then uploaded into BHDP separately.

What if the service member’s sexual assault screen is positive?

Indicate if in your clinical opinion, “the alleged assault(s) impact(s) the Soldier’s BH condition and/or otherwise contributes to the administrative separation.” If the alleged assault was reported to SHARP, indicate if the report was restricted or unrestricted.

Does a positive sexual assault screen prevent the ADSEP process from occurring?

The presence of a sexual assault incident does not prohibit ADSEP if the incident has not resulted in a BH condition warranting MEB referral (such as PTSD). The BH provider needs to determine if a sexual assault is a significant contributing factor to the reason for separation.

What if the service member has a documented case of TBI, depressive disorder, or behavioral health condition within the past 24 months?

The Service member must be evaluated and their prior BH condition must be documented as either “Not currently active (in remission)” or “Currently active but meeting AR 40-501 retention standards.” EXCEPT for “Service-related PTSD” (see below)

What if the Service member has a documented case of service-related PTSD?

If service-related PTSD is ever diagnosed, behavioral health providers can NOT recommend ADSEP for any behavioral health condition until after IDES finds the Soldier Fit for Duty.
These Service members must be referred to the MEB first, and only if they are found fit for duty can they be reevaluated for possible ADSEP.

Where can I learn more about the ADSEP process?

See the previously mentioned ADSEP guidelines & this additional resource.

What is the Navy LIMDU SMART system?

US Navy’s electronic system for documentation and tracking of medical or psychiatric diagnoses, duty limitations, deployability of US Navy (USN) and US Marine Corps (USMC) Service members placed on temporary Limited Duty (LIMDU).The system will track medical status to include treatment recommendations, progress, and previous periods of limited duty.

How is LIMDU SMART used?

Providers are able to enter a service member in LIMDU SMART and complete an abbreviated Limited Duty Medical Report (NAVMED 6100/5). This form will be routed to a senior provider and the Convening Authority (CA) for authorization of the temporary limited duty (TLD) period.

Where do the LIMDU guidelines come from?

Manual of the Medical Department:

• MANMED, NAVMED P-117, Chapter 18

What is a LIMDU period?

• A documented period of medically restricted duty that allows for treatment aimed at a RTFD (return to full duty).

When should you consider if someone may need a LIMDU?

Every behavioral health encounter should merit consideration of whether or not a LIMDU is needed, but NOT every encounter will need one. Some of these factors include the service member’s rate/MOS, changes to psychiatric medication, and psychiatric hospitalization.

Who needs access to LIMDU?

Unlike the Army E-Profile, LIMDUs can only be signed by psychologists and psychiatrists. Psychologists can be the first signature on LIMDUs, but second and third signatures are by physicians (unless the psychologist is designated as the Convening Authority).

How do you get access to LIMDU at Walter Reed?

1. Complete training certifications
   • Log into WRB Relias
   • Click the “Assignments” tab on the left hand side of the screen
   • Click "Browse Elective Courses"
   • Search “LIMDU SMART”
   • Select and enroll in “LIMDU SMART Provider Training Module- Signature Authority: NMETC-16-LIMDU PRO Sign-1.0”
     • 13 minute video that covers all the basics
     • Complete the post-test attesting that you watched the video
2. Email Mrs. Beverly Mitchell at Beverly.H.Mitchell.ctr@mail.mil (Office number: 301-400-0236) the following information to receive access to LIMDU SMART:
   • Full Name/DOD ID
   • Discipline: Psychiatry
   • Mil Email
   • Attached the completed training from WRB Relias

How do you place a LIMDU?

1. Log onto LIMDU at https://edq.med.navy.mil/LIMDU
   • Use your email certificate on your CAC.
   • A full provider user guide is available in LIMDU SMART.
2. Search for your patient – to access a service member’s profile, select the service member’s name from the search results.
3. If a profile does not appear, please verify that all information was entered correctly.
   • If the service member is NOT in LIMDU SMART, select “Enter New LIMDU Personnel” and a blank 6100/5 Form will populate
   • If the service member is in LIMDU SMART, select the service member’s name from the search results. The service member’s profile will populate. Select the “6100/5” button on the bottom left to populate the form.
4. Complete 6100/5 Form.
5. After filling out the 6100/5 Form – route and sign the form to finalize.
   • Select MTF
   • Select clinic
   • Select MEB member to obtain signature
   • Select “sign form” button and “submit” button. The “Form Successfully Signed!” icon will appear to confirm that the form has been successfully signed and the provider will receive the “Sign 6100/5” alert

What are some examples of appropriate duty limitations on a behavioral health LIMDU?

• "No deployment to an austere environment"
• "Requires 8 consecutive hours of sleep in a 24 hour period"
• "No alcohol"
• "No weapons/ammunition"
• “SM should remain near an MTF where definitive specialty care is available"

What are some examples of INAPPROPRIATE limitations on a LIMDU?

• "No 24 hour duty indefinitely"
• "No rotating shifts”
• "No formations"
• "No uniforms"
• "SM can only work from 0900-1700 hours"
• "SM cannot present to work until 1000 hours"

Should a LIMDU period affect a security clearance?

This should be decided on a case-by-case basis and will be determined based on the patient’s reliability, judgment, and severity of condition.

How do I log onto the LIMDU website?

1. Log onto LIMDU SMART at https://edq.med.navy.mil/LIMDU
2. Use your email certificate on your CAC

When do LIMDU periods expire?

LIMDUs do not simply expire. A service member must be returned to full duty by completing a 6100/6 form and a 1300/3 form. This is also performed in the LIMDU SMART website.

How do I get more help with LIMDU?

1. LIMDU SMART helpdesk (very helpful)
   • 703-273-7216
   • LIMDUSMARTHelpDesk@ucs-inc.com
2. Walter Reed LIMDU Coordinators
   • Ms. Beverly Mitchell - beverly.h.mitchell.ctr@mail.mil
   • Ms. Ronet Staley - ronet.staley.ctr@mail.mil
3. CDR Barbara Delsesto
   • Barbara.s.delsesto.mil@mail.mil

What is Light Duty (LD)?

A period when the member reports to work, but the member is excused from performance of certain aspects of military duties – the goal of Light Duty is to allow for appropriate clinical evaluation without causing further administrative actions to the patient during evaluation period.

When should a Sailor or Marine be placed on Light Duty?

Examples of when to place a service member on LD include but is not limited to:

• New diagnosis
• Starting new medications
• Adjusting medications
• Transition from higher levels of care (residential treatment, inpatient hospitalization, partial hospitalization, intensive outpatient, and ED)

How long should Light Duty last?

Up to 30 days. Max: THREE consecutive light duty chits up to 90 days. A period of >90 days or >3 consecutive light duties will require a LIMDU placement or referral to IDES for a medical evaluation board (MEB).

How is Light Duty documented?

Complete NAVMED 6310/1, Individual Sick Slip form

• Clearly annotate restrictions and limitations on member’s duty
• Include time period required in light duty status (up to 30 days)
• Place the form in service member’s health record and copies are provided to the member to deliver to parent command

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What are some examples of appropriate limitations for Light Duty?

• "No deployment to an austere environment"
• "Requires 8 consecutive hours of sleep in a 24 hour period"
• "No alcohol"
• "No weapons/ammunition"
• “SM should remain near an MTF where definitive specialty care is available"

What are some examples of INAPPROPRIATE limitations for Light Duty?

• "No 24 hour duty indefinitely"
• "No rotating shifts”
• "No formations"
• "No uniforms"
• "SM can only work from 0900-1700 hours"
• "SM cannot present to work until 1000 hours"

What is the Navy Medical Evaluation Board (MEB)?

The Navy MEB is a board of DoD medical providers that determine if a Sailor who has been referred to the Disability Evaluation System (DES) meets Navy-specific medical retention standards and is able to return to full military duties within one year of the diagnosis of the condition. The board consists of at least two physicians trained in the DES who review a Service member's case to determine the impact of the Service member's medical conditions on a his/her ability to perform the duties of his or her office, grade, rank, or rating. If the board is related to a psychiatric condition, one physician must be a psychiatrist.

Where do the MEB guidelines come from?

The guidelines related to the Navy MEB can be found in:

• MANMED P117, Chapter 18
• SECNAVINST 1850.4F

How does a service member get placed into the MEB process?

A referral by you (a DoD provider)!

If a Service Member enters into the MEB process, does this mean they will be discharged from the military?

Not at all! Simply being entered into the MEB process does NOT necessarily mean that a Sailor will be discharged from the Navy.

What happens if the MEB decides that the Service member does NOT meet retention standards and/or will be unable to return to duty within one year?

The Sailor will be referred to the Physical Evaluation Board (PEB).

What happens if the MEB decides that the Service member DOES meet retention standards & will be able to return to duty within one year?

The sailor will be returned to full duty.

What if the service member disagrees with the decision made by the MEB?

The Sailor may accept or appeal the MEB's assessment. They may also ask for an independent medical review.

When should I consider placing a Service member into the MEB process?

DoD medical providers MUST refer Service members who have at least one of the following:

• One or more medical conditions that may, individually or collectively, prevent the Service member from reasonably performing the duties of their office, grade, rank, or rating, including those duties remaining on a Reserve obligation for more than one year after diagnosis

Where can I learn more about the MEB process?

Complete these JKO trainings: a. DHA-US021: Referral of SM into the DES b. DHA-US022: Documentation of the MEB Results c. DHA-US024: Evaluation of Disability Cases All behavioral health providers should complete these three JKO trainings to become more familiar with the process and to ensure that it is followed correctly.

How do I make a referral to the MEB at Walter Reed?

• Ensure that a LIMDU has been placed in LIMDU Smart (see LIMDU tab for more details)
• Consult with CDR Delsesto ( Barbara.s.delsesto.mil@mail.mil) for appropriate referral
• Ensure that referral is communicated cleary to the Service member and Service member's command

What kind of report do I have to provide when I refer someone for MEB?

The required documentation for the MEB process includes the NARSUM, or Narrative Summary, which the referring provider will write or help write. Instructions for the NARSUM may be found in SECNAV M-1850.1. Required elements are diagnosis, symptoms experienced by the member, and clarifying diagnostic and testing procedures.

Is there a list of conditions which are NOT appropriate for MEB referral?

Yes. A list of such conditions is listed in SECNAVIST 1850.4F.

What are the basic steps of the Disability Evaluation System (DES)?

1. Referral
2. VA Claim Development and Disability Examinations
3. Medical Evaluation Board (MEB)
4. Physical Evaluation Board (PEB)
5. VA Rating
6. Appeals
7. Final Disposition

What is a Navy Administrative Separation (AdSep) for Conditions Not amounting to a Disability (CnD)?

ADSEP stands for Administrative Separation. It is the process of separation from the military for enlisted Army soldiers who do not meet required standards of conduct, discipline, and performance despite efforts to counsel, retrain, and rehabilitate. AdSep's are also called Conditions Not Amounting to a Disability (CnD) in the Navy, meaning they are not specifically listed as compensable under the Veterans Affairs Schedule for Rating Disabilities (VASRD).

Where do the AdSep/CnD guidelines come from?

MILPERSMAN 1900-120

When should I consider placing a Service Member into the AdSep/CnD process?

When - Service member has a behavioral health condition that interferes with performance of military duties & - the Behavioral health condition is eligible for ADSEP/CnD (per MILPERSMAN 1900-120) & - the Soldier has poor prognosis of recovery & has had ample opportunity for treatment to overcome their symptoms.

How do I go about proceeding with AdSep/CnD?

1) Inform Commander of diagnosis, poor prognosis and recommendation for ADSEP/CND IF THE COMMANDER AGREES, BH Prodiver will: 2) Inform soldier (explain ADSEP process, perform risk assessment) 3) Use LIMDU SMART portal, select CND under your name in upper right, and proceed with submitting a CND form through the portal for the SM. (See LIMDU tab for mroe info on accessing and using LIMDU Smart Portal)

If a SM is discharged from the Navy through the AdSep/CnD process, will it be a dishonorable discharge?

No. In fact, most behavioral health ADSEPs are generally “honorable” unless misconduct is also present.

Who can fill out and submit a CnD on LIMDU Smart

a)Psychiatrist b)Clinical Psychologist c)Licensed Clinical Social Workers d)Psychiatric Advanced Practice Registered Nurses e)Trainees (i.e. Psychiatry residents, psychology externs) •The trainee’s supervisor must endorse the plan (i.e. “agree with diagnosis and plan”), cosign AHLTA note, and cosign CnD Form. A Convening Authority will then be the third signature on the CnD Form, and they will automatically be notified of the need to review and sign it.

How do I gain access to the CnD portal?

The CnD portal is on the LIMDU Smart website. After logging in with your CAC, you can gain initial access by calling the helpline number located in the top left of the webpage and asking for CnD access. This should take no more than a couple minutes. Upon gaining access you can now click on your name in the left, upper middle of the LIMDU Smart page and see a new option on the drop down for CnD.

COMING SOON