Introduction
For years, the Air Force has required many injured and ill Airmen to pass through an internal medical screening process before they are permitted to enter the formal Disability Evaluation System. That process, commonly called the Initial Review-in-Lieu-of, or IRILO, allowed the Air Force to return an Airman to duty without ever providing the full Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) procedures available through the Integrated Disability Evaluation System (IDES).
A federal court has now ruled that this practice went too far.
On August 7, 2026, the United States District Court for the Eastern District of Virginia granted summary judgment to the plaintiffs in Watts v. Meink, a class action challenging the Air Force’s Pre-IDES screening system. According to public reporting concerning the decision, the court concluded that the Air Force lacked authority to create an “extra-statutory” screening mechanism capable of diverting qualifying service members away from IDES. The court found that the challenged process violated the Administrative Procedure Act and was arbitrary, capricious, and contrary to law.
The decision is potentially significant for thousands of current and former Air Force, Air Force Reserve, and Air National Guard members. It is equally important, however, to understand what the decision does and does not establish. The court has ruled against the challenged screening process, but the remedial phase of the litigation remains pending. As of August 10, 2026, the challenged prescreening procedures remained in effect while the court awaited proposed remedies before issuing final judgment.
What Is the Air Force IRILO Process?
The IRILO sits at the front end of the Air Force disability system.
DAFMAN 48-108 expressly describes a “two-step DES pre-screening process” for potential MEB cases. The first step is a preliminary Airman Medical Readiness Optimization (AMRO) Board review. If further review is required, the AMRO Board may direct an Initial Review-in-Lieu-of. The second step is review by the Air Force Personnel Center medical-retention authority, or the appropriate Air Reserve Component Surgeon General’s office. DAFMAN 48-108, para. 2.2.2.
The threshold for beginning that process is significant. DAFMAN 48-108 provides that Airmen who have conditions that may render them unfit for continued military service under DAFMAN 48-123, or who are unable to deploy, must undergo an IRILO. An IRILO may also be required where a duty-limiting condition has resulted, or likely will result, in a mobility restriction lasting 365 days or longer. DAFMAN 48-108, para. 2.4.
Once an IRILO is initiated, the package generally includes a Narrative Summary (NARSUM), medical records and specialty evaluations, a current AF Form 469 profile, and a Commander’s Impact Statement. The AMRO Board then recommends either MEB processing or return to duty. DAFMAN 48-108, paras. 2.4.1–2.4.3.
The critical feature of the system, and the feature at the center of Watts, comes next. The medical-retention authority could issue a final Pre-IDES disposition returning the Airman to duty rather than directing an MEB. DAFMAN 48-108 went so far as to state that AFPC/DP2NP or the equivalent ARC office’s IRILO determinations were “final” and possessed “the same effect and authority as a MEB.” DAFMAN 48-108, para. 3.1.1.2.
Thus, an Airman could have a diagnosed condition serious enough to trigger retention concerns, receive an AAC 37 because of a potential MEB, undergo the IRILO process, and nevertheless be returned to duty without ever formally entering IDES.
Why the Court Found a Problem
The dispute in Watts concerned the Air Force’s authority to place an additional decisional layer between an Airman who satisfies the federal disability-evaluation referral standard and the Disability Evaluation System established by Congress and the Department of Defense.
The current Air Force disability regulation states that a service member is submitted for disability evaluation when one or more medical conditions may, individually, collectively, or through their combined effect, prevent the member from reasonably performing the duties of office, grade, rank, or rating; when a condition creates an obvious medical risk to the member or others; or when a condition imposes unreasonable requirements on the military to maintain or protect the member. DAFI 36-3212, para. 1.3.
Those are referral criteria. They are not findings that the Airman is already unfit.
That distinction is critical. Referral into the DES and a final finding of unfitness are separate decisions. An Airman does not have to establish entitlement to medical retirement merely to obtain access to the system that determines whether the Airman is fit or unfit. DAFI 36-3212 explains that service members satisfying the referral criteria are referred for disability evaluation, while the DES subsequently determines whether the member is fit for return to duty or unfit for continued military service. DAFI 36-3212, paras. 1.1, 1.3.
The plaintiffs argued that the Air Force’s Pre-IDES process improperly collapsed these two inquiries. According to their class-certification briefing, the Air Force subjected Airmen to AMRO and IRILO review under substantially the same retention and functional criteria relevant to DES referral, but then permitted Air Force officials to terminate the case with a return-to-duty determination before the member received the formal procedures associated with IDES.
The plaintiffs characterized the IRILO as a parallel, nonstatutory system. Their argument was straightforward: once a service member satisfied the governing threshold for referral, the Air Force could not insert another screening mechanism that decided whether the member would be permitted to access the statutory disability process at all.
The federal court agreed with the central challenge. Public reporting states that the court concluded that the Air Force lacked authority to create an extra-statutory screening process that diverted service members from IDES and the protections associated with that system.
What Airmen Lost When an IRILO Ended in Return to Duty
The consequences of being stopped at the IRILO stage can be substantial because IDES is not merely another medical records review.
The plaintiffs alleged that Airmen returned to duty through the Pre-IDES process were denied the procedural protections they would have received after formal referral into IDES. Those protections include standardized medical examinations, a formal MEB process, an impartial medical review, access to counsel, an opportunity to rebut MEB findings, PEB consideration, and applicable appellate rights.
DAFMAN 48-108 itself demonstrates the difference between IRILO and formal DES entry. After an IRILO, AFPC could either return an Airman to duty or direct an MEB. If an MEB was directed, the Airman then entered DES, and IDES formally began when the referring provider signed VA Form 21-0819. DAFMAN 48-108, paras. 2.4.4.1, 3.1.2.2.
In other words, under the Air Force’s own regulatory structure, an IRILO was not itself IDES. It was the mechanism the Air Force used to determine whether the member would be allowed to enter IDES.
That distinction became the central legal vulnerability in Watts.
The Court Did Not Rule That Every Airman With a Medical Condition Is Entitled to Medical Retirement
The significance of Watts should not be overstated.
A medical diagnosis alone does not establish unfitness. DAFI 36-3212 expressly states that the mere presence of a physical or mental defect or condition does not qualify a member for disability retirement or discharge. The condition must ultimately render the member unfit for duty. DAFI 36-3212, para. 1.4.
The Medical Standards Directory likewise reflects a functional approach to retention determinations. It explains that, unless otherwise stated, relevant retention conditions generally must persist despite appropriate treatment and impair function to the point that the member cannot satisfactorily perform the required military duties of the member’s office, grade, rank, or rating. Medical Standards Directory at 2.
Watts therefore does not mean that every Airman who fails a medical retention standard must be medically retired.
It means something different. The issue is who gets access to the disability-evaluation process when the regulatory threshold for referral has been satisfied.
The ultimate PEB may still find the member fit. The member may still be returned to duty. But the government cannot avoid the prescribed disability-evaluation procedures by using an unauthorized screening mechanism to make the dispositive fitness determination before the member enters the system.
Why Watts Matters to Airmen Currently in an IRILO
For an Airman presently undergoing an IRILO, Watts may materially alter how the case should be framed.
The controlling question should not be whether the AMRO Board believes the Airman will ultimately qualify for medical retirement. Nor should the question be whether the Airman retains some residual capacity to work.
The regulatory threshold is whether the Airman’s medical condition satisfies the criteria for referral into the Disability Evaluation System.
DAFI 36-3212 requires disability evaluation when one or more conditions may, individually or collectively, prevent the service member from reasonably performing the duties of office, grade, rank, or rating; when a condition poses an obvious medical risk; or when a condition imposes unreasonable requirements on the military. DAFI 36-3212, para. 1.3.
The word “may” is important.
The referral threshold is not the same as the ultimate burden necessary to establish unfitness. Whether the member is actually unfit is determined later, after the relevant medical and occupational evidence is developed and adjudicated through the DES.
Accordingly, an Airman facing an IRILO should ensure that the record squarely addresses the regulatory referral criteria rather than allowing the case to become an informal adjudication of ultimate fitness.
The Named Plaintiffs Show Why Procedure Matters
The circumstances of the named plaintiffs illustrate the practical consequences of the Air Force’s system.
Kathleen Watts served 12 years as an Air Force orthopedic physician assistant. According to the plaintiffs’ filings, she developed cerebral venous thrombosis, intracranial-pressure problems, papilledema, migraines, and substantial treatment requirements. Her physicians documented persistent limitations, specialty-care requirements, and continuing medical risks. Nevertheless, she was returned to duty through the Pre-IDES process and ultimately separated without receiving an MEB or PEB.
According to the plaintiffs, the Air Force’s review acknowledged that her condition and associated migraines were not expected to improve sufficiently within the following 12 months for her to perform all duties of her office, grade, rank, or rating. Nevertheless, AFPC issued a return-to-duty determination without the standardized examinations, impartial medical review, counsel, MEB, PEB, or formal appeal rights associated with IDES.
Robert Newman served as an airborne cryptologic language analyst. His records documented severe anxiety associated with flying, and he remained in Duties Not Including Flying status for more than a year. His NARSUM reportedly documented symptoms consistent with PTSD, and an evaluating physician concluded that he was unlikely to return to flying within the next three years. Nevertheless, the Pre-IDES process returned him to duty with assignment limitations without formal MEB or PEB processing.
Ryan Miller, an Air Force Reservist and Aircraft Structural Maintenance Craftsman, had spinal and shoulder conditions that restricted bending, stooping, crawling, lifting, prolonged standing, physical training, and portions of the fitness test. According to the plaintiffs’ filing, he likewise was returned to duty through the Pre-IDES process without receiving the standardized examinations and adjudicative protections that would have accompanied formal DES entry.
These cases demonstrate why the distinction between screening and adjudication matters. The issue is not whether an Airman can perform some useful work. The eventual fitness inquiry concerns whether the member can reasonably perform the military duties required by the member’s particular office, grade, rank, or rating.
Why the Decision May Matter Even More to Former Airmen
The lawsuit is not limited to people currently serving.
The case was certified as a class action in January 2026 and includes current and former Air Force members. Public reporting states that plaintiffs Kathleen Watts and Robert Newman were returned to duty and denied consideration for medical retirement after undergoing the challenged screening process.
For former Airmen who passed through IRILO, received a return-to-duty determination, and later separated or retired without formal DES adjudication, the stakes may be significant.
A proper DES proceeding could potentially have resulted in a finding of unfitness and, depending upon the circumstances, disability severance pay, temporary disability retirement, or permanent disability retirement. But Watts does not presently establish that every affected former Airman was unfit or that every class member is entitled to retroactive medical retirement.
The classwide injury identified by the litigation concerns denial of access to the required disability-evaluation process. The remedy phase will therefore be critical in determining whether affected former Airmen receive new evaluations, reconsideration of prior cases, or some other corrective procedure.
What Happens Next?
The litigation is not finished.
As of August 10, 2026, public reporting indicated that the district court had ruled against the Air Force’s Pre-IDES screening system but had not yet entered a final remedial judgment. The challenged screening procedures remained in effect while the court awaited proposed remedies.
The remedial proceedings may ultimately determine how the Air Force must change its procedures and what must be done for Airmen previously screened out of IDES.
Several questions therefore remain unresolved. How will the Air Force identify affected current and former members? Will prior IRILO return-to-duty cases require new review? Will former Airmen be given access to retrospective disability evaluations? How will the Air Force restructure its front-end review process while still permitting legitimate medical screening before referral?
Those questions will matter greatly.
Until the court resolves the remedy, Airmen should not interpret Watts as creating an automatic entitlement to an MEB, a finding of unfitness, or medical retirement. The decision addresses the legality of the process used to deny access to DES, not the ultimate medical outcome of every individual case.
What Airmen Should Take Away From Watts v. Meink
The most important lesson from Watts is that three concepts must remain distinct: medical retention standards, DES referral, and ultimate fitness.
A condition can fail retention standards without automatically establishing that an Airman is unfit.
Likewise, an Airman does not need to prove ultimate unfitness before being referred into the system designed to decide that question.
DAFI 36-3212 requires referral when the medical evidence satisfies the threshold contained in paragraph 1.3. The Air Force’s own DES regulation focuses that inquiry on whether a condition may prevent reasonable performance of military duties, creates an obvious medical risk, or imposes unreasonable requirements upon the service. DAFI 36-3212, para. 1.3.
For an Airman undergoing an IRILO, the medical and occupational record should therefore address the member’s actual military duties, functional limitations caused by each condition, AF Form 469 restrictions, assignment limitations, treatment requirements, prognosis, the combined effect of multiple conditions, and whether those limitations may interfere with reasonable performance of the duties of office, grade, rank, or rating.
Watts v. Meink is an important reminder that procedure in the military disability system is substantive. The MEB, PEB, impartial medical review, counsel, hearing, and appeal protections exist because the ultimate decision can determine whether an injured or ill Airman leaves military service through ordinary separation or through the disability retirement system established by Congress.
For Airmen who were stopped at the IRILO stage, that distinction may now prove particularly important.
This article is for general informational purposes only and does not constitute legal advice. The remedial proceedings in Watts v. Meink remain ongoing, and the consequences for any particular current or former Airman will depend upon the final judgment and the facts of that individual’s case.
If you or an Airman you know is struggling with these issues, please do not hesitate to contact Joel Pettit Law to discuss your potential case.
