Length and risks of appealing FPEB?

B

bragg2022

Well-Known Member
Registered Member
I just recieved my 199 (April 13th) and recieved 20% DOD/100% VA. I was looking to appeal to add 1-2 additional disqualifying conditions so I could potentially get bumped to 30%+ and medically retire. Does anyone know how long this process may take from start to finish? Also thinking about appealing to add a combat code (would I appeal this after I finish my appeal to add disqualfying conditions?) I am at Ft Bragg (Army). Additonally, is there any risks at all with appealing as far as my VA ratings potentially being reduced or any other risks I am not aware of with appealing?

My timeline:
Legal brief - 02 November 2022
C&P Exams completed - 30 Jan 2023
NARSUM signed - 27 Feb 2023
199 - 13 Apr 2023
 
bragg2022 said:
I just recieved my 199 (April 13th) and recieved 20% DOD/100% VA. I was looking to appeal to add 1-2 additional disqualifying conditions so I could potentially get bumped to 30%+ and medically retire. Does anyone know how long this process may take from start to finish? Also thinking about appealing to add a combat code (would I appeal this after I finish my appeal to add disqualfying conditions?) I am at Ft Bragg (Army). Additonally, is there any risks at all with appealing as far as my VA ratings potentially being reduced or any other risks I am not aware of with appealing?

My timeline:
Legal brief - 02 November 2022
C&P Exams completed - 30 Jan 2023
NARSUM signed - 27 Feb 2023
199 - 13 Apr 2023
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Have you talked to legal? Requesting FPEB will get you where you want. The PEB can consider both adding new conditions and whether or not any unfitting condition is combat related. Is your DOD% for your unfitting conditions correct? If the symptoms reflect a higher rating you could also request a VARR. You can do both. Your IDES assigned legal counsel can give you the best advice on what to do.
 
bragg2022 said:
I just recieved my 199 (April 13th) and recieved 20% DOD/100% VA. I was looking to appeal to add 1-2 additional disqualifying conditions so I could potentially get bumped to 30%+ and medically retire. Does anyone know how long this process may take from start to finish? Also thinking about appealing to add a combat code (would I appeal this after I finish my appeal to add disqualfying conditions?) I am at Ft Bragg (Army). Additonally, is there any risks at all with appealing as far as my VA ratings potentially being reduced or any other risks I am not aware of with appealing?

My timeline:
Legal brief - 02 November 2022
C&P Exams completed - 30 Jan 2023
NARSUM signed - 27 Feb 2023
199 - 13 Apr 2023
Click to expand...
Currently in the exact same situation at Ft. Bragg. I talked with legal and they explained that it’s generally in your best interest to request a FPEB, but with the proper medical evidence the IPEB is generally willing to add disqualifying conditions that your lawyer will can request in your written appeal. I’ve been told that it takes 2-3 weeks to get back news on your written appeal. Regardless they will still assign you a date for a FPEB hearing. My appeal and FPEB request was submitted on the 3rd of April and I got an FPEB hearing date for the 27th of September.
 
SeaTurtle said:
Currently in the exact same situation at Ft. Bragg. I talked with legal and they explained that it’s generally in your best interest to request a FPEB, but with the proper medical evidence the IPEB is generally willing to add disqualifying conditions that your lawyer will can request in your written appeal. I’ve been told that it takes 2-3 weeks to get back news on your written appeal. Regardless they will still assign you a date for a FPEB hearing. My appeal and FPEB request was submitted on the 3rd of April and I got an FPEB hearing date for the 27th of September.
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Yes that is good advice!
 
Service provided PEB counsel is your best resource at this point. Another option is to request a VARR for your 20% condition to see if the VA will raise it to 30% or more.
 
I’m now sort of in the same situation. I just got back my ratings DOD 20%/VA 50%. I was always told that 30% was the threshold for Tricare for life. But I’m now looking into possibly appealing. I don’t know what that entails (Peblo hasn’t been great) but can anyone help with the timeline for appealing?

If an appeal can generally be within 2-3 months, I’d do it but any longer and I don’t know that I want to be in the Army for that length of time waiting. Thanks!
 
armyarmy said:
I’m now sort of in the same situation. I just got back my ratings DOD 20%/VA 50%. I was always told that 30% was the threshold for Tricare for life. But I’m now looking into possibly appealing. I don’t know what that entails (Peblo hasn’t been great) but can anyone help with the timeline for appealing?

If an appeal can generally be within 2-3 months, I’d do it but any longer and I don’t know that I want to be in the Army for that length of time waiting. Thanks!
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There are more than one way to get the rating higher. One options is FPEB to add a condition. Another option is a VARR asking the VA to look at your ratings to see if they can raise it. You can do both! My wife did. Consider hiring a private dedicated attorney. Good Luck!
 
Provis said:
There are more than one way to get the rating higher. One options is FPEB to add a condition. Another option is a VARR asking the VA to look at your ratings to see if they can raise it. You can do both! My wife did. Consider hiring a private dedicated attorney. Good Luck!
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I’ve heard the FPEB has been taking 6+ months to complete. Like many others, I’m ready to be done with the process and don’t know about waiting that much longer just to get Tricare for Life.
I imagine a VARR has a shorter timeline though. Will the DOD reevaluate a condition for a higher percentage or is that just the VA who does that for a VARR? They lumped a few of mine together and if I could get it bumped to 40% DOD, that could work.
 
armyarmy said:
I’ve heard the FPEB has been taking 6+ months to complete. Like many others, I’m ready to be done with the process and don’t know about waiting that much longer just to get Tricare for Life.
I imagine a VARR has a shorter timeline though. Will the DOD reevaluate a condition for a higher percentage or is that just the VA who does that for a VARR? They lumped a few of mine together and if I could get it bumped to 40% DOD, that could work.
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VARR is 6-8 and it is asking the VA to take another look because you believe that the rating should be higher. Also, a lot of times with a good attorney you can submit an informal consideration request with the election for FPEB and the FPEB can review it. They can and have offered to make changes if they agree meaning you don't have to wait for a FPEB hearing. This is for the Army. Each branch is a bit different.

FPEB's are for adding conditions, or challenging if a condition is combat related etc. The FPEB does not assign the DOD%. That is done by the VA. If the DOD finds a condition that is unfitting they use the VA's %. That is why a VARR is required if you agree with everything but the ratings for the condition(s).

This process is very nuanced and similar cases can have crazy different outcomes depending on what you and your legal representation does. That is why I always recommend hiring a dedicated private attorney. Same thing rings true for criminal legal system. A competent private attorney is going to more often than not get a better outcome than an overburdened public defender.
 
Provis said:
VARR is 6-8 and it is asking the VA to take another look because you believe that the rating should be higher. Also, a lot of times with a good attorney you can submit an informal consideration request with the election for FPEB and the FPEB can review it. They can and have offered to make changes if they agree meaning you don't have to wait for a FPEB hearing. This is for the Army. Each branch is a bit different.

FPEB's are for adding conditions, or challenging if a condition is combat related etc. The FPEB does not assign the DOD%. That is done by the VA. If the DOD finds a condition that is unfitting they use the VA's %. That is why a VARR is required if you agree with everything but the ratings for the condition(s).

This process is very nuanced and similar cases can have crazy different outcomes depending on what you and your legal representation does. That is why I always recommend hiring a dedicated private attorney. Same thing rings true for criminal legal system. A competent private attorney is going to more often than not get a better outcome than an overburdened public defender.
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VARR is 6-8 weeks, months? I would more than likely be doing this option because I don’t have anything new to add for a FPEB. I’m just looking to potentially bump up the ratings to get over that 30% threshold.
I speak with my PEBLO Monday to go over the options but this info has been more helpful than the two I’ve been assigned. Can’t thank you enough.
 
armyarmy said:
VARR is 6-8 weeks, months? I would more than likely be doing this option because I don’t have anything new to add for a FPEB. I’m just looking to potentially bump up the ratings to get over that 30% threshold.
I speak with my PEBLO Monday to go over the options but this info has been more helpful than the two I’ve been assigned. Can’t thank you enough.
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6-8 weeks for varr
 
armyarmy said:
I’m now sort of in the same situation. I just got back my ratings DOD 20%/VA 50%. I was always told that 30% was the threshold for Tricare for life. But I’m now looking into possibly appealing. I don’t know what that entails (Peblo hasn’t been great) but can anyone help with the timeline for appealing?

If an appeal can generally be within 2-3 months, I’d do it but any longer and I don’t know that I want to be in the Army for that length of time waiting. Thanks!
Click to expand...
My experience added about a month and a half period to get out. My appeal didn’t go the distance though.

After submitting an appeal with your rebuttal they have the opportunity to review everything and give you what you’re asking for.

If I had gone all the way through the appeals process I would still be in right now. I submitted my appeal in April and the date they scheduled my Appeal hearing for was sometime in April.

The nice thing is that you should be able to rescind your appeal and take what they gave you previously up until your hearing date.

I was only going to wait one more week win my rebuttal came back and they approved me for retirement.

Best of luck!
 
Provis said:
VARR is 6-8 and it is asking the VA to take another look because you believe that the rating should be higher. Also, a lot of times with a good attorney you can submit an informal consideration request with the election for FPEB and the FPEB can review it. They can and have offered to make changes if they agree meaning you don't have to wait for a FPEB hearing. This is for the Army. Each branch is a bit different.

FPEB's are for adding conditions, or challenging if a condition is combat related etc. The FPEB does not assign the DOD%. That is done by the VA. If the DOD finds a condition that is unfitting they use the VA's %. That is why a VARR is required if you agree with everything but the ratings for the condition(s).

This process is very nuanced and similar cases can have crazy different outcomes depending on what you and your legal representation does. That is why I always recommend hiring a dedicated private attorney. Same thing rings true for criminal legal system. A competent private attorney is going to more often than not get a better outcome than an overburdened public defender.
Click to expand...
I don't want to get too specific about my case but I am in the process of waiting for a FPEB date. I knew my VA rating exam for my referred condition felt off and brought the issue up. I was told to wait and see results during the NARSUM portion. Unsurprisingly the portion of my VA exam for referred condition (the specific DBQ) did not reflect my condition accurately. I wanted to get it fixed. I was advised that it didn't matter because I was passed along to the PEB and they only care about the DoD side. Furthermore, when it came to the ratings portion the VA would look over my entire record. Specifically, they would dig into my referred condition to ensure accuracy. I was told that DBQ will hold little weight since I had seen specialists, had testing done to support, and the VA exam was done by an individual without a specialization for the condition. Hindsight being 20-20 it seems I was encouraged to not do anything which may lengthen the process. I received ratings and for my referred condition it seems it was based solely off of my VA exam. In a way I expected this to happen so I had the specialists sort of pre-briefed at the possibility that I may need statements or records from them. I got the evidence and my own statements for a VARR. I sent them to my assigned DoD lawyer. My DoD lawyer did not have time to generate their portion, so I elected to move on to a FPEB to give us more time. My DoD lawyer said they would follow up the next week to go over our next steps, they informed me that I do not have to wait for a FPEB date and we can submit the VARR at any point. Electing for FPEB just gives us more time. It has been almost a month now without word from lawyer or PEBLO. I have an appointment with DAV on Thursday and a private attorney on Monday. Can DAV serve the same function as an attorney?

I know my assigned DoD lawyer is extremely busy, they are very helpful and knowledgeable when they give their time. I just cannot get in touch with them or schedule anytime to talk with them, even their assistant does not return my emails. I got the assistant on the phone one time about two weeks ago, they said they would get back to me via email and talk with my lawyer. Still nothing. Is this because they cannot do anything before I have a FPEB date? If so, they made it seem like we could turn around the following week and submit the VARR. Is the lawyer hoping to pass me off to the FPEB representation? They did make a comment that to the effect of "if we need even more time I can pass everything off to my colleague at the FPEB stage."
 
Bayoli said:
I don't want to get too specific about my case but I am in the process of waiting for a FPEB date. I knew my VA rating exam for my referred condition felt off and brought the issue up. I was told to wait and see results during the NARSUM portion. Unsurprisingly the portion of my VA exam for referred condition (the specific DBQ) did not reflect my condition accurately. I wanted to get it fixed. I was advised that it didn't matter because I was passed along to the PEB and they only care about the DoD side. Furthermore, when it came to the ratings portion the VA would look over my entire record. Specifically, they would dig into my referred condition to ensure accuracy. I was told that DBQ will hold little weight since I had seen specialists, had testing done to support, and the VA exam was done by an individual without a specialization for the condition. Hindsight being 20-20 it seems I was encouraged to not do anything which may lengthen the process. I received ratings and for my referred condition it seems it was based solely off of my VA exam. In a way I expected this to happen so I had the specialists sort of pre-briefed at the possibility that I may need statements or records from them. I got the evidence and my own statements for a VARR. I sent them to my assigned DoD lawyer. My DoD lawyer did not have time to generate their portion, so I elected to move on to a FPEB to give us more time. My DoD lawyer said they would follow up the next week to go over our next steps, they informed me that I do not have to wait for a FPEB date and we can submit the VARR at any point. Electing for FPEB just gives us more time. It has been almost a month now without word from lawyer or PEBLO. I have an appointment with DAV on Thursday and a private attorney on Monday. Can DAV serve the same function as an attorney?

I know my assigned DoD lawyer is extremely busy, they are very helpful and knowledgeable when they give their time. I just cannot get in touch with them or schedule anytime to talk with them, even their assistant does not return my emails. I got the assistant on the phone one time about two weeks ago, they said they would get back to me via email and talk with my lawyer. Still nothing. Is this because they cannot do anything before I have a FPEB date? If so, they made it seem like we could turn around the following week and submit the VARR. Is the lawyer hoping to pass me off to the FPEB representation? They did make a comment that to the effect of "if we need even more time I can pass everything off to my colleague at the FPEB stage."
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This is all normal for IDES assigned legal counsel. They are overstaffed and can't give each case the time they need so they encourage delay tactics to give them the time to get it done. Unfortunately you just need to trust the process and be your own advocate when using the free assigned attorney. That is why I always recommend going the dedicate private attorney route.
 
@Provis I can't get a straight answer from anyone, so I turn to you; how long after I separate from Active Duty will I continue to receive Tricare? I'm medically separating, already signed the paperwork, as I only received 20%. I ask because, I finally just received my diagnoses of Sleep Apnea with CPAP and I'm a few weeks from DD214 in hand (I will submit this claim through the VA once I'm out). Didn't know how this worked, if the VA would immediately cover that once Tricare dropped, etc. I've been told it was 3 months of Tricare from one person, but another told me 6 months of coverage after separating but I figured you'd know the answer. I also ask because if I'm technically still covered by Tricare for a certain period of time, I can potentially use that to continue getting seen for other ailments, injuries, etc. Thanks!
 
Unless there is a separate program I don't know about you should qualify for TAMP. Which is 180 days of coverage after discharged. What is your total VA% going to be? You can go get healthcare via the VA too.
 
armyarmy said:
@Provis I can't get a straight answer from anyone, so I turn to you; how long after I separate from Active Duty will I continue to receive Tricare? I'm medically separating, already signed the paperwork, as I only received 20%. I ask because, I finally just received my diagnoses of Sleep Apnea with CPAP and I'm a few weeks from DD214 in hand (I will submit this claim through the VA once I'm out). Didn't know how this worked, if the VA would immediately cover that once Tricare dropped, etc. I've been told it was 3 months of Tricare from one person, but another told me 6 months of coverage after separating but I figured you'd know the answer. I also ask because if I'm technically still covered by Tricare for a certain period of time, I can potentially use that to continue getting seen for other ailments, injuries, etc. Thanks!
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1. The Transitional Assistance Management Program (TAMP) can cover you and your family for 180 days​

This is one of two primary options provided by the Department of Defense for extending health insurance benefits. The program gives veterans and military dependents about six months of premium-free TRICARE insurance benefits after separation, when their regular TRICARE benefits end.

Who is eligible?​


TRICARE sponsors and eligible family members are generally eligible for TAMP if they fall into one of the following categories:

  • A member involuntarily separating from active duty under honorable conditions
  • A National Guard or Reserve member separating from a period of more than 30 consecutive days of active duty
  • Separating from active duty following involuntary retention (stop-loss) in support of a contingency operation
  • Separating from active duty following a voluntary agreement to stay on active duty for less than one year in support of a contingency operation
  • Members receiving a sole survivorship discharge
  • Separating from regular active duty service to immediately become a member of the Selected Reserve
To avoid eligibility issues, sponsors and dependents should ensure that their Defense Enrollment Eligibility Reporting System (DEERS) information is up to date. You can also check your eligibility for TAMP in milConnect.

How TAMP benefits work​


The 180-day TAMP period begins on the same day that your separation begins. During TAMP, you and your family members are covered under the medical benefit as active duty family members. There are no monthly premiums, but you are responsible for any applicable deductibles, cost-shares, and copayments according to the rules of your plan. The following options are available.
 
Total right now is 50% but once I submit the Sleep Apnea w/CPAP claim, I hope that goes up as it's a 50% rating. I'll also appeal other conditions to get a ratings increase in hopes of getting to 100% at some point.
 
armyarmy said:
Total right now is 50% but once I submit the Sleep Apnea w/CPAP claim, I hope that goes up as it's a 50% rating. I'll also appeal other conditions to get a ratings increase in hopes of getting to 100% at some point.
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Okay 50% + 50% = 80% VA math. That means you should easily be able to get everything through the VA for your health insurance. However, to get coverage for your family you need CHAMPVA which requires 100% VA.
 
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