MEB for back

[dvldog98]

Hi,

I am a Marine and have been in a little over 10 years. I planned on this being my career and retire, until now. My doctor is now putting me on a MEB Board for my back. I tried to delay this process as long as possible by doing two LIMU back to back. I have done everything possible, extensive physical therapy, chiropractic, TENS unit, RFA, acupuncture and medications. Nothing has worked to get my pain under control. My doctor refuses to do surgery because of too many levels of involvement in my back. I am just starting the MEB process as we speak and extremely nervous about it, especially if I'm found unfit for duty and what my rating would be. Of course I want the magic number of at least 30% because I do have a family and really need to keep the medical benefits. But I am finding it difficult to even estimate by looking at the VASRD of what I might receive. I do have a few questions that I hope someone could answer for me, since I have problems in my Lumbar, Thorac and Cervical areas of my back, do they rate each area of your back separately or all together? I do have MRI’s that show where and what the problems are in my Lumbar, Thorac and Cervical areas of my back, which I hope helps my case.

Yesterday my doctor and I sat down and got 1/2 of my narrative written up. I go in next Tuesday, so finish the rest of it up and do a ROM test. He wrote that I have Facet Syndrome, Lumbar Spondylosis, and Lumbago. But in my medical records it also shows that I have Cervical Spondylosis and Intervertebral Disc Degeneration-Cervical. Should I ask to have these two conditions included or is one of the above conditions he wrote in my narrative yesterday the same condition just under a different name. Oh, I’m so confused???? I really don’t know what all these medical terms mean. Also, are all the above conditions rated separately or as 1 condition?

I also have been diagnosed with depression/anxiety. I think I developed this because of the pain I’m constantly in from my back. I never had any symptoms of depression/anxiety until after dealing with day to day back pain. Would this help to add this to my MEB or should I not worry about it.

I apologize for the long post, any help would be appreciated.

Thanks,
Dvldog98

[builtgypsy]

Hi and welcome!

You should include all of your medical information in the packet for the MEB. Nothing should be left out. Your ROM will be a huge determining factor in how they rate your spine. Once you get your ROM done you will better be able to compare it to the VASRD to see where you stand. I'm unfamiliar with Spondylosis, but if I find it in the VASRD I'll post it here and let you know.

But I'll stress again, make sure everything is included from your medical record into your packet. If your MTF (military hospital) has a medical records office, if you go in early enough one day you may be able to get a print out of your entire electronic medical records. I've done this a few times. In fact, it was required to have a complete up to date copy of my medical records before the packet could be submitted.

[Jason]

dvldog98,

Good to have you here! And I am sorry to hear of your conditions.

Actually, two sections of your spine can be rated separately, your Cervical and Thoracolumbar. The diagnosis is not as important in back cases because you are rated on either the general rating schedule for spine conditions or on incapacitating episodes. However, as a general rule it is best to have everything recorded in your records.

You should definitely have the mental health conditions added. You won't get rated on it, though, unless the evidence shows that the condition prevents reasonable performance of your duties.

[dvldog98]

Hi Jason and Builtgypsy,

Thank you so much for both of your advice.

So no matter how many problems I have in my back, they will just rate under the General rating formula for diseases and injuries of the spine? But I can be rated separately for the Cervical and Thorac area? Do they even rate for the Lumbar area? Or does the Lumbar fall under Cervical or Thorac area? Early this year (February) I had full range of motion, but my medical records also show where I had a forward flexion of 10 degrees last month. But it doesn’t state if it was the forward flexion of the cervical spine or thoracolumbar spine. But the forward flexion test was done when I was in intense pain. So now I’m extremely nervous to do my ROM test next Tuesday. If I have full range of motion, does that mean I would get 0% for both the Cervical and Thorac area? Do they rate under pain alone? Do they take into account what my MRI shows, with all the damage that is wrong with my spine? I apologize for all the questions, I’m extremely nervous about this whole process.
Thank you again for all of your help. I really appreciate this board and have learned so much from reading the overview of MEB/PEB process and other threads on this site.
Thanks,
Dvldog98

[dvldog98]

Hi,
I’m so confused about my ROM results. Last Tuesday my doctor did my ROM test and at the end of our appointment I asked him if I had full range of motion. He walked around the answer by telling me that everyone has different ranges of motion. So basically, I never found out what my results were until today after I went up to the hospital and got my electronic records printed out for the past week. I don’t understand the ROM results whatsoever. To me it reads that I have full range of motion???

This is what was on my records:

Back exam reveals normal gait and sitting position; transfers are without apparent pain limitation. Back ROM: FF-fingertips to the knees, extension is full, and side bends are full and unguarded but has ipsilateral back muscle pain with side bends. He has no TTP at the sciatic notch. Percussion and palpation reveal mild pain over the midline from L4 to S1 and mildly over adjacent paraspinal muscles. Strength is 5/5 to heal and toe walking, and to single-leg calf raises. He has intact sensation, bilaterally equal knee and ankle cord reflexes, and 5/5 strength at the hips and knees. He has hamstring tightness bilaterally that limits his straight leg test to 60 degrees bilaterally. A sciatic stretch test is bilaterally negative. FABER testing is normal bilaterally. Bridging test reveals mild weakness but this is bilaterally. His neck exam shows FAROM but is guarded with extension. He has TTP over the midline of the T-spine at T3 & T4 and has some superior trapezius tenderness L > R as well. There is no palpable crepitance of the neck with motion. His neurological evaluation reveals intact upper extremity sensation but I am unable to elicit reflexes in either arm. He has 5/5 bilateral strength of the shoulders, elbows, forearms, wrist, and fingers. A Spurling’s test of the neck is negative for radicular symptoms.

I still haven’t read my Narsum yet, but would think the ROM would be the same. So if I’m reading this right, I have full range of motion. Does that mean I should really be concerned now about getting a decent rating? Do they rate for pain, or take into account what the MRI shows? Any help would be appreciated, I’m extremely nervous about what affect this ROM test will have on my case.

Thanks,
Dvldog98

[Jason]

dvldog98,

Yes, you should be concerned.

It appears to me that this examination does not meet the standards required for evaluation in the MEB. You should have had a range of motion evaluation using a goniometer which states your ROM in degrees.

What I gather from this is that your likely rating is 10% based on Tenderness to Palpitation (TTP).

Do you have times when you have to lay down to relieve symptoms? If so, this may be the basis for a rating under Incapacitating Episodes (but you may have to work to get this documented).

Pain by itself does not warrant a rating, but pain that restricts range of motion does.

[dvldog98]

Hi Jason,

Thank you for getting back with me. Yes, I do have times where my pain has been really intense where I had to lay down for awhile and I do know on one occasion where I was in intense pain that my doctor gave me SIQ for the day; but nothing lasting more than a day. I will start working on getting some of this documented in my records next week.

When I get to review my Narsum, I will look to see if it states my ROM in degrees. But I know for a fact he didn’t use a Goniometer measuring me, he just told me to bend this way, bend that way, etc, etc…. So I don’t think he can caclulate my ROM in Goniometers off the top of his head without actually using the Goniometer while I was there. If my ROM isn’t documented correctly in my Narsum, is it to late to have it put in correctly? Also, will the MEB Board throw my paper work back if the ROM isn’t documented correctly in genometers?

Thanks again for all of your help,
Dvldog98

[Jason]

[quote=dvldog98;14270]

Hi Jason,

Thank you for getting back with me. Yes, I do have times where my pain has been really intense where I had to lay down for awhile and I do know on one occasion where I was in intense pain that my doctor gave me SIQ for the day; but nothing lasting more than a day. I will start working on getting some of this documented in my records next week.

If you can, you may have a basis for a (much) higher rating. It would be preferable to have the MEB report state this as well, but that may or may not be in the cards.

When I get to review my Narsum, I will look to see if it states my ROM in degrees. But I know for a fact he didn’t use a Goniometer measuring me, he just told me to bend this way, bend that way, etc, etc…. So I don’t think he can caclulate my ROM in Goniometers off the top of his head without actually using the Goniometer while I was there. If my ROM isn’t documented correctly in my Narsum, is it to late to have it put in correctly? Also, will the MEB Board throw my paper work back if the ROM isn’t documented correctly in genometers?

Couple of different approaches you could take to getting this addressed before MEB is completed. Going back to same provider and asking for a new ROM, going to PT and asking for one, or perhaps requesting an independent medical advisor are all things to consider. There are pluses and minuses to each course of action. After the fact, you can disagree with MEB report and state why.

Will the PEB kick it back? Probably not, but they should. They are more likely to if you disagree, though.

Thanks again for all of your help,
Dvldog98

Glad to help!