Transcript ANG PowerPoint slide templates

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.
› 3.4.1.1. 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.P4.5.4.1. and
E3.P4.5.4.2., below, shall be presumed to have existed prior to entry into
Military Service.
› E3.P4.5.4.1. 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.P4.5.4.2. 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. 3.12.1.2.
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.