Commander's letter feedback/next steps

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MyNeckAndMyBack

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Good morning all,

I've mentioned this before in a previous post and would like to bring it up again, now that I have the letter in hand and waiting for my signature.

I was referred for possible MEB by the DAWG late last year for mental health and associated medication. For some background, I'm a 17-year AF E-6, meaning not far from retirement eligibility, but I'd prefer to separate, at this point. My mental health is rapidly deteriorating due to anxiety, depression, and PTSD, and it's in the best interest of the AF and my health for us to part ways. I do know what I'm giving up by not making 20 years, and I'm okay with that because honestly, I'm not sure if I'll make it there at this rate.

My commander informed me of his intention to recommend retention. Obviously, I disagree with his decision. I'm having trouble attaching the PDF, so here's his input. Apologies for the length but I figured the full context was necessary here:

II. EFFECT ON UNIT MISSION
1A. Can Airmen satisfactorily perform all primary AFSC in-garrison duties? YES
1B. Can Airman perform their primary duties in an austere/deployed environment? NO

CC Explanation of impact to perform primary AFSC duties/full scope of duties in future assignments and deployed locations:
TSgt XXXX is able to perform all in-garrison duties required of him and meets all expectations of his administrative and operational chains of command. That said, the member is disqualified from deployment and AFSC-specific overseas tours based on mental health diagnoses and medication. These conditions have led to the cancellation of three OCONUS assignments, which are part of a standard rotation of assignments for his AFSC. Additionally, TSgt XXXX's respiratory condition prevents him from donning a gas mask, and his hip, back, and ankle pain makes wearing PPE such as body armor difficult. Finally, ongoing hip, back, shoulder and ankle pain prevent him from sitting or standing for long periods of time.

2. Describe duties Airman is unableto perform because of their medical condition. Detail duty-related restrictions, limitations, work-arounds, or schedule modifications and how long they have been in effect.
TSgt XXXX's mental health conditions do not require any specific work restrictions or work modifications in garrison. Meanwhile, ongoing shoulder, hip, ankle and back pain make it challenging for the member to sit or stand for long periods of time, resulting in the member moving between a sitting and standing desk arrangement at his desk.

3. Days of work missed over the past 12 months due to their conditions. Specify how many were for what:
Ankle surgery convalescent leave and related appointments - 35 total days
Behavioral health appointments - 15 total days
Formal quarters - 4 total days
Physical therapy appointments - 6 total days
Other medical appointments - 5 total days

4. Have you spoken with the PCM and do you agree with their assessment of the Airman's condition? NO
With continuity of care so poor across the NCR, I instead engaged with the provider who evaluated TSgt XXXX in preparation for writing the NARSUM for this case. Col XXXX relayed that TSgt XXXX is not worldwide qualified and, following review of records and examination of member, assessed this as unlikely to change. I agree with this assessment, as well as the observation that, while challenging, it appears the member is able to perform all duties required of him at home station.

VI. COMMANDER'S RETENTION RECOMMENDATION
X. RETAIN
CC Comments:
TSgt XXXX is a strong NCO who leads exceptionally well on mission. He is meeting expectations and, in some cases, even exceeding expectations, across the board. Operational mission partners and Flight leadership under which the member works report no negative impact from TSgt XXXX's absences. It is clear to those who work the member closest that he is battling pain and feels that he is not able to do what is required of him to standards; however, the evidence before me indicates what he is doing to overcome challenges and limitations is in fact working. While he does not meet worldwide deployability criteria, the member can perform his primary duties in garrison. I support retention, to include retention with an assignment limitation code.


Apologies for the length; Adobe won't let me access the fields to delete PII and attach the document itself here.

In any case, this is definitely a retention recommendation though the commander admits he has some insight into my situation. Is there anything, anything at all, that I can do to sway AFPC/DP2NP to a full MEB decision? Currently, I have a reference letter from my ex-wife, which strongly recommends separation. I've requested copies of my MH records from the clinic, but I'm not really sure what else to do here. Lastly, I'm about to pay out of pocket for an evaluation from an outside psychologist to get a diagnostic second opinion. However, it still seems like the CC's letter will carry more weight than anything.

I'm kind of at my wit's end here so appreciate any help y'all can offer.
 
This is what I've drafted for my comments:

Though I acknowledge Lt Col XXXX's comments and observations, I respectfully disagree with his assessment. I have provided comments below, and for readability and reference, have included these same comments in memorandum format to accompany the rest of the MEB package.

As a military member and noncommissioned officer, it's my duty to remain fit and resilient enough to lead Airmen effectively. My mental illnesses, which began in and are exacerbated by military service, severely impact that duty.

To illustrate, my worse days are marked by recurring dark thoughts and thought processes, including suicidal ideations, caused by chronic depression. These episodes last anywhere from a week to several weeks or months. They are balanced by high anxiety periods including weekly panic attacks, variable and noticeable mood swings/irritation, and severe social anxiety. My anxiety is such that I feel forced to forgo adequate medical care because I do not wish to continue as a burden on the military healthcare system and be frequently absence from work. That anxiety is further worsened by an inability to meet physical standards required by the Air Force due to several physical conditions. This has resulted in the appearance of high performance but are, in reality, heavy overcompensation to avoid disciplinary/UCMJ action. In short: my anxiety about getting in trouble is so severe that I have to push past limits to avoid the perception of me as an under-performing airman.

I will almost certainly be ineligible to PCS or deploy OCONUS for the remainder of my career. According to the advice of a licensed military psychologist, I will require ongoing psychotherapy indefinitely, as well as psychiatric medication to stabilize mood swings and lessen effects of depression and anxiety. My social life is almost nonexistent and it is nearly impossible to establish and maintain personal and professional relationships. My anxiety is persistent and disturbs my sleep almost nightly, while depression makes it so I don't want to get out of bed, but anxiety also forces me out of bed instead of getting the rest I know I need. I experience panic attacks at least once a week--mostly two or three times a week--and this is a huge obstacle for normal tasks, such as grocery shopping or driving in heavy traffic. In addition, I have frequent nightmares of an experience I witnessed during deployment.

Although I am close to meeting enlisted retirement requirements, I would prefer to separate honorably now as opposed to risking any adverse action in the future due to mental illness struggles and the possibility of negative behavior stemming from them. I have weighed my options in terms of retirement benefits and am comfortable with this decision. Military service continues to degrade my mental and physical health. For me, every single day is a struggle. I don't believe that anyone should remain in the circumstances causing mental and emotional distress, but I have been for years now; if I were undergoing MEB for a spinal injury which caused an equal amount of distress and use of healthcare resources without fixing the issue, I believe this case would be easy to adjudicate in favor of an unfit finding.

I understand Lt Col XXXX's position and responsibilities as a unit commander, however, I respectfully disagree with his assessment that my health conditions do not affect work performance. When anxiety causes me to wake up at 0300, resulting in extreme fatigue and memory loss due to exhaustion, that ends in missed tasks and a severe loss in focus. When I have to leave work for any amount of time due to panic attacks, any tasks fall on my supervisors and subordinates to finish. When I need to request last-minute leave because depression has made it so getting out of bed is nearly impossible, that places an undue burden on my colleagues and airmen. For these reasons, I respectfully request that my case, including physical conditions, be examined in full to provide a comprehensive picture of my health and how it continues to worsen. Specifically, please reference radiological results from 2019 and 2020 for more information. In addition, please consider the enclosed reference letter from my ex-wife, MSgt Renee Brownell, as it contains her observations through firsthand experience.
 
Very good response. I'm AD AF (E-7) and going through a similar situation. My recommendation, if allowed, is to get a few impact letters. Perhaps from additional Doctors, supervisors, family members, chaplain...etc. Basically, looking to back-up from witnesses what you've written in your response. Again, your letter is VERY good. One other thing I'd would consider is the suicide issue in the AF. As you know, the AF trying to grab this issue and find resolution. Would it be worth mentioning in your letter this overlooked, but very basic, preventative measure regarding suicide? The AF has programs for member's who have displayed suicidal ideations and attempts; however, what are they doing to help those that are approaching that outcome. One note, as you outlined in your response, you know what happens next. You know your body, your mental state. Put that in there from the perspective as a 17 year TSgt with a responsibility to lead and perform duties, but also in taking care of the Airman.

Question: What road are you on? Are you Is your diagnosed conditions MEB conditions? For example, I have Asthma, which is a boardable condition, but my Adjustment Disorder w/Anxiety and Depression is not an MEB condition. Something to consider regarding the form 200 which would be the commanders letter recommending retention. Remember this is only his/her recommendation. When the MEB gets pushed, AFPC (term used loosely of course) reviews everything and makes their decision.

I hope this helps you. Please reply with any questions and fell free to email me if you have any questions. I'll definitely look at anything you need a good QC and provide input to help.
 
@OverRun , thanks for the feedback and recommendations. I was able to get a letter from my MSgt ex-wife, in which she was brutally honest. Unfortunately, adding more never occurred to me until I had already submitted everything. However, I plan to get an evaluation from a civilian psychiatrist soon for a second opinion because I have some concerns about my diagnoses. Luckily, her letter addressed the AF suicide issue and how my CC's input goes against the suicide prevention goals of the AF.

As far as conditions: I have bounced around between various anxiety and depression diagnoses for the past 5 years. Currently diagnoses are MDD and generalized anxiety, as well as an "unspecified mood disorder". What triggered the DAWG referral was a prescription of lamotrigine/lamictal, which is an anti-convulsant, and is used to treat mood disorders such as bipolar disorders, and therefore is referred to the DAWG immediately because it can affect worldwide qualification.

So yes, according to the AF MSD, all of these factors make the member unsuitable for retention. However, I don't know what AFPC/DP2NP is going to look at and how they'll weigh everything; if they go by the MSD, my personal remarks and those of my ex, and my treatment history, it should be an easy call. On the other hand, I don't know what the NARSUM says, I don't know what specifically is in my MH records, and the CC's letter recommends retention. In addition, I know AFPC/DP2NP is supposed to look at only the referred conditions, but I'm hoping they'll at least skim my physical records as well.

Anyway, there are a lot of unknowns, and right now I'm looking for recourse in case AFPC adjudicates me as fit. Do you have any recommendations, such as discussing another MEB referral with my docs?

Thanks again.
 
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