Migraines and MEB/PEB

Hi,

I have been reading for months about the DODI 1850.4E and Navy regulation requirements (I am in the Marines) on migraines being defined as "prostrating"

As for my situation I am having migraine attacks almost on a daily basis not able to perform my duties and away from a military installation due to being on special duty (Recruiting Duty).

I am going to see a military neurologist this month because my unit wants to know if I am fit for duty, they are sending me to Chicago Great Lakes Naval Base.

If and when my package is sent to the MEB/PEB and I know it is almost impossible to meet all the requirements as required to be "prostating".
I have been put on limited duty for this problem back in 2004 for 8 months, been on countless meds and my problem is worse than ever. But I still don't meet the requirements as required by DODI and the Navy regs for "prostating"
So my questions are

1. When my package is sent to the MEB what happens when all the "prostrating" requirements are not met (although I am not able to work, perform duties, and get out of bed on most days)?

2. When I go to the military neurologist, how should I explain this to him and is there anything I should get from him like letters or paperwork for my command, or better yet anything I should say to help my situation or case?

3. What can I do to meet those requirements for "prostrating"

4. Can the PEB find me unfit, discharge me and rate me at 0% een though I don't meet the "prostrating" guidelines?


Thanks
 
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Tony,

First off, it seems to me that if you aren't going to seek medical care for them but can't get out of bed, it seems to me that you probably would qualify for "prostrating," if you went to get medical care. More on this below.

As to your questions, here are my thoughts:

1) At the MEB level, they will look at the diagnosis, see that you have a disqualifying condition and with the symptoms (though non-prostrating currently) as bad as they are, I think it is save to presume they will forward your case to the PEB.

2) I think you have to be very careful in how you approach the neurologist. If he or she thinks you are trying to "build a case" it can be disastrous. What you need is to have the neurologist document your prostrating condition. If you address your symptoms as you described, then the neurologist will state what you need in the normal course of his narrative or notes. What you need is to be able to document the prostrating nature of your condition.

3) Here is the criteria from SECNAVINST 1850.4E :

"(4) 8100 - Migraine
"Prostrating" means that the service member must stop what he or she is doing and
seek medical attention and is incapacitated.
(a) The number of prostrating attacks per time period (day, week, month)
should be recorded by a neurologist for diagnostic confirmation.
(b) Documentation of these visits to the medical department representatives
must be available in the medical record. Estimation of the social and industrial impairment
due to migrainous attacks should be made.
(c) The Medical Board report must contain the types of medications that the​
member has tried, both prophylactically and abortive and the results of each medicine."

To meet the criteria for higher rating, you must go and seek medical care. Simply put, by not doing so you will likely not get an appropriate rating. This is one of those things that often catches Servicemembers. You can just "suck it up," and deal with it on your own. But in doing so, you jeopardize getting a proper rating. So, if you need medical care when you have a migraine, go and seek medical care.

4) Yes, they can. Again from 1850.4E, Encl 3, 3804, l:
"
l. Zero Percent Ratings and Minimum Ratings
(1) Zero Percent Rating for Residuals. Occasionally, a medical condition
that causes or contributes to unfitness for military service is of such mild degree that it does
not meet the criteria for even the lowest rating provided in the VASRD under the applicable
code. A zero percent rating may be applied in such cases even though the lowest rating​
listed is 10 percent or more, except when "minimum ratings" are specified..."


If you have been putting off going for medical care, you should start as soon as possible. If you wait too long in the MEB/PEB process, then it will clearly appear that you are again "building a case." When you go, you need to only address the medical facts. Do not mention documenting the condition, the PEB, or anything else. To do so may result in them not crediting the prostrating nature of your condition. But if you do not need to get medical care, then you will not meet the criteria.

Please let me know any questions.
 
Jason said:
Tony,

What you need is to be able to document the prostrating nature of your condition.
"(4) 8100 - Migraine
"Prostrating" means that the service member must stop what he or she is doing and
seek medical attention and is incapacitated.
(a) The number of prostrating attacks per time period (day, week, month)
should be recorded by a neurologist for diagnostic confirmation.
(c) The Medical Board report must contain the types of medications that the​
member has tried, both prophylactically and abortive and the results of each medicine."
Click to expand...


Jason,
great info thank you, couple more questions
Above you say I must be able to document the prostrating nature of my condition.

1. How do I do that? Does the Doc do that for me?

Also the above requirement for "prostrating", it says I must have a neurologist diagnostic confimation for each migraine and have it documented.
That is pretty much impossible since I can' go see my neurologist every time I have a migraine.
2.So what do I do for that requirement?

It seems to me that these are pretty far fetched requirements due to the fact I don't have access to a neurologist every day and some days I just can't get out of bed.

3. When my command writes a non-medical assesment, when they include the time I have missed due to the condition and not being able to perform duties, does tht hold any weight when it ges to the board?

4. also what is the best way to document my conditions affect on my duties and performance?


Thanks again for all you do
 
Tony,

The neurologist will review your hospital admission forms, treatment summaries, clinical notes, etc., and then document by notating in your Narrative Summary or medical history. You don't need to go to neurologist each time, just "seek medical care and be incapacitated." A clinic should count, ER would definitely.

Command statement will not impact prostrating criteria. It will carry weight on the unfitting nature of the condition. Aside from Command letter, a migraine diary annotating missed days at work, evaluation reports with comments regarding performance, counseling statements, physical profile, any change in duty hours and statements from supervisors can all be helpful.
 
exactly what I needed to know

thanks
 
Jason,

Just thought of a question, I am not wanting to get an unfit finding and discharged. I know it doesn't matter what I want.

That being said and of course you can't tell me exactly what the outcome will be.

Considring the severity of my migraines and the debilitating nature and not being able to function in the simplest way at work and not being able to control them, what are the odds in your experience that they would keep me or dicharge me?

I know you don't know exactly wat they will do but just looking for an educated geuss so I can kind of start thinking aout the future..

Also,
Today I went and seen my neurologist (civilian) and he diagnosed me with cluster migraines on top of my classic migraines w/aura, so I have 3 conditions now with the neurocardiogeic syncope....I am falling apart....:(

Thanks
 
Tony,

If you just want my best guess, from what you have described, I would say you will be found unfit.

Better than my "best guess," though, is your input on what is the state of your conditions. Forgive me if you told us before, I know you are on recruiting duty, but what is your primary MOS? Do you think that your migraines, and syncopal episodes, along with the limitations they place on you, allow you to reasonably perform the duties expected of someone of your grade and MOS? As you said:
...not being able to function in the simplest way at work and not being able to control them.
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I suspect given what you said, the answer is "no."

This may not be easy to bear, the fact that you are likely unfit. Especially when you want to be fit. And of course this is on top of dealing with the actual medical conditions themselves. I am very sorry that this is what is going on with you. But like you suggested, you are better to know more and to be able to plan ahead. I am not a medical professional, but I have had many clients with migraines. No case is exactly alike, but I have seen remissions and cases where they eventually are well controlled. Hopefully, that is the outcome in your case.

Please let me know any questions.
 
Thanks again my friend
 
Have they tried you on triptan (drugs like zomig/imitrex)to abort your migraines? Are you on any preventive drugs?

X
 
xeno said:
Have they tried you on triptan (drugs like zomig/imitrex)to abort your migraines? Are you on any preventive drugs?

X
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Oh yeah, I have been on countless preventatives and abortives, and none have worked to include the ones you mentioned...

Vicodin helps a little bit, but I can't work and function on them let alone the addiction factor. My doctor doesn't like prescribing them to me anymore..

Thanks
 
Hi Tony!

You need to read the court decisions regarding Charles Van Cleave - just google Van Cleave v. US. He also suffered migraines and the decisions dealt with the evidence supporting "prostrating" attacks. Mr. Van Cleave finally (and recently) won his case, but you could benefit from reading the claims he made and the counterclaims by the government.

Good luck!
 
Sheila,

Thanks, thats funny yo mentioned that case. I ran into that PDF like 2 weeks ago.

Thanks
 
I have a question, I'm not in the military but wanting to join. I have had migraines in the past (not so regular anymore) I do take preventatives and have meds to take if i got one. Would they accept me? Are the medications the issue or something else? One recruiter led me to believe it was the meds and even said my allergy medicine (clarinex) use would have to be stopped, can i still get in?
PH
 
hunt745 said:
I have a question, I'm not in the military but wanting to join. I have had migraines in the past (not so regular anymore) I do take preventatives and have meds to take if i got one. Would they accept me? Are the medications the issue or something else? One recruiter led me to believe it was the meds and even said my allergy medicine (clarinex) use would have to be stopped, can i still get in?
PH
Click to expand...

It depends. Each service has standards for accessions which may (and do) differ from retention standards. I think for the AF they are contained in AFI 48-123. However, some of these may be waiverable...depending upon the severity. Talk to a recruiter but make sure you are honest. If you have a limiting condition, they WILL find it at in processing and your chances of getting a waiver go down to nil if your caught trying to sneak thru.

Good luck!

Nate
 
Ok thanks Nate, I'm wanting to join the Coast Guard but its an Army recruiter that kind of got me worried about it.
 
I have another question, I just talked to my doctor, he said the medicine I take for my migraines (which do work to control my migrianes) will not show up on a drug test or as a steroid or anything. Is that what the military is worried about? And will they want me to get off the medicine? I'm just worried they're going to see "history of migraines" on my sheet and immediatly say no.
 
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