R 061359Z APR 12

ALCOAST 161/12
COMDTNOTE 1001
SUBJ: CLARIFICATION OF BENEFITS ISSUING AUTHORITY (BIA) ROLE AND
APPEAL PROCESS FOR RESERVE INCAPACITATION BENEFITS
A. RESERVE POLICY MANUAL, COMDTINST M1001.28 (SERIES)
B. COMCOGARD PSC ARLINGTON VA 192001Z OCT 10 ALCGRSV 058/10
C. COMCOGARD PSC ARLINGTON VA 261139Z OCT 10 ALCGRSV 061/10
D. COMCOGARD PSC ARLINGTON VA 121613Z OCT 11 ALCGRSV 054/11
E. COMCOGARD PSC ARLINGTON VA 151546Z MAR 12 ALCGRSV 015/12
F. TITLE 10 USC 12301(H), THE RESERVE COMPONENTS GENERALLY
G. TITLE 10 USC 12322, ACTIVE DUTY FOR HEALTH CARE
1. AS OF DECEMBER 2010, COMDT (CG-13) DESIGNATED COMDT (CG-PSC-RPM)
AS THE BENEFITS ISSUING AUTHORITY (BIA) FOR RESERVE INCAPACITATION
BENEFITS OUTLINED IN CHAP 6 OF REF A. AS THE BIA, COMDT (CG-PSC-RPM)
RELEASED PROCESS GUIDANCE FOR MEDICAL HOLD (MED HOLD) ORDERS, ACTIVE
DUTY FOR HEALTH CARE (ADHC) ORDERS, NOTICES OF ELIGIBILITY (NOE), AND
INCAPACITATION PAY CLAIMS VIA REFS B THRU E, RESPECTIVELY.
2. IAW GOVERNING STATUTES, THE CG RESERVE INCAPACITATION SYSTEM
IMPLEMENTS POLICIES TO AUTHORIZE MEDICAL AND DENTAL CARE, AS WELL AS
APPROPRIATE COMPENSATION FOR RESERVE COMPONENT (RC) MEMBERS WHO INCUR
OR AGGRAVATE AN INJURY, ILLNESS, OR DISEASE IN THE LINE OF DUTY. THE
BIAS MISSION IS TO ENSURE THE THOUGHTFUL AND DELIBERATE MANAGEMENT OF
RC INCAPACITATION BENEFITS PROGRAMS TO PROTECT BOTH RESERVISTS RIGHTS
AND THE INTERESTS OF THE COAST GUARD.
3.  IAW REFS F AND G, A MEMBER ON ACTIVE DUTY UNDER A CALL OR ORDER
TO ACTIVE DUTY FOR A PERIOD OF 30 DAYS OR LESS (ADHC) OR 31 DAYS OR
MORE (MEDICAL HOLD), WHO INCURS OR AGGRAVATES AN INJURY, ILLNESS, OR
DISEASE IN THE LINE OF DUTY MAY, WITH THE CONSENT OF THE MEMBER AND
AT THE DISCRETION OF THE SERVICE, BE RETAINED ON ACTIVE DUTY OR
CONSIDERED FOR RELEASE BASED ON THE EXTENT AND CARE REQUIRED FOR THE
INJURY, ILLNESS OR DISEASE.
4. EFFECTIVE IMMEDIATELY, AS THE BIA, COMDT (CG-PSC-RPM) HAS SOLE
AUTHORITY TO DETERMINE WHETHER A RESERVIST IS RECALLED TO, RETAINED
AND/OR EXTENDED ON ACTIVE DUTY FOR MEDICAL HOLD OR ADHC STATUS, OR IS
RELEASED FROM ACTIVE DUTY AND AUTHORIZED NOE FOR AUTHORIZED MEDICAL
CARE AND TREATMENT. THIS AUTHORITY WILL BE EXERCISED WITH CAREFUL
CONSIDERATION OF THE FACTS OF EACH CASE, INCLUDING THE SEVERITY OF
THE INJURY/ILLNESS, WAIVER REQUIREMENTS (E.G., OVER 16/18 YEARS
ACTIVE DUTY, MANDATORY RETIREMENT AT AGE 60, ETC.), MEMBER DUTY
STATUS, AND CONSULTATION WITH PSC MEDICAL OFFICERS, HSWL CLINICS AND
CIVILIAN MEDICAL PROVIDERS, AS INDICATED. INCAPACITATION PAY SHALL BE
AUTHORIZED FOR RESERVISTS WITH AN APPROVED NOE IAW CHAP 6.B OF REF A.
5. THE PROCEDURES FOR REQUESTING MED HOLD, ADHC, NOE, AND
INCAPACITATION PAY BENEFITS, AS OUTLINED IN REFS B THRU E, REMAIN
UNCHANGED.
6. APPEAL PROCESS. A RESERVIST MAY APPEAL DENIAL OR TERMINATION OF
MEDICAL HOLD, ADHC, NOE, OR INCAPACITATION PAY BENEFITS TO COMDT
(CG-13) IAW THE FOLLOWING GUIDELINES:
   A. APPEALS MUST BE SUBMITTED TO COMDT (CG-13) IN STANDARD CG MEMO
FORMAT WITHIN 30 DAYS OF THE ORIGINAL DECISION BY THE BIA.
   B. THE APPEAL MEMO SHALL INDICATE APPEAL IN THE SUBJECT LINE AND
BE
SUBMITTED TO COMDT (CG-13) VIA THE MEMBERS COMMAND AND COMDT
(CG-PSC-RPM) AS THE BIA.
   C. THE MEMO SHALL CLEARLY STATE THE JUSTIFICATION FOR THE APPEAL
AND INCLUDE SUPPORTING DOCUMENTATION.
   D. WITHIN 10 WORKING DAYS OF RECEIVING THE APPEAL, THE BIA WILL
REVIEW THE APPEAL AND THE DECISION TO DENY SUSPEND OR TERMINATE
BENEFITS.
   E. CASES WHICH HAVE BEEN REVIEWED BY THE BIA AND STILL WARRANT
DENIAL OR TERMINATION OF BENEFITS, WILL BE ENDORSED ACCORDINGLY BY
THE BIA AND FORWARDED TO COMDT (CG-13) WITH A COPY TO THE MEMBER AND
COMMAND. COMDT (CG-13) SHALL REVIEW THE APPEAL AND RENDER A RULING
WITHIN 30 DAYS OF RECEIPT FROM THE BIA.
   F. IF AN APPEAL IS UPHELD BY COMDT (CG-13), THE BIA SHALL
REINSTATE
MEMBERS ELIGIBILITY FOR HEALTH CARE WITHOUT DELAY, UNLESS THE MEMBER
IS IN AN AVAILABLE FOR FULL DUTY (AFFD) STATUS AND NO FURTHER MEDICAL
CARE/TREATMENT IS REQUIRED. PAY AND ALLOWANCES SHALL BE AUTHORIZED AS
APPROPRIATE BASED ON THE ORIGINAL DATE OF DENIAL.
7. THESE CHANGES WILL BE INCORPORATED INTO THE NEXT UPDATE OF REF A.
8. POCS:
   A. COMDT (CG-131): LT JOCELYN SORIANO, 202-475-5443,
JOCELYN.L.SORIANO(AT)USCG.MIL.
   B. COMDT (CG-PSC-RPM): LCDR CHRISTA HEFFELFINGER, 202-475-1761,
CHRISTA.OAKS.HEFFELFINGER(AT)USCG.MIL.
9. RDML DAVID R. CALLAHAN, DIRECTOR OF MILITARY PERSONNEL AND
DIRECTOR OF RESERVE, SENDS.
10. INTERNET RELEASE AUTHORIZED.