Limited Duty explained
a. Light Duty. Presumes frequent provider/patient interaction to determine whether return to full duty status or more intensive therapeutic intervention is appropriate in any given case; therefore, light duty will be ordered in periods not to exceed 30 days to ensure appropriate patient clinical oversight. Consecutive light duty for any “new condition” up to 90 days may be ordered by the provider (in maximum 30-day periods), but in no case will light duty exceed 90 consecutive days, inclusive of any convalescent leave periods.
b. Limited Duty (LIMDU). The assignment of a member in a duty status for a specified time, following a medical board action, with certain medical limitations/restrictions concerning the duties the member may perform. LIMDU is divided into two separate categories as follows:
(1) Temporary Limited Duty (TLD). A member is assigned in a TLD status when a medical officer expects the member to be able to return to duty (RTD) in a reasonable period of time. TLD is authorized locally, and may not exceed 364 days of non-deployability, by the convening authority (CA) responsible for the military treatment facility (MTF) initiating TLD. The maximum total TLD authorized is 12 months unless otherwise approved by NAVPERSCOM (PERS-454).
(2) Permanent Limited Duty (PLD) Assignment authorized by NAVPERSCOM (PERS454) to be in a PLD status to complete 20 years active service day-for-day, or remain on active duty until a specific date. Only members who have been found “unfit for continued Naval Service” by the Physical Evaluation Board (PEB) may request PLD. Members approved for PLD will be placed in ACC 105 status with a projected rotation date (PRD) that corresponds with the approved PLD date. Once placed in a PLD status, the member may remain at the current command or be assigned to a valid billet per manning control authority (MCA) priorities based on needs of the Navy. Assignment will be made to an area where the required medical care is available and shall remain in that area for the remainder of the member’s Naval Service.
c. Deployability Coordinator. Every command and MTF servicing a LIMDU population is required to appoint, in writing, a point of contact (POC) to act as the command Deployability coordinator. Close liaison between parent command and medical Deployability coordinators is critical to ensure accurate accounting, tracking, medical treatment, and expeditious movement of LIMDU personnel through the transient pipeline. Deployability coordinators shall not be in a TLD status.
d. Assignment Screening. A short concise medical screening to specifically review a member’s medical condition, and determine if a member is worldwide assignable (WWA).
e. Operational Screening (Sea Duty Screening). Screening completed when member is in receipt of PCS orders to an operational command (Type Duty Code “2” or “4”). Per OPNAVINST 1300.20 every active duty health care encounter should be utilized to annotate duty status, and if not fit for duty must result in a Medical Evaluation Board (MEB) referral (LIMDU, CND, DES).
f. Abbreviated Medical Evaluation Board Report (AMEBR) NAVMED 6100/5. A brief summary of the members medical condition limitations, and expected RTD date used to place a member on TLD.
g. Electronic Medical Evaluation Board Report (EMEBR) NAVMED 6100/50. As opposed to the AMEBR, this detailed summary of the member’s medical condition(s) is dictated by the attending physician and is used to refer a service member into the Disability Evaluation System (DES) for a fitness determination by the Physical Evaluation Board (PEB).
h. Return to Duty (RTD). At any time during a case of LIMDU, upon determination that the member’s medical condition has been resolved, the member may be returned to duty (RTD) NAVMED 6100/6 from the TLD status by the cognizant MTF.
i. For specific questions, please contact NHB/NMRTC Bremerton Patient Administration Dept., Medical Deployability Coordinator: 360-475-4896/4649.
Navy Medicine makes significant changes to LIMDU process
(DVIDS Dec. 17, 2020)
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.
Capt. Alaric Franzos, director for Force Medical Readiness, said that this analysis was telling. It's unlikely Sailors and Marines returned to duty light 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
"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 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.”
Adding to the standard described above, Navy Medicine Readiness Training Command Bremerton affirms the referred information is value added for al tenant commands in the nation’s third largest fleet concentration.
“With more cases of active duty personnel being sent into the network for timely medical appointments, duty limiting recommendations of any kind from civilian network providers should be routed through primary military medicine for concurrence and appropriateness in alignment with DOD policies to ensure command leadership receives recommendations specific to military regulations,” stated April C. Dinucci, NMRTC Bremerton Medical Board supervisor.