Optimizing Neurological Documentation in the Army Medical Evaluation Board Process: A Practical Framework for...

The Narrative Summary (NARSUM) authored by the referring physician is the clinical basis for the Integrated Disability Evaluation System (IDES) and impacts Physical Evaluation Board (PEB) determinations of fitness, disability rating, and disposition for soldiers undergoing Medical Evaluation Board (MEB) review. Neurological conditions-post-traumatic epilepsy, residual traumatic brain injury, migraine and post-traumatic headache, multiple sclerosis, and peripheral neuropathy-account for a substantial share of MEB referrals in the active and reserve component Army, but there is no published consolidated, neurology-specific framework for NARSUM construction in the military medicine literature. This commentary offers a practical framework for battalion surgeons, general medical officers, military primary care physicians, and military neurologists at Role 1, Role 2, and military treatment facility levels. The framework is offered as documentation guidance, based on operational experience and the current peer-reviewed literature on military neurological morbidity. The commentary starts with documentation of the pertinent neurological examination and supporting diagnostic studies. It then presents an 8-element NARSUM scaffold: diagnostic precision, temporal documentation, treatment documentation, functional impact tied to military duties and service fitness testing, prognosis, service connection and Line of Duty, driving and safety restrictions, and cognitive and medication side effects. Next, we will combine the discussion of special populations including Army National Guard and Army Reserve soldiers, soldiers on the Temporary Disability Retired List, and soldiers approaching retirement eligibility. Reasonable next steps for military medical policy are a standardized neurology NARSUM template and a formal neurology consultation pathway at installations without a neurologist.