MEB Question Active duty with recurring stress fractures

[jorymcr]

Ok here is my situation. I spent apx 3 1/2 years in the Air Force and then entered the army through the blue to green program. I have been in the army for 1 1/2 years now as an 11B1P. I attended Special Forces Assessment and Selection in July and was two days from completion when I obtained a major stress fracture in my left foot which caused me not to complete the training. I was casted and put on con leave for 30 days upon return to home post. This week I have now developed a stress fracture in my right foot from only walking (no training, still on profile for healing of my left foot). The orthopeadic surgeon casted my right foot and put me on an additional 30 days con leave two days ago. At my appt he also looked at my left foot and sees another stress fracture now developing. He then told me that this is cause for medical seperation and if not that I could no longer be 11B at which I was shocked to hear. I asked him if it was possible for MOS reclass but he still suggested seperation due to the fact that I would still have to do PT and ruck marches which would cause more stress fractures. He told me the reason for the recurrent fractures were from my 2nd metarasal thickening and metatarsaligia due to injuries obtained at SFAS. He also told me to take the 30 days con leave and start exploring other options for my life other than the Army. I have a wife and three kids and have no idea where to go from here. The Dr. did tell me that this would qualify me for disability but I dont know how much. I see him again in late November for examination of both feet but I'm worried because if I am seperated I have no idea how sustain the quality of life that my family now enjoys. I was wondering if someone knew if my family would retain medical coverage (I know I will) and if I would receive severance pay along with my disability pay. Any information that anyone could give would be greatly appreciated as I am in a very bad spot right now. Just walking is constant pain and I am in desperate need of any help I can get. Thanks

[Purple]

jorymcr,

Welcome aboard! I'm sorry to hear about your aliment. In Jason's signature block, it has an overview of the MEB/PEB process if you would like to check it out (if you haven't already). I will attach his signature block for easy access:
__________________
Jason

Physical Evaluation Board Forum Administrator
New Members- Read OVERVIEW OF MEB/PEB PROCESS

Check out the new Linked VASRD

Jorymcr,

From what I've been reading, and someone chime in if I'm incorrect, but, if the IPEB (Informal Physical Evaluation Board) medically seperate you, then you are entitled to severance pay, and not monthly disability pay such as retirement under TDRL (Temporary Disability Retirement List) or PDRL (Permanent Disability Retirement List).

Medical seperation (severance pay) and medical retirement (retired benefits plus monthly disability payments) by IPEB are two different processes. An individual can't receive both.

If the IPEB medically retires (PDRL or TDRL) you at 30% or more, then you are entitled to the same benefits as a retiree (PX/BX, commissary, and TRICARE if you select this coverage for you and your family).

There is a fee for TRICARE if retired. Please see this link if you would like to view the fees: https://www.hnfs.net/bene/enrollment...s-Payments.htm

I hope you feel better soon. Let us know if you have questions.

[jorymcr]

Thank you very much for all the info. Going to look over the MEB process now. Thanks again!

[Purple]

You are welcome.

[Piedpiper]

Hi all......Just for clarification...you're right on the money but ......Tricare is the coverage if you qualify through retirement.....

Purple said....

"If the IPEB medically retires (PDRL or TDRL) you at 30% or more, then you are entitled to the same benefits as a retiree (PX/BX, commissary, and TRICARE if you select this coverage for you and your family).

There is a fee for TRICARE if retired. Please see this link if you would like to view the fees: https://www.hnfs.net/bene/enrollment/fees/Enrollment+Fees-Payments.htmestions.
"

But "Tricare" IS FREE. What needs to be clarified is that the fees stated are for "Tricare Prime", which is a selection you make at the time of retirement. Read as much info you can find on Tricare Standard and Tricare Prime, ask questions, and consider you location. Your location and participating doctors can be a determining factor in your choice. If you choose Tricare Prime (which can work like an HMO)...you'll pay, however, "Tricare Standard" is free for retired personnel......Thanks...keep up the good work....Pied

[Purple]

piedpiper,

thank you for the clarification. For easy access for other's to view, I have attached the link: TRICARE Standard and Extra

Also, I attached some of the information for easy reading from the TRICARE Standard link:

TRICARE Standard and Extra

TRICARE Standard is a fee-for-service option. When you use TRICARE Standard, you have more choice in providers as you can seek care from any TRICARE-authorized provider (network or non-network), but you'll pay higher out-of-pocket costs.
To reduce your out-of-pocket costs, use the TRICARE Extra option by seeking care TRICARE network providers. Using TRICARE Extra is like using a Preferred Provider Option (PPO).




Key features include:

• Freedom to choose any TRICARE-authorized provider.
• Referrals not required, but some care may require prior authorization.
• Highest out-of-pocket costs.
• You may have to submit health care claims.
• Save time and money with the TRICARE Extra option:
  • Visit a TRICARE network provider.
  • Pay fewer out-of-pocket costs.
  • Network providers will file claims for you.
  • Receive care in a military treatment facility on a space-available basis only.
• TRICARE Standard is available worldwide, but Extra option is not available overseas.
• Enrollment NOT required

Eligibility




In general, the following are eligible for TRICARE Standard and Extra:

• Active duty family members.
• Retirees and their family members
• Surviving family members (widowed spouses, children)
• Eligible former spouses
• Family members of activated National Guard or Reserve members
• Retired National Guard and Reserve members and their families (upon reaching age 60)
• Medal of Honor recipients and their families

How TRICARE Standard and Extra Works for You
To learn more about how TRICARE Standard and Extra works for you, you'll need to enter your profile and select "TRICARE Standard and Extra" as your health plan.



What are my options?Need help in determining which plan options are available to you? Visit the Plan Wizard. After answering a series of questions, it will tell you which plan options you may be eligible for.
How does it compare?You can compare the basic features of two TRICARE plans side by side by using Compare Plans.



All, I hope this information helped from myself and piedpiper.

[Purple]

Hi all again, I wanted to add to my last post (the one right before this one): TRICARE Standard Overview - Military Benefits - Military.com

Reasons for Choosing TRICARE Standard:

Beneficiaries who are happy with the treatment they currently receive from a specific civilian provider that may not be in the TRICARE provider network often choose to use TRICARE Standard. Some beneficiaries, especially retirees under age 65 and their families, may live in areas where the TRICARE Prime network is not available, and TRICARE Standard may be their only option. Additionally, retired service members may have employer-sponsored health insurance. TRICARE Standard may be used as secondary coverage for these beneficiaries.


Standard's Pros - Advantages

• Broadest choice of providers
• Widely available
• No enrollment fee
• You may also use TRICARE Extra

Standard's Cons - Disadvantages

• No Primary Care Manager
• Patient pays Deductible and Co-payment
• Patient pays balance if bill exceeds allowable charge and provider is non-participating (up to 15% additional)
• Nonavailability statement may be required for civilian inpatient care for areas surrounding MTFs
• Beneficiaries may have to do their own paperwork and file their own claims

Important Note: The Point of Service annual deductible and cost-share amounts do not count toward your enrollment-year maximum out-ofpocket expense, but instead are credited to your fiscal year maximum. There is no limit to the amount of a patient’s responsibility under the POS option.

Back to Top
TRICARE Standard Features:

TRICARE Standard offers greater provider choice. Beneficiaries may choose any TRICARE-authorized provider. TRICARE-authorized providers are not required to participate in the TRICARE network; however, they must be certified as an authorized provider by the managed care support contractor (MCSC) in that region. Beneficiaries should contact their regional MCSC to find a TRICARE authorized provider.


TRICARE Standard allows beneficiaries to self-refer for specialty care. Beneficiaries who choose TRICARE Standard are not assigned a primary care manager, so, in most cases, they are able to see specialists without prior authorization. There are some outpatient procedures that require prior authorization. Beneficiaries should contact their regional contractor for authorization assistance before seeking care.
For inpatient mental health care, pre-authorization and continued stay authorization requirements apply to Residential Treatment Center care, partial hospitalization program care, and alcoholism detoxification and rehabilitation. All beneficiaries should contact TRICARE regional contractors regarding potential limits on length-of-stay at these facilities. TRICARE Standard beneficiaries living in an MTF catchment area must obtain a non-availability statement from their local MTF before being admitted as an inpatient for mental health services.
Back to Top
Costs for TRICARE Standard:

Beneficiaries are responsible for cost shares and deductibles for care that is covered under TRICARE Standard. Providers who participate in TRICARE will accept the TRICARE allowable charge (TAC) as the full fee for services they render. However, non-participating providers may charge up to 15 percent above the TAC for their services, and TRICARE Standard beneficiaries are financially responsible for these additional charges.
A "catastrophic cap" is the annual upper limit a family will have to pay for TRICARE Standard-covered services in any fiscal year. The catastrophic cap for families of active duty service members is $1,000. All others have a catastrophic cap of $3,000. The catastrophic cap applies only to allowable charges for covered services. The catastrophic cap does not apply to services that are not covered, or to the total amount of what nonparticipating providers may charge above the TAC.
The chart below shows the costs beneficiaries may incur under TRICARE Standard:

*FY 2005; rates change every fiscal year
The chart below shows the costs beneficiaries may incur under TRICARE Standard:

Family Members of Active Duty Service Members
Retirees, Their Family Members and Others
Annual Deductible
$150 per individual or $300 per family for E-5 and above; $50 per individual or $100 per family for E-4 and below.
$150 per individual or $300 per family
Cost Share
(outpatient visits, emergency care and mental health visits)
20 percent of allowable charges
25 percent of allowable charges
Civilian Inpatient Cost Share
Greater of $25 or $13.90* per day
Lesser of $512* per day or 25 percent of billed charges plus 25 percent of allowed separately billed professional fees
Civilian Inpatient Mental Health
$20 per day
Lesser of $169* per day or 25 percent of allowable fees plus 25 percent of allowed separately billed professional fees

Please see the link for the actual chart with the breakdown of payments for active duty, retirees, their family members and others. For some reason, I can't post chart from the link.

I hope this information helps.