systemic diseases Sjogren's Syndrome rating question

A

asearles

PEB Forum Regular Member
Registered Member
My husband just got back his results for MEB. Seperation with severance with disability 20%, 5099-5002. With a note to apply for LAS due to his 17+ years in service (Air Force).

He wants to stay in for 20 or get medical retirement as he feels he has earned it with all the deployments and service he has done. I agree. He should not just be released from duty. He is able to do his job (contracting) but not able to deploy due to medication.

We are trying to decide what to do. I found that Sjogren's has a different analogous code of 6399-6350 but I can not find what disability percent it is. Can someone help with this matter?

Any ideas on past results of appeal for this type of disease?

Thank you for all you do here in this forum, it has helped a lot just knowing others are going through the same thing.
 
asearles,

Welcome! Sorry to hear about your husband's condition. As far as analagous codes go, you just ignore the first four digits and look at the last four. In the case of 6399-6350, that is:

6350 Lupus erythematosus, systemic (disseminated):

Not to be combined with ratings under DC 7809

Acute, with frequent exacerbations, producing severe impairment
of health 100

Exacerbations lasting a week or more, 2 or 3 times per year 60

Exacerbations once or twice a year or symptomatic during the
past 2 years 10

Note: Evaluate this condition either by combining the evaluations for residuals under the appropriate system, or by evaluating DC 6350, whichever method results in a higher evaluation.
 
Jason, where would I find these findings? I found the codes 6399-6350 in DoDI 1332.39 but I need the document where you found the percents. If we are to appeal we need backup documents. We were told the 5099-5002 is a catch all when they dont find the exact coding for the disease, is this true? What do you find for percents for 5099-5002. Why would they use a catch all code for a disease that has a code?
 
asearles said:
Jason, where would I find these findings? I found the codes 6399-6350 in DoDI 1332.39 but I need the document where you found the percents. If we are to appeal we need backup documents. We were told the 5099-5002 is a catch all when they dont find the exact coding for the disease, is this true? What do you find for percents for 5099-5002. Why would they use a catch all code for a disease that has a code?
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Could you be more specific with the wording on the ratings he received? 5002 is for Rheumatoid Arthritis (RA) or Gout, and others. You have time to appeal the decision.. Does he have systemic lupus erythematous with Sjogren's syndrome or the syndrome only?

Section 4.88b for the ratings Jason provided here:

http://www.warms.vba.va.gov/bookc.html#n

You probably won't find statistics on appealing this specific disease here. I did post a new article today on the statistics of appealing an IPEB rating though.
http://www.pebforum.com/showthread.php?t=17387
 
He only has the Sjogren's Syndrome. He does not have Rheumatoid Arthritis (was tested and negative).
Doc's letter in MEB paperwork stated he has the following: Sjogren's Syndrome with associated inflammatory polyarthropathy with exacerbations of pain.
Per IPEB returned as 5099-5002 and 20% with seperation w/ severance. I found the code 6399-6350 for Sjogrens in DoDI.
He will be appealing but not sure on what to appeal, wrong coding maybe, increase in % maybe, not sure? He wants the 30+% with retirement.
thanks for all help you can give, this has been so stressful for him and us as a family. We were to get orders this month.
 
Would need much more information and details to give any meaningful input. What are his symptoms? What do you disagree with?
 
Symptoms are: painful joints, every movement causes him pain. Joints affected at this time: hips, knees, ankles, shoulders, elbows and now his hands have started going numb. He was told by specialist he is not to run as it will cause more harm to his knees. He has the common symptoms of Sjogren's of dry eyes and mouth also but those really dont bother him. The medication he is on can cause damage to his liver and kidneys but so far have not. Just depletes his body of Vitamin D and folic acid in which he has to take supplements. He goes to the specialist this coming monday and we will discuss his future and how this disease may progress.
We are worried that if he accepts the seperation and tries for the LAS in which he only needs 2 1/2 years to get to 20 for retirement, that he will get more ill and not be able to finish.
We disagree with the coding and percentage he was given. He can do his job but can not at this time complete physical training to keep his weight down and keep what muscle he has working the way it should. He pushes himself greatly and tries very hard to keep up with everyone else but then is in agony during the nights.
He wants a higher percentage for the Sjogrens and pain he is enduring and a medical retirement as he has given over 17 years and many deployments to the AF. He is a great troop and has no bad things in his record. He does not agree with being released with a little money. His career field right now is offering more then his severance for reenlistments.
let me know if you need more info. we just have bad help here and I work here in the medical clinic. And being here in Alaska we are stuck with no other bases to go to also for help. Husband has been trying to call Lackland for two days now, leaving only messages.
thank you for your time.
 
Jason said:
Would need much more information and details to give any meaningful input. What are his symptoms? What do you disagree with?
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see post from days ago. Would it be possible to appeal that the codes are not correct and ask for 30% disablity and medical retirement or should we go appeal for return to duty?
 
Jason,
I answered your questions. What do you think about the possible miss coding? Should we fight for more disability or run with return to work?
Someone said you are available for hire, what do you charge?

Adrienne
 
asearles said:
see post from days ago. Would it be possible to appeal that the codes are not correct and ask for 30% disablity and medical retirement or should we go appeal for return to duty?
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Yes, you can appeal and ask for a different code and/or a higher rating. As far as asking for a return to duty, likewise, you can ask for that, too; however, it sounds like this would be an unlikely outcome.
 
asearles said:
Jason,

Someone said you are available for hire, what do you charge?

Adrienne
Click to expand...

You can find information about my services at www.peblawyer.com . I will send you a Private Message with more information. I am not trying to be opaque; I try to keep this forum and site as a source of information about military physical disability issues and don't want this to be an advertisement for my services.
 
I was finally diagnosed with Sjogren's and because it's such a weird and hard disease to diagnose it makes it hard to determine...as much as RA is. They're both autoimmune diseases (which I have both but not sure which type of RA yet...perhaps reactive but it attacks me differently than the typical ra does) so your husband needs to find a good rheumatologist who can test him regularly for anti-ccp and other blood workup so that they don't miss anything.
They're both pretty nasty and I had to find my doc because the other rheumy I saw only wanted to diagnose me if my blood stayed elevated (which it won't if you're on drugs...duh) and my new doc told me she treats symptoms not blood labs! I am very happy but unsure what the military will do with me...
It is scary and you have to just take care of yourself and hopefully your husband can get relief!
I honestly blame the vaccinations for my conditions but nobody in the medical community agrees with me. It's sad really!
 
Hello,

I just got diagnosed with Sjorgen's Syndrome and was told that I will be undergoing a MEB. I have been in the military for 12 yrs now however never dealt with this so I am completely unaware of the process. As with other things in the military, I know that research and knowledge of the process is key to success. I have began reading about my condition and also how the MEB process works. Has anyone out there been through this process and can help me out. Any little bit can help. What are some of things I need to look out for? Or ask my doctor? How should I prepare myself for this? I really do not want to get screwed in this process..... Thank you for your help in advance.
 
I was also just diagnosed with Sjogren's Syndrome. I was previously diagnosed with Undifferentiated Connective Tissue Disease (UCTD) and was MEB'd and PEB'd. The decision was permanent retirement at 40% and VA disability of 80%. Unfortunately I was not rated for my UCTD and began an appeal. While being reevaluated by my Rheumatologist I was then diagnosed with Sjogren's, my board was restarted on 18 Nov 2011. I have researched the VA rating for Sjogren's and it looks like it ranges from 10%-20%. Keep engaged with your PEBLO and register at the VA E Benefits website. This will allow you to track the progress.
 
kmarcus said:
I was also just diagnosed with Sjogren's Syndrome. I was previously diagnosed with Undifferentiated Connective Tissue Disease (UCTD) and was MEB'd and PEB'd. The decision was permanent retirement at 40% and VA disability of 80%. Unfortunately I was not rated for my UCTD and began an appeal. While being reevaluated by my Rheumatologist I was then diagnosed with Sjogren's, my board was restarted on 18 Nov 2011. I have researched the VA rating for Sjogren's and it looks like it ranges from 10%-20%. Keep engaged with your PEBLO and register at the VA E Benefits website. This will allow you to track the progress.
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kmarcus,
I was diagnosed for Mixed Connective Tissue Disease with poly-inflammatory arthritis and Raynauds Disease. The Air Force TDRL'd me and then found "condition stable, do not return to service". And booted me at 10% DOD and 20% VA. I now have Sjogrens and Fibromyalgia. They are lumping it all together for a whole 20%. Good luck on your fight, I am fighting myself. Hope you feel better cuz I feel your pain.
 
I have tri-compartmental OARTHRITIS, What is Sjogrens, never heard of that, during my VA EXAM, They found almost every part of my body is damaged.
Bi-lateral shoulder impringment
Bi-lateral elbow issues
Bi-lateral knees problems
My lumbar showed abnormal x-ray and arthritis
 
Sorry to hear about that kmarcus! You should have not appealed it and took the 40%...unless you think you can get higher? I am not sure what to do at this point since my NARSUM stated that arthritis and sjogren's messed me up...they are pretty much pyramading all of my injuries under it, which could be valid, but what about the other manifestations I have; GI, pansinusitis, migraines, chronic fatigue, chronic pain, etc? They want to deny it and just pretend that it's all resulting of this while they at the same time are denying I have RA and Sjogren's! It's a shell game and they're very good at denying our illnesses and problems. At least they have been with me and my records. I saw my PCM who is 76 the other day and had him evaluate my collar bone and elbows. He said his collar bone has arthritis too! I wanted to knock him out! I'm only 37, don't patronize me or make me feel as though it's all in my head...maybe IF he did his damn job and did the TESTS to rule out anything or to PROVE anything, well they would find something out. Nope, instead, they deny, deny, deny. I also have neuropathy in both feet which was confirmed with a nerve conduction study and EMG. They are denying my surgery but have NOT done my LODs yet and I've been waiting for 5 months now for the paperwork since the FPEB won't even look at the paperwork unless a LOD has been generated. ENSURE YOU GET THE DOCUMENTATION DONE ASAP!

So, while I wait, my PEBLO said they are denying surgery because it will change my rating but I also said I have developed a 'mood disorder' secondary to my chronic pain and see mental health now for treatment. My podiatrist is writing an appeal letter to the chairman of the board to get the surgery done. Why make me wait? It's not like they're rating me on it anyways, they pushed my paperwork thru so fast even before I reached optimal level of health because I've been on orders 'TOO LONG' according to my commander and the NGB. Well, if the dipshits (excuse me) at Ft. Sam and wilfred Hall did their due diligence and read the xray and mri reports correctly, they would have seen the HEEL FRACTURE and maybe the cyst growing in my feet? Nope. So, now I have tarsal tunnel in both feet and they want me to wait another year after I appeal the board? Yeah, NOT! Your doc can write a letter stating you need surgery if it will 'save your life, save the function of the body part, or return you to fit for duty status' so that crap about no surgery is BS. They just don't want to PAY for your benefits because after surgery, they OWN that body part :) Read the regs and the VA WARMS ratings for your own good. You will learn a lot that way.

The problem with connective tissue disorders and RA is that they are subjective and they don't rate us on pain. I have problems with my elbows now and knees are much worse since they first diagnosed me. Plus, my shoulder is jacked up. They will say I'm lying but do the darn tests and you will more than likely find something...problem is they don't want to do the tests so that they can rule out the problems....duh. The less they pay US the more they save...the more in their pockets. I wonder if these docs get special bonuses or incentives for denying benefits? I kinda feel as though they do some days....

If you have more than 15 years of ACTIVE duty service you can qualify for an early retirement, NOT A SEVERANCE CHECK! That is absolute BS! Ensure you know the title 10 usc 12733 of reserve pay. http://www.law.cornell.edu/uscode/text/10/12733 It has the pertinent info on there. You have to have 8 years of active duty to qualify for a retirement...even if you're ANG or RES you will qualify if you have enough points....so ensure you get the right information or RIP from the FSS MPF personnel.

Good luck and I am right there with you all....it totally sucks. I told my husband today, if I don't get a retirement check, I don't know what I'll do cuz I can't do a regular job anymore. I suffer from so many ailments...it is horrible ;( The military just doesn't care about us once we can't deploy or get sick after we volunteer to go everywhere...and it is connected to the vaccines, the environmental contaminants or something else I am pretty sure and convinced because the rates of RA and regular arthritis are much higher than that of the civilian population. That being said, most people with RA will almost always have GI involvement so ensure you are being honest with your doctors!

Godspeed and good luck....I'll try and post how they rate me after I get my results. They were sent to IPEB for the VA and the USAF back in Feb but I don't have all of my LODs completed yet...waiting on 4 more to be done!!!
 
dfinniss said:
You have to have 8 years of active duty to qualify for a retirement...even if you're ANG or RES you will qualify if you have enough points....so ensure you get the right information or RIP from the FSS MPF personnel.
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Not sure what you are referencing, but there is no requirement for 8 years to qualify for disability retirement. The only "importance" of 8 years is to make you qualify for 8 year rule- making pre-existing condition compensable.
 
I am referring to the link that was recently changed.
Concurrent Receipt Eligibility

To qualify for concurrent receipt you must:
  • Be a Military Retiree with 20 or more years of service, including:
    • Chapter 61 Medical Retirees with 20 years or more.
    • National Guard and Reserve with 20 or more good years. (Once they turn 60 and begin drawing a retirement check)
    • Temporary Early Retirement Authority (TERA) Retirees may also be eligible.
  • Have a Service Related VA disability rating of 50% or higher.
The title 10 USC 12733 refers to the 8 year active duty rule to draw a pension provided you get a 30% rating...and if you get a VA rating >50% you should get both. I know many people who get both right now.
 
dfinniss said:
The title 10 USC 12733 refers to the 8 year active duty rule to draw a pension provided you get a 30% rating...and if you get a VA rating >50% you should get both. I know many people who get both right now.
Click to expand...


http://www.law.cornell.edu/uscode/text/10/12733

I see nothing here that refers to eight year rule (which has to do with compensability of pre-existing conditions).
 
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