OVERVIEW OF MEB/PEB PROCESS

[Jason]

This post, like this site, is a work in progress. I realized recently that even though all the information on the Physical Disability Evaluation System (PDES) can be found here, first time visitors probably need a guide to understand what is going on with their case.

I will be posting a more comprehensive "Guide" in the near future. But for now, I want to put out this post to help newcomers and members alike understand how to use this site.

First, in the Physical Disability Evaluation System Overview Forum, you can find some basic overview/information papers on understanding the process. The updated "Guide" that I will publish will eventually replace the info papers found there. But for now, you can get a grasp of the process.

I will try to cover some high points. The PDES is mandated by Federal Law. The system is composed of four components:
1) Medical Evaluation (carried out by the MEB).
2) Physical Disability Evaluation (Carried out by PEB)
3) Counseling (carried out by PEBLO)
4) Personnel Action/Approval. (Carried out by Service Secretary or designee).


The MEB will determine if you have conditions that are disqualifying for retention. They do not make fitness determination, nor do they assign ratings. Their most important function as far as your case is concerned is in accurately diagnosing your conditions, and providing other info in their Narrative Summary. In order to find what conditions are disqualifying you should look here, depending on your Branch of Service:

Army AR 40-501 Chapter 3
Navy/USMC SECNAVINST 1850.4E Chapter 8
Air Force AFI 48-123, Volume 2. Attachment 2
Coast Guard Medical Manual, Chapter 3 Section F

If you have conditions that they are not considering, you have the right to appeal the findings and recommendations of the MEB.
Here are the regulations covering the MEB for each Service:

Army AR 40-400, Patient Administration. Chapter 7
Navy/USMC Manual of the Medical Department, Chapter 18
Air Force AFI 41-210, Chapter 10
Coast Guard COMDTINST M1850.2D

You should also look in the MEB Forum for some posts on MEBs.

Once you have identified what conditions are disqualifying, you should look them up in the Veterans Affairs Schedule for Rating Disabilities. You can find each system in this link to Conditions Forum. Once you have found each condition, you should compare your conditions to the rating criteria and see what you should be rated at. If you have the results of an Informal PEB in hand, you should also see what the criteria is for what they rated you at and compare what you think is correct versus what they actually rated you at. If there is a difference, you need to think about why they did not rate you at the higher level. Oftentimes, it is because you lack evidence of the severity of your condition. You should try to think of ways to better document your condition. This may include other medical evaluations, examinations, photographic evidence, or statements from others. Your own testimony may help as well.

You should read this post on Fitness vs. Unfitness. You can only be rated by the PEB for conditions that are unfitting. The following links contain the regulations for each Service's PEB:

Army AR 635-40
Navy/USMC SECNAVINST 1850.4E
Air Force AFI 36-3212
Coast Guard COMDTINST M1850.2D

You may want to look over the following forums for discussions on Informal PEBs and Formal PEBs.

Later, I will post some on how to find info on appeals and post administrative remedies.

One last thought. I have been privileged to represent Servicemembers both on active duty and in private practice as a civilian attorney. I have learned that there are three very important phases of your case. The first happens well before the PEB. It can make a huge difference in your case if you have a good understanding of what you will be rated on and how to ensure your conditions are properly documented. The next crucial phase is the Formal PEB. Here, a good advocate can present your case in the strongest manner, but equally important is identifying and preserving the legal errors made in your case. The third crucial phase is in appealing the decision if the PEB has made an error in your case. Based on this, my best advice is to start educating yourself and preparing for your case early. In this way, you can better understand what is happening with your case and you can ensure you have the evidence you need to get an accurate rating. Waiting until you are at the Formal hearing before preparing is putting yourself at a disadvantage.

Okay, like I said, this is a work in progress. Any requests will be considered.

[James Lawler]

Sir, I am a recently 80% permanent disability retired soldier. I have been working as a ad-hoc patient advocate for over 2 years now. I need some help with a soldier at Ft Riley WTU who was recently offered 0% informal board with a diagnosis by the Army of MS. I advised the soldier to request a formal board as AR 40-501 Cp 3 states MS is mandatory MEB. VASRD rating under VBA 38 CFR has MS 8018 with a rating minimum of 30%. The soldier has 21 good years toward retirement, so the 8 year rule does not apply. Any ideas or guidence would be more then helpful.
Thank you in advance
James Lawler

[maparker]

I would begin with an IPEB appeal pointing out the 30% rating requirement and asking why they did not rate it accordingly. Also demand a formal board as the formal can be dropped if they fix it based on the IPEB appeal.

Mike

[Melly]

Hi Jason,

I am active duty AF (Captain) and just received a decision from the IPEB of 20% (Severance), 20% permanent, LOD (yes) and I am confused about whether or not to appeal. I am 24 weeks pregnant was boarded for RSD that resulted from a left ankle injury. I have until 7/1/08 to sign the paperwork and that just doesn't seem to give me time to weigh my options. However, me and my husband fear that if I appeal the decision the appeal process may interfere with my delivery date. This process just started in April when I returned from 83 days of con-leave. I have only been AD for 4years, but the condition with the pregnancy has become so overwhelming that I have been placed on 4 hour days and I am currently in an air cast with a long list of restrictions. My questions are: Why am I not entitled to AD benefits for the full term of my pregnancy? Is it logical to appeal on that basis primarily so I can get a fair separation physical? I was told there was no code for RSD (reflex sympathetic dystrophy) so my diagnostic code was determined to be external popliteal nerve paralysis, however, the disease is currently affecting other body parts to include my hands.
Any information you can offer as to how I should proceed would be greatly appreciated.

[Jason]

Melly,

Welcome! Before I get into your questions, are you opposed to a fit finding? If not, there is little risk in appealing. 0%, 10%, and 20% results in the same payment, so there is little risk in appealing.

I am not sure what your concern is about the delivery date. If you are in labor or near delivery they will reschedule your board.

Originally Posted by Melly

Hi Jason,
Why am I not entitled to AD benefits for the full term of my pregnancy?

This is a question of what status you hold. If you lose military status, you lose the entitlement.

Originally Posted by Melly

Is it logical to appeal on that basis primarily so I can get a fair separation physical?

No, I think the PEB lacks power to address statutory entitlements. I would not argue that you need to stay on duty just because you are pregnant. However, if your pregnancy is impacting your RSD, I might argue (depending on your goals) that you should not be boarded yet as you have not reached optimal hospitalization benefit.

Originally Posted by Melly

I was told there was no code for RSD (reflex sympathetic dystrophy) so my diagnostic code was determined to be external popliteal nerve paralysis, however, the disease is currently affecting other body parts to include my hands.

This is where you may have a case for a retirement. How does the RSD impact your hands? Does this (or would it) affect your duty performance? What other body parts are affected? In order to know more, you would want to try to get your limitations evaluated. Based on the outcome of evaluation, you may be in a position to argue for an additional 10% (or more).

Hope this was helpful and congratulations on the addition to your family!

[Melly]

Jason,

Thank you so much for your prompt reply as I am sure you realize this process causes much anxiety. Your replies were very helpful, but what I meant about the AD benefits for a pregnant member is that it has always been my understanding that even if a woman were in reserve status she would be entitled to benefits through delivery and up to 6months thereafter. It just doesn't make since that I am already active duty and would lose that as a result of the board.

In this case my fear of not taking severance is that if I appeal and let's say I only get 30-40%, I am the breadwinner in the house and I fear that I won't be able to carry the load until I am in a position to work again. Whereas, with severance it gives me time to recover from the pregnancy (C-section planned), but at the same time I am Stage 3 RSD (final stage) and I am a nurse and I doubt that I will be able to find stable employment until after after the pregnancy when I can further rehabilitate. I am hoping that the severance, VA benefits and unemployment (is that an option?) will get me through or do you think waiving the appeal would be making a big mistake?

As far as my hands are concerned I have constant numbness mainly in my fingertips and intermittent feelings of pins and needles all over because my sympathetic nervous system is currently completely affected and I cannot get the proper pain management at this time because I am high risk pregnancy.

So that is why I think that an appeal may prolong this process for me...about how long do you think it will take before I get a separation date if I were to waive the appeal?

Thanks,
Melly

[Jason]

Melly,

I sure do understand about the anxiety. However, I am not aware of any additional benefit for separated pregnant members.

The big difference for getting to retirement is going to be the retiree health benefits for you and your eligible dependents. Without the benefit of CRDP (20 years or more service) or CRSC (combat-related injuries) you will have an offset of either your severance or retirement pay. It is true that the severance pay will give you a lump sum that can help with your transition. But, the VA offset will likely make your ultimate military compensation the same. The compensation issue aside, the health insurance benefit is very valuable.

As far as you getting "only 30-40%", I think with RSD, it is a likely outcome that you will be placed on TDRL. That would get you paid at a minumum of 50%. This is not a sure thing, like everything, the facts of your case will determine the likely outcomes.

Best of luck in making a decision and in getting a good result.

[AFPEBLO]

I’m sorry I didn’t see this post and join sooner. If your MTF has labor and delivery then you can apply for secretarial designee status which would take you through delivery. I can’t remember which AFI covers it off the top of my head either 41-115 or 41-114. Also; Check with your personnel flight and TRICARE service center for transition assistance benefits.

[Jason]

I was looking over some of the "viewed" threads statistics and noticed that this thread, probably the most important for new members to read, was not getting near as many hits as I would have suspected, and I keep on seeing some questions posted that are answered here....I thought that the problem might have been the title...so I changed it, and updated the link in my signature block.

I welcome any feedback!

[DragonFly757]

This may be a misdirected question, but I guess I will ask anyway and find out.

My husband was rated 80% by the Army and 100% by the VA. He is TDRL. Now that they have changed the rules for ratings, does this mean we should ask for a new MEB via the Army or just go through the VA for additional consideration despite already being 100%? Or is the MEB/PEB process done and over with and we simply deal with the VA now?

That aside, I have a vent....

I am finding that being TDRL is more trouble than it is worth. ALL his ratings are combat related and not expected to improve. In fact, his PTSD has been exacerbated and his TBI may not have been properly screened. On top of that, because he is TDRL he is not entitled to benefits that he otherwise would recieve as a PDRL. For instance, until he is considered TOTAL and PERMANENT, the GI Bill benefits cannot be transferred to me. Even the state cannot help me until I have been a resident in this state for five continuous years. That's pretty hard when you've spent over three years at WRAMC to establish any type of residency for state benefits.

I even find civilian programs require a "permanent" rating in order to qualify.

The Army did not involve me in ANY of his MEB/PEB process. They did not do a retirement briefing to let him know what entitlements he had. One example of falling through the cracks is that our family was dropped from dental coverage. When I found out, it was too late to be inside the "window" for continued and full coverage. Now we have limited coverage and average about $500 to $1000 a month out of pocket in dental expenses for the family. My son's speech therapy was discontinued until he gets his teeth fixed, which we simply cannot afford. And we cannot afford the one-year waiting period for orthodontic care. So, we are stuck juggling the expense every month. Had anyone told us that we had to manually enroll, we certainly would have! We have four members of our family that need orthodontic care, extractions and other medically necessary dental work.

Seamless transition, my arse. See also the AW2 update I gave on this thread: CRSC for TDRL vet - so confusing!

I don't know how anyone can keep up with it all!

ETA: Oh yes...one more frustration...I made it abundantly clear to his doctors that his PTSD is getting worse in part of the group therapy he attends. He does NOT do well in a group therapy environment. Not only did his provider enroll him in another series of group therapy (thanks doc!), but she admitted she has NEVER reviewed his medical records from Walter Reed and asked me to get them for her. My question is...how in the heck have they been treating him for this past year not having any records to work with? And it's MY job to get the medical records transferred between the facilities? In the civilian sector, you sign a records release form and the two institutions communicate and transfer records. In the military and VA systems, you have to hand carry everything and they don't even tell you that they never saw anything until a year later. Insane.