Changes to referral

[Jessica D.]

Background info-
Oct. 2010-Mar. 2011-Physical therapy for back pain
April 2011- Emergency discectomy to relieve "cauda equina syndrome" (nerve compression, lumbar).
April-2012-Referred to MEB.

So, I have already sent my referral back to my doctor for a change in the diagnosis list. My referral lists one condition, lumbar spondylosis. This is new to me, since I have always in the past been diagnosed with DDD + radiculopathy. So, anyways, I sent a request back to the doc to have the DDD and radiculopathy added to my referral paperwork. I'm not sure if this was the right thing to do, but I want to make sure that my the radiculopathy is listed as a separate condition, so I figured I should start right off the bat with the referral paperwork. Was I out of line for this one?

 

[ranger2992]

You definitely want radiculopathy listed separately. That was what made the difference between 20 and 30% for me. Had I not appealed it as only being listed as DDD, I would have gotten 20% and severance vs the 30% and retirement I got.

 

[tarain]

You definitely want radiculopathy listed separately. That was what made the difference between 20 and 30% for me. Had I not appealed it as only being listed as DDD, I would have gotten 20% and severance vs the 30% and retirement I got.

I just got my MRI back for my lumbar it reflect Mod to server DDD and DJD I have nevre issue but do not know how to read the MRI info so how do I know if the diagnoses is going to reflect the radiculapathy? The other thing I see a number of SM with is the ROM and DDD for 30% when is the ROM done and is it done in all back issues. I have the MRI report the MRI was done on monday I go back to the MTF for the MD to provide the results tomorrow.

 

[ranger2992]

I just got my MRI back for my lumbar it reflect Mod to server DDD and DJD I have nevre issue but do not know how to read the MRI info so how do I know if the diagnoses is going to reflect the radiculapathy? The other thing I see a number of SM with is the ROM and DDD for 30% when is the ROM done and is it done in all back issues. I have the MRI report the MRI was done on monday I go back to the MTF for the MD to provide the results tomorrow.

Your ROM would have to be pretty bad to get 30%. If you look on the VASRD, the numbers that warrant above 20% are pretty limiting. Your MRI will show if a nerve root is being compressed from the DDD. If there is compression and pain down a leg, or arm, or anywhere else, then the Dr should be looking for the root that is compressed. He should also be writing this in your diagnosis. That is how you will get radiculapathy listed.

 

[tarain]

Your ROM would have to be pretty bad to get 30%. If you look on the VASRD, the numbers that warrant above 20% are pretty limiting. Your MRI will show if a nerve root is being compressed from the DDD. If there is compression and pain down a leg, or arm, or anywhere else, then the Dr should be looking for the root that is compressed. He should also be writing this in your diagnosis. That is how you will get radiculapathy listed.

I had 2 MRI's last week one at the MTF and another by a civilian ortho the report was completed by a Board Certified Musculoskeletal Radiologist. I have pain going down my left leg that is why the MTF ordered there MRI the military info states there is mild bilateral facet arthrosis with moderate to sever left and moderate right neuroforaminal narrowing. the wording on the military MRI I do not get.

The civilian documents stated IMPINGEMENT on the thecal sac and right S1 nerve root, impingement on left L4 root beyond neural foramen, the civilian MRI also stated Chronic DDD.

I do not see anything in the military MRI that states impingment of anything. I got the 2nd opinion because the MTF did x-rays 2yrs ago and said don't call us we will call you. They did not call so I self medicated when needed and moved on until about 8 weeks ago. I could not stand the pain went to a civilan doc first had x-rays then went to the ortho M.D.. This is a total mess not sure what to so with it all and working through it with the help of SM on this site.

 

[green594]

Jessica- ranger is on the money. 10 and 20% are common ratings for the back and the radiculpathy can make the difference between getting the 30% retirement and severance. i think we have a tendency to think that we will be rated higher, i think you need to prepare for the worst case scenario.

 

[tarain]

Jessica- ranger is on the money. 10 and 20% are common ratings for the back and the radiculpathy can make the difference between getting the 30% retirement and severance. i think we have a tendency to think that we will be rated higher, i think you need to prepare for the worst case scenario.

I am thinking less then 30%. I honesty would be elated with 30%. Thinking about getting an attorney to review everything before I go to the MEB any opinion on that.

 

[Jessica D.]

I just got my MRI back for my lumbar it reflect Mod to server DDD and DJD I have nevre issue but do not know how to read the MRI info so how do I know if the diagnoses is going to reflect the radiculapathy? The other thing I see a number of SM with is the ROM and DDD for 30% when is the ROM done and is it done in all back issues. I have the MRI report the MRI was done on monday I go back to the MTF for the MD to provide the results tomorrow.

I had a herniated disc that went on for so long that even after decompression I have constant siatic nerve pain. My MRI no longer shows compression, but I believe my previous diagnosis of cauda equina syndrome would be sufficient to prove radiculopathy. Or, at least, I'm hoping that's enough.

 

[Jessica D.]

Jessica- ranger is on the money. 10 and 20% are common ratings for the back and the radiculpathy can make the difference between getting the 30% retirement and severance. i think we have a tendency to think that we will be rated higher, i think you need to prepare for the worst case scenario.

Yes, I've been researching, and basically I would need to have terrible ROM to get 30% just with the back pain, so I'm hoping the radiculopathy brings it up. My back surgery was an "emergency" (they did an MRI, and surgery within two hours of that, due to the nerve compression) so I doubt they will deny my request to add radiculopathy, but you never know.

 

[ranger2992]

Yes, I've been researching, and basically I would need to have terrible ROM to get 30% just with the back pain, so I'm hoping the radiculopathy brings it up. My back surgery was an "emergency" (they did an MRI, and surgery within two hours of that, due to the nerve compression) so I doubt they will deny my request to add radiculopathy, but you never know.

First I don't think you need to pay to hire an attorney. Use the JAG MEB lawyer. The MEB is really not too complex. All they are doing is listing items that fail to meet retention standards as per the AR. They list all the stuff from the VA exams on your NARSUM. If they fail to list something, appeal it. You can also request an impartial review. If if your appeal is denied, you have laid the bricks for the PEB. They will see your appeal in your packet.

When you have your VA exams make sure your examiner is aware of your leg pain. They will do some simple tests. You can also request a nerve conduction test to see the extent of the damage. In my case, the surgery decompressed my nerve root, but I have some perm damage. That is what causes the radiculopathy.

 

[Jason Perry]

First I don't think you need to pay to hire an attorney. Use the JAG MEB lawyer. The MEB is really not too complex. All they are doing is listing items that fail to meet retention standards as per the AR. They list all the stuff from the VA exams on your NARSUM.

I have mixed feelings about this. (In the spirit of full disclosure, as an attorney who practices in this area, I may have a bit of a conflict of interest). In some cases, I think the issues are straight forward and an attorney (civilian or otherwise) is not necessary. In the easy cases, it seems to me that having the JAG check over the packet is fine. The harder question is when there are errors. I would start with the baseline point that like anything else there are good attorneys and bad attorneys and experienced attorneys and inexperienced attorneys. I strongly support the Army's MEB Outreach attorney program in the abstract. My problem or concern is that many do not have direct experience at the PEB (and often are going off of their training classes, which may or may not be enough to give them a large depth of experience). I tend to think that they are generally less knowledgeable about VA standards, which must be met in documenting the MEB Narrative Summary. If they don't know the standards, they may miss the point that should be addressed.

It is a tough call whether the investment is worth it without first knowing all the facts of a case. In some cases it flat out is not worth it; the case is straight forward, the MEB well written, and there is no need. On the other hand, the MEB may be poorly drafted and omits important facts or evidence. The difficulty is that without knowing what is in the MEB, it is hard to tell whether one needs experienced help. In some cases, it may be somewhat like "insurance" having a set of experienced eyes on a case.

I think some cases clearly need help from attorneys. That said, one solution could be to seek advice initially from the JAG. If you are lucky and get a good, dedicated, experienced JAG, then there is no need to seek outside help. If you don't have a good feeling about the qualifications or experience of the JAG, then it may make sense to explore outside representation.

If they fail to list something, appeal it. You can also request an impartial review. If if your appeal is denied, you have laid the bricks for the PEB. They will see your appeal in your packet.

I agree with all of this. In cases where there is any concern about the contents of the MEB, I would strongly lean towards requesting impartial review. Doing so triggers more time for you to respond to the MEB and it also means that the MEB Convening Authority has to respond to your written rebuttal in writing. This can be very helpful. Of course, there are cases when the MEB is well written and there is no need to rebut...no reason to appeal just for the sake of appealing if you agree with everything and it is well drafted.

 

[ranger2992]

I completely agree with you Jason. There are cases where an attorney is warranted. If the service member feels they are getting screwed and cant get anywhere it makes complete sense. It will be money well spent. Most cases are pretty straight forward though. My personal opinion is to run the NARSUM by purple heart, VFW and JAG. If the service member still feels they are being screwed, go for the lawyer.

What I see happen most is people just aren't smart enough about the process in general and think a lot more should be in than needed. Educating yourself is the best weapon. I literately spent 100 hours on this site before my MEB started. I knew what questions to ask, and what to say. In general I think this keeps the PEBLO and MEB on their toes. They are people too and will rubber stamp at 3 pm on a Friday, or just get lazy like all humans do. Personally knowing the process and your conditions prevents this for the most part.

Anyway, you have done a great job with this site and give great advice. Thank you for all you do. I owe what I have in a large part to what i learned on here.

Joe

 

[hawkdrivermtp]

I agree. I am not sure what I would have done without this site and everyone I come across going through an MEB or possible MEB, I pass this website info on to them. It has been a huge asset and just having the knowledge that so many of us are going through the same experiences is what keeps me coming back. I wish everyone would take the time and read through the forums and understand the process of the MEB/PEB.

 

[Jessica D.]

My doctor added the radiculopathy to my referral without a problem, and said that the degenerative disc disease was in *some write up that I haven't seen yet, that I don't remember the name of right now*. So, it looks like that went over without a problem.
Without this site, I wouldn't have even thought to have anything added to it, so, I am very thankful for that This site is awesome

 

[tarain]

Thank you all for the info and thank god for this site. I am going about this process alone with out any guidence from my unit. I am in the very begining and mentioned to the 1SG I was doing this follow up on my back and was told well you need to complete a FCC 507. I have nothing yet that states I have been recommended a MEB though. This form asked for condtions to be noted I do not have a diagnoses yet. I fear I am being leaded down a dark path I have seen far to many things in my unit that have been done that have not been in the best intrest of some of these young men and women. Thank you agian for your assistance.

 

[Buckeye1982]

My doctor added the radiculopathy to my referral without a problem, and said that the degenerative disc disease was in *some write up that I haven't seen yet, that I don't remember the name of right now*. So, it looks like that went over without a problem.
Without this site, I wouldn't have even thought to have anything added to it, so, I am very thankful for that This site is awesome

Jessica, and anyone else reading this post...

I have a similar situation in which I dont feel like my referral takes into account the several different issues I have related to the main referral. I was referred to the MEB for "multi knee ligament reconstructions." However it does not mention, degenerative arthritis, or the peroneal nerve issue that is causing me to have tingling and numbness in my leg and not have complete flexion in foot. My question is, who did you send your original referral back to, the MEB doc or the original doc who referred you to the MEB? I was told by my PEBLO that this was not an issue and that the main referral would encompass the "total injury" and all residual effects of it. Does this sound correct to you. I

Also, if this route does not work would it be advisable to have my MEB JAG attorney appeal to have this annotated as a separate issue, or who would I need to talk to, PEBLO etc,? I just want to be sure I am getting what I deserve.

Thank you in advance.

Adam

 

[ranger2992]

Jessica, and anyone else reading this post...

I have a similar situation in which I dont feel like my referral takes into account the several different issues I have related to the main referral. I was referred to the MEB for "multi knee ligament reconstructions." However it does not mention, degenerative arthritis, or the peroneal nerve issue that is causing me to have tingling and numbness in my leg and not have complete flexion in foot. My question is, who did you send your original referral back to, the MEB doc or the original doc who referred you to the MEB? I was told by my PEBLO that this was not an issue and that the main referral would encompass the "total injury" and all residual effects of it. Does this sound correct to you. I

Also, if this route does not work would it be advisable to have my MEB JAG attorney appeal to have this annotated as a separate issue, or who would I need to talk to, PEBLO etc,? I just want to be sure I am getting what I deserve.

Thank you in advance.

Adam

Adam,

Are those other conditions you mentioned listed and were they checked during your VA exam? The VA exams will be the main driving point for your NARSUM.

The JAG attorney can certainly write an appeal for you. It is actually a very easy process. I wrote my own appeal, and the MEB granted it the same day I submitted. Basically I wrote a simple memo stating what I thought was missing from my NARSUM and why it should be listed. I turned it in at 8 am and got the response the same day at about 3 pm.

Remember, the MEB should capture all your conditions that were noted during your VA exams. These are your claimed conditions. They will then notate "fails to meet retention standards" or "meets retention standards". Generally conditions that are "P3" will be fails to meet retention standards. All the other conditions are not items that would keep you from doing your job. It is not up to the MEB as to whether you are "fit", or "unfit". They just need to ensure all your conditions are listed.

If your NARSUM does not include everything, then I would certainly not sign and go to JAG. You can also have purple heart, VFW, or anybody else look at it as well. Appeal anything that is incorrect or not included. You can also request an independent review which will buy you a little more time before you have to sign the NARSUM

 

[Buckeye1982]

Ranger,

Thanks for the reply. Yes, the other conditions were listed when I submitted my form to the VA prior to the VA exam. The conditions were also examined by the VA physician assistant. They have not completed my NARSUM as the PA needed to review my records and he sent me for a few xrays, I also had a couple appointments the following week that he wanted to wait for and review as well.

I will be sure to review the NARSUM thoroughly to ensure all the above conditions are listed and described to my liking before I sign everything. I also plan to have JAG look over the NARSUM and see if we need to appeal anything.

Thank you again