The United States Air Force (USAF) is committed to ensuring the health and well-being of its Service members, both during active duty and upon separation. One of the key systems in place for this purpose is the Disability Evaluation System (DES), which helps determine whether an Airman with a medical condition can continue serving or should be medically separated or retired. A fundamental part of this process is the Initial Review in Lieu of (IRILO), an initial medical review step that is crucial in determining whether an Airman’s case should be escalated to the formal DES.
In this blog, we’ll explore the IRILO process, its purpose, and how it fits within the broader context of the Air Force’s DES.
What is the IRILO Process?
The IRILO (Initial Review in Lieu Of) is the first step in the Air Force’s Disability Evaluation System (DES) designed to assess whether an Airman’s medical condition warrants further evaluation by the formal DES. The IRILO provides an initial, informal medical review, which serves as a pre-screening tool to determine if a Service member should be referred to the next stage of the DES, the Medical Evaluation Board (MEB).
The IRILO is not intended to make a final determination about the Airman’s fitness for duty or disability status. Instead, it acts as a gatekeeper, ensuring that only those who truly need a formal MEB are forwarded into the DES process. In some cases, the IRILO may determine that the Airman can continue serving without further evaluation, while in others, it may lead to a referral for a more thorough MEB review.
Why is IRILO Important?
IRILO is a critical part of the Air Force’s overall approach to handling medical conditions that impact Service members. By providing an early, informal review, the Air Force can more efficiently manage cases, reducing the need for every medical condition to be automatically elevated to the MEB. This early intervention saves time and resources, while also allowing Airmen with manageable conditions to continue their careers without unnecessary delays.
Moreover, the IRILO helps streamline the DES process by ensuring that only those Airmen who need more detailed medical evaluations go through the MEB. This means that Airmen who are fit to continue service can avoid the lengthy and sometimes stressful process of a full medical board evaluation
The IRILO Process: Step-by-Step Breakdown
Here’s how the IRILO process typically unfolds within the broader Disability Evaluation System:
1. Identification of a Medical Condition
The IRILO process begins when an Airman develops or is diagnosed with a medical condition that could potentially impact their ability to perform their duties. This could be a new injury, illness, or worsening of a pre-existing condition. Typically, the Airman’s healthcare provider or primary care manager identifies the condition and assesses whether it might be incompatible with continued military service.
In some cases, the condition may be identified during a routine health assessment or in the course of treatment for an unrelated issue.
2. Referral to IRILO
Once a potentially limiting medical condition is identified, the healthcare provider will refer the Airman’s case to the Physical Evaluation Board Liaison Officer (PEBLO), who acts as a guide throughout the DES process. The PEBLO collects the necessary medical documentation and prepares the IRILO package for submission.
The package typically includes:
- Medical documentation outlining the Airman’s diagnosis, treatment, and prognosis.
- Commander’s Impact Statement (CIS) describing the Airman’s duty performance and any limitations the medical condition imposes on their ability to perform their duties.
- Additional supporting documents, such as profiles or functional capacity evaluations, that help assess the Airman’s overall ability to serve.
3. Initial Informal Medical Review
Once the IRILO package is complete, it is submitted to the Medical Standards Branch (AFPC/DP2NP) at the Air Force Personnel Center (AFPC) for review. Here, medical professionals will evaluate the Airman’s condition to determine whether it impacts their ability to continue serving.
The medical review is based on:
- The Airman’s current medical status.
- The potential long-term prognosis of the medical condition.
- Whether the Airman can still meet their Air Force Specialty Code (AFSC) duties.
- Whether the condition is likely to deteriorate or improve.
The Medical Standards Branch may consult with the Airman’s treating physician or other specialists as needed.
4. IRILO Determination
After the informal medical review, the Medical Standards Branch makes one of the following determinations:
- Return to Duty (RTD): If the medical condition is deemed not severe enough to interfere with the Airman’s ability to perform their duties or if it is expected to improve, the Airman may be returned to duty without needing a formal MEB.
- Initiate Medical Evaluation Board (MEB): If the medical condition is more complex or likely to impact the Airman’s long-term ability to serve, the case is referred to a formal MEB for a more in-depth evaluation.
- Continued Monitoring or Temporary Limited Duty (TLD): In some cases, the IRILO may recommend continued monitoring of the condition with periodic re-evaluations or place the Airman on a period of Temporary Limited Duty (TLD) to allow for recovery or further observation.
5. Next Steps: MEB or Return to Duty
If the IRILO determines that an MEB is necessary, the Airman’s case will move forward into the formal DES process. The MEB will conduct a more comprehensive evaluation of the Airman’s condition, including a detailed medical review, to determine whether they meet the Air Force’s retention standards. If the MEB finds the Airman unfit for continued service, the case will be forwarded to the Physical Evaluation Board (PEB), which will determine the appropriate disability rating and recommend separation or medical retirement.
If, however, the IRILO recommends Return to Duty (RTD), the Airman can continue serving without further involvement in the DES process. In many cases, this recommendation will come with the condition that the Airman’s medical condition be monitored periodically to ensure it does not worsen.
Key Benefits of the IRILO Process
The IRILO process plays a vital role in the Air Force’s approach to managing service-related medical conditions. Its key benefits include:
- Efficiency: By filtering out cases that do not require a formal MEB, the IRILO process helps streamline the DES, saving time and resources.
- Flexibility: The IRILO process allows for flexible decision-making, such as returning Airmen to duty, placing them on Temporary Limited Duty (TLD), or referring them for further evaluation.
- Reduced Stress for Airmen: For those whose conditions do not require a formal MEB, the IRILO provides a quicker resolution, allowing Airmen to focus on their duties without the added stress of a lengthy DES process.
- Fairness: The IRILO ensures that Airmen with medical conditions are fairly and objectively evaluated to determine the best course of action for their health and career.
Conclusion
The IRILO process is an essential part of the Air Force’s Disability Evaluation System, providing an early, informal medical review to determine whether an Airman’s case requires further evaluation by the Medical Evaluation Board. By acting as a gatekeeper, the IRILO helps ensure that only those Airmen who truly need a formal DES review go through the process, while those who are fit to continue serving can return to duty more quickly. This approach benefits both the individual Airman and the Air Force as a whole by promoting efficiency, fairness, and a commitment to the well-being of its Service members.
If you would like to read more about the IRILO process, or any part of the Air Force’s Disability Evaluation System, download DAFI 36-3212.
If you are an Airman facing an IRILO or referred into the Integrated Disability Evaluation System, please contact Joel Pettit Law for a free consultation.
