DOCI: DODI 1010.13
TITL: DODI 1010.13 Provision of Medically Related Services to Children Receiving or
Eligible to Receive Special Education in DoD Dependents Schools Outside the United States,
February 2, 1990, ASD(HA)/ASD(FM&P), Thru Ch 1, February 2, 1990
(a) Public Law 95-561, "Defense Dependents' Education Act of 1978," as
amended (Title 20, United States Code, Sections 921-932) .
(b) Public Law 94-142, "Education for All Handicapped Children Act of 1975," as
amended (Title 20, United
(c) DoD Instruction 1342.12, "Education of Handicapped Children in the DoD Dependents
Schools," December 17, 1981
(d) DoD Directive 1342.13, "Eligibility Requirements for Education of Minor
Dependents in Overseas Areas," July 8, 1982
(e) through (m), see enclosure 1
1. Establishes policies and procedures to provide medically related services to children
receiving or eligible to receive special education under references (a), (b), (c), (d),
2. Establishes policies and procedures to promote the development of a coordinated network
for health care provider training and delivery of medically related services to children
receiving or eligible to receive special education from the Department of Defense
Dependents Schools (DoDDS) in order to ensure that these services are provided in the most
appropriate, efficient, and effective manner.
3. Cancels reference (f).
B. APPLICABILITY AND SCOPE
1. This Instruction applies to the Office of the Secretary of Defense (OSD), the Military
Departments and all DoD Components that make use of DoDDS.
2. The provisions encompass children who are or may be identified as handicapped under
reference (c) and who are receiving or entitled to receive education from DoDDS under
reference (d), and their parents.
3. The provisions do not apply to children attending schools operated by the Department of
Defense (DoD) within the United States, and children outside the United States who attend
non-DoDDS schools when they have not been placed in those schools by DoDDS.
4. This Instruction does not create any rights or remedies and maynot be relied upon by
any person, organization, or other entity to allege a denial of any such rights or
remedies. To the extent that this Instruction conflicts with reference (c), reference (c)
Terms used in this Instruction and related service providers are defined in enclosure 2.
It is DoD policy that:
1. The military medical departments be responsible for the provision and professional
supervision of medically related services in designated areas.
2. The following services be provided at identified sites with the same priority as
medical care is provided to active duty service members:
a. Medical evaluations and other services of a medical nature that are necessary to
determine if a student is eligible for special education and related services.
b. The medically related services that the student requires as specified by the student's
Individualized Education Program (IEP).
3. The existing quality assurance program in each medical treatment facility that provides
medically related services monitor and evaluate the medical care for children receiving
such services as described by this Instruction. Standards used by the Joint Commission on
Accreditation of Hospitals (reference (g)), or equivalent standards shall be used, where
applicable, to assure accessibility, acceptability, and adequacy of medically related
1. The Assistant Secretary of Defense (Health Affairs) (ASD(HA)) shall:
a. Ensure the review of medically related service implementation plans and programs of the
Military Departments for compliance and suitability with this Instruction.
b. Ensure the provision of advice and consultation about the provision of medically
related services to the Assistant Secretary of Defense (Force Management and Personnel)
(ASD(FM&P)) and the General Counsel of the Department of Defense (GC, DoD).
c. Ensure the development of health care provider workload standards and performance
levels that will determine staffing requirements of designated centers. These standards
shall take into account the provider training needs and the additional time required to
provide medically related services for assessment and treatment and for coordination with
other resources, such as DoDDS.
d. Assign the military medical departments geographical areas of responsibility for
providing medically related services under paragraph F.6.a., below.
2. The Secretaries of the Military Departments shall:
a. Ensure the coordination and cooperation between the Military Departments when
considering assignment(s) to an area where medically related services are the
responsibility of another Military Department.
b. Ensure that the Surgeons General share appropriate medical information when providing
medically related services becomes the responsibility of another Military Department.
c. Ensure the establishment of procedures that provide for the assignment of service
members with handicapped children (who are entitled or close to the age of entitlement to
receive educational services from DoDDS) to areas where necessary special education and
medically related services are available or can be readily obtained.
d. Ensure that medically related service programs are developed and implementation plans
are submitted to ASD(HA).
3. The Surgeons General of the Military Departments shall:
a. Ensure the development of policies and procedures for providing, documenting, and
evaluating medically related services.
b. Ensure that medically related services are provided in accordance with this
c. Ensure that resources are allocated in accordance with the health care provider
workload standards and performance levels developed under the direction of ASD(HA).
d. Ensure the cooperation and coordination between their respective offices, the offices
of other Surgeons General, and DoDDS with respect to the implementation of this
e. Ensure that training is available for each health care provider serving as a member of
a Case Study Committee (CSC). This training shall include information about the roles and
responsibilities of the CSC and the development of an IEP.
f. Ensure the provision of inservice training on medically related services to
educational, legal, line, and other suitable personnel, if requested and feasible.
1. Each Military Service shall establish a mechanism for obtaining or determining specific
information regarding the possible medically related service need(s) of potential DoDDS
handicapped students before they leave the United States. This information shall:
a. Include the child's medical and/or educational needs.
b. Be used when necessary to facilitate assignment to areas designated as centers for
medically related services in accordance with this Instruction.
2. Medical and other information shall be shared with other Service medical personnel when
medically related services are to become the responsibility of another Military
Department. This information, while in no way binding on the CSC, shall include:
a. The medical and educational information needed to determine the specific type and
extent of medically related services the child is likely to require.
b. The type and frequency of medically related services likely to be specified in the IEP
in compliance with DoD Instruction 1342.12 (reference (c)).
c. Diagnosis based on, and consistent with, current acceptable professional usage and the
four- and five-digit International Classification of Diseases (ICD)-9-CM categories in DoD
Instruction 6040.33 (reference (k)).
3. Sponsors shall be advised to ensure that information about the child's medically
related needs remains current.
4. If medically related services are likely to be required or should be considered,
assignments shall be pinpointed to areas with the resources available.
5. The assignment personnel of all Military Services in coordination with Service medical
personnel, who provide advice on medical services available, shall coordinate with DoDDS
personnel so that handicapped children who are entitled to receive or are receiving
education from DoDDS and who require or are likely to require medically related services
are sent to locations where those medically related services can be provided. Medical
personnel and personnel officials shall cooperate in efforts to assign sponsor(s) with
children needing medically related services to overseas locations where those services are
currently available or can readily be obtained.
6. Each Military Department shall establish centers in consultation with DoDDS, within
designated areas of geographical responsibility outside the United States capable of
providing necessary medically related services to support the needs of eligible
a. ASD(HA) shall assign the Military Departments geographical areas of medical
responsibility using the Military Health Services System (MHSS) Sizing Model methodology.
The Military Service sending members or civilian employees to unassigned areas or without
first verifying the availability of medically related services shall be responsible for
providing medically related services for the children sent to those areas.
b. If any parts of this Instruction create a potential disruption of established medically
related services to children, DoDDS and the Military Departments in the areas involved
shall devise an interim agreement for a phased shift of responsibility to the medical
facility having geographical responsibility. The agreement shall: provide for a shift of
responsibility as soon as possible but not to exceed three years; be formulated so that no
eligible child goes unserved; and clearly describe referral procedures to be used during
the transition. Copies of such agreements shall be forwarded to ASD(HA) for review within
90 days of publication. ASD(HA) shall provide copies to ASD(FM&P) and GC, DoD.
c. Centers shall be staffed with appropriate professional staff, which should include
occupational therapist(s) with pediatric experience; physical therapist(s) with pediatric
experience; audiologist(s) with pediatric experience; child psychiatrist(s); clinical
psychologist(s) with pediatric experience; social worker(s) with pediatric experience;
community health nurse(s) or equivalent; and pediatrician(s) with experience and/or
training in developmental pediatrics.
d. Before assigning civilian employees with children outside the United States, the
employing DoD Component shall provide such employees with information on the location of
existing centers which are fully equipped to provide medically related services to
children receiving or eligible to receive special education, and the medically related
services currently available where the civilian is to be assigned. The employing DoD
Component shall not suggest that if such employees accept overseas assignments, their
handicapped children who are entitled to receive an education from DoDDS will fail to
receive a free appropriate public education.
7. Each Military Department shall ensure that medical treatment facilities responsible for
providing medically related services in a geographic area initiate memoranda of
understanding with the DoDDS schools served specifying the referral and evaluation
8. Upon request by a CSC, the responsible Military Department shall ensure that a
qualified medical authority conducts or verifies a medical evaluation for use by the CSC
in determining eligibility for special education, including the specific medically related
services necessary for the student to benefit from the individually designed special
education curriculum delineated in the IEP. This medical evaluation, including necessary
consultation with other medical personnel, shall be supervised by a physician or other
qualified health care provider.
a. This medical evaluation shall include a review of general health history, current
health assessment, systems evaluation to include growth and developmental assessment, and,
if pertinent, detailed evaluation of gross motor and fine motor adaptive skills,
psychological status, and visual and audiological capabilities, including details of
present level of performance in each of these areas affecting the student's performance in
b. Evaluation reports from physicians or other health care professionals shall address the
present level of performance, the impact of the child's medical condition(s) on his or her
educational performance, and, when pertinent, offer specific recommendations on the
nature, frequency, and amount of medically related services. Replies to CSC referrals
shall include evaluation results, relationships of findings to educational functioning,
and response(s) to question(s) posed in the original referral.
9. The Commander of the Medical Treatment Facility (MTF) shall ensure the provision of a
summary evaluation report to the CSC and appoint a health care coordinator to serve on the
CSC when eligibility, placement or requirements for medically related services are to be
10. Each MTF designated as a center or providing medically related services under this
Instruction shall designate a health care provider known as the "Medically Related
Services Liaison Officer" to:
a. Provide liaison between the MTF and DoDDS schools.
b. Offer, on a consultative basis, training for DoDDS personnel on medical aspects of
specific handicapping conditions.
c. Offer consultation and advice as needed regarding the health services provided at
school (for example, tracheostomy care, tube feeding, speech and language therapy).
d. Participate with DoDDS and legal personnel in developing and delivering inservice
training programs that include familiarization with various conditions that handicap a
child's educational endeavors, the relationship of medical findings to educational
functioning, medically related services, DoD Instruction 1342.12 (reference (c)), and this
G. EFFECTIVE DATE
This Instruction is. effective immediately. Forward two copies of implementing documents
to the Assistant Secretary of Defense (Health Affairs) within 180 days.
Chapman B. Cox William Maye , M.D.
Assistant Secretary of Defense Assistant Secretary of Defense
(Force Management and Personnel) (Health Affairs)
Enclosures - 2
(e) Secretary of Defense Memorandum, "Provision of Medically Related Services to
Handicapped Dependents in Overseas Areas," September 16, 1983
(f) Office of the Assistant Secretary of Defense (Manpower Reserve Affairs and Logistics)
Memorandum, December 1, 1982, "Assignment of Responsibility for Related Services of a
Medical Nature under DoD Instruction 1342.12, Education of Handicapped Children in the DoD
Dependents Schools December 17, 1981 (hereby canceled by agreement with Assistant
Secretary of Defense (Force Management and Personnel))
(g) Joint Commission on Accreditation of Hospitals, "Accreditation Manual for
(h) DoD Instruction 6040.33, "Medical Diagnoses and Surgical Operations Nomenclature
and Statistical Classification," January 12, 1979
(i) DoD Directive 6025.4, "Credentialing of Health Care Providers," February 11,
(j) DoD Directive 6025.6, "Licensure of DoD Health Care Providers," July 18,
1. Audiology. Audiologic, diagnostic, and prescriptive services provided by audiologists
who have a Certificate of Clinical Competence - Audiology (CCC-A) and pediatric
experience. Audiology shall not include speech therapy.
2. Case Study Committee. A multidisciplinary team comprising, among others, educators and
medically related service providers who determine the eligibility of the student for
special education and formulate an individualized educational curriculum reflected in an
Individualized Education Program (IEP) that is based upon the diagnosis of handicapping
conditions of school-aged children in DoDDS. Full committee membership is detailed in DoD
Instruction 1342.12 (reference (c)).
3. Handicapping conditions. As defined in the definitions listed in
DoD Instruction 1342.12 (reference (c)).
4. Handicapped student. One identified as being eligible for special education by a
multidisciplinary Case Study Committee in accordance with DoD Instruction 1342.12
5. Medically Related Services.
a. Medical services (as defined in 6. below) and those services provided under
professional medical supervision which are required by a Case Study Committee either to
determine a student's eligibility for special education or, if the student is eligible,
the special education and related services required by the student under DoD Instruction
1342.12 (reference (c)).
b. Provision of either direct or indirect services listed in an Individualized Education
Program as necessary for the student to benefit from the educational curriculum. These
services may include medical; social work; community health nursing; dietary; psychiatric
diagnosis, evaluation, and followup; occupational therapy; physical therapy; audiology;
ophthalmology; and psychological testing and therapy.
6. Medical Services. Those evaluative, diagnostic, therapeutic, and supervisory services
provided by a licensed/credentialed physician to assist Case Study Committee(s) and to
implement Individualized Education Program(s). Medical services include diagnosis,
evaluation, and medical supervision of related services that, by statute, regulation, or
professional tradition, are the responsibility of a licensed and credentialed physician.
7. Occupational Therapy. Therapy that provides developmental evaluations and treatment
programs using selected tasks to restore, reinforce, or enhance functional performance. It
addresses the quality and level of function in areas such as behavior, motor coordination,
spatial orientation; visual, motor, and sensory integration; and general activities of
daily living. This therapy, which is conducted by a qualified occupational therapist,
provides training and guidance in using special equipment to improve the patient's
function in skills of daily living, work, and study.
8. Physical Therapy. Therapy that provides evaluations and treatment programs using
exercise, modalities, and adaptive equipment to restore, reinforce or enhance motoric
performance. It focuses on the quality of movement, reflex development, range of motion,
muscle strength, gait, and gross motor development, seeking to decrease abnormal movement
and posture while facilitating normal movement and equilibrium reactions. The therapy,
which is conducted by a qualified physical therapist, provides for measurement and
training in the use of adaptive equipment and prosthetic and orthotic appliances.
9. Psychological Services. Services listed below that are provided by a qualified
a. Administering psychological and educational tests and other assessment procedures.
b. Interpreting test and assessment results.
c. Obtaining, integrating, and interpreting information about a child's behavior and
conditions related to his or her learning.
d. Consulting with other staff members in planning school programs to meet the special
needs of children, as indicated by psychological tests, interviews, and behavioral
e. Planning and managing a program of psychological services, including psychological
counseling or therapy for children. A qualified psychologist is a clinical psychologist
licensed in a state of the United States who has a degree in clinical psychology and
additional pediatric training and or experience. Additionally, DoDDS may certify the
psychologist(s) who work(s) in schools.
10. Qualified occupational therapist. An occupational therapist who has pediatric
education or training beyond the basic degree or has pediatric experience and is
credentialed under DoD Directive 6025.11 (reference (l)).
11. Qualified physical therapist. A physical therapist who has pediatric education or
training beyond the basic degree or has pediatric experience and is credentialed under DoD
Directive 6025.11 (reference (l)) and licensed under DoD Directive 6025.6 (reference m)).
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