IDES Timeline- Arthritis in Charleston, SC

Discussion in 'Navy Case Timelines' started by Truck2121, May 31, 2012.

  1. Truck2121

    Truck2121 PEB Forum Regular Member

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    Long time lurker, first time poster. Thought I would share my timeline with everyone else. It's amusing, in a slightly sick sort of way.
    My issues started in about 2002-2004 when I got the anthrax shot after the terrorist attacks. Started having joint pains and limited motion in wrists (slight). Fast Forward to about 2006- now I can't do push ups properly since my wrists won't bend back (told to do them on knuckles by UMO). Move on to 2009- Report to my first shore duty at my 12 yr point. Get told that I can't do pushups on knuckles. Get blown off twice by UMO until I get a new doc. New doc starts saying arthritis, nuclear disqual and sub disqual. In 2010-2011 the doc gets me a variety of appts, ending up in May 2011 with RHeumatologist. TOld I have arthritis, most likely Ankylosing Spondilytis (spine/pelvis) arthritis. I'm supposed to transfer in July 2012 and doc starts MEB process in October 2011.
    Now I'll use a less crappy format for the timeline:
    Oct 2011-LIMDU- Start MEB
    Late Oct/Early Nov 2011- C&P Exams, NARSUM finally done
    Dec 2011- More C&P exams/X-rays and blood work- finally done with poking and prodding
    Jan 23, 2012- MEB completed and submitted, signed
    Feb 23, 2012- IPEB says I'm unfit, forwarded to VA
    Feb 29, 2012- VA "gets" package for ratings
    May 30, 2012- Call Va again (I'm skipping about 5 calls and 2 emails) and get told it's in RI. Don't know when it got there.
    Today 31 May still waiting. Hoping that I'll get my ratings before I hit my EAOS (Sep 2014). Ebenefits still says "review of Evidence"

    My PEBLO is great. She always looks up my package, even though we both know it hasn't moved in 98 days. She did tell me that last week a bunch of packages moved because the PEB put some pressure on so maybe some motion soon. Good luck to everyone out there.
     
  2. medicalmystery

    medicalmystery PEB Forum Veteran

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    Hi, WTH? Pushups on your knuckles? Where regs allow that to even be possible? It amazes me more and more by experiencing idiosyncrasies in the military and being on these forums, how perpetrators abuse their authority. In regards to your MEB, did you have to do additional C&P exams due to additional findings?
     
  3. Truck2121

    Truck2121 PEB Forum Regular Member

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    Yep, I said the same thing about the pushups, but I was out on a sub at the time and it was easier for the UMO to ignore it than fix me. I didn't get any help until I got to Charleston and a better doc. As for the exams, I did have to get some additional x rays and range of motion tests for other joints (elbow, ankle) that I didn't list. The QTC contractors had some questions to nail down before they sent the package off.
     
  4. maparker

    maparker Staff Member PEB Forum Veteran

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    There have been huge problems with incorrect ratings for ankylosing spondylitis. The VA recently announced they are adding a new section to the VASRD for rheumatic diseases. Perhaps that might fix some of the past issues. See the information below.

    Mike

    Documenting and Rating Spondyloarthropathies



    Documenting and rating Spondyloarthropathies is often not understood very well by MEB, PEB and VA officials. Proper documentation in MEBs and TDRL review examinations is critical. Per DoDI 1332.38, MEBs and TDRL review examinations physicals are required to cover all medical conditions with full clinical data. In addition, the 14 October 2008 DoD Directive Type Memorandum requires that MEBs include the minimum data from applicable VA AMIE worksheets. These worksheets can be found here: http://www.vba.va.gov/bln/21/Benefits/exams/index.htm

    Spondyloarthropathy, depending on manifestations, can include the need for the data from the following VA worksheets, depending on manifestations:

    Bones: http://www.vba.va.gov/bln/21/Benefits/exams/disexm06.pdf

    Eyes: http://www.vba.va.gov/bln/21/Benefits/exams/disexm20.pdf

    General Medical Exam: http://www.vba.va.gov/bln/21/Benefits/exams/disexm23.pdf

    Hand, Thumb, Fingers: http://www.vba.va.gov/bln/21/Benefits/exams/disexm27.pdf

    Heart: http://www.vba.va.gov/bln/21/Benefits/exams/disexm28.pdf

    Infectious, Immune and Nutritional:

    http://www.vba.va.gov/bln/21/Benefits/exams/disexm28.pdf

    Intestines: http://www.vba.va.gov/bln/21/Benefits/exams/disexm33.pdf

    Joints: http://www.vba.va.gov/bln/21/Benefits/exams/disexm34.pdf

    Respiratory:

    http://www.vba.va.gov/bln/21/Benefits/exams/disexm48.pdf

    http://www.vba.va.gov/bln/21/Benefits/exams/disexm49.pdf

    Skin Diseases: http://www.vba.va.gov/bln/21/Benefits/exams/disexm52.pdf

    Spine: http://www.vba.va.gov/bln/21/Benefits/exams/disexm53a.pdf

    To ensure proper ratings, it is critical that MEBs, TDRL review physicals and VA C&P examinations properly cover all the manifestations of Spondyloarthropathy.

    Spondyloarthropathy is rated under DC 5002 and is complicated. Ankylosing Spondylitis is even more complicated due to the addition of VASRD 5240 (Ankylosing Spondylitis) in 2003. When DC 5240 was added, many VA and military raters opined that DC 5002 rating criteria could no longer be used for Ankylosing Spondylitis. This was never true but it still took me over four years to get the VA to clarify this issue and many wounded warriors were cheated out of proper benefits in the interim. In the February 2009 VA Conference Call newsletter, the VA stated the following:

    Evaluating claims for ankylosing spondylitis


    Ankylosing Spondylitis (AS) was assigned a specific Diagnostic Code (DC) of5240 with the VA Schedule for Rating Disabilities change for conditions of the spine in September 2003. C&P Service has received multiple inquiries from veterans’ advocates, indicating that AS is being improperly evaluated in light of this change. DC 5240 falls under the General Rating Formula for Diseases and Injuries of the Spine. Raters must be cognizantthat AS, in addition to causing limitation of motion of the spine or other symptoms, may be an active disease process. If the AS is manifested as an active disease process, consideration must be given to evaluating it under the provisions of DC 5009, as an arthritic process. DC 5009, according to the schedule, is to be evaluated under the criteria for rheumatoid arthritis, DC 5002. AS, when an active process, may affect other joints or body systems. Such other residuals should be identified and properly adjudicated.



    Therefore, when evaluating AS, the RVSR must determine, based on the evidence in file, if the AS is an active process, and if so, properly evaluate it under DC 5009 (5002). If the AS is quiescent, it would be evaluated under 5240 based on the chronic residuals affecting the spine as well as any other joints or body systems under the appropriate diagnostic code.



    In August 2009, the United States Army Physical Disability Agency (USAPDA) released policy that echoes the VA clarification above. The policy can be found here:

    https://www.hrc.army.mil/site/active/tagd/pda/AS.pdf. Other services should be rating Ankylosing Spondylitis in this manner.



    The DC 5002 rating criteria has two parts, the active disease process and the chronic residuals. The active disease criteria still suffers from subjective rating terminology such as exacerbations, incapacitating exacerbations, severely incapacitating exacerbations, totally incapacitating, definite impairment to health and severe impairment to health. I have tried numerous times to get the VA to define these terms objectively but without success.

    5002 Arthritis rheumatoid (atrophic) as an active process

    With constitutional manifestations associated with active joint involvement, totally incapacitating 100%

    Less than criteria for 100% but with weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring 4 or more times a year or a lesser number over prolonged periods............................................................................ 60%

    Symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year …………..40%

    One or two exacerbations a year in a well-established diagnosis............... 20%

    It behooves individuals with Spondyloarthropathy to try and ensure their MEB, TDRL, review or VA exam describe their condition using this terminology. If the disease is in the active process (active inflammation treated with TNF drugs such as Enbrel or Humira) the report needs to state the disease is in an active process and use DC 5002 terminology to describe the impact.

    VASRD DC 5002 also has criteria for chronic residuals. (Note: the higher of the active process and chronic residual criteria is used for the final rating). This chronic residual criteria is as follows:

    For chronic residuals:

    For residuals such as limitation of motion or ankylosis, favorable or unfavorable, rate under the appropriate diagnostic codes for the specific joints involved. Where, however, the limitation of motion of the specific joint or joints involved is noncompensable under the codes a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5002. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.

    Note: The ratings for the active process will not be combined with the residual ratings for limitation of motion or ankylosis. Assign the higher evaluation.

    Please note the 10% per joint provision as this can often lead to the highest rating. Every joint affected needs to be thoroughly evaluated to include a range of motion study. Each major joint (or set of minor joints) with any limitation of motion should be rated at no less than 10% disabling. If the spine is affected, and it usually is with Ankylosing Spondylitis, the residual damage to the spine in rated per VASRD DC 5240. Other joints affected are rated per the VASRD DC covering that area or condition.

    All other manifestations of Spondyloarthropathy need to be included as well. This can include eye, lung, GI and heart issues. Often psoriasis is a manifestation of Spondyloarthropathy. If so, under VASRD DC 7816, it should be rated at no less than 60% disabling if it is treated on a continual basis with an immunosuppressive drug such Enbrel, Humira or Remicade.

    In conclusion, Spondyloarthropathy is a tricky disease to evaluating and rate. It is important that those undergoing DES or VA evaluation for Spondyloarthropathy understand how these conditions are properly evaluated and rated and ensure their evaluations document the truth well.

    A good place to read up on rating issues and proper rating procedures is the VA’s Board of Veteran Appeals (BVA). The BVA site is located here: http://www.index.va.gov/search/va/bva.html

    On the site you can search for Spondyloarthropathy cases and review the evaluation and rating issues raised on how the BVA ruled on these issues. Similarly, the US Court of Appeals for Veteran Claims (CAVC) website can be used to research Spondyloarthropathy cases and how the CAVC ruled on these cases. The CAVC website can be found here: http://www.uscourts.cavc.gov/research_court_cases/DecisionsOpinions.cfm



    Michael A. Parker
    LTC, USA (Retired)
    Wounded Warrior Advocate
     
  5. Truck2121

    Truck2121 PEB Forum Regular Member

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    5 June Update- Ebenefits shifted to Preparation for Decision today. Hoping I get the results soon.
     
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  6. Truck2121

    Truck2121 PEB Forum Regular Member

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    12 June Shifted to Pending Decision Approval. 110 days from going to VA. 252 days since beginning. There's a light. A very dim light, but one is there.
     
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  7. klamsnacks

    klamsnacks PEB Forum Veteran

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    LOL - yes it is very dim, more like a candle in a hurricane from 100 miles out =P Either way glad things are moving for you. I do not trust ebenefits site though for this simple reason. My Information has been at Pending Decision Approval since 9 (10) April 2012. I received my Official ratings from PEBLO on Jun 7, 2012, and she received them on 4 May 2012. With documents officially dated 29 May 2012. See all those dates, and as of 2 minutes ago when checking, ebenefits still shows Pending Decision Approval. I like what I can touch,see, and feel and my copies of said documents are better than this mythological creature known as ebenefits !!! =P Either way stay strong, things are moving, so that is indeed a plus, just realize you may get your answers sooner than the site will show.

    v/r
    Klam
     
  8. Truck2121

    Truck2121 PEB Forum Regular Member

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    Having been through 3 hurricanes, I have to agree with your assessment. It's just nice to actually see some change, even if it's slow/out of date. Gives me a warmish fuzzy feeling. I finally got an email back from the VA about my case and my prelim ratings were finished on the 12th. I'm hoping the PEB gets them this week and I get my official ratings before the end of the month, but what's a few more days when it's been 9 months or so? It's funny, I don't even get mad anymore about how long it's taking. I'm just glad it'll be over soon.
     
  9. mikey29445us

    mikey29445us PEB Forum Regular Member

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    MR PARKER, I SEEN WHAT U WROTE GREAT JOB HOPE IT HELPS ME OUT SO YOUR SAYING IS THAT THE V.A. DIDNT DO THE C.M.PS RIGHT FOR ALL THOSE ITEMS, I FALL INTO 2 OF THOSE RESPIRATORY & SKIN DISEASES IF THIS IS THE CASE WILL THEY INFORM US OR GO TO OUR LOCAL V.A. REP ? THANK YOU
     
  10. Truck2121

    Truck2121 PEB Forum Regular Member

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    So I called my PEBLO THursday, after being "encouraged" to by my Coc. I found out from her that they just shifted to a new tracking system and my package now says information is needed. She didn't know if it would affect my timeline since she only found out they shifted it over when she got a nasty email about screwed up packages. Maybe next week.
     
  11. Truck2121

    Truck2121 PEB Forum Regular Member

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    Results are in! Talkig to PEBLO today to see about my options. Currently have 10% DOD, 80% VA. I'm thinking I should have at least 40% DOD based on my arthritis needing Humira to be "normal". I'll see what I can do and update y'all later.
     
  12. Truck2121

    Truck2121 PEB Forum Regular Member

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    Had meeting with PEBLO today. My 10% DOD is based on the spondolytis, but since I don't have debilitating episodes I only get the 10%. It doesn't look like I'll be able to get more than that and probably won't get the 30% I need for retirement. The 80% V is based on the arthritis and a bunch of joint conditions, with a handful of 0's as well.
    In talking with the wife we're thinking about taking the 10% and severance and moving on to one of the two jobs I'm interviewing for. I have 60 dayish to get out, including my 30 ish days of terminal.
    As a note, I'm on day 280 from start of the whole process. The VA had my ratings for about 130 days or so. I have my follow up with the PEBLO on Thursday to sign my paperwork. I'm so relieved to finally get the results and move on.
     
  13. Jennifer.Duhaine

    Jennifer.Duhaine PEB Forum Veteran

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    If you don't mind me asking, since I'm slightly new to the game. Why would you decide on the 10% plus severance over the 80%?
     
  14. medicalmystery

    medicalmystery PEB Forum Veteran

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    He is referring to taking the 10% for severance, but he will not be forfeiting his VA as he will still get that.
     
  15. Jennifer.Duhaine

    Jennifer.Duhaine PEB Forum Veteran

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    I understand that....but just to make sure I'm making sure I know for myself possibly......he can't claim his 80% monthly paycheck until he "pays back" his severance pay....correct? or have I been schooled wrong
     
  16. medicalmystery

    medicalmystery PEB Forum Veteran

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    You are working me. Lol! Really, I get confused about that myself. Keep in mind that I am only a couple of stages ahead of you, but I think unless, it is combat-related the VA does recoup, but I don't know for sure. It's in plenty of these threads, I just never looked deeper into it because I am expecting at least, retirement.
     
  17. Truck2121

    Truck2121 PEB Forum Regular Member

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    I'm meeting with my MSC soon to figure all this out, but I think I have a good idea so far, mostly due to this site. I get the severance since I'm less than 30% DOD. I will have to pay back the severance, but not lose all my VA monthly payments to do it. I lose 10% (my DOD rating) of the VA payment every month to go towards the repayment. If I had received the 30% DOD I would just get the VA money every month and have retirement benefits. I spent a few hours this afternoon looking up all this stuff and figuring it out. Unfortunately, the system is so complex and poorly written out it takes a lot of digging to find out simple answers. Some other threads deal with the repayment of severance pay and have calculators to figure it out. Hope this helps a bit.
     
  18. Truck2121

    Truck2121 PEB Forum Regular Member

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    So I signed my election of options today. Decided to take the ratings as they are and separate the 31st of August. I've got about 25 days of leave coming to me, including house hunting and such. PEBLO said it could take 2-3 weeks for my orders to show up. More waiting, I guess. I hope I can get most of the check out stuff rolling in the meantime.
     
  19. MKDickerson

    MKDickerson PEB Forum Regular Member

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    Good luck getting it rolling, I signed my findings on Thursday of last week and the only thing they will let me do until my message and orders show up is print off my page 4 and page 5 and my awards page. They won't let me even attempt to plan how to get to Arizona where my job starts on September 17 until this magical message arrives. And they say to always have a plan...
     
  20. grizz13

    grizz13 PEB Forum Veteran

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    Plans while in the service?!?! Are you daft? Hahaha!!!! Making plans went down the drain as soon as i joined...
     

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