CRPS

[The average guy]

In short I’ve recently been placed in a limdu status with the Doc saying fair to poor return to fit for full duty. They say i have crps in my upper left extremity, basically my dominant arm. Ive got muscle atrophy, pain(burning/stabbing), numbness, weakness, and can barely use it. How will the PEB rate this? I am afraid of being sent to PEB, i dont want to lose benefits for myself and the family. The original injury stems from radial nerve surgery.
Any have experience with CRPS?

 

[PERS-95]

If you want to know the potential reading, or range of ratings, for a condition, you need to go look in 38 CFR. That is the legal document which gives guidance to VA and DOD on what ratings to give for what conditions.

If you go look it up, and you are clearly well about 30%, then you should not have any fear of PEB. You would not lose any benefits in that occasion.

 

[RetiredAtty]

The VA Schedule for Rating Disabilities (the VASRD) does not have a separate diagnostic code, or rating, for CRPS. That being the case, the Navy (or Marines - you don't specify) in the MEB and PEB process to assess your unfitness and assign it a VA provided rating, will derive a rating by looking at the VASRD disability codes for the specific impairments caused by the CRPS, which may include the following: (1) partial paralysis; (2) muscular atrophy; (3) limited range of motion in your arm (or wrists or elbows); (4) peripheral nerve damage; or (5) neuralgia. In addition, chronic pain alone can be a disabling condition if it causes impairments, regardless of whether it’s tied to another diagnosis.

Keep in mind that the focus for the military is on whether the condition, however it is characterized, prevents you from performing your duties. The Navy or Marines may limit that determination to merely one condition which it determines best reflects the cause of your unfitness and it is the rating for that one unfitting condition that will determine your eligibility for a disability retirement (30% or greater) or a severance payment (less than 30%). Although it is required by statue and DoDI 1332.18, the military often unlawfully does not properly refer to the VA for rating as part of the IDES process various conditions that themselves are not unfitting but together with or separately from the unfitting condition contribute to unfitness. On the other hand, as you go through the IDES, the VA will assess and rate all your service connected conditions (whether as a condition referred by the PEB or a condition you claim) regardless of their unfitting nature. That is why a combined VA rating is often different from the military rating determined by a PEB.

You should remain mindful both with respect to your military rating and your VA rating, that CRPS often arises as a secondary condition to an injury, such as to an extremity, which itself is disabling. The military often focuses just on the underlying condition and improperly refuses to refer for rating secondary conditions. In addition, CRPS often causes other conditions, mental and physical, that have separate VA disability ratings, such as: (1) depression; (2) anxiety; (3) PTSD; (4) insomnia; (5) gastrointestinal disorders; and (6) ulcers. The underlying or secondary conditions must be service connected, however. When you have multiple conditions that qualify as service-related disabilities, even if they’re all related to CRPS, you can combine the disability ratings to obtain a higher overall rating.

The bottom line is that you need to take on the responsibility of ensuring that as you go through the IDES process, all of your current medical conditions, including pain, are claimed and noted, and you need to be your own advocate to make sure the MEB, the NARSUM, and the C&P examinations fully and properly document all of your conditions. To the extent feasible, having your own lawyer assist you is also critical, although cost and access to a private lawyer is often problematic. Military counsel typically do not have the time or resources to advocate for service members until the formal PEB, at the earliest. Just as an example, make sure you explicitly tell providers the full extent of the pain you suffer in terms of sharpness, frequency, and resulting limitations. Going through the IDES is not the time to be stoic. Do not rely on the PEBLO to be your advocate.

Google "VA ratings for CRPS" and you'll find some good information, some of which I've lifted here.

 

[alsdnd]

The VA Schedule for Rating Disabilities (the VASRD) does not have a separate diagnostic code, or rating, for CRPS. That being the case, the Navy (or Marines - you don't specify) in the MEB and PEB process to assess your unfitness and assign it a VA provided rating, will derive a rating by looking at the VASRD disability codes for the specific impairments caused by the CRPS, which may include the following: (1) partial paralysis; (2) muscular atrophy; (3) limited range of motion in your arm (or wrists or elbows); (4) peripheral nerve damage; or (5) neuralgia. In addition, chronic pain alone can be a disabling condition if it causes impairments, regardless of whether it’s tied to another diagnosis.

Keep in mind that the focus for the military is on whether the condition, however it is characterized, prevents you from performing your duties. The Navy or Marines may limit that determination to merely one condition which it determines best reflects the cause of your unfitness and it is the rating for that one unfitting condition that will determine your eligibility for a disability retirement (30% or greater) or a severance payment (less than 30%). Although it is required by statue and DoDI 1332.18, the military often unlawfully does not properly refer to the VA for rating as part of the IDES process various conditions that themselves are not unfitting but together with or separately from the unfitting condition contribute to unfitness. On the other hand, as you go through the IDES, the VA will assess and rate all your service connected conditions (whether as a condition referred by the PEB or a condition you claim) regardless of their unfitting nature. That is why a combined VA rating is often different from the military rating determined by a PEB.

You should remain mindful both with respect to your military rating and your VA rating, that CRPS often arises as a secondary condition to an injury, such as to an extremity, which itself is disabling. The military often focuses just on the underlying condition and improperly refuses to refer for rating secondary conditions. In addition, CRPS often causes other conditions, mental and physical, that have separate VA disability ratings, such as: (1) depression; (2) anxiety; (3) PTSD; (4) insomnia; (5) gastrointestinal disorders; and (6) ulcers. The underlying or secondary conditions must be service connected, however. When you have multiple conditions that qualify as service-related disabilities, even if they’re all related to CRPS, you can combine the disability ratings to obtain a higher overall rating.

The bottom line is that you need to take on the responsibility of ensuring that as you go through the IDES process, all of your current medical conditions, including pain, are claimed and noted, and you need to be your own advocate to make sure the MEB, the NARSUM, and the C&P examinations fully and properly document all of your conditions. To the extent feasible, having your own lawyer assist you is also critical, although cost and access to a private lawyer is often problematic. Military counsel typically do not have the time or resources to advocate for service members until the formal PEB, at the earliest. Just as an example, make sure you explicitly tell providers the full extent of the pain you suffer in terms of sharpness, frequency, and resulting limitations. Going through the IDES is not the time to be stoic. Do not rely on the PEBLO to be your advocate.

Google "VA ratings for CRPS" and you'll find some good information, some of which I've lifted here.

Hello RetiredAtty,

Thank you for the detailed post regarding CRPS. I have a few more questions, if you could kindly help answer.. As far as the P3 profiles go on the PULHES, If CRPS was derived from a surgery of the left foot, will it be a separate P3 profile on the 'P' instead of the 'L' on the DOD side of rating?

It seems as if the highest rating you can get for a loss of left foot is 30% from DoD.

Thank you in advance.

 

[RetiredAtty]

I am no expert on profiles or PULHES, but generally the P3 designation for conditions related to the legs or feet will be under the lower extremity "L" designation and there is only one designation even if numerous conditions. However, each of the disabling conditions should be called out in the explanatory portions of the profile document. That is where the military will either intentionally or negligently fall short and not fully describe all the conditions contributing to unfitness.

As related in my original post, you are entitled to have every condition that either causes or contributes to your unfitness to be separately rated. The military is not free to simply pick one unfitting condition and lump everything related to it under that condition and give only one rating. That is inconsistent with the "combined effect" requirement, which has a well-established statutory and regulatory basis.

10 U.S.C. § 1216a(b) provides "Consideration of all medical conditions.--In making a determination of the rating of disability of a member of the armed forces for purposes of this chapter, the Secretary concerned shall take into account all medical conditions, whether individually or collectively, that render the member unfit to perform the duties of the member's office, grade, rank, or rating." The statute is implemented by Department of Defense Instruction (DoDI) 1332.18, Disability Evaluation System (Nov. 10, 2022), ¶ 6.4.d. (previously DoDI 1332.18 (May 17, 2018), Appx. 2 to Encl. 3, ¶ 4.d.), which provides:

"d. Combined Effect.
(1) A Service member may be determined unfit as a result of the combined effect of two or more conditions even though each of them, standing alone, would not cause the Service member to be referred into the DES or be found unfit because of disability.
(2) The PEB will include in its official findings, in cases where two or more medical conditions (referred or claimed) are present in the service treatment record, that the combined effect was considered in the fitness determination rendered by the PEB, as referred by the MEB.
(3) Combined effect includes the pairing of a singularly unfitting condition with a condition that standing alone would not be unfitting."

Each of the military department’s disability regulations further implements the combined effect requirement. See Army Reg. 635-40, ¶ 5-4.g.; AF Inst. 36-3212, ¶ 3.11, Attach. 1 – Glossary Terms; SECNAVINST 1850.4F, ¶ 4.e.

Complex Regional Pain Syndrome is a neuropathic pain disorder, in your case secondary to foot surgery. Neuropathy, to the extent contributing to unfitness, may be a separate condition than the foot condition (including amputation) depending on the circumstances that must be separately rated under the combined effect requirement. The U.S. Circuit Court of Appeals for the D.C. Circuit in a recent decision made it very clear that the military must comply with the combined effect requirement. Sissel v. Wormuth, 77 F.4th 941 (D.C. Cir. 2023). The Sissel case involved unfitting back pain and right leg weakness that the Army combined and rated only as a back condition. The Court found this to be error as the leg condition had to be separately rated because it contributed to unfitness consistent with the combined effect requirement. As a result of Sissel, the Navy recently settled a class action lawsuit in which it agreed to go back and re-look PEB cases where it had similarly and improperly failed to separately rate conditions that contributed to unfitness (so-called Category II Conditions). A copy of the Sissel opinion and the joint status report reporting the Navy settlement are attached.

Just FYI, all nerve conditions are rated based on the loss of function of the affected body part, whether paralysis, neuritis, or neuralgia. Once it is determined which of the three categories the nerve damage falls under, it can then be rated either under that category or based on limited motion, whichever results in the higher disability rating. If the nerve damage is causing the limited motion, then only one rating can be assigned either under a nerve diagnostic code or under limited motion. However, if the limited motion is not caused by the nerve damage, then it can be rated separately, in addition to a nerve diagnostic code rating. The pain caused by CRPS may also be separately rated in a similar manner depending on the circumstances or may impact the body part rating.

All this is why you need good counsel as early as possible in the DES process, including for preparation for C&P and other medical exams. Waiting for appointed military counsel may be too late.

 

[alsdnd]

I am no expert on profiles or PULHES, but generally the P3 designation for conditions related to the legs or feet will be under the lower extremity "L" designation and there is only one designation even if numerous conditions. However, each of the disabling conditions should be called out in the explanatory portions of the profile document. That is where the military will either intentionally or negligently fall short and not fully describe all the conditions contributing to unfitness.

As related in my original post, you are entitled to have every condition that either causes or contributes to your unfitness to be separately rated. The military is not free to simply pick one unfitting condition and lump everything related to it under that condition and give only one rating. That is inconsistent with the "combined effect" requirement, which has a well-established statutory and regulatory basis.

10 U.S.C. § 1216a(b) provides "Consideration of all medical conditions.--In making a determination of the rating of disability of a member of the armed forces for purposes of this chapter, the Secretary concerned shall take into account all medical conditions, whether individually or collectively, that render the member unfit to perform the duties of the member's office, grade, rank, or rating." The statute is implemented by Department of Defense Instruction (DoDI) 1332.18, Disability Evaluation System (Nov. 10, 2022), ¶ 6.4.d. (previously DoDI 1332.18 (May 17, 2018), Appx. 2 to Encl. 3, ¶ 4.d.), which provides:

"d. Combined Effect.
(1) A Service member may be determined unfit as a result of the combined effect of two or more conditions even though each of them, standing alone, would not cause the Service member to be referred into the DES or be found unfit because of disability.
(2) The PEB will include in its official findings, in cases where two or more medical conditions (referred or claimed) are present in the service treatment record, that the combined effect was considered in the fitness determination rendered by the PEB, as referred by the MEB.
(3) Combined effect includes the pairing of a singularly unfitting condition with a condition that standing alone would not be unfitting."

Each of the military department’s disability regulations further implements the combined effect requirement. See Army Reg. 635-40, ¶ 5-4.g.; AF Inst. 36-3212, ¶ 3.11, Attach. 1 – Glossary Terms; SECNAVINST 1850.4F, ¶ 4.e.

Complex Regional Pain Syndrome is a neuropathic pain disorder, in your case secondary to foot surgery. Neuropathy, to the extent contributing to unfitness, may be a separate condition than the foot condition (including amputation) depending on the circumstances that must be separately rated under the combined effect requirement. The U.S. Circuit Court of Appeals for the D.C. Circuit in a recent decision made it very clear that the military must comply with the combined effect requirement. Sissel v. Wormuth, 77 F.4th 941 (D.C. Cir. 2023). The Sissel case involved unfitting back pain and right leg weakness that the Army combined and rated only as a back condition. The Court found this to be error as the leg condition had to be separately rated because it contributed to unfitness consistent with the combined effect requirement. As a result of Sissel, the Navy recently settled a class action lawsuit in which it agreed to go back and re-look PEB cases where it had similarly and improperly failed to separately rate conditions that contributed to unfitness (so-called Category II Conditions). A copy of the Sissel opinion and the joint status report reporting the Navy settlement are attached.

Just FYI, all nerve conditions are rated based on the loss of function of the affected body part, whether paralysis, neuritis, or neuralgia. Once it is determined which of the three categories the nerve damage falls under, it can then be rated either under that category or based on limited motion, whichever results in the higher disability rating. If the nerve damage is causing the limited motion, then only one rating can be assigned either under a nerve diagnostic code or under limited motion. However, if the limited motion is not caused by the nerve damage, then it can be rated separately, in addition to a nerve diagnostic code rating. The pain caused by CRPS may also be separately rated in a similar manner depending on the circumstances or may impact the body part rating.

All this is why you need good counsel as early as possible in the DES process, including for preparation for C&P and other medical exams. Waiting for appointed military counsel may be too late.

This is golden. Thank you for the detailed response.

 

[Grenhep]

A family looking for a new apartment in Colorado faced a issue with TurboTenant background checks. TurboTenant assists property owners check renters before they sign in. The family failed the check because TurboTenant spotted a late bill from years ago. The family explained they paid it way back, but TurboTenant’s report anyway listed it. They missed the home they wanted due to this. The landlord shared TurboTenant helps them pick good tenants. But the family thought the system was not fair. TurboTenant gets information from financial sources to create their reports. Some tenants say TurboTenant should check closer at old cases. The family had to look for a new place to live. People are worried their private info might not be protected. TurboTenant says they obey laws to guard info secure. A renter suggested TurboTenant should let tenants explain their story first. TurboTenant is trying to update how they handle old issues. Rules in various states make it hard for TurboTenant to operate the same everywhere. Some owners recently ask TurboTenant to share their process. Leaders are discussing new laws to ensure checks are fair. Experts think TurboTenant needs to improve their process for tenants. People want owners to choose more accurate background checks. There’s a big effort for TurboTenant to become more reliable for everyone. To learn more about TurboTenant background checks, visit click here for helpful tips. Owners should check TurboTenant reports for mistakes before choosing. If something seems wrong, they should to contact TurboTenant quickly. This keeps the process fair for everyone. Renters can request to view their TurboTenant report if they want to. They can fix any bad details they spot. Saving a copy can help in the future. TurboTenant offers support to fix issues fast. Owners should teach their team about laws for checks. This can stop issues down the road. Tenants should understand their rights with TurboTenant checks. Openness creates confidence for all. TurboTenant allows people see reports online. This keeps the system more open. Owners enjoy TurboTenant’s quick reports for choosing. A good service like TurboTenant makes a big impact.