16 years in; was recently told by my derm that I had mild to severe atopic dermatitis; was put on Dupilumab (biologic)

J

jamiejame911

New Member
Registered Member
The derm put me in for a p3 and med board, so I can't deploy next month as the meds need to be refrigerated. After 4 months of using the meds, I am nearly cleared up. Will they retain me (and just let me retire in 4 years) by maybe putting me in a non-deployable location? Any advice on this?

Thanks all...
 
Hello,

There are many on this board who will be able to share their experiences with you if they choose. I do not have that experience.

General.

One source.
Reference: https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/133245p.pdf?ver=2018-08-01-143025-053 <---LINK

It is DoD policy that:
a. To maximize the lethality and readiness of the joint force, all Service members are expected to be deployable.
b. Service members who are considered non-deployable for more than 12 consecutive months will be evaluated for:
(1) A retention determination by their respective Military Departments.
(2) As appropriate, referral into the Disability Evaluation System (DES) in accordance with DoD Instruction (DoDI) 1332.18 or initiation of processing for administrative separation in accordance with DoDI 1332.14 or DoDI 1332.30. This policy on retention determinations for non-deployable Service members does not supersede the policies and processes concerning referral to the DES or the initiation of administrative separation proceedings found in these issuances.

The Secretaries May:

(1) Retain in service those Service members whose period of non-deployability exceeds the 12 consecutive month limit in Paragraph 1.2. of this issuance if determined to be in the best interest of the Military Service. (2) Delegate the authority in Paragraph 2.4.(b)(1) of this issuance to retain in service those Service members whose period of non-deployability exceeds the 12 consecutive month limit. Such a delegation must be in writing, and may only be made to Presidentially A ppointed, Senate-Confirmed officials; Senior Executive Service members; or general/flag officers servingat the Military Department or Service headquarters. (3) Initiate administrative separation processing, or referral to the DES, as appropriate,prior to a non-deployable Service member being in a non-deployable status for 12 months when the Military Service determines there is a reasonable expectation that the reason will not be resolved and the Service member will not become deployable

Ron
 
Things have changed since the DoD policy on lethality. Prior to that policy, some profiles just said deploy to location with electricity. Which is darn near everywhere.

In some ways the DoD policy has hurt DoD. Separating a fully trained member for petty reasons cost DoD lots of money to retrain the replacement and all the experience factor is also lost. I hope the DoD policy will be revisited and services given greater latitude to implement the guidance. If we can hit an incoming missile with our missile using exoatmospheric intercept, we sure ought to be able to find a way to keep refrigerated meds in the field for out members.
 
OP above is Army SM, and we've discussed ab it over DM already. I'll leave details there, but to give basic run down of current Army policy and situation I share the general info here.

Current regulation status:
40-501 2016 Dec update = Non-deployable status = automatic finding of Unfit at PEB.
40-502 2018 update = biologic therapy, chronic immune suppression are not compatible with deployed environment because of inability to treat opportunistic infection in deployed setting.

40-501 Jun 2019 = Conditions requiring IV therapy, chronic lab tests, or treatments requiring repeated supervision of a physician do not meet the standard.
Conditions controlled on oral medications and stable, meet the standard.

Also currently MOD 14 and soon to be released MOD 15 for CENTCOM don't allow immune suppression or biologic. Current Army policy allows MEB for not meeting COCOM/GCC deployment standards (which can be more strict than 40-501).


Separate from that:
SM's are still able to have 365 days before reaching MRDP (Medical retention Decision Point). If a physician wishes to start MEB prior to 365 MRDP they must support why the SM will not be able to recover or have their situation change in the remaining time period.

Patients on Biologics CAN transition back to orals, and remain in service if they choose. Decision to stop biologic and transition to orals needs to be made by SM and their provider understanding the risks of lose of control and the outcome of symptoms return worse.

In this case SM has only 4 months on the duty limiting medication. The above listed diagnosis, while certainly debilitating/distracting its not life threatening, so SM and Provider can have a reasonable discussion about cessation and transition to orals without risk to life/limb/eyesight. Some biologics once withdrawn cannot be reused. Any SM looking at this option need to have long discussion and make informed decisions about their diagnosis and future treatment.

If SM wishes to reach 20, should discuss P3 being changes to T3 until 365 days on Biologics and around the 9-10m mark discuss a trial of orals.
 
Thank you all for this AMAZING information. This has been very, very helpful. For clarification...

-I have been on the meds for about 4 months, so what options do I have now?
-Also, if I stayed on the meds until near the 12 month window, who is it that makes the call for me to try to get off the meds and back on topicals?
-My derm doc is great, but I think she put me in for 12 months of the meds, yet a p3 profile. Does this automatically put me into the med process? I am trying to get her or the bde docs to put me on the temp, for the 365 days, so that I can get an assessment and possibly move off and move on.
 
What Options now:
- Talk to Derm, tell them you want to try and stay in the Army. Ask them for a T3 instead of Perm and that you'd like to consider transitioning back to Orals after a few more months of remission.
- If they won't consider it you can ask for a second opinion. Second opinions per Tricare mean a 2nd Dr not a 2nd facility, so they could just send you into the office next door if they have more than 1, no guarantee.
- Also if they wont consider make them explain to you in laymans terms that you understand why they wont, what risks are involved, whats the bad outcome, etc.
- Medicine and Military Medicine especially is very patriarchal, if you come in questioning them and their knowledge they'll shut down and not help. Instead approach them politely, and start by telling them you want to find a way to stay in the Army and you're looking for options. Many are jaded from a small portion of SM who "work the system" to get out of service early or avoid bad conduct cases. Most find SM trying to stay in to be refreshing and will work to help.

Who makes the call to transition:
- You do in conjunction with your Dermatologist. If same one is still there give him a heads up now, and then around the 9-10 month mark (4-5 months from now) remind him you want to try and transition of biologics. You're currently trying to buy time for deeper remission by staying on them now and transitioning later.
- If the current Derm PCS's get in with the new one sooner rather than later and let them know whats going on and that you are looking to transition off and stay in so they aren't blindsided.
- DoD can order "make" you accept medical care while on the battlefield, and for force health protection (vaccines etc). That's it. Your Derm or any other Dr can't force or order you to stay on medications. If you wish to stop you can. They can advise against it and document in your medical records that they advised against it, but they cannot force you to stay on it.
- In this case the treatment not the diagnosis is duty limiting. So discuss with this Derm and sort out your options I know of Ulcerative Colitis patients who stepped of Biologics to Oral mesalamine and they successfully stayed in service.

Medication already written for 12 months:
- This is for convenience of provider and to help you not miss doses by dealing with refill process.
- MEB are started based on evidence that SM cannot make a recovery and return to duty without prohibited limitations by 365 OR your are at day 365.
- You're not at 365. So they can only start it by saying "no way they'll be able to stop this med in a year, so we don't want to waste SMs time and are starting now"
- What you're trying/wanting to do is ask them to pump the breaks and actually give you that full 365, so you can do a "Trial of Duty" off biologics around 300 day mark, and see if
things hold.
- If Derm put the P3 in, they'll need to adjust it. BDE providers will get there hands slapped screwing with a specialty clinics profile.

Last thought:
This is not the end of the road. If all this fails, you can still start the MEB process and then discuss/argue the case with the MEB Dr for a trial without biologics. If That fails, you can also still appeal at PEB and try stating your current MOS and why you can perform all those duties while in service and still be deplorable if they limited it to certain units (say a Medical BDE CSH (field hosp). This is called a COAD (Continuation on Active Duty) it means the Army cane still benefit from your service without mission loss. Basically you argue hey I'll stay in this location, so the able bodied person there can still go forward. Or I'll deploy, I just need to have my type of unit restricted not the combat theater. Any and all appeal through all of this are just burning down that gap between now and the 20 yr mark.

I would still encourage you to discuss pros/cons life risks with your Dr. discuss it with your family, and decide how the risks of changing meds, or the risks of being found fit and have reduced VA %, or not finishing your 20 balance out for you and them.
 
Last edited:
Joe Plasm,
Why did they give you TDRL and not PDRL? Having over 20 years? The same thing seemed to happen to USN1977
 
essexr said:
Joe Plasm,
Why did they give you TDRL and not PDRL? Having over 20 years? The same thing seemed to happen to USN1977
Click to expand...
As we all know the "T" stands for temporary. That rating is an indication that the evaluators had determined that the condition was not yet stabilized.

Ron
 
essexr said:
Joe Plasm,
Why did they give you TDRL and not PDRL? Having over 20 years? The same thing seemed to happen to USN1977
Click to expand...

I don't know if it's DoDi or Army - But regulation says mental health disorders HAVE to be TRDL (even if you have other Perm disqualifying). Two fold, make sure you get "followed up on" and don't fall through the cracks of care. Also many improve from just not being in the military any more, and DoD doesn't want to pay you extra for being better for having left... as convoluted as that seems.

I have 2 PEB Disqualifying conditions that are Perm. So I'll for on PRDL no matter what, eventually. But I also have PTSD as a 3rd PEB disqualifying condition, as a mental health condition I have to be on the TRDL even though it doesn't really matter for PRDL in the long run because of the other two. Once my TRDL exam is done, I'll go on PRDL, either with PTSD intact, or with it reduced to 0 but still having my other 2 conditions anyways.

Hope that helps.
 
JoePlasm said:
I don't know if it's DoDi or Army - But regulation says mental health disorders HAVE to be TRDL (even if you have other Perm disqualifying). Two fold, make sure you get "followed up on" and don't fall through the cracks of care. Also many improve from just not being in the military any more, and DoD doesn't want to pay you extra for being better for having left... as convoluted as that seems.

I have 2 PEB Disqualifying conditions that are Perm. So I'll for on PRDL no matter what, eventually. But I also have PTSD as a 3rd PEB disqualifying condition, as a mental health condition I have to be on the TRDL even though it doesn't really matter for PRDL in the long run because of the other two. Once my TRDL exam is done, I'll go on PRDL, either with PTSD intact, or with it reduced to 0 but still having my other 2 conditions anyways.

Hope that helps.
Click to expand...
Good Afternoon,
Thank you very much. I have a better picture now. Did they combine your TBI with PTSD? Or was it separate? If it was separate, would you mind sharing the percentage?
I will be going up for a Moderate TBI/ Chronic Migraines, PTSD Combat, MDD moderate, Chronic back, and bilateral knee pain.
 
The VA combines them, under the argument that it's not realistic or possible to cleanly split mental symptoms for one diagnosis form another diagnosis. Which makes a lot of sense when things have duplication symptoms. As such it was rated together, some of my TBI stuff was lower and some higher, same with PTSD, but the VA MH chart is basically have 3 of X for 50% 3 of X + y for 70%. There is a chart floating around here that's very easy to read, better than i can explain.

DoD didn't give me anything for my TBI because it was not a disqualifying condition for me, but they gave me the full % VA award for PTSD.
 
I was wondering that I'm also diagnosed with GAD PTSD and some other like mild depression I was wondering if they would say GAD 70 and PTSD 50 depression 30 or say nope mental condition can't be distinguished 70 for all. I'm not sure if they can be distinguished. But your saying there is a calculation for combining them I'd like to know more about that.
 
Is it like the normal VA calculator then you take the combined rate of all mental disorders and plug it into another new calculation?
 
No not calculation for combining them. Chart that's says these symptoms at this level = X% regardless of which of the component diagnosis it came form.

They just add all the symptoms on same chart and by law take what benefits you the most in combination.
 
Ok cause my vso told me it doesn't matter if I add PTSD cause it is rated with GAD and panic disorder. The VSO made it seem like adding extra behavioral health issues would not help the rating cause they are all rated as one issue.
 
Yes, they are all rated as one issue, because they can't be teased apart by symptom. I'm saying the same thing. What I was attempting to explain is that the % for that combined issues is based on the symptoms across all your MH diagnosis, not just one, or the most severe.

Here this is from oddpedestrian.

Say all your GAD symptoms are 30% symptoms on this chart. You have TBI that's 10% for mild impairment but has Spatial disorientation in work and home. The stacking of those separate things could possibly net you 70% because it's rated as a single issues and so all the symptoms get used together instead of separately, that's what I was trying to explain to you.

Basically they will ignore the label/diagnosis, look at all the symptoms together as 1 disorder, plop it on this here chart and then see what number it gives them.

There is no adding them together with VA math, there is also no picking the greatest one either. Though in most cases the final MH % will be more than any of the single diagnosis anyways.

1590632984722.png
 
Last edited:
JoePlasm said:
Yes, they are all rated as one issue, becasue they can't be teased apart by symptom. I'm saying the same thing. What I was attempting to explain is that the % for that combined issues is based on the symptoms across all your MH diagnosis, not just one, or the most severe.
Click to expand...
Could they look at ptsd as 30 and had as 70 and say my mental health is 80 something like that. Thanks for the responses.
 
Jmc81 said:
Could they look at ptsd as 30 and had as 70 and say my mental health is 80 something like that. Thanks for the responses.
Click to expand...

See above, I was editing after getting the Chart from one of Oddpedestrian's posts
 
JoePlasm said:
OP above is Army SM, and we've discussed ab it over DM already. I'll leave details there, but to give basic run down of current Army policy and situation I share the general info here.

Current regulation status:
40-501 2016 Dec update = Non-deployable status = automatic finding of Unfit at PEB.
40-502 2018 update = biologic therapy, chronic immune suppression are not compatible with deployed environment because of inability to treat opportunistic infection in deployed setting.

40-501 Jun 2019 = Conditions requiring IV therapy, chronic lab tests, or treatments requiring repeated supervision of a physician do not meet the standard.
Conditions controlled on oral medications and stable, meet the standard.

Also currently MOD 14 and soon to be released MOD 15 for CENTCOM don't allow immune suppression or biologic. Current Army policy allows MEB for not meeting COCOM/GCC deployment standards (which can be more strict than 40-501).


Separate from that:
SM's are still able to have 365 days before reaching MRDP (Medical retention Decision Point). If a physician wishes to start MEB prior to 365 MRDP they must support why the SM will not be able to recover or have their situation change in the remaining time period.

Patients on Biologics CAN transition back to orals, and remain in service if they choose. Decision to stop biologic and transition to orals needs to be made by SM and their provider understanding the risks of lose of control and the outcome of symptoms return worse.

In this case SM has only 4 months on the duty limiting medication. The above listed diagnosis, while certainly debilitating/distracting its not life threatening, so SM and Provider can have a reasonable discussion about cessation and transition to orals without risk to life/limb/eyesight. Some biologics once withdrawn cannot be reused. Any SM looking at this option need to have long discussion and make informed decisions about their diagnosis and future treatment.

If SM wishes to reach 20, should discuss P3 being changes to T3 until 365 days on Biologics and around the 9-10m mark discuss a trial of orals.
Click to expand...
Do you have any information about the AF regulations for these issues?

I'm going to an IRILO and my Peblo and doc keep insisting that I'll almost certainly be returned to duty. This seems at odds to what I'm seeing on this site.
 
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