**STAFFING**

**1. REASON FOR ISSUE:** To revise Department of Veterans Affairs (VA)
procedures related to staffing.

**2. SUMMARY OF CONTENTS/MAJOR CHANGES:** This handbook contains
mandatory VA procedures on staffing. The pages in this transmittal
replace the corresponding pages and add pages to VA Handbook 5005. These
changes will be incorporated into the electronic version of VA Handbook
5005 that is maintained on the [Office of Human Resources Management and
Labor Relations Web site.](http://vaww.va.gov/ohrm) Significant changes
include:

a\. Part II, Chapter 3, Section C, Professional Standards Boards,
reflects changes made regarding the establishment, approving
authorities, membership, composition, functions, and locations of
Professional Standards Boards (PSB).

b\. Part II, Appendix O, Organizational Location of Hybrid Title 38
Professional Standards Boards, is added.

c\. Part II, Appendix P, Procedures for Selecting Hybrid Title 38
Professional Standards Boards Members, is added.

d\. Part III, Chapter 4, Section B, Promotion and Internal Placement of
Hybrid Title 38 Employees, is added.

e\. Part III, Appendix J, Documentation of Advancements on SF 50-B,
Notification of Personnel Action, reflects the inclusion of "All Hybrid
Occupations", clarification of certain Appointment Authorities, and
inclusion of "Pay Adjustment" as a Nature of Action.

f\. Part III, Appendix K, Advancements Approved by the Under Secretary
for Health, Network Directors, and Facility Directors, reflects the
addition of other officials and designees as approval authorities.

g\. Part III, Appendix L, Title 38 Time-in-Grade Requirements, reflects
the removal of time-in-grade (TIG) requirements for all hybrid title 38
employees. Note that TIG requirements remain in effect for full title 38
and title 5 employees.

h\. Part III, Appendix M, Processing Title 38 and Hybrid Title 38
Promotions and Advancements, reflects the inclusion of all hybrids in
column A and clarifies certain references in column B.

i\. Part III, Appendix O, Full Performance Levels for Hybrid Title 38
Positions, is added.

j\. Part III, Appendix P, Procedures for Reporting Questionable Behavior
and Judgment Exhibited by Hybrid Title 38 Professional Standards Boards
Members, is added.

**3. RESPONSIBLE OFFICE:** The Recruitment and Placement Policy Service
(059), Office of the Deputy Assistant Secretary for Human Resources and
Labor Relations

**4. RELATED DIRECTIVE:** VA Directive 5005, "Staffing."

**5. RESCISSIONS:** None.

**CERTIFIED BY: BY DIRECTION OF THE SECRETARY**

**OF VETERANS AFFAIRS:**

/s/Robert T. Howard /s/R. Allen Pittman

Senior Advisor to the Deputy Secretary Assistant Secretary for Human

Supervisor, Office Information and Resources and Administration

Technology

ELECTRONIC DISTRIBUTION ONLY

**CONTENTS-CONTINUED**

# PARAGRAPH PAGE

**APPENDICES-Continued**

II-G14. [OCCUPATIONAL THERAPIST QUALIFICATION
STANDARD](http://vaww1.va.gov/ohrm) II-G14-1

II-G15. [LICENSED PHARMACIST QUALIFICATION STANDARD](#AppIIG15) II-G15-1

II-G16 [DOCTOR OF CHIROPRACTIC QUALIFICATIONS STANDARD](#AppIIG16)
II-G16-1

II-G17 [DEVELOPMENT OF QUALIFICATION STANDARDS FOR
VETERANS](http://vaww1.va.gov/ohrm)

[HEALTH ADMINISTRATION (VHA) POSITIONS FILLED
UNDER](http://vaww1.va.gov/ohrm)

[38 U.S.C. **§** 7401(3)](http://vaww1.va.gov/ohrm) II-G17-1

II-H. [APPOINTMENT PROCEDURES BY OCCUPATION/ASSIGNMENT](#AppIIH1)

II-H1. [PROCEDURES FOR APPOINTING PHYSICIANS TO SERVICE CHIEF](#AppIIH1)

[AND COMPARABLE POSITIONS](#AppIIH1) II-H1-1

II-H2. [PROCEDURES FOR APPOINTING DENTISTS AND EFDAS](#AppIIH2) II-H2-1

II-H3. [PROCEDURES FOR APPOINTING PODIATRISTS](#AppIIH3) II-H3-1

II-H4. [PROCEDURES FOR APPOINTING OPTOMETRISTS](#AppIIH4) II-H4-1

II-H5. [RECRUITMENT, APPOINTMENT, ADVANCEMENT, CHANGE IN](#AppIIH5)

[ASSIGNMENT AND REASSIGNMENT OF REGISTERED NURSES (RNs)](#AppIIH5)

[IN GRADES IV AND V](#AppIIH5) II-H5-1

II-H6. [PROCEDURES FOR APPOINTING NURSE ANESTHETISTS TO](#AppIIH6)

[SECTION CHIEF POSITIONS](#AppIIH6) II-H6-1

II-H7. [PROCEDURES FOR APPOINTING PHYSICIAN ASSISTANTS AT](#AppIIH7)

[CHIEF GRADE](#AppIIH7) II-H7-1

II-H8. [PROCEDURES FOR APPOINTING CHIEFS OF PHARMACY SERVICE](#AppIIH8)

[(ALL GRADES), CLINICAL PHARMACY/PHARMACY SPECIALISTS,](#AppIIH8)

[AND PROGRAM SPECIALISTS AT GRADES GS-13 AND ABOVE](#AppIIH8) II-H8-1

II-H9. [PROCEDURES FOR APPOINTING OCCUPATIONAL AND PHYSICAL](#AppIIH9)

[THERAPISTS AS SECTION CHIEF](#AppIIH9) II-H9-1

II-H10 [PROCEDURES FOR APPOINTING DOCTORS OF CHIROPRACTIC](#AppIIH10)
II-H10-1

II-I. [ENGLISH LANGUAGE PROFICIENCY](#AppIIi) II-I-1

II-J. [REQUESTS FOR APPROVAL TO PETITION THE UNITED STATES
DEPARTMENT](#AppIIJ)

[OF STATE (DOS) FOR SUPPORT OF A WAIVER OF THE 2-YEAR HOME](#AppIIJ)

[RESIDENCE REQUIREMENT OF THE UNITED STATES EXCHANGE VISITOR](#AppIIJ)

[PROGRAM](#AppIIJ) II-J-1

II-K. [RCVL (RESIDENT/TRAINEE CREDENTIALS VERIFICATION LETTER)](#AppIIK)
II-K-1

II-L. [CREDENTIALING CHECKLIST](#AppIIL) II-L-1

II-M. [SAMPLE CONSULTANT CERTIFICATE](#AppIIM) II-M-1

II-N. [CAREER INTERN PROGRAM](#AppIIN) II-N-1

\[II-O. [ORGANIZATIONAL LOCATION OF HYBRID TITLE 38
PROFESSIONAL](#AppIIO)

[STANDARDS BOARDS](#AppIIO) II-O-1

II-P. [PROCEDURES FOR SELECTING HYBRID TITLE 38 PROFESSIONAL
STANDARDS](#AppIIP)

[BOARDS MEMBERS](#AppIIP) II-P-1\]

\*Use in conjunction with the OPM Standard.

## SECTION C. PROFESSIONAL STANDARDS BOARDS

**1.** **ESTABLISHMENT**

a\. Professional Standards Boards for occupations listed in 38 U.S.C.
7401(1) act for, are responsible to, and are agencies of the Under
Secretary for Health in matters concerning appointments, advancements,
and probationary reviews of physicians, dentists, podiatrists,
chiropractors, optometrists, nurses (RNs), nurse anesthetists, PAs and
EFDAs. Boards will determine eligibility and recommend the appropriate
grade for appointments under authority of 38 U.S.C. 7401(1) and
7405(a)(1)\[(A)\]; recommend candidates for advancements; \[ \] and
conduct probationary reviews.

b\. Professional Standards Boards for occupations listed in 38 U.S.C.
7401(3) act for, are responsible to, and are agencies of the Under
Secretary for Health in matters concerning appointments and advancements
of individuals \[in all hybrid occupations.\] Boards will determine
eligibility and recommend the appropriate grade level for appointment
under authority of 38 U.S.C. 7401(3) and 7405(a)(1)\[(B)\], and will
recommend candidates \[for special advancements for achievement and
promotions to grades above the full performance level. (See Appendix
III-O, part III, this handbook.)\]

c\. Members of boards serve in a dual capacity. They \[ \] deal with
matters in which they must divest themselves of their identity with the
particular facility at which they are employed and must become
representatives of and primarily concerned with the needs and problems
of the entire VHA.

\[d. VHA management officials are responsible for ensuring the effective
functioning of boards under their jurisdiction.

e\. See Appendix III-P, part III, this handbook, Procedures for
Reporting Questionable Behavior and Judgment Exhibited by Hybrid Title
38 Professional Standards Boards Members.

f\. The Organizational Location of Hybrid Title 38 Professional
Standards Boards is located in Appendix O, this part.\]

**2.** **APPROVING AUTHORITIES FOR BOARD MEMBERSHIP.** The following
officials \[may approve or terminate\] board membership. \[A second
Chair, or Co-Chair, may be appointed to a Board when the approving
authority determines it is necessary and appropriate to do so.\] (For
composition of boards, see paragraph 5.)

a\. \[**National**\] **Boards.** The Under Secretary for Health, or
designee, \[may approve or terminate\] membership \[on National\]
boards, \[including appointment of the board Chair\].

b\. **VISN Boards.** \[Except as provided in paragraph 3a, the Network
Director will establish VISN boards. The Network Director or designee
may approve or terminate membership on VISN boards, including
appointment of the board Chair\].

c\. **Facility Boards.** The facility Director \[may approve or
terminate membership on facility\] boards, \[including appointment of
the board Chair\]. The \[appropriate service chief or equivalent
position will nominate board members and recommend a board Chair\].

d\. \[**Termination of Board Membership.** Appointments to the board
under paragraphs 2a through 2c above may be terminated whenever an
individual\'s performance, conduct, or position is incompatible with
board membership. Examples include receipt of performance rating of
below the fully successful level (or equivalent), breach of
confidentiality, failure to attend meetings or to complete assignments
in a timely manner, expiration of term as Board member, and election or
appointment as a union official\].

**3.** **DESIGNATION OF ALTERNATE BOARD**

a\. Whenever necessary, the Under Secretary for Health, or designee, may
designate a VISN board to serve one or more VISNs. \[VISN boards for
nurses in grades IV and V are established by the Chief Nursing Officer
(see appendix II-H5).\]

b\. When \[a VISN or\] facility board cannot be properly constituted,
actions will be referred to \[another\] appropriate Board.

\[ \]

**4. BOARD MEMBERSHIP** \[(See Appendix P, this part, Procedures for
Selecting Title 38 Hybrid Professional Standards Boards Members.)\]

a\. Persons selected to serve on boards will be chosen from the most
capable, experienced and responsible personnel. \[Board members must be
at a grade and level that is equal to or higher than that of the
candidate being considered. Board membership should also be sufficiently
broad to cover the range of practice within an occupation and where
possible include all grades and levels within an occupation\].

b\. \[Recommending officials will not serve on boards considering their
recommendations. Employees will not serve on boards for which they serve
as the approving official\].

c\. Boards may be composed of three \[or five voting members who were\]
appointed under 38 U.S.C. chapter 73 or 74\[. However, when necessary,\]
the Under Secretary for Health \[ \] or designee \[may appoint other
qualified individuals to National boards. One of the members will be
appointed as chairperson of the board. Board membership will also
include a Secretary, who may or may not be one of the voting members.
The role of the Secretary is to record, prepare and submit notes of the
Board proceedings and relevant discussion to the PSB Chair. The
Secretary is also responsible for completing page two of VA Form 10-2543
and obtaining Board members' signatures\].

d\. The Human Resources Management Officer or designee will serve as
technical advisor on all board actions. Attendance at Board meetings
\[by the Human Resources technical advisor\] is \[recommended but\] not
required.

\[e. Upon initial and all subsequent appointments to a Board, whether a
facility, VISN, or national Board, all appointees, including the Chair,
members, and the secretary, must take the Professional Standards Board
training.\]

**5. COMPOSITION OF BOARDS**

\[Whenever possible, professional standards boards will be composed of
three or five employees from the same occupation as the individual being
considered. However, appropriately qualified individuals from other
occupations may be appointed, provided the board is composed of a
majority of the employees from the occupation involved. When the
appropriate minimum number of employees in the occupation is not
available or the number of employees is too small to provide for an
independent review, an alternate board must be used\].

**6.** **BOARD FUNCTIONS.** The primary functions of boards are to:

a\. Review and act on employment applications and determine whether the
applicant meets the requirements set forth in VA qualification
standards. \[Sound professional and administrative judgment will be
exercised in reviewing applications to ensure that VA obtains the best
qualified personnel\].

b\. Review completely an individual's qualifications for advancement by
an examination of the personnel folder, proficiency reports or
performance appraisals, supervisory evaluations, and other pertinent
records; and to make recommendations based on their findings.

c\. Conduct probationary reviews for individuals appointed under 38
U.S.C. 7401(1).

d\. Execute VA Form 10-2543, Board Action.

e\. \[National\] boards make recommendations to the Under Secretary for
Health or designee on appointments and advancements, and on probationary
reviews of individuals appointed under 38 U.S.C. 7401(1), which require
approval in Central Office. This includes recommendations on requests
for promotion reconsideration by registered nurses and other occupations
as determined by the Under Secretary for Health or other central office
designee.

**7.** **EXCEPTIONS.** The Under Secretary for Health or designee may
establish procedures for appointing employees without action by a
Professional Standards Board in instances such as:

a\. Temporary appointment \[under 38 U.S.C. 7405\] pending processing by
a Professional Standards Board for an appointment under 38 U.S.C.
7401(1) \[or\] 7401(3).

b\. Conversion of an employee appointed under 38 U.S.C. 7401(1) or
7401(3) to an appointment under 38 U.S.C. 7405(a)(1) \[or 7405(a)(2)\].

c\. Conversion of an employee from an appointment under 38 U.S.C.
7405(a)(1) to an appointment under 38 U.S.C. 7401(1) or 7401(3),
provided the employee had previously acquired permanent status under 38
U.S.C. 7401(1) \[or 7401(3)\] and has had continuous service under 38
U.S.C., chapter 73 or 74 since acquiring such status.

d\. \[Appointment of graduate technicians pending licensure,
certification, or registration, student technicians pending graduation,
and other individuals appointed under 38 U.S.C. 7405(a)(1) pending
completion of requirements for appointment.\]

**8.** \[**FACILITY**\] **DIRECTOR** \[**DECISIONS**\]**.** When the
facility Director is the approving official for a board action, the
Director's decision is final. This does not preclude employees from
requesting promotion reconsideration under the provisions of part III,
chapter 4, \[sections A or B (whichever is appropriate),\] of this
handbook.

**9. LOCATION OF BOARDS**\[**.** See Appendix O, this part,
Organizational Location of Hybrid Title 38 Professional Standards
Boards.\]

> a\. \[**National**\] **Boards.** \[National b\]oards are established
> \[ \] to act on appointments, advancements, \[and\] probationary
> reviews for Central Office and VISN office employees\[, and for
> facility employees where facility and VISN boards do not exist\].
> \[National boards also\] act\[ \] on \[ \] promotion reconsideration
> requests \[submitted under part III, chapter 4, sections A and B, of
> this handbook\].
>
> \[(1) The National Physician and Dentist Professional Standards Boards
> also act on appointments, advancements, temporary promotions, and
> probationary reviews for placement at Executive Grade (e.g., Chief of
> Staff and VISN product/care line manager).
>
> \(2\) The National Nurse PSB acts on all promotion reconsideration
> requests from registered nurses and licensed practical/vocational
> nurses, any waiver of education required to place an employee at Nurse
> IV, all appointments, advancements, probationary reviews, and
> reassignments involving Nurse Executive and Nurse V positions, as well
> as on actions requiring a second waiver for placement of an individual
> at a particular grade or level.
>
> \(3\) Other \[National\] Boards may be constituted as needed by the
> Under Secretary for Health.\]

b\. \[**VISN**\] **Boards**\[ \]

\[(1) **Nurses.** Except as provided in paragraph 9a(2), the VISN NPSB
shall consider the appointment, advancement, change in assignment and
reassignment of registered nurses in Nurse IV. The appropriate VISN NPSB
is identified in appendix II-H5.

\(2\) **Hybrids.** A VISN PSB will be established for most occupations
within each VISN, at the facility designated by the Network Director, to
consider appointments and advancements of individuals in these
occupations. The VISN Board will act on appointments and advancements
when a facility board cannot be properly constituted, and will consider
requests for reconsideration or review of promotions initially
considered by a facility Standards Board.\]

c\. \[**Facility**\] **Boards.** Facility boards will be established to
act on all appointments, advancements and probationary reviews, when a
board can be properly constituted as provided in paragraph 5\].

\[ \]

[]{#AppIIO .anchor}\[**APPENDIX O. ORGANIZATIONAL LOCATION OF HYBRID
TITLE 38 PROFESSIONAL STANDARDS BOARDS**

+--------------------------------+-------------------------------------+
| **OCCUPATION**                 | **BOARD LOCATION**                  |
+--------------------------------+-------------------------------------+
| 0180 Psychologist              | VISN & Facility PSB through GS-13   |
|                                |                                     |
|                                | National PSB for GS-14 and above    |
|                                |                                     |
|                                | Regional PSB for Readjustment       |
|                                | Counseling Service (RCS)            |
|                                | Psychologists GS-13 & below         |
|                                |                                     |
|                                | National PSB for RCS Psychologists  |
|                                | GS-14 & above                       |
+--------------------------------+-------------------------------------+
| 0185 Social Worker             | VISN & Facility PSB through GS-12   |
|                                |                                     |
|                                | National PSB for GS-13 and above    |
|                                |                                     |
|                                | Regional PSB for Readjustment       |
|                                | Counseling Service (RCS) Social     |
|                                | Workers GS-12 & below               |
|                                |                                     |
|                                | National PSB for RCS SWs GS-13 &    |
|                                | above                               |
+--------------------------------+-------------------------------------+
| 0601 Registered Respiratory    | VISN PSB through GS-8               |
| Therapist                      |                                     |
|                                | National PSB GS-9 and above         |
+--------------------------------+-------------------------------------+
| 0620 LPN/LVN                   | VISN & Facility PSB through GS-6    |
|                                |                                     |
|                                | VISN PSB GS-7                       |
|                                |                                     |
|                                | National PSB for all                |
|                                | reconsideration actions             |
+--------------------------------+-------------------------------------+
| 0630 Dietitian                 | VISN & Facility PSB through GS-12   |
|                                |                                     |
|                                | National PSB for GS-13 and above    |
+--------------------------------+-------------------------------------+
| 0631 Occupational Therapist    | Regional PSB through GS-12          |
|                                |                                     |
|                                | Northeast Region: VISNs 1-6 & 10    |
|                                |                                     |
|                                | Southeast Region: VISNs 7-9, 16 &   |
|                                | 17                                  |
|                                |                                     |
|                                | Midwest Region: VISN's 11-15 & 23   |
|                                |                                     |
|                                | West Region: VISN's 18-22           |
|                                |                                     |
|                                | National PSB GS-13 and above        |
+--------------------------------+-------------------------------------+

+--------------------------------+-------------------------------------+
| 0633 Physical Therapist        | Regional PSB through GS-12          |
|                                |                                     |
|                                | Northeast Region: VISNs 1-6 & 10    |
|                                |                                     |
|                                | Southeast Region: VISNs 7-9, 16 &   |
|                                | 17                                  |
|                                |                                     |
|                                | Midwest Region: VISNs 11- 15 & 23   |
|                                |                                     |
|                                | West Region: VISNs 18-22            |
|                                |                                     |
|                                | National PSB GS-13 and above        |
+--------------------------------+-------------------------------------+
| 0635 Kinesiotherapist          | > Regional PSB through GS-12        |
|                                |                                     |
| (Corrective Therapist)         | Northeast Region: VISNs 1-6, 10     |
|                                |                                     |
|                                | Southeast Region: VISNs 7-9, 16 &   |
|                                | 17                                  |
|                                |                                     |
|                                | Midwest Region: 11-15 & 23          |
|                                |                                     |
|                                | West Region: VISNs 18-22            |
|                                |                                     |
|                                | National PSB for GS-13 and above    |
+--------------------------------+-------------------------------------+
| 0636 Occupational/Physical     | Regional PSB through GS-7           |
| Therapy Assistant              |                                     |
|                                | Northeast Region: VISNs 1-6, 10     |
|                                |                                     |
|                                | Southeast Region: VISNs 7-9, 16 &   |
|                                | 17                                  |
|                                |                                     |
|                                | Midwest Region: VISNs 11-15 & 23    |
|                                |                                     |
|                                | West Region: VISNs 18-22            |
|                                |                                     |
|                                | National PSB for GS-8 and above     |
+--------------------------------+-------------------------------------+
| 0640 Certified Respiratory     | VISN PSB through GS-7               |
| Therapist                      |                                     |
|                                | National PSB GS-8 and above         |
+--------------------------------+-------------------------------------+
| 0601 Nuclear Medicine          | National PSB for all grades         |
| Technologist                   |                                     |
+--------------------------------+-------------------------------------+
| 0644 Medical Technologist      | VISN & Facility PSB through GS-11   |
|                                |                                     |
|                                | VISN PSB GS-12 & 13                 |
|                                |                                     |
|                                | National PSB for GS-14 and above    |
+--------------------------------+-------------------------------------+
| 0647 Diagnostic Radiologic     | Regional PSB through GS-9           |
| Technologist/Technician        |                                     |
|                                | East Region: VISNs 1-11             |
|                                |                                     |
|                                | West Region: VISNs 12-23            |
|                                |                                     |
|                                | National PSB for GS-10 and above    |
+--------------------------------+-------------------------------------+
| 0648 Therapeutic Radiologic    | National PSB for all Grades         |
| Technologist/Technician        |                                     |
+--------------------------------+-------------------------------------+

+--------------------------------+-------------------------------------+
| 0649 Medical Instrument        | Hemodialysis 0649-19                |
| Technician                     |                                     |
|                                | VISN PSB for all grades             |
|                                |                                     |
|                                | Cardiac 0649-15/16/23/27            |
|                                |                                     |
|                                | VISN PSB for all grades             |
|                                |                                     |
|                                | Perfusion 0649-18                   |
|                                |                                     |
|                                | VISN PSB for all grades             |
|                                |                                     |
|                                | Other 0649-17/21/22/24/28           |
|                                |                                     |
|                                | VISN PSB for all grades             |
|                                |                                     |
|                                | National Board for reconsideration  |
|                                | actions and to board VISN Board     |
|                                | members                             |
+--------------------------------+-------------------------------------+
| 0660 Pharmacist                | VISN PSB GS-11-14 including Chiefs  |
|                                |                                     |
|                                | National PSB GS-15                  |
+--------------------------------+-------------------------------------+
| 0661 Pharmacy Technician       | National PSB for CMOP Pharmacy      |
|                                | Technicians through GS-8            |
|                                |                                     |
|                                | Regional PSBs for VAMC Pharmacy     |
|                                | Technicians through GS-8            |
|                                |                                     |
|                                | East Region: VISNs 1-6/9            |
|                                |                                     |
|                                | Central/West Region: VISNs          |
|                                | 10-15/19-21/23                      |
|                                |                                     |
|                                | South Region: VISNs 7-8/16-18/22    |
|                                |                                     |
|                                | National PSB(as needed)             |
+--------------------------------+-------------------------------------+
| 0665 Audiologist,              | Regional PSB through GS-12          |
|                                |                                     |
| Speech Pathologist &           | Atlantic Region: VISNs 1-6          |
|                                |                                     |
| Audiologist/Speech             | Southern Region: VISNs 7,8, 16, 17  |
|                                |                                     |
| Pathologist                    | Midwest Region: 9-12, 15, & 23      |
|                                |                                     |
|                                | Western Region: 18-22               |
|                                |                                     |
|                                | National PSB for GS-13 and above    |
|                                | and all Research positions          |
+--------------------------------+-------------------------------------+

+--------------------------------+-------------------------------------+
| 0667 Orthotist/Prosthetist     | Regional PSB through GS-11          |
|                                |                                     |
|                                | East Region: VISNs 1-6 & 9          |
|                                |                                     |
|                                | South/West Region: VISNs 7, 8,      |
|                                | 18-22                               |
|                                |                                     |
|                                | Central Region: VISNs 10-12, 15-17, |
|                                | & 23                                |
|                                |                                     |
|                                | National PSB for GS-12 and above    |
+--------------------------------+-------------------------------------+
| 0669 Medical Records           | VISN & Facility PSB for GS-5 to     |
| Administrator/Specialist       | GS-12                               |
|                                |                                     |
|                                | National PSB for GS-13 and above    |
+--------------------------------+-------------------------------------+
| 0672 Prosthetic Representative | Regional PSBs through GS-13         |
|                                |                                     |
|                                | East Region: VISNs 1-6, & 9         |
|                                |                                     |
|                                | South/West Region: VISNs 7, 8,      |
|                                | 18-22                               |
|                                |                                     |
|                                | Central Region: VISNs 10-12, 15-17, |
|                                | & 23                                |
|                                |                                     |
|                                | National PSB for GS-14 and above    |
+--------------------------------+-------------------------------------+
| 0675 Medical Records           | Regional & Facility PSBs through    |
| Technician                     | GS-8                                |
|                                |                                     |
|                                | Eastern Region: VISNs 1-11          |
|                                |                                     |
|                                | Western Region: VISNs 12-23         |
|                                |                                     |
|                                | National PSB for MRT (Tumor/Cancer  |
|                                | Registry) for grades GS-4-8)        |
|                                |                                     |
|                                | National PSB for MRT GS-9 and above |
+--------------------------------+-------------------------------------+
| 0681 Dental Assistant          | National PSB for all grades         |
+--------------------------------+-------------------------------------+
| 0682 Dental Hygienist          | National PSB for all grades         |
+--------------------------------+-------------------------------------+
| 0858 Biomedical Engineer       | National PSB for all grades         |
+--------------------------------+-------------------------------------+

**NOTE: Regional Boards are alternate boards that are used when VISN
boards cannot be constituted.**

[]{#AppIIP .anchor}**APPENDIX P. PROCEDURES FOR SELECTING HYBRID TITLE
38 PROFESSIONAL STANDARDS BOARDS MEMBERS**

**1. SCOPE.** This appendix provides a fair, consistent, and objective
process for approving officials to follow when selecting national,
regional, VISN, and facility Professional Standards Boards (PSB)
members. All employees will have the opportunity to participate in the
peer review process for their occupation. Approval and Selecting
officials are encouraged to consider and select from all interested,
available, and qualified employees, whenever possible.

**2. PROCEDURES.**

> a\. Approving officials, or designees, will solicit applications for
> PSB members annually from all interested employees. Unions will also
> be asked for employee recommendations for PSB membership. These
> applications and recommendations will comprise the selection pool.
>
> b\. When reviewing applications and Union recommendations, the
> selecting official will consider such criteria as the employee's
> quality and quantity of experience in the occupation, the employee's
> most recent performance appraisal, the employee's conduct and
> disciplinary record, and other appropriate criteria determined by the
> Service Chief and VISN Medical Officer in consultation with the Human
> Resources Manager.
>
> c\. The employees selected for the initial Board will serve either a
> 1-year, 2-year, or 3-year term. At the end of each of these initial
> terms, all new members will be selected to serve a 2-year term. Thus,
> members will rotate off the Board on a staggered basis and there will
> always be at least one member remaining on the Board from the previous
> year.
>
> d\. Selections for the Boards will be made by the Facility Director,
> the VISN Director, or the Program Director, as appropriate.
>
> e\. The Chair of the Board will notify all applicants if they were
> qualified or not. Unqualified applicants will be informed of which
> criteria they did not meet.
>
> f\. Unions will be notified of the selections for the boards and may
> express concerns regarding those selections to management.\]

**CONTENTS-CONTINUED**

**PARAGRAPH PAGE**

[CHAPTER 3.](http://vaww1.va.gov/ohrm) PROMOTION (TITLE 5)-Continued

12\. [CAREER PROMOTIONS](#PtIIIch3par12) III-30

13\. [PROHIBITED PRACTICES](#PtIIIch3par13) III-33

14\. [SUPERVISORY POSITIONS](#PtIIIch3par14) III-34

15\. [TEMPORARY PROMOTIONS](#PtIIIch3par15) III-35

16\. [EMPLOYEE AND LABOR RELATIONS](#PtIIIch3par16) III-35

17\. [GRIEVANCES](#PtIIIch3par17) III-36

18\. [PROMOTION RECORDS](#PtIIIch3par18) III-37

19\. [SELECTION PROCEDURE DOCUMENTATION](#PtIIIch3par19) III-38

20\. [PERIODIC REVIEW](#PtIIIch3par20) III-39

21\. [CORRECTIVE ACTIONS](#PtIIIch3par21) III-39

[CHAPTER 4.](#PtIIIch4) TITLE 38 AND HYBRID TITLE 38 PROMOTIONS AND
INTERNAL PLACEMENTS

SECTION A: PROMOTION AND INTERNAL PLACEMENT OF TITLE 38 EMPLOYEES

1\. [GENERAL](#PtIIIch4par1) III-41

2\. [PERSONS AUTHORIZED TO ACT ON RECOMMENDATION OF\
BOARDS FOR ADVANCEMENTS](#PtIIIch4par2) III-42

3\. [PROFESSIONAL STANDARDS BOARDS AND STANDARDS BOARDS](#PtIIIch4par3)
III-42

4\. [PROMOTION - GENERAL](#PtIIIch4par4) III-42

5\. [PROMOTION OF PHYSICIANS, DENTISTS, PODIATRISTS, OPTOMETRISTS,\
CHIROPRACTORS, PHYSICIAN ASSISTANTS, EXPANDED-FUNCTION DENTAL
AUXILIARIES](#PtIIIch4par5) III-44

6\. [PROMOTION AND ADVANCEMENT TO A HIGHER LEVEL\
WITHIN THE GRADE OF REGISTERED NURSES AND NURSE
ANESTHETISTS](#PtIIIch4par6) III-46

7\. [PROMOTION RECONSIDERATION AND REVIEW](#PtIIIch4par7) III-51

8\. [EFFECTING ADVANCEMENT AND PROMOTION ACTIONS](#PtIIIch4par8) III-53

9\. [ADJUSTMENT OF PROMOTIONS OR ADVANCEMENTS TO A HIGHER\
LEVEL WITHIN THE GRADE](#PtIIIch4par9) III-53

10\. [ADVANCEMENT OF RESIDENTS](#PtIIIch4par10) III-53

11\. [TEMPORARY CHIEF OF STAFF ASSIGNMENTS (PROMOTIONS)](#PtIIIch4par11)
III-54

12\. [DETAILS, TEMPORARY REASSIGNMENTS, AND TEMPORARY\
PROMOTIONS FOR REGISTERED NURSES AND NURSE ANESTHETISTS](#PtIIIch4par12)
III-54

13\. [OTHER GRADE CHANGES](#PtIIIch4par13) III-55

**SECTION B: PROMOTION AND INTERNAL PLACEMENT OF HYBRID TITLE 38
EMPLOYEES**

\[1. [GENERAL](#PtIIIch4par1) III-57

2\. [PERSONS AUTHORIZED TO ACT ON RECOMMENDATIONS OF BOARDS
FOR](#PtIIIch4par2)

[PROMOTIONS](#PtIIIch4par2) III-57

**CONTENTS-CONTINUED**

**PARAGRAPH PAGE**

[CHAPTER 4.](#PtIIIch4) **TITLE 38 AND HYBRID TITLE 38 PROMOTIONS AND
INTERNAL PLACEMENTS-Continued**

3\. [PROFESSIONAL STANDARD BOARDS](#PtIIIch4par3) III-57

4\. [PROMOTION GENERAL](#PtIIIch4par4) III-58

5\. [PROMOTION CONSIDERATION](#PtIIIch4par5) III-58

6\. [PROMOTION RECONSIDERATION AND REVIEW](#PtIIIch4par6) III-60

7\. [EFFECTING ADVANCEMENT AND PROMOTION ACTIONS](#PtIIIch4par7) III-62

8\. [TEMPORARY PROMOTIONS](#PtIIIch4par8) III-62\]

9\. [OTHER GRADE
CHANGES](#PtIIIch4par9).................................................................................III-\[62\]

[CHAPTER 5.](#PtIIIch5) CONVERSIONS (TITLE 38)

1\. [DEFINITION](#PtIIIch5par1) III-\[63\]

2\. [UTILIZATION ON A FEE BASIS](#PtIIIch5par2) III-\[63\]

3\. [ACTION BY PROFESSIONAL STANDARDS BOARD](#PtIIIch5par3) III-\[63\]

4\. [APPROVAL AUTHORITY](#PtIIIch5par4) III-\[64\]

5\. [PROCESSING REQUIREMENTS](#PtIIIch5par5) III-\[64\]

6\. [CONVERSION TO APPOINTMENT UNDER SECTION 7401(1) FROM\
APPOINTMENT UNDER SECTION 7306](#PtIIIch5par6) III-\[64\]

7\. [CONVERSION TO RESIDENCY APPOINTMENTS UNDER SECTION
7406](#PtIIIch5par7) III-\[64\]

[CHAPTER 6.](#PtIIIch6) MILITARY LEAVE AND RESTORATION/REEMPLOYMENT
AFTER SERVICE WITH THE ARMED FORCES

1\. [MILITARY LEAVE](#PtIIIch6par1) III-\[65\]

2\. [ENTITLEMENT TO RESTORATION](#PtIIIch6par2) III-\[66\]

3\. [ACTIONS AT THE TIME OF SEPARATION](#PtIIIch6par3) III-\[66\]

4\. [ACTIONS WHILE EMPLOYEES ARE ABSENT ON MILITARY DUTY](#PtIIIch6par4)
III-\[67\]

5\. [PLACEMENT OF INDIVIDUALS WHOSE POSITIONS HAVE BEEN
ABOLISHED](#PtIIIch6par5) III-\[68\]

6\. [ELIGIBILITY FOR RESTORATION AFTER MILITARY
SEPARATION](#PtIIIch6par6) III-\[69\]

7\. [RESTORATION AFTER UNIFORMED SERVICE](#PtIIIch6par7) III-\[70\]

APPENDICES

III-A. [PROBATIONARY PERIOD FOR FIRST-TIME
SUPERVISORS/MANAGERS](#appendix-o.-full-performance-levels-for-hybrid-title-38-positions)
III-A-1

III-B. [TIME-IN-GRADE RESTRICTIONS](#AppIIIB) III-B-1

III-C. [INTERCHANGE AGREEMENTS](#AppIIIC) III-C-1

III-D. [SAMPLE REFERRAL CERTIFICATE](#AppIIID) III-D-1

III-E. [MERIT PROMOTION PLAN FOR COMPETITIVE POSITIONS](#AppIIIE)

[CENTRALIZED TO THE SECRETARY](#AppIIIE) III-E-1

> III-F. [PRIORITY PLACEMENT PROGRAM FOR EMPLOYEES IN
> RETAINED](#AppIIIF)

[GRADE OR PAY STATUS](#AppIIIF) III-F-1

**CONTENTS-CONTINUED**

**PARAGRAPH PAGE**

APPENDICES-Continued

III-G. [DEVELOPMENT OF RATING AND RANKING PROCEDURES](#AppIIIG) III-G-1

III-H. [JOB-ELEMENT APPROACH FOR WAGE GRADE JOBS](#AppIIIH) III-H-1

III-I. [PROCEDURES FOR BREAKING TIES](#AppIIIi) III-I-1

III-J. [DOCUMENTATION OF ADVANCEMENTS ON SF 50-B,
NOTIFICATION](#AppIIIJ)

[OF PERSONNEL ACTION](#AppIIIJ) III-J-1

III-K. [ADVANCEMENTS APPROVED BY THE UNDER SECRETARY FOR
HEALTH](#AppIIIK)

[OR A DESIGNEE, NETWORK DIRECTORS AND FACILITY DIRECTORS](#AppIIIK)
III-K-1

III-L. [TIME IN GRADE TITLE
38](#appendix-l.-title-38-time-in-grade-requirements) III-L-1

III-M. [PROCESSING TITLE 38 PROMOTIONS AND ADVANCEMENTS](#AppIIIM)
III-M-1

III-N. [UTILIZATION OF TITLE 38 EMPLOYEES
(APPOINTMENT/ASSIGNMENT](#AppIIIN)

[TO NON-CLINICAL DUTIES)](#AppIIIN) III-N-1

\[**SECTION B. PROMOTION AND INTERNAL PLACEMENT OF HYBRID TITLE 38
EMPLOYEES**

[]{#PtIIIch4par1 .anchor}**1. GENERAL**

a\. This section contains instructions and procedures governing the
promotion of employees in hybrid title 38 occupations who are appointed
under sections 7401(3) and 7405 (a)(1)(B) of title 38, United States
Code. Promotion is advancement to a higher grade level and recognizes
that an employee is providing a higher level of service to VA.

b\. The promotion system shall provide advancement opportunities for
employees, predicated upon the recognition of the quality of service
rendered, additional experience and professional attainment as
determined by an examination of the employee's individual record.

c\. To meet the criteria for promotion, the individual must meet the
criteria for the next higher grade level in the applicable VA
qualification standard. Examination of the individual's total record
must reveal evidence that the contribution to VA medical service is of
sufficient value to warrant promotion. Potential for continuously
greater contribution is also a prerequisite. Reviews and recommendations
of supervisors and professional standards boards will be sufficient to
ensure that promotion is fully merited and not recommended based on
meeting administrative requirements alone.

d\. Promotion actions will be taken without regard to race, color,
religion, sex, national origin, disability, age, sexual orientation, or
status as a parent, or any other non-merit factor, and shall be based
solely on job-related criteria.

e\. Promotion actions will conform to the restrictions governing the
employment of relatives. (See VA Handbook 5025, Legal.)

f\. Employees may also be advanced in steps within a grade. (For Special
Advancements for Achievement and Special Advancements for Performance
see Handbook 5017, Employee Recognition and Awards)

[]{#PtIIIch4par2 .anchor}**2. PERSONS AUTHORIZED TO ACT ON
RECOMMENDATIONS OF BOARDS FOR PROMOTIONS**

(See appendix III-K, this part.)

[]{#PtIIIch4par3 .anchor}**3. PROFESSIONAL STANDARDS BOARDS**

See part II, chapter 3, section C, this handbook, for VA policy covering
Professional Standards Boards.

See Appendix II-O, part II, this handbook, Organizational Location of
Hybrid Title 38 Professional Standards Boards. See Appendix II-P, part
II, this handbook, Procedures for Selecting Hybrid Title 38 Professional
Standards Boards Members. See Appendix III-P, this part, Procedures for
Reporting Questionable Behavior and Judgment Exhibited by Hybrid Title
38 Professional Standards Boards Members.

[]{#PtIIIch4par4 .anchor}**4. PROMOTION - GENERAL**

a\. **Administrative Requirements for Consideration**

\(1\) A current performance rating of "Satisfactory" or higher.

\(2\) The experience, education, and performance requirements set forth
in VA Qualification Standards. Employees must meet the same grade
requirements, including the specified demonstrated accomplishments, as
for appointment. Any deviation or exception to these requirements will
be limited to those specified in the appropriate qualification standard.
(See part II, appendix G).

b\. **Promotions Based on Additional Experience and/or Education.**
Promotions based solely on additional experience acquired by the
employee shall be limited to advancements of one grade or grade interval
at a time. If an employee has attained a higher level of education that,
when combined with their additional experience, is qualifying for a
grade higher than the next grade or grade interval, the employee may be
promoted to whatever grade in the qualification standard the additional
education warrants.

c**. Processing Procedures.** (See appendix III-M, this part)

[]{#PtIIIch4par5 .anchor}**5. PROMOTION CONSIDERATION**

a**.** Full-time, part-time, and intermittent employees shall be
considered periodically for promotion in their current occupation.
Eligibility for such promotion considerations shall be based upon fully
meeting prescribed administrative requirements.

b\. **Notification of Eligibility.** Approximately 60 days prior to the
date the employee meets the required period for promotion consideration,
the health care facility will receive from the Austin Automation Center
(AAC) a VA Form 97, Notice of Pending Personnel Action, in duplicate,
identifying the employee and stating that the employee meets the
requirements for promotion \[consideration\] as of the date specified.
In addition, the VA Form 97 will indicate if there is a satisfactory
performance rating on record. Human Resources Management Officers are
responsible for assuring that appropriate officials are notified that
the employee is eligible for promotion consideration. The employee shall
also be notified of the eligibility and be given 30 days to submit to
their supervisor a self-assessment of their qualifications for promotion
consideration. Employees may also notify their supervisor in writing
that they are declining to submit a self-assessment during this 30 day
period. If this is done, the supervisor may proceed with a
recommendation. Human Resources Management Officers are to destroy the
VA Form 97 in the circumstances described in paragraph 5d(3) below.

**c. Promotion to Grades at or Below Full Performance Level.**
Promotions to grades at or below the full performance level (see
Appendix III-O, this part) will be based on the recommendation of the
immediate supervisor and approved by the next higher level supervisory
official. Upon receipt of the employee\'s self-assessment, the
supervisor will make a recommendation on promotion that is to be acted
upon by the approving official within 30 days of the self-assessment
being received.

\(1\) Employees who have demonstrated the capability to successfully
perform at the next higher grade level will be recommended for
promotion. Promotions will become effective on the first day of the
first full pay period following approval by the second level supervisor.
In no case will the promotion be effected later than the first day of
the first full pay period commencing 60 days after the employee's
anniversary date. (See paragraph 7.a.(1) below)

\(2\) Employees who have not demonstrated such capability will be
informed in writing by the supervisor that they are not being
recommended for promotion. The written notice will state the reason(s)
why the employee does not meet the criteria for promotion. The
supervisor may recommend the employee for promotion at a later date if
it is determined that the employee has met the appropriate criteria. If
not promoted during the intervening period, the employee is entitled to
promotion consideration on the next anniversary date of grade. Employees
who are not promoted may request promotion reconsideration under
paragraph 6d(1) below.

d**.** **Promotion to Grades above the Full Performance Level**.
Employees who are eligible for promotion \[consideration\] to a grade
that requires a combination of personal qualifications and assignment
characteristics are to be considered for promotion to such grades on the
first anniversary date of their last promotion, provided they meet the
administrative requirements. In addition, employees who are selected for
supervisory or managerial assignments that warrant consideration for a
higher grade and for assignments based on complexity will be considered
for promotion on a date other than the anniversary date of last
promotion.

\(1\) If after reviewing the employee\'s self-assessment, if submitted,
and other relevant material, the appropriate management official (e.g.,
service chief) determines that the assignment does not meet the
qualification standard for a higher grade, that official shall document
the reasons for this determination in writing and provide a copy of the
determination to the employee. Employees who do not agree with the
determination may request promotion reconsideration under paragraph
6.d.(2) below.

\(2\) If the appropriate management official believes the assignment
meets the qualification standard requirements for promotion, a Board
Action is to be prepared and submitted, along with all relevant
information to the Professional Standards Board for consideration within
30 days. If applicable, the employee will be given a copy of the
supervisor's comments relating to the self-assessment. The Professional
Standards Board will have 30 calendar days to forward its recommendation
to the approving official, who will have 30 days to make a decision.
Promotions will become effective on the first day of the first full pay
period following approval by the approving official. In no case will the
promotion be effected later than the first day of the first full pay
period commencing 120 days after the employee's anniversary date. (See
paragraph 7.a.(1) below)

\(3\) If, under paragraph (1) or (2) above, the appropriate management
official or the Professional Standards Board does not recommend
promotion, or the approving official does not approve the employee's
promotion, the employee will no longer receive annual promotion
consideration. The appropriate management official may recommend such
employees for promotion at any time in the future provided the
employees' duties and responsibilities change to the point that the
criteria for

promotion to the next grade may be warranted. Employees may request
promotion consideration by the appropriate management official on
subsequent anniversary dates if their duties have changed since they
were last considered and the employee believes that these changes meet
the criteria in the qualification standard for a higher grade.

[]{#PtIIIch4par6 .anchor}**6. PROMOTION RECONSIDERATION AND REVIEW**

a\. **Coverage.** This paragraph applies to hybrids appointed under 38
U.S.C. 7401(3) or 7405(a)(1)(B)**.**

b\. **Notice of Decision.** Employees are to be advised by their
supervisors in writing of any decision not to promote them, of the
reason(s) for the decision, of their right to request reconsideration,
and that reconsideration must be preceded by an informal discussion with
their supervisor.

c\. **Informal Discussion.** Employees must discuss their
dissatisfaction with their immediate supervisor prior to submitting a
request for reconsideration under paragraph d below.

d\. **Reconsideration Requests**

\(1\) **To Grades at or Below the Full Performance Level**

\(a\) If promotion to a grade at or below the full performance level
(see Appendix III-O, this part) is involved, the employee may, within 30
days of being notified of the decision, submit a written request through
the immediate supervisor to the second level supervisor. The employee's
written request for reconsideration must indicate when the informal
discussion was held with the immediate supervisor and cite the specific
reason(s) why the employee believes the decision was not proper. The
approving official or designee may extend the 30-day period at the
written request of the employee if the employee is unable to submit the
information for reasons beyond the employee's control.

\(b\) Second level supervisors are to review the employee's request
within 30 days and determine whether to promote the employee. If the
second level supervisor determines that a promotion is not warranted,
that supervisor will provide the reasons for this decision to the
employee in writing.

\(c\) If the employee is not satisfied with the explanation of the
determination to not promote, the employee can request within 30 days to
have the determination reviewed by the next higher level board. The
employee's request for reconsideration and the supervisor's explanation
will be forwarded to the higher level board within 30 days.

\(d\) The higher level board will make a recommendation within 30 days
to the appropriate approving official, who will make a final decision
within 30 days

\(e\) If the promotion is approved, the employee is to be promoted on
the first day of the first pay period \[following a decision by the
approving official. In no case will the promotion be effected later than
the first day of the first full pay period commencing 180 days after the
employee submits a written request for reconsideration, unless the
employee requested an extension to the 30-day period to submit a

written request for reconsideration. In such cases, the number of
additional days taken by the employee to submit a request will be added
to the 180-day time limit.\] If the promotion is denied, the employee
will be provided with a copy of the board action. (See paragraph 7.a.(1)
below)

\(2\) **For Promotions to Grades Above The Full Performance Level**

\(a\) An employee may submit a written request for reconsideration
through the supervisor to the next higher level Professional Standards
Board for review within 30 calendar days of the non-promotion decision.
The approving official or designee may extend the 30-day period at the
written request of the employee if the employee is unable to submit the
information for reasons beyond the employee's control. The employee's
written request for reconsideration must indicate when the informal
discussion was held with the immediate supervisor and cite the specific
reason(s) why the employee believes the decision was not proper.
Supervisors are to review and comment on the employee's request in
writing, and provide copies of those comments to the employee within 30
days.

\(b\) The appropriate Professional Standards Board will review the
information submitted by the employee, along with the supervisor's
comments, and make a recommendation to the approving official within 30
days. If the employee's request does not include the information
specified in paragraph d.(1) above, the technical representative to the
Professional Standards Board will return the request to the employee for
completion. The employee has 30 calendar days from the date of receipt
of the request to obtain the additional information and return it to the
Professional Standards Board through the technical representative;
however, the appropriate management official may extend the 30-day
period if the employee is unable to submit the information for good
cause shown. The 30-day period the Board has to make its recommendation
may be extended up to the number of days it took the employee to provide
the Board with the appropriate information. Upon completing its review,
the Professional Standards Board is to forward its recommendation to the
approving official for action under paragraph e. below.

e\. **Action by Approving Authority.** Upon review of the
reconsideration file, the approving official shall take one of the
following actions within 30 days:

\(1\) Request any additional information needed to make a decision. This
includes, but is not limited to, meeting with representatives of the
Professional Standards Board, the employee, and/or the employee's
supervisor prior to making a decision under paragraph (2) or (3) below.

\(2\) Approve the employee's promotion. Promotions will be made
effective on the first day of the first full pay period following
approval. In no case will the promotion be effected later than the first
day of the first full pay period commencing 120 days after the employee
submits a written request for reconsideration, unless the employee
requested an extension of the 30-day period to submit a written request
for reconsideration. In such cases the number of additional days taken
by the employee to submit a request will be added to the 120-day time
limit. (See paragraph 7.a.(1) below)

\(3\) Disapprove the promotion and notify the employee of the decision
in writing.

f\. **Coverage as Employee Grievance.** Requests for promotion
reconsideration are excluded from

the Agency Grievance Procedure. See VA Handbook 5021, Part IV, Chapter
3, paragraph 16. Promotion reconsideration is also excluded from the
negotiated grievance procedure pursuant to 38 U.S.C. 7403(f)(1)(B).

[]{#PtIIIch4par7 .anchor}**7. EFFECTING ADVANCEMENT AND PROMOTION
ACTIONS**

a\. **Effective Date**

\(1\) The promotion will be made effective by the Human Resources
Management Officer on the first day of the pay period following the date
of approval of the promotion by the approving official, but in no case
earlier than the date on which all administrative requirements are met.
A promotion may also be made effective at a future date set by the
approving authority that does not violate law or negotiated agreement
when doing so would benefit the employee. Promotion recommendations and
actions that are administratively delayed beyond the time limits
specified in paragraphs 5 and 6 above will be made retroactive.

\(2\) If an employee becomes eligible for promotion while on LWOP for
purposes for which they have a statutory entitlement to receive
promotion consideration (e.g., military service, OWCP), no action will
be taken until the employee returns to duty. If the employee on return
to duty meets all of the requirements for promotion consideration, he or
she will be considered for promotion as if he or she had been
continuously employed in the position.

**NOTE:** *See chapter 6, this part, for effecting promotion actions
upon return from military service.*

b\. **Disposition of Forms.** On completion of the promotion action, or
disapproval of promotion, the original VA Form 10-2543 and any
accompanying documents will be filed in a separate envelope in the
employee's personnel folder.

[]{#PtIIIch4par8 .anchor}**8. TEMPORARY PROMOTION**

a\. An employee may be temporarily promoted to a higher graded position
where the grade of the position is based on the complexity of the
assignment. The employee must meet the administrative and qualification
requirements for promotion and such promotions are to be processed using
the procedures in paragraph 5d above.

b\. On expiration or termination of the assignment, the grade and salary
of the employee will be adjusted in accordance with the provisions of VA
Handbook 5007, Pay Administration. In applying the provisions of this
handbook, the salary will be adjusted to the salary held previously,
unless a higher rate is warranted by reason of periodic step increases.
On assignment, the following statement will be placed in the "Remarks"
item of the SF 50-B, Notification of Personnel Action: "Employee
informed of conditions of temporary grade assignment."\]

[]{#PtIIIch4par9 .anchor}**9. OTHER GRADE CHANGES**

a\. **Change to Lower Grade**

\(1\) **General.** As provided by 38 U.S.C. 7403, where an employee's
grade level and salary are based on both the nature of the assignment
and the employee's personal qualifications, and the assignment is
subsequently changed, the grade and salary may be adjusted as
appropriate. Such action may be taken by the Under Secretary for Health
or designee for Hybrid Title 38 employees in centralized positions and
for all Hybrid Title 38 employees in assignments at GS-13 and above; and
by the facility Director for all Hybrid Title 38 employees in
noncentralized assignments below GS-13. The facility Director may
delegate the authority to the Chief of Staff, Associate Director, Nurse
Executive, Pharmacy Chief for occupations under their respective
purview.

\(2\) **Hybrid Title 38 employees.** Employees appointed under authority
of 38 U.S.C. 7401(3) and permanent part-time employees appointed under
38 U.S.C. 7405 (a)(1)(B) are entitled to the following grade and pay
retention provisions.

\(a\) **Erroneously Graded Assignments.** If an employee's grade is
based on both the nature of assignment and personal qualifications and
the assignment does not meet the requirements for the employee's grade,
the employee shall be eligible for grade and pay retention if the
employee has been in grade for at least 1 year. If the employee has been
in grade for less than 1 year, the employee shall be eligible for pay
retention, and pay shall be set in accordance with 5 CFR, part 536.

\(b\) **Change in Assignment.** If the duties and responsibilities of an
employee's assignment change sufficiently, either through gradual
erosion or planned management action, so that it no longer warrants the
grade level of the incumbent, the incumbent shall be eligible for grade
and pay retention provided the incumbent has been in grade for at least
52 weeks. If the employee has been in grade for less than 52 weeks, the
employee shall be eligible for pay retention, and pay shall be set in
accordance with

5 CFR, part 536.

\(c\) **Assignment Change.** If an employee is voluntarily placed in a
different assignment which does not warrant the employee's current grade
level, the employee will not be eligible for grade retention. The
employee's entitlement to pay retention will be determined in accordance
with VA Handbook 5007, Pay Administration.

\(d\) **Assignment Change for Cause or at the Employee's Request.** If
an employee is changed to an assignment which does not warrant the
employee's current grade level for cause or at the employee's request,
the employee is not eligible for grade or pay retention**.**

**NOTE:** *Directed transfers or reductions in grade approved under this
paragraph will not be considered adverse actions under 38 U.S.C. 7461,
provided they are not based on charges related to conduct or
performance. The actions are, however, grievable under the provisions of
VA Handbook 5021, (Employee/Management Relations).*\]

[]{#AppIIIJ .anchor}**APPENDIX J. DOCUMENTATION OF ADVANCEMENTS ON SF
50-B,**

**NOTIFICATION OF PERSONNEL ACTION**

+----------+--------+-------------+-------+---------------------------+
| **       | **A    | **Nature of | **Le  | **VA Required Remarks**   |
| Category | ppoint | Action**    | gal** |                           |
| of**     | ment** |             |       |                           |
|          |        |             | **A   |                           |
| **Em     | *      |             | uthor |                           |
| ployee** | *Autho |             | ity** |                           |
|          | rity** |             |       |                           |
+----------+--------+-------------+-------+---------------------------+
| Phy      | 38     | "Promotion" | 38    | "Special Advancement for  |
| sicians, | U.S.C. |             | U     | Performance"              |
|          |        | "\[Pay      | .S.C. |                           |
| D        | 7      | Ad          |       | "Grade Adjustment. For    |
| entists, | 401(1) | justment\]" | 7403  | consistency with          |
|          |        |             |       | (promotion                |
| Podi     |        | "Promotion" |       | requirements)." Will be   |
| atrists, |        | or "Change  |       | shown for promotion grade |
| Chirop   |        | to Lower    |       | adjustments.              |
| ractors, |        | Grade," as  |       |                           |
|          |        | appropriate |       | "Grade Adjustment. For    |
| Optom    |        |             |       | consistency with (duty    |
| etrists, |        | "Change to  |       | assignment)." Will be     |
|          |        | Lower       |       | shown when employee       |
| Re       |        | Grade"      |       | changed from level of     |
| gistered |        |             |       | assignment where grade is |
| nurses,  |        | "\[Pay      |       | based on both nature of   |
|          |        | Ad          |       | assignment and personal   |
| P        |        | justment\]" |       | qualifications.           |
| hysician |        |             |       |                           |
|          |        |             |       | "Special Advancement for  |
| Ass      |        |             |       | Achievement"              |
| istants, |        |             |       |                           |
|          |        |             |       |                           |
| E        |        |             |       |                           |
| xpanded- |        |             |       |                           |
|          |        |             |       |                           |
| Function |        |             |       |                           |
| dental   |        |             |       |                           |
|          |        |             |       |                           |
| Aux      |        |             |       |                           |
| iliaries |        |             |       |                           |
| and      |        |             |       |                           |
|          |        |             |       |                           |
| nurse    |        |             |       |                           |
| anes     |        |             |       |                           |
| thetists |        |             |       |                           |
+----------+--------+-------------+-------+---------------------------+
| Phy      | 38     | "Promotion" | 38 U. | "Special Advancement for  |
| sicians, | U.S.C. |             | S. C. | Performance"              |
|          |        | "\[Pay      |       |                           |
| d        | 7405   | Ad          | 74    | "Grade Adjustment. For    |
| entists, | (a)(1) | justment\]" | 05(b) | consistency with          |
|          |        |             |       | (promotion                |
| podi     | \      | "Promotion" |       | requirements)." Will be   |
| atrists, | [(A)\] | or "Change  |       | shown for promotion grade |
|          |        | to Lower    |       | adjustments.              |
| Chirop   |        | Grade," as  |       |                           |
| ractors, |        | appropriate |       | "Grade Adjustment. For    |
|          |        |             |       | consistency with (duty    |
| optom    |        | "Change to  |       | assignment)." Will be     |
| etrists, |        | Lower       |       | shown when employee       |
|          |        | Grade"      |       | changed from level of     |
| re       |        |             |       | assignment where grade is |
| gistered |        | "\[Pay      |       | based on both nature of   |
| nurses,  |        | Ad          |       | assignment and personal   |
|          |        | justment\]" |       | qualifications.           |
| p        |        |             |       |                           |
| hysician |        |             |       | "Special Advancement for  |
|          |        |             |       | Achievement"              |
| as       |        |             |       |                           |
| sistants |        |             |       |                           |
|          |        |             |       |                           |
| e        |        |             |       |                           |
| xpanded- |        |             |       |                           |
|          |        |             |       |                           |
| function |        |             |       |                           |
| dental   |        |             |       |                           |
|          |        |             |       |                           |
| aux      |        |             |       |                           |
| iliaries |        |             |       |                           |
| and      |        |             |       |                           |
|          |        |             |       |                           |
| nurse    |        |             |       |                           |
| anes     |        |             |       |                           |
| thetists |        |             |       |                           |
+----------+--------+-------------+-------+---------------------------+
| Medical  | 38     | "Promotion" | 38    |                           |
|          | U.S.C. |             | U     |                           |
| and      |        |             | .S.C. |                           |
| dental   | 7406   |             |       |                           |
|          |        |             | 7406  |                           |
| r        |        |             |       |                           |
| esidents |        |             |       |                           |
+----------+--------+-------------+-------+---------------------------+
| Career   | 38     | "Promotion" | 38 U. | "Special Advancement for  |
|          | U.S.C. |             | S. C. | Performance" or           |
| R        |        | "\[Pay      |       |                           |
| esidents | 7406   | Ad          | 7406  | "Special Advancement for  |
|          |        | justment\]" |       | Achievement"              |
+----------+--------+-------------+-------+---------------------------+

**DOCUMENTATION OF ADVANCEMENTS ON SF 50-B,**

**NOTIFICATION OF PERSONNEL ACTION (CONTINUED)**

+----------+--------+-------------+-------+---------------------------+
| **       | **A    | **Nature of | **Le  | **VA Required Remarks**   |
| Category | ppoint | Action**    | gal** |                           |
| of**     | ment** |             |       |                           |
|          |        |             | **A   |                           |
| **Em     | *      |             | uthor |                           |
| ployee** | *Autho |             | ity** |                           |
|          | rity** |             |       |                           |
+----------+--------+-------------+-------+---------------------------+
| \[All    | 38     | "Promotion" | 38    | "Special Advancement for  |
| Hybrid   | U.S.C. |             | U     | Performance"              |
| Occup    |        | "\[Pay      | .S.C. |                           |
| ations\] | 7      | Ad          |       | "Grade Adjustment. For    |
|          | 401(3) | justment\]" | 7403  | consistency with          |
|          |        |             |       | (promotion                |
|          |        | "Promotion" |       | requirements)." Will be   |
|          |        | or "Change  |       | shown for promotion grade |
|          |        | to          |       | adjustments.              |
|          |        |             |       |                           |
|          |        | Lower       |       | "Grade Adjustment. For    |
|          |        | Grade," as  |       | consistency with (duty    |
|          |        | appropriate |       | assignment)." Will be     |
|          |        |             |       | shown when employee       |
|          |        | "Change to  |       | changed from level of     |
|          |        | Lower       |       | assignment where grade is |
|          |        | Grade"      |       | based on both nature of   |
|          |        |             |       | assignment and personal   |
|          |        | "\[Pay      |       | qualifications.           |
|          |        | Ad          |       |                           |
|          |        | justment\]" |       | "Special Advancement for  |
|          |        |             |       | Achievement"              |
+----------+--------+-------------+-------+---------------------------+
| \[All    | 38     | "Promotion" | 38 U. | "Special Advancement for  |
| Hybrid   | U.S.C. |             | S. C. | Performance"              |
| Occup    |        | "\[Pay      |       |                           |
| ations\] | 7405   | Ad          | 7405( | "Grade Adjustment. For    |
|          | (a)(1) | justment\]" | b)(2) | consistency with          |
|          |        |             |       | (promotion                |
|          | \      | "Promotion" |       | requirements)." Will be   |
|          | [(B)\] | or "Change  |       | shown for promotion grade |
|          |        | to          |       | adjustments.              |
|          |        |             |       |                           |
|          |        | Lower       |       | "Grade Adjustment. For    |
|          |        | Grade," as  |       | consistency with (duty    |
|          |        | appropriate |       | assignment)." Will be     |
|          |        |             |       | shown when employee       |
|          |        | "Change to  |       | changed from level of     |
|          |        | Lower       |       | assignment where grade is |
|          |        | Grade"      |       | based on both nature of   |
|          |        |             |       | assignment and personal   |
|          |        | ## "\[Pay   |       | qualifications.           |
|          |        |  Adjustment |       |                           |
|          |        | \]" {#pay-a |       | "Special Advancement for  |
|          |        | djustment . |       | Achievement"              |
|          |        | unnumbered} |       |                           |
+----------+--------+-------------+-------+---------------------------+

# APPENDIX K. \[PROMOTIONS,\] ADVANCEMENT \[TO A HIGHER LEVEL WITHIN THE GRADE, OR CHANGE IN ASSIGNMENTS\] APPROVED BY THE UNDER SECRETARY FOR HEALTH OR A DESIGNEE, NETWORK DIRECTORS AND FACILITY DIRECTORS

\[*NOTE: The term advancement in this appendix refers to advancement to
a higher level within the grade for nurses, not special advancements for
achievement or performance.*\]

**1. Under Secretary for Health** \[**or designee**\]

\[**NOTE:** *All actions affecting Directors of medical and regional
office centers requiring approval of the Under Secretary for Health, or
designee, will also require the concurrence of the Under Secretary for
Benefit.*\]

a\. Advancement of Chiefs of Pharmacy Service to GS-15

\[b. Promotion of VHA Central Office employees

c\. Promotion reconsideration requests from registered nurses and VHA
Central Office employees\]

**2.** \[**Network Directors**\]

\[ \]

a\. Advancement of \[VISN employees\]

b\. \[Advancement of employees in VISN product lines, which may be
delegated to the appropriate line manager\].

\[c. Promotion reconsideration requests from employees at field
facilities within the respective VISNs. This applies to all occupations
except that of registered nurse

d\. Temporary change in assignments to Chief of Staff or comparable
positions in tier 4 for renewable periods not to exceed 1 year.\]

**3.** \[**Facility Directors**\]

a\. \[Advancement of Chief of Pharmacy Service at GS-14 and below\]

b\. \[Promotion of Pharmacists. Facility directors may delegate to the
Chief of Pharmacy Service the advancement of pharmacists in
noncentralized assignments below GS-13, Assistant Chiefs of Pharmacy
Service at GS-13, and Pharmacy Technicians and Aids\].

c\. \[Promotion of all other hybrids, which may be delegated to the
Chief of Staff, the Associate Director, or Nurse Executive, as
appropriate\].

\[d. Promotion of Optometrists

e\. Promotion of Chiropractors

f\. Promotion of Podiatrists

g\. Change in assignment of Dentists (staff dentists, service chiefs and
positions comparable to service chief).

h\. Promotion of Expanded-Function Dental Auxiliaries.

i\. Promotion of Physician Assistants

j\. Promotion of Physicians

k\. Promotion or advancement to a higher level within the grade of Nurse
Anesthetists

l\. Promotion of Registered Nurses at Nurse III and below, which may be
delegated to the Nurse Executive

m\. Promotion of Registered Nurses at Nurse IV and Nurse V, which may
not be delegated to the Nurse Executive.\]

# APPENDIX L. TITLE 38 TIME-IN-GRADE REQUIREMENTS

**NOTE: Time-in-grade requirements are in years except where
indicated:**

  ------------------------------ ------------ ------------ ------- ---------- ----- ----- --------------- ------------ ------- --
  **Grade:**                     **Junior**   **Assoc.**           **Full**               **Intermed.**   **Senior**           

  Physicians                     \--                       1                  1     3                                  4       

  Dentists                       \--                       1                  1     3                                  4       

  Podiatrists                    \--                       2\*                2\*   3                                  4       

  Optometrists                   \--                       2\*                2\*   3                                  4       

  Chiropractors                  \--                       2\*                2\*   3                                  4       

  Physician Assistants           \--                       2\*                2     2                                  \--     

  Expanded-Function Dental       2\*                       2                  \--   \--                                \--     
  Auxiliaries                                                                                                                  
  ------------------------------ ------------ ------------ ------- ---------- ----- ----- --------------- ------------ ------- --

  ------------- --------- --------- --------- --------- --------- --------- ---------
  **Grade:**    **Nurse                       **Nurse   **Nurse   **Nurse   **Nurse
                I**                           II**      III**     IV**      V**

  **Level:**    **Level   **Level   **Level   **n/a**   **n/a**   **n/a**   **n/a**
                1**       2**       3**                                     

  Registered    1\*\*     1\*\*     1\*\*     1\*\*     None      None      None
  Nurse                                                                     

  Nurse         1\*\*     1\*\*     \--       2\*\*     2\*\*     None      None
  Anesthetist                                                               
  ------------- --------- --------- --------- --------- --------- --------- ---------

\[ \]

\*The time-in-grade requirement will be 1 year for \[P\]hysician
\[A\]ssistants in Associate grade and 1 year for
\[E\]xpanded-\[F\]unction \[D\]ental \[A\]uxiliaries in Junior grade,
who meet the requirements set forth in VA qualification standards. The
time-in-grade requirement will be 1 year for \[P\]odiatrists,
\[O\]ptometrists, and \[C\]hiropractors in Associate grade and in Full
grade if they meet the requirements set forth in the VA Qualification
Standards.

\*\*The time-in-grade requirement for \[R\]egistered \[N\]urses will be
as follows: one year for each level in Nurse I before advancement to the
next higher level (total of three years before advancement to Nurse II)
and one year in Nurse II before advancement to Nurse III. The time in
grade requirement for Nurse Anesthetists is two years for advancement to
Nurse II, Nurse III and Nurse IV.

**NOTE*: ****In exceptional circumstances, the appointing official may
waive the time-in-grade requirements for advancement of an employee to
the next higher grade*[]{#AppIIIM .anchor}

**APPENDIX M. PROCESSING TITLE 38** \[**AND HYBRID TITLE 38**\]
**PROMOTIONS AND ADVANCEMENTS**

+---+------------------------+----------------------------------------+
| * |                        |                                        |
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| A |                        |                                        |
| L |                        |                                        |
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| U |                        |                                        |
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| I |                        |                                        |
| L |                        |                                        |
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| A |                        |                                        |
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| E |                        |                                        |
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| ] |                        |                                        |
+---+------------------------+----------------------------------------+
| * |                        | **B**                                  |
| * |                        |                                        |
| A |                        |                                        |
| * |                        |                                        |
| * |                        |                                        |
+---+------------------------+----------------------------------------+
| S | If a full-time,        | then take these steps                  |
|   | part-time or           |                                        |
| T | intermittent employee  |                                        |
|   | meets the\[experience  |                                        |
| E | and\] time-in-grade    |                                        |
|   | requirements specified |                                        |
| P | and is a               |                                        |
|   |                        |                                        |
| S |                        |                                        |
+---+------------------------+----------------------------------------+
| 1 | physician, dentist,    | Upon receipt of VA Form 5-97, Notice   |
|   | podiatrist,            | of Pending Personnel Action, the HRM   |
|   | chiropractor,          | Office will forward the original copy  |
|   | \[optometrist,\] nurse | to the employee's service chief        |
|   | anesthetist, \[or a    | through the Chief of Staff, as         |
|   | hybrid\]               | appropriate. The duplicate copy will   |
|   |                        | be retained in the HRM office as a     |
|   |                        | suspense copy.                         |
+---+------------------------+----------------------------------------+
| 2 |                        | The service will make appropriate      |
|   |                        | recommendation to the Professional     |
|   |                        | Standards Board or Standards Board     |
|   |                        | (through the health care facility      |
|   |                        | Director and Chief of Staff, \[or      |
|   |                        | other appropriate designee\] when      |
|   |                        | appropriate, such as for physicians    |
|   |                        | and dentists), including a concise     |
|   |                        | evaluation based on the criteria in \[ |
|   |                        | \] chapter 4, this part (as            |
|   |                        | appropriate). The Chief of Staff \[or  |
|   |                        | Associate Director\] will make         |
|   |                        | recommendations similarly for service  |
|   |                        | chiefs. Significant changes in recent  |
|   |                        | proficiency/performance ratings or     |
|   |                        | unusually high or low elements will be |
|   |                        | evaluated in terms of promotion        |
|   |                        | consideration. Each of these officials |
|   |                        | will indicate concurrence or           |
|   |                        | non-concurrence, including specific    |
|   |                        | reasons for such recommendation.       |
+---+------------------------+----------------------------------------+
| 3 |                        | The Professional Standards Board or    |
|   |                        | Standards Board will examine the       |
|   |                        | personnel folder, supervisory          |
|   |                        | evaluations, and all other information |
|   |                        | furnished. Additional information may  |
|   |                        | be obtained at the direction of the    |
|   |                        | board. Boards will report their        |
|   |                        | findings and recommendations on VA     |
|   |                        | Form 10-2543, Board Action. All        |
|   |                        | members will sign the form. The board  |
|   |                        | action and all related papers will     |
|   |                        | then be forwarded to the appropriate   |
|   |                        | promotion approving authority listed   |
|   |                        | in Appendix III-K. Action by the       |
|   |                        | approving authority is required even   |
|   |                        | \[if\] promotion is not recommended.   |
+---+------------------------+----------------------------------------+
| 4 |                        | When the health care facility Director |
|   |                        | is the approving authority, this       |
|   |                        | official will note the final decision  |
|   |                        | on the Board's recommendation, sign VA |
|   |                        | Form 10-2543 and take appropriate      |
|   |                        | action.                                |
+---+------------------------+----------------------------------------+

  ----------------------- ---------------------- -------------------------------------------
  **HOW TO PROCESS A                             
  PROMOTION FOR                                  
  PHYSICIANS, DENTISTS,                          
  PODIATRISTS,                                   
  CHIROPRACTORS,**                               
  \[**OPTOMETRISTS,**\]                          
  **NURSE ANESTHETISTS,                          
  PHYSICIAN ASSISTANTS,                          
  EXPANDED-FUNCTION                              
  DENTAL AUXILIARIES,**                          
  \[**AND HYBRIDS**\]                            
  **(Continued)**                                

  **A**                                          **B**

  5                                              When the Under Secretary for Health, or a
                                                 designee, is the approving authority, the
                                                 official will review the findings and
                                                 recommendations of the board, and may
                                                 require a professional examination even
                                                 though one was not recommended by the
                                                 board. The promotion may be approved or
                                                 disapproved without a professional
                                                 examination even though one was recommended
                                                 by the board. If no professional
                                                 examination is to be required, the
                                                 approving authority will notify the health
                                                 care facility concerned of the approval or
                                                 disapproval of the promotion. If a
                                                 professional examination is authorized, the
                                                 approving authority will not take action on
                                                 the promotion until notified of the results
                                                 of the examination.

  6                                              The health care facility Director or a
                                                 designee will notify the employee of the
                                                 results of promotion consideration. If the
                                                 employee is not promoted, the appropriate
                                                 official will discuss with the employee the
                                                 reasons for non-promotion and what the
                                                 employee should do to meet the promotion
                                                 requirements. If an employee who has
                                                 acquired permanent status or an employee
                                                 serving on a probationary appointment
                                                 believes that the action taken to deny a
                                                 promotion not requiring a waiver by the
                                                 Under Secretary for Health or a designee
                                                 was improper, the provisions of chapter 4
                                                 \[ \] will apply.

  7                       physician assistant or See step 1 (above).
                          expanded-function      
                          dental auxiliary       

  8                                              The service chief should make an
                                                 appropriate recommendation to the
                                                 Professional Standards Board through the
                                                 Chief of Staff and the health care facility
                                                 Director, including a concise evaluation
                                                 which will clearly indicate specific
                                                 professional or administrative strengths
                                                 and weaknesses and will cite substantiating
                                                 examples of accomplishments or lack
                                                 thereof. Significant changes in recent
                                                 proficiency ratings or unusually high or
                                                 low elements will be evaluated in terms of
                                                 promotion consideration. Each official will
                                                 indicate concurrence or non-concurrence,
                                                 including specific reasons for such
                                                 recommendation.

  9                                              See steps 3 through 6 (above).
  ----------------------- ---------------------- -------------------------------------------

+----+-----------------------+-----------------------------------------+
| #  |                       |                                         |
| ## |                       |                                         |
| ## |                       |                                         |
| ## |                       |                                         |
| #  |                       |                                         |
| HO |                       |                                         |
| W  |                       |                                         |
| TO |                       |                                         |
|  P |                       |                                         |
| RO |                       |                                         |
| CE |                       |                                         |
| SS |                       |                                         |
|  A |                       |                                         |
|  P |                       |                                         |
| RO |                       |                                         |
| MO |                       |                                         |
| TI |                       |                                         |
| ON |                       |                                         |
|  F |                       |                                         |
| OR |                       |                                         |
|  R |                       |                                         |
| EG |                       |                                         |
| IS |                       |                                         |
| TE |                       |                                         |
| RE |                       |                                         |
| D  |                       |                                         |
| NU |                       |                                         |
| RS |                       |                                         |
| ES |                       |                                         |
+----+-----------------------+-----------------------------------------+
| *  |                       | **B**                                   |
| *A |                       |                                         |
| ** |                       |                                         |
+----+-----------------------+-----------------------------------------+
| S  | If a full-time,       | then take these steps                   |
|    | part-time or          |                                         |
| T  | intermittent employee |                                         |
|    | meets the             |                                         |
| E  | \[experience and\]    |                                         |
|    | time-in-grade         |                                         |
| P  | requirements          |                                         |
|    | specified \[ \], and  |                                         |
| S  | is a                  |                                         |
|    |                       |                                         |
|    | Registered Nurse (not |                                         |
|    | a nurse anesthetist)  |                                         |
+----+-----------------------+-----------------------------------------+
| 1  |                       | Upon receipt of VA Form 5-97, Notice of |
|    |                       | Pending Personnel Action the HRM Office |
|    |                       | will retain the duplicate copy of the   |
|    |                       | form as a suspense copy and forward the |
|    |                       | original to the Chairperson, Nurse      |
|    |                       | Professional Standards Board, through   |
|    |                       | the Nurse Executive.                    |
+----+-----------------------+-----------------------------------------+
| 2  |                       | The Nurse Professional Standards Board  |
|    |                       | will obtain the candidate's personnel   |
|    |                       | folder, including VA Form 10-2623,      |
|    |                       | Proficiency Report, rendered during the |
|    |                       | period under consideration, and         |
|    |                       | official transcripts or other           |
|    |                       | documentation of advanced educational   |
|    |                       | credits.                                |
+----+-----------------------+-----------------------------------------+
| 3  |                       | If the most recent proficiency report   |
|    |                       | on file was prepared more than 6 months |
|    |                       | before the date of promotion            |
|    |                       | consideration, narrative performance    |
|    |                       | evaluations will be obtained from at    |
|    |                       | least two professional nurses or        |
|    |                       | appropriate others who have supervised  |
|    |                       | the candidate during the period under   |
|    |                       | consideration. Ordinarily, one of these |
|    |                       | evaluations will be prepared by the     |
|    |                       | immediate supervisor. Evaluations may   |
|    |                       | be in the form of a supplement to the   |
|    |                       | latest proficiency report. This         |
|    |                       | information specified in step 4, below, |
|    |                       | should be included in the evaluations   |
|    |                       | for consideration by the board.         |
+----+-----------------------+-----------------------------------------+
| 4  |                       | Evaluations of a registered nurse will  |
|    |                       | clearly indicate specific professional  |
|    |                       | or administrative strengths and         |
|    |                       | weaknesses and will cite substantiating |
|    |                       | examples of accomplishments or lack     |
|    |                       | thereof. Examples of areas to be        |
|    |                       | emphasized are skill in human           |
|    |                       | relationships; application of knowledge |
|    |                       | and experience in recognizing nursing   |
|    |                       | needs of patients; technical skills;    |
|    |                       | leadership ability in planning,         |
|    |                       | directing and supervising the actions   |
|    |                       | of others; contributions to the         |
|    |                       | profession and community; acceptance of |
|    |                       | organizational and personal             |
|    |                       | responsibility. Attention should be     |
|    |                       | given to the requirements specified in  |
|    |                       | the "Nurse VA Qualification Standard"   |
|    |                       | and in chapter 4 \[ \] of this part.    |
+----+-----------------------+-----------------------------------------+
| 5  |                       | If a supervisor evaluation reflects     |
|    |                       | information concerning performance      |
|    |                       | which has been previously discussed     |
|    |                       | with the employee, an informal          |
|    |                       | conference will be conducted to discuss |
|    |                       | the evaluation.                         |
+----+-----------------------+-----------------------------------------+
| 6  |                       | The Professional Standards Board will   |
|    |                       | analyze the registered nurse's          |
|    |                       | qualifications based on the above data. |
|    |                       | Additional information may be obtained  |
|    |                       | at the discretion of the board. Boards  |
|    |                       | may recommend that a professional       |
|    |                       | examination be conducted if, after      |
|    |                       | review of the record, such an           |
|    |                       | examination is indicated.               |
+----+-----------------------+-----------------------------------------+

  --------------- ---------------------- ------------------------------------------
  **HOW TO                               
  PROCESS A                              
  PROMOTION FOR                          
  REGISTERED                             
  NURSES                                 
  (Continued)**                          

  **A**                                  **B**

  7                                      The board will report its findings and
                                         recommendations on VA Form 10-2543, Board
                                         Action. If the registered nurse does not
                                         fully meet the experience or education
                                         requirements, the board will state that
                                         the registered nurse is ineligible for
                                         promotion consideration and specify the
                                         reasons for this finding. If the
                                         registered nurse is eligible for promotion
                                         consideration, the board will make a
                                         recommendation that the registered nurse
                                         either be promoted or not promoted and
                                         specify reasons for its recommendation.
                                         All board members will sign the board
                                         action which will then be authority for
                                         action. Action by the approving authority
                                         is required even if promotion is not
                                         recommended.

  8                                      When the facility Director is the
                                         approving authority, this official will
                                         note the final decision on the Board's
                                         recommendation, sign VA Form 10-2543 and
                                         take appropriate action.

  9                                      When the Under Secretary for Health or
                                         designee is the approving authority, the
                                         findings and recommendations of the board
                                         will be reviewed. The approving authority
                                         may require a professional examination
                                         even though one was not recommended by the
                                         board. The approving authority may approve
                                         or disapprove the promotion without a
                                         professional examination even though one
                                         was recommended by the board. If no
                                         professional examination is to be
                                         required, the approving authority will
                                         notify the health care facility concerned
                                         of the approval of the promotion. If a
                                         professional examination is authorized,
                                         the approving authority will not take
                                         action on the promotion until notified of
                                         the results of the examination.

  10                                     The Nurse Executive or designee, will
                                         notify the registered nurse of the results
                                         of promotion consideration. If the
                                         employee is not promoted, the appropriate
                                         official will discuss with the employee
                                         the reasons for non-promotion and what the
                                         employee should do to meet the
                                         requirements. If an employee who has
                                         acquired permanent status or an employee
                                         serving on a probationary appointment,
                                         believes that the action taken to deny a
                                         promotion not requiring a waiver by the
                                         Under Secretary for Health or a designee
                                         was improper, the provisions of chapter 4
                                         \[ \] this part, will apply.
  --------------- ---------------------- ------------------------------------------

# \[APPENDIX O. FULL PERFORMANCE LEVELS FOR HYBRID TITLE 38 POSITIONS

**1. SCOPE.** This appendix contains the full performance levels for
hybrid title 38 positions listed under section 7401(3) of title 38,
United States Code, and applies to Veteran Health Administration
employees appointed under 38 U.S.C. 7401(3) or 7405(a)(1)(B). This
appendix is to be used in conjunction with the promotion procedures in
section B of Chapter 4, this part.

**2. LIST OF POSITIONS AND FULL PERFORMANCE LEVELS**

Audiologist/Speech-Pathologist/Audiologist-Speech Pathologist GS-0665-12

Biomedical Engineer GS-0858-11

Certified Respiratory Therapist GS-0640-7

Dietitian GS-0630-11

Medical Record Administrator/Specialist GS-0669-11

Medical Record Technician GS-0675-7

Medical Record Technician (Tumor Registry) GS-0675-8

Medical Record Technician (Medical Coder) GS-0675-8

Medical Technologist GS-0644-9

Dental Assistant GS-0681-5

Dental Hygienist GS-0682-8

Nuclear Medicine Technologist GS-0601-9

Occupational Therapy Assistant GS-0636-7

Kinesiotherapist GS-0635-10

Licensed Physical Therapist GS-0633-9

Licensed Practical or Vocational Nurse GS-0620-6

Occupational Therapist GS-0631-9

Orthotist-Prosthetist GS-0667-11

Pharmacist GS-0660-11

Pharmacy Technician GS-0661-5

Physical Therapy Assistant GS-0636-7

Prosthetic Representative GS-0672-11

Psychologist GS-0180-13

Diagnostic Radiologic Technologist GS-0647-8

Therapeutic Radiologic Technologist GS-0648-8

Registered Respiratory Therapist GS-0601-8

Social Worker GS-0185-11

Medical Instrument Technician (see specializations below)

Specializations

Anesthesia GS-0649-8

Cardiac Catheterization GS-0649-8

Electrocardiograph (EKG) GS-0649-7

Electroencephalograph (EEG) GS-0649-8

Perfusion GS-0649-10

Hemodialysis GS-0649-8

Pulmonary Function GS-0649-8

Diagnostic Ultrasound GS-0649-8

Echocardiography GS-0649-8

Polysomnography GS-0649-8

Vascular GS-0649-8

**APPENDIX P. PROCEDURES FOR REPORTING QUESTIONABLE BEHAVIOR AND
JUDGMENT EXHIBITED BY HYBRID TITLE 38 PROFESSIONAL STANDARDS BOARDS
MEMBERS**

**1. SCOPE.** This appendix covers the procedures to be followed when a
hybrid Board member (Chair, Member, or Secretary) believes a hybrid
Board co-member (Chair, Member, or Secretary) is exhibiting questionable
behavior or judgment during deliberations or when determining
recommendations for the approving official. Examples of questionable
behavior and judgment that may be displayed include, but is not limited
to:

a\. Incorrectly interpreting qualification standards criteria, employee
self-assessments, supervisory recommendations, or performance
evaluations to the advantage or disadvantage of the PSB subject;

b\. Failing to recuse themselves when it would be appropriate to do so
or recusing themselves when there is no reason to;

c\. Failing to respect the privacy of the Board subject;

d\. Violating Board confidentiality; or

d\. Displaying a lack of integrity

**2. PROCEDURES.** The member should raise their concern with the Chair
of the next higher level hybrid Board using the following procedures:

a\. Discuss the issue with the Chair of the next higher level Board,
either in person or via telephone, within 15 days of the last Board at
which the questionable behavior or judgment was displayed.

b\. If the issue remains unresolved and the member wishes to pursue the
matter further, the member must express her/his concerns to the Chair of
the next higher level Board in writing or via email within 15 days of
the discussion.

c\. The Chair of the next higher level Board will conduct an inquiry
within 30 days by whatever means the Chair deems appropriate. This may
include, but is not limited to, discussions with members of the lower
level Board, including the Chair and the subject of the Board,
discussions with the HR technical advisor to the lower level Board, and
discussions with the approving official for the lower level Board.

d\. Within 30 days of completion of the inquiry, the Chair must discuss
the issue and recommendations for resolution with the approving official
for the higher level Board and must submit the recommendations in
writing to the lower level Board's approving official. The
recommendations may include, but are not limited to, additional training
for the member or removal from the Board.

e\. The approving official may take whatever action is deemed
appropriate.\]