IPEB rated Fibromyalgia and did not include Sleep Apnea / GAD. Appeal?

I just received the results of my IPEB today. They rated me at 20% and recommend discharge with severance pay.

Under Category I - Unfitting conditions which are compensable and ratable:
Myalgias and myositis, diagnosed with fibromyalgia (FM) 20%

Under Category II - Conditions that can be unfitting but are not currently compensable or ratable: 1. Obstructive sleep apnea (OSA) requiring CPAP 0%
2. Generalized anxiety disorder (GAD) 0%

The rheumatologist that diagnosed the FM clearly stated that the FM was aggravated by OSA and GAD.

Should I appeal for rating >30% ?

What is the precedent for rating conditions that aggravate an unfitting condition? Do they always only rate only the unfitting condition? Do they usually include conditions that aggravate and unfitting condition?

Thanks for the help,
Josh Lang
SSgt USAF
 
Click to expand...
Were all your medical conditions covered in your DES medical exam with full clinical data to include the minimum data from the applicable AMIE worksheets?

Mike
 
What is th AMIE worksheet? I just received my 618 today and it did not include ANY of my secondary conditions from it. I'm nervous about it too. They only put Fibro, Myofascial pain, and chronic back/neck pain. nothing about my spinal disease, radiculapathy, anxiety/depression from pain. and they did not ask my phyciatrist to write an addendum. So confused right now. How long did you wait?
 
I'm sorry, I'm not sure what a DES medical exam or an AMIA worksheet is. Both conditions are listed on my MEB (AF IMT 618), my IPEB (AF FORM 356), and are in multiple documents in my medical history (Chronological record of medical care and the narratives/notes from mental heath, pulmonary (OSA), and rheumatology (FMS))

I've been searching through the documentation and my rheumatologist does clearly list OSA and anxiety as possible contributing factor. However, the seperate evaluations of OSA and anxiety indicate no limitation on duty. IE, sleep apnea is being treated effectively (not unfitting on its own) and anxiety causes mild social impairment but should not limit duties(not unfitting on its own).

Thanks for the prompt response.
Josh
 
Amygal82,

My IPEB came back from Randolph suprising fast, 3-4 weeks. My PEBLO initially said it would take at least 60 days.

I had notes and addendums submitted for my OSA and Anxiety before my package was sent off to Randolph, so at least they are included on my 618.
 
What is a OSA? I asked my MEB civilian if I could have my 618 fixed to add my spinal stenosis, DDD, spondylisis, cervical radiculapathy, and migrains because they are the resons why I have have muscle, neck, back pain and she said no....
 
How did they rate you 0% for sleep apnea secondary to your fibro when it's medically known they are associated together?
 
I was told they didn't rate the Sleep Apnea because sleep apnea alone is not unfitting and would not have resulted in discharge. Same for Generalized Anxiety Disorder.

I'm a little perplexed by this. Sleep apnea and anxiety definitely make fibromyalgia worse and are commonly associated with fibromyalgia. Maybe that's just the way the AFI dictates ratings?
 
But the AFI states sleep apnea as a boardable criteria even though it is not unfitting. So are migraines...so I'm guessing the board won't give me anything for that either...sigh. I am scared they will only give me 20% too. I'm going to have to change my life, career, major, everything because of the pain I am in... not to meantion all the drugs I am on and I don't even drive anymore. How long have you been in for Josh?
 
I've been in for a little over 7 years. My life has already been affected a lot by this condition. I have to be so careful with my exercise, sleep, eating, everything habits to keep my pain minimal. Luckily I can still do most things, I just have to be careful not to overdo it with any kind of physical activity. I'm only 26, isn't that sad? I'm already like an old man. But that's just how it is with fibromyalgia.

Either way, at this point the Air Force isn't conducive to dealing with fibromyalgia. The increased stress and shift work schedules tend to aggravate my fibromyalgia, so I want out. I only have 7 years, so its tough. If I was closer to 20 years I might try to ride it out.

Josh
 
LangJoshuaG said:
I was told they didn't rate the Sleep Apnea because sleep apnea alone is not unfitting and would not have resulted in discharge. Same for Generalized Anxiety Disorder.

I'm a little perplexed by this. Sleep apnea and anxiety definitely make fibromyalgia worse and are commonly associated with fibromyalgia. Maybe that's just the way the AFI dictates ratings?
Click to expand...

Sleep apnea certainly is ratable. The threshold is that it has to be unfitting (or contributes to unfitness). It is, admittedly, rare that they find sleep apnea unfitting, but it can happen. More recently, usually it happens when the member has unresolved problems in spite of treatment, such as Excessive Daytime Sleepiness.

Amygal62,

If you have concerns with the 618, request an impartial review then rebut the MEB findings/NARSUM. The review likely won't change anything but will trigger the requirement that they respond in writing to your concerns and forward everything to the PEB.
 
AMIE worksheets can be found here: Index of Disability Examination Worksheets (U.S. Department of Veterans Affairs)

If your MEB did not include full medical data on all conditions to include the minimum data of the applicable AMIE worksheets, request supension of your case until your MEB is conducted to standard. Request a formal anyways to fight for a higher rating. Are you under the legacy DES or the Integrated DES?

From The 14 October 2008 DoD Directive Type Memorandum (DTM):

REVISED AND NEW POLICIES TO IMPLEMENT THE NATIONAL DEFENSE AUTHORIZATION ACT (NDAA) FOR FISCAL YEAR 2008

The policies below implement specific disability-related policies and sections of the FY 2008 NDAA (Pub. L. 110-181) and rescind DoDI 1332.39, Application of the Veterans
Administration Schedule for Rating Disabilities, November 14, 1996. The respective issuances cited below are revised as indicated. Text in BOLD is new/added. Text with strikethrough is deleted. References cited in the numbered paragraphs below pertain to the reference listings in the respective DoD issuances. Military Departments will implement these policies immediately.

Replace E3.P1.2.6 (DoDI 1332.38, “Physical Disability Evaluation,” November 14, 1996, with the following:

E3.P1.2.6. Additional instructions for Disability Medical Evaluation.
E3.P1.2.6.1. The Military Departments shall publish policies that ensure:
E3.P1.2.6.1.1. Service disability medical examinations for the DES meet the minimum criteria outlined in the VA General Medical Exam, and the applicable Compensation and Pension Automated Medical Information Exchange (AMIE) worksheets.

From the 21 November 2007 DTM on the Pilot Program (IDES):

5.3. The Assistant Secretary of Defense for Health Affairs [ASD (HA)], under the USD (P&R), shall:

5.3.1. In coordination with the Military Departments and the DVA, ensure the conduct of a single, comprehensive, standardized medical examination, which will include the protocol-based General Medical Exam and Specialty Exams (based upon DVA examination worksheets and templates) for referred and claimed conditions. The Military Department MEB will use the medical examination results to identify conditions that are potentially unfitting for military service. The DVA will use the medical examination results to determine the disability rating(s) for the referred and claimed condition(s). The exam will also serve as the separation physical should separation from the military service occur. The exam will include an electrocardiogram (EKG) if the member is over 40 years old and a Human Immunodeficiency Virus (HIV) test to meet military separation physical requirements.
 
Sleep Apnea with a machine is non-deployable due to possible lack of needed voltage, etc. I have seen guys get medically retired at 50% disability for this in the past(2005-2006 timeframe). To be blunt, they are cutting 43k enlisted and it sounds like you are one of them. A guy I work with has 18 yrs and 11 months of service, over 10 of those as an enlisted aviator in special operations, and he was just offered 10% and severence (no retirement) for a serious spinal issue. I am dodging MEBs left and right for now, even though I can't fly and my problems are stacking up. It is a really bad time to be dealing with health issues in the Air Force. They are trying to cut spending and personnel. I have over 17 yrs in, and I am afraid if I get boarded they are going to screw me out of my retirement and pull my childrens' Tri-Care. That is even though I had a condition 5 yrs ago that the offered me 40% disability for and I elected to get surgery and a waiver to continue flying and stay on active duty. They are NOT taking care of their people right now!
 
Thanks for weighing in everyone.

Jason,
I have no illusions about my sleep apnea or anxiety being unfitting. I would have to pull an act of some sort to try and say that they are. I'm tolerating the CPAP and I only have mild social dysfunction from anxiety. However, my fibromyalgia most definitely is unfitting and sleep apnea and anxiety play a big role in fibromyalgia. I might not have fibromyalgia or it might not be as bad if I didn't have issues with sleep or anxiety.

So, to perhaps word my question better, are secondary conditions that aggravate / contribute to an unfitting condition usually included in the rating? Or are the rules pretty clear that ONLY conditions that specifically make you unfitting, on their own, will be rated?

Another twist, some Doctor's might argue that fibromyalgia is actually secondary to sleep apnea and anxiety. Is it possible that I could fight for having sleep apnea and anxiety rated instead of fibromyalgia?

Thanks again,
Josh
 
maparker,

I checked out the AMIE worksheets. I haven't seen a form that looks specifically like that but looking at the fibromyalgia worksheet I think every question on the form was covered in my MEB narratives, A/P notes, and chronological history. I left some of my documentation at the office but I'm going compare the worksheet in detail to make sure all the information is there.

I'm also pretty sure I'm on legacy DES. I was told if my package had went through after June I would have had another option besides outright appeal / FPEB.
 
All conditions that contribute to unfitness should be rated. From the 14 october 2008 DTM:

E7.1.2. The Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) shall be used in making ratings determinations for each of the medical conditions
determined to be unfitting independently or due to combined effect, to include in combination with an independently unfitting condition. If more than 1 military unfitting
condition exists, the VASRD will be used to determine a combined disability rating for each unfitting condition. For purposes of establishing a rating, the VASRD will be used in
relation to the Service member's physical disability at the time of the evaluation. If use of convalescent ratings and/or other interim ratings (i.e prestabilization ratings) applies, the Service member may be placed on the Temporary Disability Retired List (TDRL) for reevaluation purposes.

Mike
 
Amygal82 said:
Do you know why they gave you only 20% for your firbro and not 40%?
Click to expand...

My fibro is episodic. For example, today I'm in quite a bit of pain. It could be the stress of this, the weather, not getting good sleep, almost anything it seems like. I have triggers that will cause a "flare up". However, yesterday I was mostly fine. I had a little ache here and there but nothing major.

Folks with a rating of 40% specifically for fibromyalgia are in almost constant pain, ie not episodic.

Here's an excerpt from another poster from the schedule of ratings

5025 - Fibromyalgia (fibrositis, primary fibromyalgia syndrome)

That are constant, or nearly so, and refractory to therapy.......................... 40
That are episodic, with exacerbations often precipitated by
environmental or emotional stress or by overexertion, but that
are present more than one-third of the time............................................ 20
That require continuous medication for control.......................................... 10
 
You must log in or register to reply here.
Top