Thread: HELP!!! FT. Lewis MEB Intake on Medical History - OVER THE PHONE

Dear One and All:

On April 7, 2010 my Packet was forwarded to Ft. Lewis MEB for processing.

I am a NG Soldier, mobilized for OIF, sustained injuries, and was put into WTU 2007. In 2008, I was transferred from Ft. Lewis WTU to CB-WTU Sacramento. I am stationed at home, receiving medical care at my HOR.

Today, I rec'd an email from Ft. Lewis telling me that with the new VA/DoD Joint program, I am to receive a telephone call at 0800, 19 April at my home number. The purpose of this call is to do the Medical History update on me. The person on the other end will be a Physician's Assistant. The reason they are doing this by phone is to avoid putting me on orders, traveling to Ft. Lewis (130 miles one way).

1. What is the purpose of this call?

2. How important is this call?

3. Do I have the right to tape record this call?

4. I have NOT completed the treatment care plan as developed by the CB-WTU.
a. I still have the 12-week PTSD Course to do (starts May - ends AUG).
b. I still need an assessment from a shrink medical doctor (PTSD/MDD severe).
c. I still have physical therapy to complete.
d. I still have pain management to do.
e. I may have to do bladder surgery - will know the end of this month if needed.
f. The plate and screws moved a bit in my neck. The surgeon will assess next week to see if anything can be done to fix it. This consult takes place AFTER the phone call with MEB PA.

5. In what way have I achieved "optimal medical care"? Have I achieved "optimal medical care if I still have all this stuff to do?

6. My initial AD medical records for this deployment have been lost. The VA needs them for their part of the process. When I had to go on Emergency Leave to be with my dying spouse, my unit returned on time back from IRAQ, but without my medical records. No one knows where they are.

a. How important are these records?

b. Will the VA have to assume I was a "picket fence" because I was. It's just, what do I do now that I have no deployment medical/dental records? Do they just have to take my word for it? I was a picket fence when I left for Iraq, but I'n not anymore.

c. I was injured during a combat lanes training pre-deployment exercise in Nov 06. Went to ER that same day, told I had sprains, given muscle relaxer and 24hrs bedrest. DEC 06 went to Iraq. Aggravated injuries while in Iraq - got worse. Came home in May 07 (EML), transferred to WTU August 07 and have been in CB-WTU since SEP 08.

HOW DO I prove I was injured in a Combat lanes training exerecise?

7. What should I expect from this phone call with some PA at Ft. Lewis. Do I have the right to request a FEMALE?

v/r,
nwlivewire

Bump Please for any or all moderators or legal eagles. This phone call comes at 0800 this Monday morning.

Hope I get some takers over the week-end.

Will post you all an update as soon as I can get to the cimputer by the end of Monday. Got doctoring and stuff to do that day on top of this phone call.

Phone call comes in Wednesday morning - 0800. I am getting my records in order and highlighting stuff so I can be prepared for what this process is. Does anyone know what this step in the MEB process is like? I will be doing this Medical History update over the phone - NOT in person - as I am located 130 miles from Ft. Lewis.

I feel uneasy with this aspect as I do NOT get direct face time. The PA who will be doing my medical intake for the history part is anonymous to me and I to him. Very impersonal. If i remember correctly, this piece tomorrow morning is the major foundation underlying my NARSUM.

Will someone please respond to my first posting on this thread (please scroll down to first posting) and look at my questions and see if you can answer ANY of them?

Thank-you so much for your time and efforts on this.

nwlivewire

Hey Livewire,

I'm not a legal eagle I'm afraid, but saw that you're getting short on time here and no replies. I don't know if I can be of much help, but this is what I THINK. It can't be any part of a physical exam obviously, so I'm guessing that it's that first appointment that I had with the MEB physician where he filled out the version of my profile that was going to be used to go forward to request my VA appointments (which are the physical exams), and he basically filled out a form based on questions he asked me about my symptoms and what tasks I could or could not perform (such as APFT or military tasks such as rucking or 3-5 second rushes). During this time, he was on the other side of his desk, never touched me, and did not look at any part of me other than looking me in the eye when he talked to me. He could easily have done what he did on the phone and it wouldn't have been any different at all. This was the part that initiated the MEB "for real". I mean, I had been referred to the MEB at least a month before by a profile generated by one of my physicians and forwarded to PAD, but this was the appointment that really kicked the process off. I was supposed to see the VA Rep that day to fill out the corresponding VA claim form so that could go forward, but the Army had failed to come up with my records (which I had requested 2 months prior), at that point, so I had to wait for that appointment because we didn't want me to end up with appointments and no records at the VA. It kind of happened anyway because they didn't provide my psych records, and I was given VA appointments so the VA psychiatrist had NO records on me at all. The point being for your purposes, I think that this appointment can happen over the phone without it being a problem, if it's the first one I had. I think if you tell them everything that you have in your first post here, you will be fine.

When it comes to recording the phone interview, I think you can certainly ask, but I don't know if they will agree. The PA probably has the right to decline to be taped. As for requesting a female, I have a feeling that you may not have the right to request one where a physical exam is not being performed. Or well, you may have the right to request one, but it's doubtful that you will get one for a phone appointment. I may well be wrong on that, hopefully someone with some expertise will get on here before tomorrow and trump me with some real knowledge here, but that would be my guess. With all the stuff about proving injury etc etc, I don't think that's going to come up in this one phone interview. Just tell them the facts. The issue of documentation is going to come up in the process later, but for the purposes of this phone call, they may not even ask that. They'll probably just ask you about the injuries.

Try not to get too much more stressed about it right now. And if I were you, most of all I'd try not to take all the frustration and stress of the situation out on the PA on the other end of the phone. He/she is probably not setting out to screw you.

And again... I'm just another soldier going through the Pilot program, not an attorney or any kind of qualified legal eagle, so take everything i said with a grain of salt and hope for some real advice! I'm just going on experience.

Good luck!

Murph

Thanks Murph!

Any other takers out there?
v/r,
nwlivewire

Originally Posted by nwlivewire

Dear One and All:

1. What is the purpose of this call?

It sounds like they already told you (from your statement above):
"The purpose of this call is to do the Medical History update on me. The person on the other end will be a Physician's Assistant. The reason they are doing this by phone is to avoid putting me on orders, traveling to Ft. Lewis (130 miles one way)."

2. How important is this call?

If they are just taking history, I would think that this may be used to determine future appointments. But, it is the outcome of the NARSUM that is most important (well, the Rating decision, too, in Pilot Program cases).

3. Do I have the right to tape record this call?

"Right"? No, I don't think so. You can ask, but they don't have to permit it. Be careful about unconsensual recordings. Depending on your jurisdiction, this can even be a crime.

5. In what way have I achieved "optimal medical care"? Have I achieved "optimal medical care if I still have all this stuff to do?

You probably have not. This rule is not an ironclad issue, but you can raise it. It is very hard to speculate whether this plays in your favor or not (that is, for some people, the earlier board actually would show a worse condition, while others will do better with more time in service).

6. My initial AD medical records for this deployment have been lost. The VA needs them for their part of the process. When I had to go on Emergency Leave to be with my dying spouse, my unit returned on time back from IRAQ, but without my medical records. No one knows where they are.

a. How important are these records?

It depends...but, it seems to me that the most important issue would be use of the records to establish Line of Duty determinations. Otherwise, it is really your current condition that matters. That is, it would, of course be better to have the records...but if the MEB is accurate, this should not matter. That can be a big "if" though.

b. Will the VA have to assume I was a "picket fence" because I was. It's just, what do I do now that I have no deployment medical/dental records? Do they just have to take my word for it? I was a picket fence when I left for Iraq, but I'n not anymore.

If you mean your Profile series being all ones, they should do an updated profile for you.

c. I was injured during a combat lanes training pre-deployment exercise in Nov 06. Went to ER that same day, told I had sprains, given muscle relaxer and 24hrs bedrest. DEC 06 went to Iraq. Aggravated injuries while in Iraq - got worse. Came home in May 07 (EML), transferred to WTU August 07 and have been in CB-WTU since SEP 08.

HOW DO I prove I was injured in a Combat lanes training exerecise?

Witness statements, Line of Duty Determinations and medical records are the usual suspects. You can also testify about the nature of your injuries, but this is much stronger coming from outside evidence from your testimony.

7. What should I expect from this phone call with some PA at Ft. Lewis. Do I have the right to request a FEMALE?

You can request a female, but I don't think there is anything giving you a "right" to a female PA. The military is given wide latitude in how it staffs its missions. But, you can request. The only caution I would give is that between the tape recording and, if you get a male PA, you may run into a problem with turning this more adversarial at this point than you might want. I would think that most professionals would not mind the questions and would respond well. But, sometimes, people can get turned off and a personality conflict can develop. In an ideal world, this might not be an issue. But, it could be. So, just approach these issues tactfully.

Hope all goes well!

Thanks Jason.

I have had time to think a bit about this, and am glad you weighed in on this.

I did request a female, but they did not have one, otherwise I more than likely, would have been accomodated with that request.

I am aware of the pitfalls of the recording of conversation without consent, and simply would not do that as that would defeat the purpose of recording for accuracy of rememberance.

Since my initial posting, I have had conversations with MEB/PEB personnel and have been granted a meeting to discuss my major concern: I believe that involving the PDES process at this juncture of my medical issues and care is a bit premature.

I base this on the following:
I have not completed my treatment care plan, a plan that was developed by the Army CB-WTU in one years time. This is through no fault of the Soldier (myself), it's just that in some cases, a Soldier can only have so many surgeries at a time, and can only heal so fast, and can only go as fast as the physical body and the military and medical institutions can allow.

The one year timeline is also a guideline - it also is not hard and fast.

**************
Army WTU Consolidated Guidance dtd 20 MAR 2009 states the following on page 83, in 6-2, Referral to The Army Physical Disability Evaluation System (PDES):

It is not within the mission of the Army to retain members on active duty or in the Ready Reserve to provide prolonged, definitive (mine) medical care when it is unlikely the Soldier will not return to full military duty. As provided, in DODI 1332.38, (reference dd.) ADME participants will be referred to the Army PDES:

a. As soon as the treating military physician determined that the Soldier does not meet medical retention standards as per AR 40-501 - Standards of Medical Fitness, Chapter 3.

b. All Soldiers shall be referred into the PDES evaluation within one year of the diagnosis of their medical condition if they are unable to return to military duty. As provided in DODI 1332.38, E3.P1.6.1 page 20 (reference dd.). Per DODD DTM 3 May 2007 if the Soldiers' condition requires more than one year to obtain optimum medical benefit, the referral into the PDES process will be deferred.

c. Referred Soldiers into the PDES as soon as the probability that they will be unable to return to full duty is ascertained and optimal treatment benefits have been attained.

***************

So the question I ask myself and I will ask tomorrow of others is this:

If I have NOT YET completed my treatment care plan, as designed by the Army medical staff of the CB-WTU, then how can I possibly have attained "optimal medical treatment benefit"? I have a couple of these things to do, plus another surgery or two, and then I will have completed their treatment care plan - which I assume is the most basic underlying standard of treatment I will get. Failure to complete my basic treatment care plan will leave me in a degraded condition - certainly not even close to achieving "optimal medical treatment benefit". I cannot benefit from something I have yet to receive.

I mean, how is it possible for the Army to place me into the PDES process at this juncture when I have not been received optimal medical treatment benefit as per my treatment care plan for LOD-related injuries?

Believe me, as frustrating as it has been for me to negotiate through the military medical treatment system, I in no way wish to set up ANY adversarial relationships. If anything, I need someone to see that the introduction of the PDES process at this time, is a bit premature in my case - by about six months.

Now, I realize that if the PDES process arrives anyway, and the MEB/PEB arrives anyway, before I receive "optimal medical treatment benefit" for LOD-related injuries, I'll get parted out still broken, and then have to see the VA for continuation of treatment of Army LOD injuries. I also realize that going into the PDES process as more "broken" than "repaired" may possibly be to my benefit in terms of possible percentages awarded. But truth be told, I just want to complete the basic repairs and achieve or attain the basic level of "optimal medical treatment benefits" for these injuries. This is why I think my involvement in the PDES process is premature at this time.

I mean, how can the PDES process get an accurate snapshot of me if I have not even achieved this basic level of "optimal medical treatment benefit"? One cannot attain this benefit level unless or until they at first receive the medical treatments as per one's medical treatment plan.

Who knows, maybe tomorrow I will get some answers that make sense to me. Regardless, I hope to get answers. Will post whatever answers I get tomorrow on the following day, as I will have a long day tomorrow and get home late.

I wish for a favorable and logical outcome.

v/r,
nwlivewire

livewire,

Just got your message. I first want to concur with and re-emphasize everything Jason stated.

It seems your primary concern is that if you are placed in the PDES, you will not receive optimal care prior to your discharge from the military. This is certainly a justifiable fear. My thoughts are that if you will be in need of several surgeries and have chronic conditions that are still in a stage where they are "bad" (relative to the treatment required to "cure" these ailments), then you will probably face a retirement finding from the PEB in the end anway. This way (speaking from the personnel perspective) the Army has wiped its hands of you, you have wiped your hands of the Army - and oh yeah, you have retirement and TRICARE for life (or if TDRL...at least til' your next examination).

In the regulation you cited, it states that those Soldiers (I'm paraphrasing) should be referred to the PDES, as a baseline, when found to be failing the standards in AR 40-501 chapter 3. I'm unsure how you stand to this scrutiny, but something to think about. Regarding optimum treatment taking more than one year, I think this may be trumped by a Soldier clearly failing AR 40-501 CH 3 and a definitively "un-curable" condition - inasmuch as the treatment for that condition will not feasibly return them to duty status in any reasonable period of time (i.e. if I get into a motorcycle accident as a 11B and lose my legs, the cosmetic reconstruction of damage to my face is not reaching optimum treatment - an extreme, but hopefully the point is across).

Those are just my thoughts, nothing to quote in there. How long have you been receiving treatment?

Dear Carnelli53:

I was placed into the WTU AUG/SEP 07 and spent a year on the "Madigan Merri-Go-Round" (Ft. Lewis). This period of time came shortly on the heels of the blow-out back in D.C., and the Army, in response to that scandalous affair, stood up and/or increased the number of personnel required to maintain the increase in size to the Wounded Warriors in the new WTU at Ft. Lewis. That year (07/08) was a disaster for alot of us in the WW program as the institional "growing pains" was very disruptive to receiving any type of continuity of care, let alone a treatment care plan. And I didn't know anything either, as I had always been a healthy person and only went to hospital or urgent care to have a baby and some other minor out-patient thing. During the first 10 months at Ft. Lewis, while the WTU was standing up, I had no less than four case managers (the last three were civilians - brand new - with no prior experience) and three primary care doctors. So when the opportunity to transfer to the CB-WTU program became known to me, I jumped on it and was selected for transfer in SEP 08.

It was at CB-WTU that I first rec'd a treatment care plan based on some of the diagnostics that had been completed at Ft Lewis. Some of my medical issues were still unknown or not fully diagnosed as to what type of treatment would be needed as well. My 12 months at CB-WTU was spent achieving some aspects of optimal medical treatment while some of my time was spent getting to diagnosis for the others. I have made excellent forward progress and as such, some of my issues are as far as they will get and I know I am done with those IAW Army standards. In other words, I ain't well, but at least I know on some of my issues, I will be able to continue teatment at the VA as we at least know what those issues are.

As for the other issues that are now known at this time but were not at time of initial entry into CB-WTU, I have a treatment care plan for them and am just now able to begin to attack these remaining issues now. Like I wrote before, I came to CB-WTU not fully diagnosed, so I spent this past 18 months achieving surgeries and post op healing for the known issues, while at the same time, spent time and efforts getting to diagnosis on the others so I could obtain a baseline for a treatment care plan for those remaining unknown issues. This has been achieved and I am now on the last leg of this phase - receiving treatment for issues that are now known that were previously not fully diagnosed. Thank God!

I anticipate this last leg will take about 4-6 months to complete the basic baseline of treatment IAW these Army medical standards. And again, no, I will not be fully repaired, but at least I will have achieved the opportunity to have attained the basic "optimal medical treatment benefits" for these injuries, and know that I will need to continue my medical treatment through the VA. That is all I ask for these days.

I know many of my issues will be needing additional treatment well after I am out of the Army. I am not expecting the Army to keep me on the 20 year plan for those issues that are now resolved to the level of the Army's obligation of at least providing to the injured Soldier the "optimal medical treatment benefits", as further continuing care of those issues can be obtained through the VA.

I am only asking that the Army allow me about six more months to treat the issues that remain - issues that are going to begin to recieve treatment now that the other issues are minimally resolved. Like I wrote before, a body can only do so many surgeries at once, can only heal so fast, and the Soldier can only go as fast as the Army medical and Army institutions will allow. I would have been completed sooner, except for the institutional "growing pains" at Fort Lewis really put a damper on the speed and direction at which I was able to go. I was really glad I had the chance to get to CB-WTU, because this allowed me to stabilize my medical staff and get off that "Madigan merry-go-round", and get to a baseline level of continuity of care. '07 and '08 was a tough time to be in the Ft. Lewis WW program for all the institutional growing pains that were going on.

I also realize that perhaps the "PDES process must go on" in spite of these circumstances. ??? If that be the case, then I suppose they will have to rate me higher for issues left untreated as these remaining issues will not have recieved the opportunity to attain "optimal medical treatment benefits". That is my big concern. I've come all this way only to get to the mountaintop, and then get told I will not get to enter the Promised Land. That's the frustrating part. In an ideal institution, where the personnel and systems are seasoned and running like a well-oiled machine, I suppose it would take about a year to get through. But when the institution sucks up your time with medical and institutional merry-go-round growing pains, new employees that don't know what they are doing, computer programs and insurance companies that don't interface and you drop off the rolls every six months, and you're on the receiving impact end of this, it's simply not my fault that it took over a year to get to this point. I've done everything I can and could do (I even got told once I was doing my case managers job - but I had too, because either she didn't know it was her job, or she was taking too long to get around to fixing the problem - too big a case load - I don't know). And somehow, I'm suppossed to concentrate on healing and I have had alot more than that to do.

I just hope this morning when I get that phone call, the PA will understand my position in this line-up and let me finish to a minimal standard. I'm so close.......