2018 - Navy - 14 yrs AD - E6 - TIMELINE

brokenlizard

Registered Member
#1
Long time lurking here, and gained a massive appreciation for how complex this whole IDES process is and to those that helped me in the past thank you for spreading the wealth of knowledge for us newbies. Time now to establish my own timeline, as I'm fully embedded into this IDES process now, and also keeps me on track and provides an outlet to ask questions during the process.

MEB referring conditions:

1) Recurrent Rhabdomyolysis
2) Metabolic Myopathy
3) Depression
*MH addendum letter submitted
*PENDING Urology addendum letter

Diagnosed for years with recurrent Rhabdomyolysis, Metabolic Myopathy, Persistent Depression, Major Depression Disorder, Insomnia, Generalized Anxiety, Social Anxiety, Attention-Deficit Hyperactivity Disorder (ADHD) and Micturition Hesitancy with evidence of retention. After my original MH provider submitted the addendum letter, I was relocated to the hospital to finish my PEB and got assigned to a new physiatrist, decided to diagnose me with Borderline PD and adjustment disorder, which are not rated by VA, but EPTS over 8 yrs AD creates a moot point for this provider to try and hurt my ratings. I've had no NJP's, not single counseling/charge sheet, good evals, zero financial issues. Recently being evaluated outside of Tricare, out in town psychologist to determine if the PD/AD was falsely added to my record by this psychiatrist or not, and to be treated for trauma's from prior to service and my recently disclosed MST matter.

22 Jan 18 - MEB 'unfit'
14 Feb 18 - IDES referral for IPEB
15 Feb 18 - NARSUM 'unfit remarks' submitted
05 Mar 18 - MH addendum letter submitted
06 Mar 18 - Personal impact letter submitted *pending revision upon Urology diagnosis*
15 Mar 18 - C&P exams completed
06 Apr 18 - MEBLO placed IPEB in 'deferment' status
06 Apr 18 - Urology needs further work-ups, prior to submitting Urology addendum letter
26 Apr 18 - NMA submitted - CO remarks are for 'unfit'
-Pending Urology-

Background:
Documented 2 cases of Rhabdomyolysis, 2 undocumented cases for a total of 4 Rhabdo events. My recent relapse running the O-course with my unit in Jan 18, which has initiated this MEB for IDES. Found to be partially deficient in the muscle enzyme myoadenylate deaminase and phosphofructokinase, found by pathology excision of muscle biopsy and noted partial deficiency, resulted in a diagnosis of metabolic myopathy.

My younger brother (2 yrs apart), was a Sergeant in the USMC also experienced a metabolic condition (compartment syndrome) with history of PTSD, IPEB found him UNFIT and medically retired for his conditions at his 8 year mark in the military. Somehow his symptoms developed around the same time I had my first experiences with Rhabdo, and during similar age range (25-28 years old), later Neurology said it's likely a genetic correlation between my brother and I exists.

After my mother's passing from cancer when I was 16 yrs old, at 19 years of age, having admirations to become a Navy SEAL one day, I enlisted into the Navy on 01 Apr 2004 as a Navy Corpsman. Felt hopeful and mentally in a good place, medical waiver upon entry for childhood Asthma, (exercise induced Asthma from the ages of around 5-9 years old). History of hospitalizations, but later in life, I luckily out grew my Asthma condition (apparently plagued with exercise inducing diseases throughout my life). While in boot camp, experienced another loss in the family, both my grandparents passed away in the same week but kept this to myself as I didn’t want to be placed on emergency leave and miss training. From October to December 2004, MST occurred in another training facility, attended BUD/S (SEAL training) in 2010 between Feb - June, where I experienced my first 2 encounters of Rhabdomylysis. Both occasions, observed dark 'coke-color' urine with muscle weakness, didn't seek medical attention, for fear of getting disqualified from training and at this time didn't know what Rhabdo was or what the symptoms were telling me. Untreated Rhabdo episodes, to my knowledge no permanent damage occurred but did begin experiencing Nocturia and Insomnia progressively worsening issues. Also facing elevated major depression and anxiety, dropping from SEAL training, trouble with marriage (led to divorce and not being apart from my kid), death of my mother during my childhood/early adulthood from cancer and MST during one of my training schools in 2004 created an assortment of other MH conditions as the years went on did not seek professional care until 2012.

2011 deployed to Afghanistan, where I experienced my 3rd and 1st medically documented Rhabdomyolysis, did my usual cross-fit/weight training work-out, the following morning had the same dark color urine and extremity soreness, so I explained to my flight surgeon I worked for at the time, what this all meant and that I've experienced exact symptoms twice during BUD/S? He immediately knew it was Rhabdo, and later was transported to the Role 3 hospital via ambulance and serum test showed I was 181,600 CK and positive on urine dipstick for Myoglobinuria. Admitted and treated for 2 nights, discharged and was advised to get a muscle biopsy and follow up with Neuro and Internal Medicine. Released from the Role III, with limitations at work but was able to remain and complete the tour. 2012 returned from theater, and went through extensive work-ups with IMC/Neuro/Neuro-surgery, to include a muscle biopsy which revealed I have a metabolic condition that (partial enzyme deficiency) that puts me at risk from further Rhabdo epsisodes. Further medical/physical limitations we placed on me, but no MEB was initiated at this time, because they felt I could stay in if I follow their recommended limitations i.e., drink plenty of water, avoid exercise in hot conditions, avoid strenuous activities....

This placed an intrusive physical/medical limitation for me professionally and personally, as I couldn’t enjoy working out like I used to in the past i.e., biking to and from work (14 miles each way), heavy weight lifting 5 days a week (+100lbs free weight dumbbells per arm during chest workouts, +35/40lb free weight per arm and +80-350lb free weights for lower extremity workouts), highly involved in cross-fit and spent my weekends doing long distance. Due to the limitations, I’ve literally had to cut out a lot of what I was doing, decrease the amount of distance in runs/swims, reduce the amount of heavy weights I was lifting, which indirectly forced me to modify my active lifestyle and ultimately altered my life for the worst because I can’t find the same satisfaction I once had working out without limitations. Not being able to push myself during my exercises, and or being extra cognizant/paranoid about if I reached my threshold limit or not, have been beyond difficult to monitor on my own, especially not knowing where my serum CK level is post workout. This has hindered my performance professionally, a slow decline in PRT scores. Unable to participate in strenuous training events/programs or workouts with my unit i.e., hikes, conditioning courses, group PT events.

I felt I was ‘asymptomatic’ throughout the last years after adjusting to a modified ‘light to moderate’ workouts on & off duty, at least to the “best of my knowledge.” Uncertain how many overlooked/missed Rhabdo episodes I may have been exposed to and what effects it has on me with untreated episodes. Until 12 Jan 2018, my 4th Rhabdomyolysis episode event, stationed in Camp Pendleton, CA, our company ran the Obstacle-Course (O-Course) along with various moderate to strenuous exercises. The day after there was NO black colored urine, felt some extremity soreness but nothing too unusual for me for post workout muscle soreness. However I noticed a slight pink hue to my urine on the morning of 13 Jan 2018 (Saturday), and decided to be on the safe side and get it checked out at the Naval Hospital Emergency Room. I explained to the physician there of my Rhabdo medical history and needed the CK serum test drawn as well as the Urinalysis (UA) to be sure, but she refused to test my CK and said the urinalysis was adequate enough based off my symptoms (UA results were negative for blood). She discharged me and said the CK serum test needs to be ordered by my PCM at the 21 Area Medical instead, which was closed till the 16th of Jan due to the MLK holiday. On Tuesday morning (16 Jan 2018) the CK blood test was drawn, and the following day (17 Jan 2018), I was contacted by the on-call Independent Duty Corpsman (IDC) from 21 Area Medical around 1700 and then instructed to report to the hospital ER immediately. The results were positive for Rhabdo, as my CK on the 16th of Jan was 42,791 U/L (would’ve been considerably higher, if the test was done 3 days ago in the ER). Admitted to the ER and received aggressive IV hydration, afterwards reexamined the CK, resulted in 28233 U/L, since the CK was in a downward trend, discharged 2215, with follow-up to Internal Medicine.

With 5 continuous years of MH care (going on 6 years) treatments and therapies, still battling with issues with no improvement to my conditions. Currently enrolled in an intensive Outpatient Dialectical Behavior Therapy (DBT) (weekly-basis), bi-weekly Physiatrist appointment’s, assigned to a Tricare network behavioral health therapist (weekly-basis), Wounded Warrior Program (WWP) intensive 20 day Outpatient treatment - Project Warrior Care Network, WWP 3-5 day - Project Odyssey, WWP counselor - Project WWP Talk (weekly-basis), assigned an emotional support animal at home. Recently disclosed my MST issue experienced in 2004, because of the PEB, I felt it was the right time to disclose it and not keep it to myself no longer.

Urology will now determine if I warrant an additional addendum letter to be added into the MEB prior to sending it out to IPEB. Years of micturition hesitancy/Nocturia/blockage/urine retention/OAB/BPH/high frequency symptoms post 2010 Rhabdo epsiodes, being evaluated for what the root cause could be. Ultrasound and catheter procedure revealed urine retention post voids, and will being following up with my Urologist next week to discuss where to go from here. Addendum letter to be submitted upon further work ups for diagnostic scans (CT/MRI), possible to have permanent scarring in kidneys from Rhabdo (especially the overlooked/untreated events). Possibly related to Neurogenic issues or a combination of that and physiological issues.

I'll try and keep my head up, but that's been easier said than done, most days I wish I could end it all, finding my MDD to be very difficult to handle especially during such a stress inducing time such as a medical board. This forum however, has relieved me of some anxiety that I'm not the only one facing issues, and lifelong ailments. I hope I made sense explain my scenario, long winded for sure, but wanted to be as detailed as possible to provide the right information going forward. Thanks in advance for anyone's suggestions/inputs going along this process, and support the members from this forum provides!
 

NAVYDC

Registered Member
#2
Keep your head high boss!!!! I am pretty close timeline wise with you and just riding this roller coaster. No suggestions or inputs but I hope everything works out in your favor forsure!!!
 

brokenlizard

Registered Member
#3
Keep your head high boss!!!! I am pretty close timeline wise with you and just riding this roller coaster. No suggestions or inputs but I hope everything works out in your favor forsure!!!
Thanks! Nice to hear similar timelines, hopefully it works out, and to you as well!!
 

brokenlizard

Registered Member
#4
Well took a little over 4 weeks to receive the addendum by Urology, PEBLO spoke to provider directly and confirmed the letter will be completed COB today. Scheduled IDES Attorney/PEBLO appointment to review/sign NARSUM, with the addendums from MH and Urology, and to get the package sent out early next week. Hoping for a projected rating from the attorney to get an idea of what the outcome percentage wise could be.
 
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chaplaincharlie

PEB Forum Veteran
Registered Member
#5
I think a second opinion is in order for the BPD diagnosis. There is significant evidence that BPD is often over diagnosed, when PTSD should be the diagnosis in patients with a history of (M)ST.
 

brokenlizard

Registered Member
#6
I think a second opinion is in order for the BPD diagnosis. There is significant evidence that BPD is often over diagnosed, when PTSD should be the diagnosis in patients with a history of (M)ST.
Indeed, I've got a civilian psych going over everything from a clean slate, she's aware of what the psychiatrist diagnosed me recently with BPD, my current provider is adamant about diagnosing me with all conditions considered.

PTSD was claimed and confirmed via the C&P examiner from traumas during my mothers suicidal gestures/attempts and death from natural but sudden causes, however the MST was just recently disclosed after the C&P exam (took a lot to even bring it up at all), so the only mention of it is in my personal impact letter.

The MH addendum doesn't list PTSD, but reoccurring persistent MDD and anxiety being the main driving condition for review. Question I may have the attorney is, is it best to include at the recent notes from my current provider treating me for MST or wait till the IFEB results come back, and submit a request for FPEB if warranted from FIT findings...
 
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chaplaincharlie

PEB Forum Veteran
Registered Member
#7
Listing all MH diseases in the addendum is probably not important. The VA rolls most MH diseases into a single percentage.

Glad you have someone else looking at your condition. Best wishes,
Mike
 

brokenlizard

Registered Member
#8
Listing all MH diseases in the addendum is probably not important. The VA rolls most MH diseases into a single percentage.

Glad you have someone else looking at your condition. Best wishes,
Mike
Very good information to know, thank you as always for breaking things down for me!!

Hopefully good results from it, and use that for the just in case scenario contingency plan.
 

brokenlizard

Registered Member
#10
Met with the attorney, prediction from them is ‘unfit’ between 50-70% siding with likely 70% for referred mental health conditions are bundled together. Prediction on the Myopathy and Rhabdo is a bit complex for them to determine what the ratings would be but, assured me the Myopathy alone is another ‘unfit’ condition. Urology ratings were difficult to determine, as the C&P exams didn’t address urology matters but, with the Urology addendum in place should produce some ratings, but unilikely a ‘unfit’ condition/s. LOD (obstacle course training) memos reviewed to determine and address Myopathy/Rhabdo were under the Simulating War (SW) criteria for CRSC considerations, likely to be done after I receive my DD214 from what I gather. NMA reviewed, and favored ‘unfit’ comments with no verbiage for retention and unable to perform duties in garrison or sea.

My physchologist our in town has been amazing, and gave me the heads up the notes from their office will be forwarded to my PEBLO prior to submitting the package online, to redact a prior physichiatrist markings of BPD and AD diagnosis placed in my record couple months ago, hopefully that’ll be sufficient, and thanks @chaplaincharlie for all the advice, really!!

Signed the disclosure forms, agreed with everything in the NARSUM’s/MEB recommendations and attorneys briefing so now will submit it to IPEB. PEBLO said it’s very likely I’ll receive findings within 90 days, so hopefully by mid August (at the latest), and projected EAS NOV/DEC, if there are no appeals or secondary C&P exam requests during the process.

Here’s hoping for favorable results, and now the long wait begins...
 

brokenlizard

Registered Member
#12
If the MH is 70% and additional 20% unfitting rating will max you out on DoD.
70% for MH +
20% of remaining 30%= 6%
76% is rounded up to 80%
75% is DoD max
Thank you for breaking down the DoD rates like that, makes a lot of sense now with how they calculate ratings from that side.

I'm assuming the Urology addendum for voiding dysfunction in the opinion of the attorney and doctor, it won't be a 'unfit' condition. Also assuming the Rhabdo and Myopathy (unfit conditions), will be evaluated by the analogous rating under Muscle Group or Renal affected, in the C&P it's noted my right thigh has pain/numbness from the muscle biopsy site, but was determined in the C&P results stating not debilitating so unsure I'll get much for ratings for the two ....
 

brokenlizard

Registered Member
#15
Timeline update: MEBLO submitted package yesterday to IPEB, along with the additional notes by my civilian MH provider to include personal trauma events, and hopefully written to preclude previous PD diagnosis from military MH. Too be patient for 90 days will be a challenge to say the least....would it be worth my time to ask the attorney whether he believe it'd be a PDRL or TDRL outcome, or is that something most attorneys won't likely be able to predict?
 
#16
Contacted their office, and IPEB confirmed package received 17 May (day after package sent out).

He mentioned if found 'fit' should receive findings by 1 month.

For 'Unfit' 2-3 months.

Seems to be a vague prediction, since I'm seeing more and more folks on here getting 'Unfit' notices quite sooner than 2-3 months, whelp it's back to waiting to see what happens!
 
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