V. 2.

4
Updated: 09 Dec 2013

Proposed: DoD (Form ####) Significant Event Tracker (SET)

CONCEPT: The Significant Event Tracker (SET) is designed to be a cost-effective, low-burden tool that utilizes already established resources within the DOD/Military to administratively track and verify a Service-Members exposure to potential events typically related to Post Traumatic Stress (PTS) or Traumatic Brain Injury (TBI). The process would include entry of an event, verification of the event, storage of approved events into a centrally maintained (secured) database, and production of an Official DoD document upon discharge containing service related events. Entries would be defined as any event or exposure that involves traumatic, violent, life threatening, or potentially life threatening environments; sustained hazardous duty; concussive and/or mechanical event that places individual at risk for PTS and/or TBI. It would become the Service Members responsibility to track encounters and to log these events into an online reporting system that would escalate to an approved agent that would verify these entries against current (and future) reporting systems (TIC, SITREPs, LOD, PCR, Unit Logs, etc), Command Leadership, and Medical Treatment Facilities. Once verified and approved, the officially recognized Event would be entered into the secure, centrally maintained tracking database. Upon discharge, the Service Member would receive a tamper-proof copy of the (SET) DD-#### along with their DD214. This document would carry equal authority as the DD214/5 for verification by the VA and other organizations to be used for care, treatment and compensation. A key point is that this is an administrative tool (as opposed to diagnostic) which is intended to be used to specifically document and confirm Events that have been identified as potential Stressors that have been shown to be related to PTS/TBI claims, and to do so as close to real-time as possible. The process and benefits shall be explained throughout this document.

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(Draft) 2013

Summit for Soldiers: Proposed SET DD Form####

V.2.4
ONE EXAMPLE of what the User Interface/Data Entry System might look like: (EXAMPLE ONLY, Actual User Interface TBD)

Date/Timeframe: STATUS: Deployed Hazardous Duty Training Normal Duty Other

Location: EVENT: Enemy Engagement Witnessed Death/Injury Non-Kinetic Patrol Concussive Event Head related Injury Indirect Fire Other

Unit: Was an Injury Sustained during Event: YES NO

Explanation:

Selectable Pull-Down Menus

Free Text

The User Interface is envisioned as a CAC Card accessible data entry system that would consist of various pull-down menus and selectable entries to decrease burden and facilitate data entry, as well as, option and comment fields to elaborate upon or specify unique events. As an Administrative tool, the user interface would be developed on the concept of factually based and easily verifiable information (who, what, where, when). Defining the types of reportable events/entries will need To Be Determined beyond the obvious (IED blasts, Combat engagements, WIA) however, as new risk factors are identified, the system can be updated to reflect those concerns (ie, Sexual Assualt, burn pit, etc).

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(Draft) 2013

Summit for Soldiers: Proposed SET DD Form####

V.2.4
BACKGROUND: PTS and mild TBI are considered the invisible wounds of war, and thankfully they have finally been recognized as valid injuries sustained in the line of duty. Veterans with service connected PTS/TBI related issues are eligible for treatment and compensation though the Veterans Administration. Unfortunately, many of the difficulties associated with determining a veterans eligibility revolve around verifying the veterans claim to begin with. While great progress has been made to treat and compensate our veterans won are suffering from these injuries, we still endure lengthy waits, a complicated process, back-logged VBA, multiple appeals, fraudulent claims, etc which leads to many veterans in need simply avoiding the system all together. The process for verifying legitimate claims can be extremely frustrating to a veteran, especially for those who have not been awarded a service qualifier (CAR, CIB, etc) that designates them as a Combat Veteran." While most of the information in regards to a units Significant Actions remain unclassified, veterans do not typically have general access to this information. Even with the designator, it can still be extremely difficult and frustrating identifying a point in time that qualifies as a recognized Stressor especially for individuals who may be several years beyond the time they were exposed to their service related issue, or for individuals that have had a period of exposure instead of just a singular stressor. In fact most veterans who are reporting with mental health related injuries most likely have been exposed to several events, over a lengthy period of time, and several years removed from the time of occurrence. On top of that the diminished cognitive state, and ability to recall while in crisis lends itself to perceived discrepancies by the VBA that results to claims denial. The similarities between the symptoms of PTS and TBI cases can easily result in overlooking appropriate diagnosis for mild TBI, this could delay appropriate treatment, particularly if the veteran struggles with accurate recall due too related cognitive issues. An accurate history is key to identifying accumulative events that might suggest a mTBI. Many times these events (singularly) seem insignificant, until you begin looking at the accumulative number of events. The VA pays out billions of dollars each year for service related disabilities, so it is understandable that PTS, TBI and other mental health related claims are approached with caution by the VBA system. While the VBA is working hard to process claims, the growing backlog is resulting in most veterans waiting up to several years to receive a decision. The frustration involved with filing a claim (or even getting seen by the VHA in some cases) can be extremely difficult for the veteran, especially for someone who is relying on this compensation due to the inability to work. And while there are exceptions that allow expedited claims, the majority of veterans must bear the burden of these inconveniences. The difficulties, costs and time consumption required of the VA system to verify these events (independently, years removed from the event, and with limited resources for verification) must be enormous. The need for a cost-effective verifiable means to simplify and expedite a veterans legitimate claim for diagnosis, treatment, and compensation of PTS/mTBI has never been more necessary. www.summitforsoldiers.org * [email protected] * (614) 314-5829
(Draft) 2013

Summit for Soldiers: Proposed SET DD Form####

V.2.4
BENEFITS: The SET as a recognized Official Document could provide the following benefits: 1. Cost effective real-time (close to real-time) verification of Service Members potential PTS/TBI related events and exposure through currently established DoD/Military resources and reporting systems, instead of the time-consuming and potentially costly investigation/verification via the current VBA process. 2. Reduced burden on VBA claims process, minimizing future backlogs: (ie: recognized official document that already identifies potential stressors close to real time verses the current process of submitting a VA Form 21-0781 for verification/scrutiny, often times requiring multiply submissions.) 3. An official document that provides Simplified/Expedited access, treatment, and claims process for a veterans PTS/TBI related issues. (Clearly defined and identified stressor expediting enrollment into the PTSD Clinic, for example.) 4. Secondary diagnostic tool and reference for VHA providers to differentiate between PTS and TBI related events and steer a more appropriate treatment process. 5. Veterans with PTS/TBI related issues that are beyond initial enrollment opportunities (or other circumstances) could then bring in their DD214 and the VA recognized SET Tracker, again eliminating lengthy time periods to get treatment and/or claims decision. 6. Naturally reduces STIGMA, as all members would be required to report and maintain their SET. Those less likely to come forward under the current process could now have a safe means to report their potential stressors. 7. Better control through a more accurate reporting system can result in a reduction of fraudulent claims and abuse of an already over-tasked system. 8. Database entries could be compiled for Statistical, Research and Medical Studies. PROCESS: The submission, verification and approval process for entering events into the tracking database would involve four primary steps: Event Submission, Event Verification, Command Approval, and Event Storage and Processing. 1. Submission of an Event a. Service Member Entry - It would be the primary responsibility of the Service Member to enter and maintain events into their MemberSpecific tracker. Proper training and enforcement would fall under the responsibility of the Unit Command Leadership. i. Member is exposed to a reportable event. ii. Member accesses CAC enabled user interface at earliest convenience and enters information into system and then submits for review and approval. iii. Example of types of required information. 1. Name, Date, Location, Unit. (These could be auto-filled with the ability to adjust if necessary.) 2. Duty Status (Deployed, Hazardous, Training, etc) www.summitforsoldiers.org * [email protected] * (614) 314-5829 4
(Draft) 2013

Summit for Soldiers: Proposed SET DD Form####

V.2.4
3. Type of Event (Patrol, IED, Witnessed death, etc) 4. Injury sustained as a result (Y/N) 5. etc b. Command Witnessed Entry - Unit/Team leadership that witnesses an event affecting entire team/unit, could be authorized to directly enter that event for ALL members affected. c. Medical Treatment Facility Entry For those members WIA requiring escalated care and treatment, the MTF would issue a direct entry into the tracker. d. Reportable Events include, but not limited to: (Details TBD.) i. Kinetic Combat Patrols ii. Witnessed loss of life/dismemberment. iii. Exposure to life-threatening or perceived life-threatening environments. iv. Sustained exposure to hazardous duty (ie: multiple non-kinetic combat patrols, etc) v. Potential TBI qualifying injury or exposure, to include both concussive and mechanical events involving the head. vi. etc 2. Event Verification a. For Individually entered events, an Authorizing Agent (TBD), most likely would be an admin at the units command element, would have access to the tracking entry system (not the main storage database) to verify entered events. After verification/denial the entry would be escalated for approval by Command Leadership. Verification tools include: i. DoD/Military Reports (TIC, SITREP, PCR, Patrol Order, etc) ii. Unit Logs iii. Unit Medical Department iv. Creditable Witnesses (patrol leaders, etc) b. Direct Entry from Unit/Patrol Leadership would escalate directly to the Command Approval process. c. MTF Entered Event would escalate directly to the Main Tracking Database. 3. Command Approval a. Commanding Officer (or designation) would have exclusive access to Approve and Submit the verified entry into the Secured Tracking Database. b. The Commanding Officer reserves the right to contest an entry (approved or denied) contested submissions could be stored in the database for future examination, but not printed on official discharge document. i. APPROVED: Clear documentation and verification of facts and individuals exposure. ii. APPROVED/CONTESTED: Clear documentation and verification of event, however, CO maintains reasonable doubt for approval. iii. DENIED/CONTESTED: Questionable documentation or verification, however, CO maintains reasonable doubt for denial. iv. DENIED: No clear evidence of entered facts, or individuals exposure to claim. www.summitforsoldiers.org * [email protected] * (614) 314-5829
(Draft) 2013

Summit for Soldiers: Proposed SET DD Form####

V.2.4
4. Event Storage and Processing a. Once verified and approved at the command Level, the Event would be forwarded to a centrally stored, secured Database where it would become an official entry into the members SET. (MTF entries would escalate directly to this stage.) b. Upon discharge from Active Service, an Authorizing Agent (TBD) with cleared access to the Tracking Database would generate an official (SET) form DD####, that would be issued to member along with their DD214. DISTRIBUTION AND CONTROL:

The SET would be distributed in accordance and consistent with the Military Services internal requirements and instructions.
Here is an example of the current DD214/5 Distribution process: Copy 1 Service Member Copy 2 Service Personnel File Copy 3 United States Department of Veterans Affairs Copy 4 Member (if initialed in Block 30) Copy 5 United States Department of Labor Copy 6 State Director of Veteran Affairs Copy 7 & 8 Distributed in accordance with Military Service Department directions Service member will receive their official copy upon discharge; however, a copy shall be maintained within the Service Members Medical Record/Medical Department while on Active Duty/Active Reserve status. Electronically storage and distributing will be maintained and controlled by government compliant standards and format. Official Hard Copy form will be in a tamper-proof format. CONTRIBUTIONS: The Office of Sen. Brown (Ohio) Ohio USMC Wounded Warrior Regiment VHA OIF/OEF Case Workers Veteran Service Officers Service Connected OIF/OEF Veterans Military Unit Leaders Military Unit Healthcare Providers Resurrecting Lives (TBI) Foundation The Office of Rep. Tiberi (Ohio) The Office of Sen. Portman (Ohio) VFW

www.summitforsoldiers.org * [email protected] * (614) 314-5829

(Draft) 2013

Summit for Soldiers: Proposed SET DD Form####

V.2.4
EXAMPLE of what an Official DD#### Form might look like:

www.summitforsoldiers.org * [email protected] * (614) 314-5829

(Draft) 2013

Summit for Soldiers: Proposed SET DD Form####

V.2.4
EXAMPLE: STEP by STEP Process and Flow

1.
A. SELF REPORTED EVENT

EVENT SUBMISSION
B. COMMAND WITNESSED EVENT C. MTF/HOSPITAL ADMISSION

2. MEMBER ENTERS EVENT

!
3. EVENT VERIFIED 4. COMMAND APPROVAL or CONTESTMENT 6. DISCHARGE SET DD FORM#### 5. MAIN DOD SECURED TRACKER DATABASE

www.summitforsoldiers.org * [email protected] * (614) 314-5829

(Draft) 2013