HL7 FHIR Implementation Guide: Military Service History and Status Release 1 - US Realm | STU1, published by Cross Group Projects WG. This is not an authorized publication; it is the continuous build for version 1.0.0). This version is based on the current content of https://github.com/HL7/fhir-military-service/ and changes regularly. See the Directory of published versions

Terminology

Terminology Requirements

An initial gap analysis of SNOMED CT terminology identified that we are missing significant content related to discharge status requirements in DischargeStatusCode.

Other terminology extension and harmonization targets are:

• Military Branch Code

• Pay Grade Code

Another gap is “separation reason” that requires a coded concept for its Observation component and its allowed values.

In the future, the Combat Episode Mission Value Set may also need a SNOMED CT extension if the VA API requires it.

Figure 3: Terminology Requirements

Job Supervisory Level or Pay Grade (ODH)

This code system is used in value set:” Job Supervisory Level or Pay Grade (ODH)”

https://phinvads.cdc.gov/vads/ViewValueSet.action?id=B35E2ABE-C20F-EA11-8183-005056ABE2F0

• Canonical URL based on the current version of UT: http://build.fhir.org/ig/HL7/UTG/CodeSystem-PHOccupationalDataForHealthODH.html

Industry CDC NAICS 2012 (ODH)

This code system used in value set Military Branch Code

Code system url: Currently the code system URL will be the one published by the UT project.

• http://build.fhir.org/ig/HL7/UTG/CodeSystem-PHOccupationalDataForHealthODH.html

SNOMED CT

SNOMED CT will be used to fill any terminology gaps that are not already addressed by FDA code systems in the US.

Industry NAICS Detail (ODH)

https://phinvads.cdc.gov/vads/ViewValueSet.action?id=5718C508-111B-4737-A48C-FDCFD301C0D

Value Set Name: Industry NAICS Detail (ODH)

Value Set OID 2.16.840.1.114222.4.11.7900

Value Set Description Concepts describing the kind of business that compensates the person for work (e.g., wages, training) or assigns work to a volunteer, as reported by the person. The kind of business is determined based on the primary business activity conducted by the company, organization, or individual (for those who are self-employed), or, for a military position, the self-reported branch of service. The value set was created by coding the NAICS index terms, which are relatable to the general public, to facilitate collection and validation by patients. A downloadable file available from the PHIN VADS ODH Hot Topics section is structured to support computer-assisted searching of this value set. The file also contains a crosswalk from the concepts in this value set to Occupation_CDC_Census value set concepts.

Discharge Status Code

A SNOMED CT Extension needed to describe the status when an individual leaves military service.

The VA API and Z-segment specification declares local extensions to SNOMED CT corresponding to subtypes of “Left Military Service” 266964007 concept.

Question: Should it include “active” because we may have a DoD API that works in a similar way?

Answer: No, the cardinality should allow for this data element to omitted if the service episode is the current episode.

	Description
general	General status. This concept is a gap in SNOMED CT. subtype of “Left Military Service” 266964007 concept. local concept id:
honorable	Additional description pending.] This concept is a gap in SNOMED CT.
dishonorable discharge	This status has an equivalent concept in SNOMED CT: 276086007
bad-conduct	This concept is a gap in SNOMED CT.
other-than-honorable	This concept is a gap in SNOMED CT. Relationships: This concept has two child concepts: honorable-for-va-purposes dishonorable-for-va-purposes During the review process, the Veteran will in “Pending Character of Discharge” (COD) state defined as “
dishonorable-for-va-purposes	This status is obtained when “other-than-honorable” is later deemed to be dishonorable for Title 38 Veteran Benefits criteria. This concept is a gap in SNOMED CT. “Has a Character of Discharge (COD) review from VBA ruling the individual Dishonorable for VA Purposes (DVA), and was originally one of the discharge types in the second row of this table.” Relationships: This concept is a subtypes of “Other-than-honorable” .
honorable-for-va-purposes	This status is obtained when “other-than-honorable” is later deemed to be honorable for Title 38 Veteran Benefits criteria. This concept is a gap in SNOMED CT. “Has a character of discharge of: • Honorable • Under Honorable Conditions (General) • Uncharacterized (Entry level separation) OR Has a Character of Discharge (COD) review from VBA ruling the individual Honorable for VA Purposes (HVA).” Relationships: This concept is a subtypes of “Other-than-honorable”
honorable-absence-of-negative-report	This concept is a gap in SNOMED CT. Relationships: This concept is a subtype of “honorable-discharge ?”
uncharacterized	This concept is a gap in SNOMED CT.
unknown	This concept is a gap in SNOMED CT. Missing information about discharge status.

Military Branch Code

“The military branch associated with service, National Guard, and Reserve.”

The Military Branches coded concepts are documented in PHIN VADS as Industry CDC NAICS 2012 (ODH).

Localization Note:

• From an occupational standpoint, any foreign military service should be captured as well as US military service. The profile allows an “extensible” terminology binding to allow a service history that includes service in US and foreign armed forces.

• The VA API will be limited to US Armed Forces; similarly, Canadian Forces will implement a realm-specific approach that accommodates Canadian requirements.

Note: the following is complete list of concepts to describe the military branch.

Additional: NOAA and Merchant Marine members may also be included in this value set.

	Description
U. S. Armed Forces - Branch not specified	Code: 9870: Military Reserves or National Guard System URL: http://terminology.hl7.org/CodeSystem/PHIndustryCDCCensus2010
U. S. Army	Code: 9670 (U.S. Army) System URL: http://terminology.hl7.org/CodeSystem/PHIndustryCDCCensus2010
U. S. Air Force	Code: 9680: U.S. Air Force System URL: http://terminology.hl7.org/CodeSystem/PHIndustryCDCCensus2010
U. S. Marine Corps	Code: 9770 (U.S. Marines) System URL: http://terminology.hl7.org/CodeSystem/PHIndustryCDCCensus2010
U. S. Navy	Code: 9690: U.S. Navy System URL: http://terminology.hl7.org/CodeSystem/PHIndustryCDCCensus2010
U. S. Coast Guard	Code: 9780: U.S. Coast Guard System URL: http://terminology.hl7.org/CodeSystem/PHIndustryCDCCensus2010
Military Reserves or National Guard	Concept (id: 9870] is used to specify Reserves or National Guard service. Code: 9870: Military Reserves or National Guard System URL: http://terminology.hl7.org/CodeSystem/PHIndustryCDCCensus2010
Non-US Armed Forces (out-of-scope)	This concept is out of scope but it was discussed as potential requirement. This concept is out-of-scope at this time.

Pay Grade Code

Defines the level of compensation for a position, normalized across military branches. This value set harmonizes the concepts used in VA wit those specified by FDA for Occupational Data for Health implementations.

This specification will use the latest FDA value set specified in Job Supervisory Level or Pay Grade.

Separation Reason Code

“Additional description for separation reason beyond discharge status value.”

Note: This may need to be specified as a code value rather than a text value.