substantially or materially detrimental to interests of the member:

(a) Would retire the member permanently for physical disability in lieu of being placed on the TDRL;

(b) Would separate the member for physical disability, with or without severance pay, in lieu of temporary or permanent retirement for physical disability;

(c) Would separate the member for physical disability without severance pay, in lieu of separation for physical disability with severance pay;

(d) Would decrease (below 80 percent) the percentage of disability at which the member will be temporarily or permanently retired for physical disability;

(e) Would change a recommendation of "fit for duty" or its equivalent under §§ 725.519-725.525 to a recommendation of "unfit for duty" or its equivalent under §§ 725.519-725.525, unless member or his counsel specifically requested a finding of "unfit for duty";

(f) Would change a recommendation of "unfit for duty" or its equivalent under §§ 725.519-725.525 to a recommendation of "fit for duty" or its equivalent under §§ 725.519-725.525, unless member or his counsel specifically requested a finding of "fit for duty";

(g) Would retire the member temporarily in lieu of permanently;

(h) Would add an EPTE rating or revise an assigned EPTE rating which may affect ultimate benefits;

(i) Would add a diagnosis of a psychiatric nature not mentioned in the medical board report referring member's case to a physical evaluation board.

§ 725.238 Reserve component.

Either the U.S. Naval Reserve or the U.S. Marine Corps Reserve.

§ 725.239 Secretary.

Unless otherwise qualified, refers to the Secretary of the Navy. 10 U.S.C. 101(8)

§ 725.240 Total disability ratings.

Total disability will be considered to exist when the member's impairment is sufficient to render its impossible

for the average person to follow a substantially gainful occupation. Accordingly, in cases in which the VASRD does not provide a 100 percent rating, under the appropriate (or analogous) VA Code, a member may be assigned a disability rating of 100 percent, if his impairment is sufficient to render it impossible for him to follow a substantially gainful occupation.

§ 725.241 Unauthorized absence.

Any absence from duty without authority, such as contemplated under articles 85, 86, and 87 of the Uniform Code of Military Justice (10 U.S.C. chapter 47) or such as was contemplated by the provisions of the Articles for the Government of the Navy, which were in effect prior to 1951. When a disability is incurred at any time during a period of unauthorized absence, regardless of whether the absence interfered with the members' military duties, the member is excluded from receiving benefits under 10 U.S.C. chapter 61.

mand, on the recommendation of the medical officer of the command to which such person is attached. A Medical Board may also be convened by the Chief of Naval Operations, the Commandant of the Marine Corps, the Chief of Naval Personnel, or the Chief, Bureau of Medicine and Surgery.

(b) Individual cases shall be referred to the Board, in such manner as the convening authority directs.

§ 725.302 Composition.

(a) Medical Boards will be composed of two Medical Corps officers of the Armed Forces or Public Health Service. A third member may be assigned at the discretion of the convening authority.

(b) One of the Medical Board members shall be a senior officer with detailed knowledge of the directives pertaining to standards of medical fitness and unfitness, disposition of patients, and disability separation procedures. Whenever possible, the Medical Board shall be composed of the Chief of Service (or his designated representative) and the medical or dental officer responsible for the patient's care. Other medical or dental officers may be assigned as the convening authority directs.

(c) When a member of the medical board does not have training in the specialty of the patient's primary impairment, appropriate specialty consultations shall be obtained prior to consideration of the case by the medical board.

(d) When the party before the board is a reservist, the membership of the board shall include Reserve representation. In any instance where Reserve members are not available, the convening authority shall so indicate in his forwarding endorsement.

(e) In cases involving questions of mental competency, the membership of the board shall include a psychiatrist.

§ 725.303 Purpose.

The medical board serves to report upon the present state of health of any member of the Armed Forces and as an administrative board by which the convening authority or higher au

thority obtains a considered clinical opinion regarding physical fitness of service personnel.

§ 725.304 Necessity for accurate medical evaluation.

(a) Although medical and dental officers do not determine physical unfitness for service, they should be familiar with the basic policies and concepts to be able to carry out the responsibility for identifying members whose physical fitness for full duty may be in doubt. There is no provision or authority for waiving a defect that would interfere with a member's ability to reasonably perform his duties. It is not possible to list and define all the medical factors that may compromise a member's ability to reasonably perform his duties; however, SECNA VINST 1830.3B provides certain guidelines on conditions which normally render an individual unfit because of physical disability and should be referred to in questionable cases. On the other hand, there is no substitute for competent and mature military medical judgment in appraising all the relevant factors in a given case.

(b) The mere presence of a physical defect does not in itself automatically require or justify referring a case to a PEB. The test must always be whether the defect interferes with the member's reasonable performance of his assigned duties. Initial enlistment and commissioning

physical standards must not be confused with physical capability to perform duty. Once he is enlisted or commissioned, the fact that a member may later fall below initial entry standards does not require that his case be referred to a PEB. Similarly, there are prescribed minimum physical standards for special duties such as flying. Disqualification for special duties does not necessarily imply physical unfitness unless the disqualifying defect would also interfere with performance of other duties. Medical board evaluation is appropriate only in instances where the member's ability to reasonably perform military service is in doubt.

(c) Information contained in medical boards may play an important role in determining the rights of an individu

al to certain benefits (such as pensions, compensation, promotion, retirement, income tax exemptions, etc.). It is, therefore, essential to include in the report all available information with adequate documentation concerning the origin, nature, aggravation by service, and other significant facts concerning all the member's conditions which unfit the member and those which do not.

§ 725.305 Board procedure.

(a) The board shall consider and report upon the case of a member who is referred to it by competent authority. It shall require and examine such records in the case as are necessary to formulate a considered conclusion regarding the member's present state of health and the recommendations required. The board's report and recommendations shall be discussed with the member provided it is considered by competent medical authority that such discussion will not adversely affect his health.

(b) Unless it is considered that the information contained in the board's report might have an adverse affect on the member's physical or mental health.

(1) The member shall be allowed to read the board's report or be furnished a copy thereof;

(2) Significant findings and opinions and recommended disposition shall be brought to the member's attention;

(3) He shall be afforded an opportunity to submit a statement in rebuttal to any portion of the board's report. If a member submits a statement in rebuttal, the board shall review same and make any change which is considered appropriate or prepare a statement in surrebuttal.

(c) The NAVMED Form 6100/2 statement concerning the findings and recommendations of the board shall be completed, referred to the member for signature, and witnessed. This form and statement in rebuttal, if applicable, shall accompany the board's report but shall not be incorporated into it.

§ 725.306 Board preparation.

(a) The medical board report shall be submitted to the convening author

ity on NAVMED Form 6100/1 (Medical Board Report Cover Sheet). The SF 502 (Narrative Summary) may be used for the body of the board's report provided the SF 502 includes all pertinent data concerning the case; otherwise, the body of the report shall be prepared on plain white bond paper.

(1) The cover sheet shall be completed in accordance with the guidelines set forth in article 18-24, ManMed.

(2) The body of the report shall present, in narrative form, all pertinent data concerning each complaint, symptom, disease, injury or disability presented by the member which causes or is alleged to cause impairment of health. The facts should be presented briefly and concisely. Emphasis must be placed on the detailed recording of each physical disability in such a manner that subsequent evaluation by adjudicative bodies can be made on the basis of the records.

(3) The narrative section of the board's report should be no more and certainly no less than a well written narrative summary and should answer the following questions:

(i) Why did the patient enter the hospital?

(ii) What physical findings (negative and positive) were found?

(iii) What were the results of pertinent laboratory and X-ray tests?

(iv) What medical or surgical treatment was rendered?

(v) What is the current physical condition of the patient at the time the medical board is written?

(vi) What is the prognosis and recommendation of the board concerning the disposition to be effected in the case?

(vii) What instructions were given to the patient, such as medication to be taken, physical restrictions, etc.?

(viii) Have all conditions and abnormalities been recorded?

(b) Since the medical board is considered the heart of the naval disability evaluation system, incomplete, inaccurate, misleading, or delayed reports may result in an injustice to the member or the Government. The history of his illness; objective findings on examinations; results of X-ray and laboratory tests; reports of consultations; and subjective conclusions with

the reasons therefor, are pertinent evidence to support findings and recommendations. The mere presence of a physical disability does not necessarily render the member unfit for duty. The board's report shall clearly reflect the member's functional impairment, if any.

(1) Apparent contradictions in the records, such as disagreement with a report or consultation, should be thoroughly explained. The condition of a patient following therapy, his response thereto, the degree of severity of his disease or injury, and, when appropriate, their effect on his functional ability must be described in detail.

(c) If a previous medical board has been prepared, it is not necessary to repeat the detailed information contained therein pertaining to past history. In such cases, attention may be invited to the previous report and the description of the present illness restricted to the interval history and currently pertinent data.

(d) Any facts which are not a matter of record or of personal knowledge to a member of the board, but which are based on the member's own statement, should be recorded as "according to the member's own statement." Medical-social reports must be held in the strictest confidence, should not be shown to the member, and information derived therefrom shall not be entered in the board's report. Such data are obtained primarily for the benefit of the patient in diagnosis and treatment, and may be utilized for the purpose of further interrogation of the patient if pertinent. Any additional history so obtained from the patient or from other sources contacted as a result of "lead information" may be incorporated as a part of the history of the case.

(e) In the following instances, the board's report shall contain a statement concerning the member's capability to manage his own affairs:

(1) All psychoses.

(2) Organic brain disorders when the board's report indicates impairment of judgment.

(3) Psychoneuroses, severe, where possible impairment of judgment is indicated.

(4) Any case in which a member has previously been declared incapable of managing his own affairs.

(5) All psychiatric cases of sufficient severity to require further hospitalization.

(f) Except where considered necessary, the information reported on the cover sheet need not be repeated in the body of the board's report.

to

$ 725.307 Patients who refuse medical, dental, or surgical treatment. (a) When a member refuses submit to recommended therapeutic measures for a remedial defect or condition which has interfered with his performance of duty and following prescribed therapy the member is expected to be fit for full duty, the following procedures shall apply:

(1) After being counseled concerning the matter, any member of the naval service who refuses to submit to recommended medical, surgical, dental or diagnostic measures, other than routine treatment for minor or temporary disabilities, shall be transferred to a naval hospital for further evaluation and appearance before a medical board. (See article 3-14, ManMed, concerning compulsory medical or surgical treatment.)

(2) The board shall study the case, inquire into the merits of the individual's refusal to submit to treatment, and report the facts with appropriate recommendations.

(b) In surgical cases, the board's report shall contain answers to the following questions:

(1) Is surgical treatment required to relieve the incapacity and restore the individual to a duty status, and may it be expected to do so?

(2) Is the proposed surgery an established procedure that qualified and experienced surgeons ordinarily would recommend and undertake?

(3) Considering the risks ordinarily associated with surgical treatment, the patient's age and general physical condition, and his reasons for refusing treatment, is the refusal reasonable or unreasonable? (Fear of surgery or religious scruples may be considered, along with all the other evidence, for

whatever weight may appear appropriate.)

(c) As a general rule, refusal of minor surgery should be considered unreasonable in the absence of substantial contraindications. Cases of major surgical operations may be reasonable or unreasonable, according to the circumstances. The age of the patient, previous unsuccessful operations, existing physical or mental contraindications, and any special risks, should all be taken into consideration.

(d) As a matter of policy, surgery shall not be performed on a person over his protest if he is mentally competent.

(e) In medical, dental or diagnostic cases, the board should show the need and risk of the recommended procedure.

(f) If a medical board decides that a diagnostic, medical, dental or surgical procedure is indicated, these findings must be made known to the patient. The board's report shall show that the patient was afforded an opportunity to submit a written statement explaining the grounds for his refusal, and any statement submitted shall be forwarded with the board's report. The patient should be advised that even if his disability originally arose in line of duty, its continuance would be attributable to his unreasonable refusal to cooperate in its correction; and that the continuance of the disability might, therefore, result in the member's separation without benefits.

(g) The patient should be advised that section 1207 of Title 10, U.S. Code, precludes disposition of his case under Chapter 61 of Title 10, U.S. Code, if his disability is due to intentional misconduct or willful neglect, or if it was incurred during a period of unauthorized absence. He should be further advised that benefits from the Veterans' Administration will be dependent upon a finding that his disability is in line of duty and is not due to his own willful misconduct. He should be further advised that the Social Security Act contains special provisions relating to benefits for "disabled" persons, and certain provisions relating to persons disabled "in line of duty" during service in the Armed

Forces. In many instances persons deemed to have "remediable" disorders have been held not "disabled" within the meaning of that term as used in the statute, and Federal courts have upheld that interpretation. One who is deemed unreasonably to have refused to undergo available surgical procedures may be deemed both "not disabled" and "not in the line of duty."

(h) The board's report will be forwarded direct to the Central PEB except in those cases where the convening authority desires that the case be referred for Departmental review. § 725.308 Disposition of report.

The report of the medical board shall be signed by all the members of the board and transmitted to the convening authority.

§ 725.309 Action by convening authority.

(a) When the indicated disposition is appearance before a physical evaluation board and the convening authority of the medical board concurs and is the Commanding Officer of a naval hospital or U.S. Naval Hospital, the Commanding Officer of the Naval Submarine Medical Center, or the Commandant of the Fourteenth Naval District, he shall endorse and forward an original and two copies of the medical board report and other required documents to the Central PEB located in the Office of Naval Disability Evaluation, Washington, D.C. 20390. In this connection, a copy of the member's current Health Record, injury report or investigative report (when appropriate), and the following clinical record documents shall accompany the medical board report-a copy (photostatic, quickcopy, typed, etc.) of the history, physical examination, doctor's progress notes, all laboratory, Xray, and operative reports, copies of previous medical board reports relating to the condition for which the member is presently being reported on, and all consultations. Colored photographs (2 x 2 color slides are acceptable) should be provided in those cases involving scarring with disfigurement, pigmentation, or in cases of unusual deformities such as ankylosis of indi