JOINT CIRCULAR No. 20/2000/TTLT/BLDTBXH-BYT GUIDING THE RE-EVALUATION OF DISABILITY AND WORK CAPACITY FOR INJURED PERSONS AND VETERANS

JOINT CIRCULAR

Guidelines for re-examination of disability for injured persons and re-examinationof work capacity for war invalids due to recurrence of old diseases.

Re-examination of disability for injured persons and re-examination of workcapacity for war invalids due to recurrence of old diseases.

Pursuant to Article 32 and Article 48 of Decree No. 28/CP dated April 29, 1995 ofthe Government on re-examination of disability for injured persons and re-examinationof work capacity for war invalids due to recurrence of old diseases.

After receiving comments from the Ministry of Finance in Circular No. 5850/TC/HCSNdated November 19, 1999;

The Ministry of Labor, War Invalids and Social Affairs and the Ministry ofHealth hereby issue the following guidelines for implementation:

I. Objectives and Documentation for Re-examination

A. Objectives

1. For Injured Persons:

Article 32 of Decree No. 28/CP dated April 29, 1995 of the Government stipulates:"Injured persons who have been assessed by the Medical Examination Board with apercentage of lost working capacity due to disability, if the injury recurs twoyears after the initial assessment, may be re-examined for disability..." Specifically:

a/ Only those injured persons whose physical injuries recorded in their originaldisability files recur will be considered for re-examination of disability.

b/ The injured persons referred to in Article 32 above are those injured whileperforming duties as prescribed in Article 25 of Decree No. 28/CP dated April 29,1995 of the Government and detailed in Joint Circular No. 16/1998/TTLT-BLDTBXH-BQP-BCA dated November 25, 1998 of the Ministry of Labor, War Invalids andSocial Affairs, the Ministry of Defense, and the Ministry of Public Security, whowere assessed by the authorized Medical Examination Board with a disabilitypercentage ranging from 5% to 20% (persons eligible for one-time allowance) andthose assessed with a permanent disability percentage of 21% or higher confirmedas war invalids or persons entitled to benefits equivalent to war invalids.

c/ If the injury recurs after two years... shall be understood and handled asfollows:

From the month and year when the Medical Examination Board concluded thepermanent disability rate or a disability rate ranging from 5% to 20% (theassessment after treatment and convalescence following injury) and the injurystill recurs requiring continued treatment, then starting from the 25th month(2 years and 1 month) onwards, they will be considered for referral forre-examination (first reconsideration).

Cases where injuries to the body parts listed below, although having undergonefirst reconsideration, still recur within two years and health deterioratesfurther, will be considered for second reconsideration:

Brain injury resulting in skull defect causing neurological and mentaldisorders, paralysis.

Facial, neck, eye, ear injuries causing facial and neck deformities, orrequiring multiple surgeries for artificial eyes or ears affecting hearing.

Lung injury causing complications such as thickened pleura or collapsed lung,requiring lung or lobe removal significantly impacting respiratory function.

Chest injury affecting cardiac physiological functions.

Abdominal injury affecting stomach or intestines causing complications such astomach disorders or intestinal adhesions requiring surgery.

Liver, spleen, pancreas, kidney injuries causing complications significantlyimpacting physiological functions requiring surgery.

Spinal injury causing hemiplegia, sphincter dysfunction, or loss of urinarycontrol.

Limb injuries requiring repeated amputation or partial limb removal due torecurrence.

Other injuries leaving metal fragments in dangerous areas, post-surgicalresidual effects threatening organ function and life.

d/ Recurrent old injuries considered for re-examination must meet the followingcriteria:

The injured person must be hospitalized for treatment of the old injuryrecorded in the original injury certificate or for complications arising fromthe recurrence of the old injury, which reduce physiological and workingfunctions.

The injured person must undergo surgery or non-surgical treatment, but thefunction of the injured organ must be noticeably reduced.

Old injuries considered for re-examination as mentioned above must be treatedat district-level healthcare centers or higher.

2. For War Invalids:

Article 48 of Decree No. 28/CP dated April 29, 1995 of the Government stipulates:"War invalids suffering severe recurrence of old diseases will be re-examinedfor work capacity, and the conclusion of the Medical Examination Board will serveas the basis for determining additional allowances for war invalids." Specifically:

1. War invalids eligible for re-examination of work capacity are those with aloss of working capacity of 61% or more, possessing complete and valid filespursuant to Article 43 of Decree No. 28/CP dated April 29, 1995 of the Government.

2. Severe recurrence of old diseases eligible for re-examination of work capacityare those chronic diseases recorded in the medical examination report uponleaving the military or police force that severely recur leading to:

Severe deterioration of nervous system or mental health, unable to self-manage.

Cardiovascular, respiratory, digestive diseases recurring severely leading toparalysis, unable to self-care (lung disease, digestive organ disease, cancer,liver cirrhosis, heart failure, kidney failure, etc.).

Endocrine diseases recurring causing deformities significantly impactingphysiological functions of multiple organs, leading to paralysis, unable toself-care.

Severe recurrence of old diseases eligible for re-examination of work capacitymust be treated at district-level healthcare centers or higher.

B. Documentation for Re-examination of Disability

Upon receipt of the application for re-examination of disability from injuredpersons, the Department of Labor, War Invalids and Social Affairs of provincesand cities shall review and, if they meet the conditions set out in point 1,section A, part I above, prepare the documentation for referral to medicalexamination including the following documents:

1. For injured persons with a disability rate of 5% to 20%, the documentationincludes:

Application for re-examination of disability signed by the injured person,confirmed by the People's Committee of the commune (ward), verified by theDepartment of Labor, War Invalids and Social Affairs (Organizational and LaborAffairs Department) of the district or county regarding the progression ofdisability and work capacity (no general confirmation allowed).

Identity card (to be carried during the disability examination)

Original injury certificate (issued by the authority or unit at the time ofinjury or by authorized rehabilitation centers immediately after injury andafter treatment and convalescence).

In case the original certificate of injury is torn, damaged, unusable, lost, the authority or unit that issued the original certificate of injury shall reissue it based on the original certificate of injury or according to the list of injured persons kept by the managing authority or unit after the injury. The reissued certificate of injury must clearly state the grounds for reissuance;

Original disability assessment report (assessment immediately after injury, post-treatment, convalescence) if available.

Discharge certificate (clearly stating the diagnosis of injuries, causes, locations of recurrent wounds, work capacity, if surgical intervention is required, there must be a surgery record, both types of certificates must be signed and stamped by the hospital leader at the district level or higher - not authorized signature);

Introduction for re-assessment of disability (model number 07GT attached, fully recording all previous disability assessments) signed and stamped by the Director of the Department of Labor, Invalids, and Social Affairs.

2. For war invalids and persons enjoying benefits similar to war invalids with a disability rate of 21% or more, the file includes:

Application for re-assessment of disability by war invalids, certified by the People's Committee of the commune (ward), confirmed by the Labor and Invalids Social Affairs Office (Organizational and Labor Social Affairs Office) of the district or county regarding the specific progression of disability and work capacity;

Certificate of war invalid status, persons enjoying benefits similar to war invalids (to be carried when undergoing disability assessment);

Disability file summary (model number 08TL attached, recorded according to the original injury certificate) and introduction for re-assessment (model number 07GT attached) signed and stamped by the Director of the Department of Labor, Invalids, and Social Affairs managing the file (introduction fully records all previous assessments);

Discharge certificate (clearly stating the diagnosis of injuries, causes, locations of recurrent wounds, work capacity, if surgical intervention is required, there must be a surgery record, both types of certificates must be signed and stamped by the hospital leader at the district level or higher - not authorized signature);         

3. After reviewing the disability reassessment file, the Department of Labor, Invalids, and Social Affairs will establish a list recommending disability reassessment (03 copies - model number 01DS attached to this Circular). Each individual's file and the list recommending disability reassessment will be sent to the Ministry of Labor, Invalids, and Social Affairs (Department of War Invalids and Martyrs and Persons with Merit) for preliminary review before being transferred to the Medical Examination Council for examination according to current regulations.

4. Handling benefits after reassessing disability:

a/For individuals with a disability rate from 5% to 20%: If the reassessment still shows a rate below 21%, the Department of Labor, Invalids, and Social Affairs will retain the disability assessment report without implementing the one-time allowance. If the reassessment determines a disability rate of 21% or more, the Director of the Department of Labor, Invalids, and Social Affairs will issue a decision on allowances, and a certificate of disability allowance will be established. Simultaneously, send the list and abstract of each person's file (model number 02TL attached to this Circular) to the Ministry of Labor, Invalids, and Social Affairs for registration (registration number of the war invalid certificate). The Ministry of Labor, Invalids, and Social Affairs authorizes the Director of the Department of War Invalids and Martyrs and Persons with Merit to sign, stamp, organize storage of disability records, and transfer the list with files back to the Department of Labor, Invalids, and Social Affairs for management and implementation of disability allowance payments according to current regulations.

b/For individuals with a disability rate of 21% or more: If the reassessment shows a decrease, increase, or unchanged disability rate, the Director of the Department of Labor, Invalids, and Social Affairs will issue a decision adjusting the disability allowance (05 copies - model number 03DC attached to this Circular): 01 copy sent to the Ministry of Labor, Invalids, and Social Affairs (Department of War Invalids and Martyrs and Persons with Merit), 01 copy retained by the department, 01 copy for the Head of the Labor and Invalids Social Affairs Office of the district or county, 01 copy for the concerned party.

C. Disability Reassessment File:

After receiving the application for disability reassessment from war invalids, the provincial or municipal Departments of Labor, Invalids, and Social Affairs will check if they meet the conditions stipulated in point 2, Section A, Part I above, then establish the procedures and file for introducing them for disability reassessment including the following documents:

1. The disability reassessment file includes:

Application for disability reassessment by war invalids (if the war invalid has mental illness, it may be written by a family member), certified by the People's Committee of the commune (ward) and confirmed by the Labor and Invalids Social Affairs Office (Organizational and Labor Social Affairs Office) of the district or county regarding the specific progression of illness, severity, and self-care ability (not general confirmation).

Certificate of war invalid status (war invalids carry when undergoing assessment);

Decision on demobilization or discharge (if applicable);

Summary of the war invalid file (recorded according to the illness certificate model number 06BB attached) and introduction for disability reassessment (model number 07GT attached) signed and stamped by the Director of the Department of Labor, Invalids, and Social Affairs managing the file (introduction fully records all previous assessments);

Discharge certificate (clearly stating the diagnosis of illnesses, causes of recurrence, severity, self-care ability, if surgical intervention is required, there must be a surgery record, both types of certificates must be signed and stamped by the hospital leader at the district level or higher - not authorized signature), if mental illness, must have old and new outpatient treatment records;  

2. After reviewing the disability reassessment file, the Department of Labor, Invalids, and Social Affairs will establish a list recommending disability reassessment (03 copies - model number 04DS attached to this Circular). Each individual's file and the list recommending disability reassessment will be sent to the Ministry of Labor, Invalids, and Social Affairs (Department of War Invalids and Martyrs and Persons with Merit) for preliminary review before being transferred to the Provincial or Municipal Medical Examination Council specified in Part II of this Circular.

3. After reassessing disability, if the percentage of loss of working capacity due to illness decreases, increases, or remains unchanged, the Director of the Department of Labor, Invalids, and Social Affairs will issue a decision adjusting the war invalid allowance (04 copies - model number 05DC attached to this Circular), 01 copy retained by the department, 01 copy for the Head of the Labor and Invalids Social Affairs Office of the district or county, 01 copy for the concerned party.

II. Classification and Delegation of Authority for Re-examination of Disability and Illness by Provincial and Central City Medical Examination Boards.

1. Conditions for Classification of Provincial and Central City Medical Examination Boards:

a/Provincial and Central City Medical Examination Boards that are classified to conduct re-examinations of disability and illness must be those boards located in provinces and cities with comprehensive hospitals equipped with sufficient specialized facilities and infrastructure, organized properly, and possessing adequate professional capabilities in accordance with the provisions of Joint Circular No. 16/TTLT-YT-LĐTBXH dated July 26, 1995 of the Ministry of Health and the Ministry of Labor, Invalids, and Social Affairs.

Localities that believe they meet the required conditions should report to the Central Medical Examination Institute for review and then submit to the Ministry of Health for classification decision after reaching consensus with the Ministry of Labor, Invalids, and Social Affairs.

b/Members and medical examiners of the classified Medical Examination Boards must regularly undergo comprehensive training in their professional duties and must thoroughly understand the standards for disability and illness before conducting re-examinations of disability and illness.

c/The results of re-examinations of disability and illness conducted by classified Medical Examination Boards must be reported to the Central Medical Examination Board or its Branches I and II, and transferred to the Department of Labor, Invalids, and Social Affairs of the province or central city where the examination was recommended for implementation.

d/The Central Medical Examination Institute is responsible for guiding and inspecting the classification and examination procedures of provincial and central city Medical Examination Boards.

2.Provinces and cities that do not meet the conditions for classification for re-examination of disability and illness shall have their Departments of Labor, Invalids, and Social Affairs arrange for individuals with disabilities or illnesses to be re-examined at the Central Medical Examination Board or its Branches I and II.

III. Funding for Re-examination of Disability and Illness.

1.Persons with disabilities who are entitled to re-examination of disability and persons with service-related illnesses who are entitled to re-examination of illness as stipulated in this Circular shall have their travel expenses covered by the Department of Labor, Invalids, and Social Affairs of the locality where the examination was recommended.

a/Fare for transportation from place of residence (commune, ward, town) to the Central Medical Examination Board or provincial/city level and back (if applicable) according to the state-set fare for regular passenger transport vehicles.

b/Medical examination fees include: costs for specialist examinations, necessary clinical tests as prescribed by the Medical Examination Board, and charges according to the current state-prescribed fee schedule for provinces and cities authorized for medical examination.

2.Funding Sources:

The funding to cover the expenses specified in Section 1 of Part III above comes from the preferential assistance funds for persons with meritorious service to the revolution as stipulated in Joint Circular No. 135/1998/TTLT-BTC-BLĐTBXH dated October 16, 1998 of the Ministry of Finance and the Ministry of Labor, Invalids, and Social Affairs.

IV. Implementation Organization.

1/Provincial and Central City Departments of Labor, Invalids, and Social Affairs shall cooperate with Provincial and Central City Health Departments and relevant agencies to widely disseminate the contents of the regulations on re-examination of disability and illness as stipulated in this Circular.

2/Provincial and Central City Health Departments shall guide hospitals and district-level health centers and above to be responsible for examining, treating recurrent injuries and illnesses, issuing discharge certificates, and other documents as prescribed in this Circular for individuals requiring re-examination of disability and illness (without needing a medical record).

3/The Central Medical Examination Institute is responsible for providing guidance on organization, professional training, and specifying equipment and technical means in accordance with the regulations of the Ministry of Health.

4/After the Medical Examination Board issues its conclusion, the Department of Labor, Invalids, and Social Affairs shall notify the result of each individual's re-examination to the commune (ward) where the person resides for public announcement at the People's Committee office, or inform the workplace if the person is employed. If there are no complaints or accusations within 15 days of notification, the process for enjoying benefits according to regulations will be initiated.

5/Complaints and accusations regarding pre-re-examination files shall be reviewed and resolved by the Director of the Department of Labor, Invalids, and Social Affairs of the province or central city.

Complaints and accusations about the re-examination of disability and illness shall be handled by the Medical Examination Board conducting the re-examination. If unresolved, they shall be referred to the Central Medical Examination Board or its Branches I and II for consideration and decision.

6/Annually, based on the number of disabled and service-related ill individuals requiring re-examination of disability and illness, the Departments of Labor, Invalids, and Social Affairs of the provinces and cities shall consider, plan, and budget for re-examination expenses together with the preferential assistance budget for persons with meritorious service to the revolution and submit them to competent authorities according to current regulations.

7/The Medical Examination Board of the Ministry of National Defense and the Ministry of Public Security shall conduct re-examinations of disability for individuals injured while working in the People's Army and the People's Police.

Conditions, procedures, and documentation for re-examination of disability and classification for re-examination of disability shall follow the guidelines of the Ministry of National Defense and the Ministry of Public Security after consultation with the Ministry of Health and the Ministry of Labor, Invalids, and Social Affairs.

8/This Circular takes effect 15 days after the date of signature. Previous regulations contrary to this Circular are hereby abolished.

During the implementation process, any difficulties encountered should be reported to the Joint Ministries for study and resolution./.