DA 3947 and NARSUM Review

C

crsdsabers

PEB Forum Regular Member
PEB Forum Veteran
Hi,
I just received my signed DA 3947 and NARSUM for the 7 day review. I spoke with the MEB Outreach Counsel yesterday and discussed the documents at length with my PEBLO. Below are the findings:
1.) Conditions that fail to meet retention standards IAW AR 40-501
a.) Herniated cervical disc with radiculopathy, chap. 3-39c., ICD-9, 722.71
b.) Herniated lumbar disc with radiculopathy, chaper 3-39e., ICD-9, 722.10
c.) Post traumatic arthritis of the right foot and ankle, chap. 3-14b, ICD-9, 716.97

Conditions that meet retention standards
Depression
Recurrent left trochanteric bursitis
meralgia parasthetica
nicotine dependence
hearing loss
tinnitus
history of strabismic amblyopia
allergic rhinitis
OSA
RLS
Insomnia


My questions are these:

1.) Any guess on what Lewis PEB might decide?
2.) With 8 years AD and 17 "good" reserve years for retirement, will this have an impact of medical discharge with severance vs. TDRL/PDRL
3.) PEBLO tells me that his experience with back/spine injury almost always results in PDRL vice TDRL? Truth to this?


Attached records show history dating back to mobilization (CONUS) in 2003 and 2 back/spine surgeies and three right foot surgeries (Broke 4 of 5 metatarsals in 2008). I have complete LODs on all conditions, and they're included. My wife, boss, and coworker are all writing letters to the board reinforcing my disability over time.


What else should I do?


Thanks,
 
Ensure your MEB includes the minimum data from the VA AMIE worksheets for all conditions regardless if they meet retention standards or not. If not satisfied with the contents of the MEB, request an impartial medical review. In your request, list your questions and concerns that you want the impartial medical review to address. The link to the VA AMIE worksheets is here:

Index of Disability Examination Worksheets (U.S. Department of Veterans Affairs)


Mike
 
Well, the narsum does. Should it be annotated on the 3947 also? Will the PEB members review the attached NARSUM and records (which are complete)?

Thanks,
 
Had a quick question in regards to your NARSUM.

The conditions listed under: Conditions that meet retention standards; can those conditions still be rated by the IPEB as unfitting, or does it nullify them looking & rating those conditions by the MEB listing it as "meeting retention standards"?

Also to Mike, Sir do the MEB powers that be have to utilize the VA AMIE work sheets? and if so can you tell me where in the reg it states that? Last just out of curiosity what does "AMIE" stand for? tried doing a Google search couldn't find anything. I completely agree that all docs should utilize those worksheets, as they seem completely thorough & fair.

Thank you.


crsdsabers said:
Hi,
I just received my signed DA 3947 and NARSUM for the 7 day review. I spoke with the MEB Outreach Counsel yesterday and discussed the documents at length with my PEBLO. Below are the findings:
1.) Conditions that fail to meet retention standards IAW AR 40-501
a.) Herniated cervical disc with radiculopathy, chap. 3-39c., ICD-9, 722.71
b.) Herniated lumbar disc with radiculopathy, chaper 3-39e., ICD-9, 722.10
c.) Post traumatic arthritis of the right foot and ankle, chap. 3-14b, ICD-9, 716.97

Conditions that meet retention standards
Depression
Recurrent left trochanteric bursitis
meralgia parasthetica
nicotine dependence
hearing loss
tinnitus
history of strabismic amblyopia
allergic rhinitis
OSA
RLS
Insomnia


My questions are these:

1.) Any guess on what Lewis PEB might decide?
2.) With 8 years AD and 17 "good" reserve years for retirement, will this have an impact of medical discharge with severance vs. TDRL/PDRL
3.) PEBLO tells me that his experience with back/spine injury almost always results in PDRL vice TDRL? Truth to this?


Attached records show history dating back to mobilization (CONUS) in 2003 and 2 back/spine surgeies and three right foot surgeries (Broke 4 of 5 metatarsals in 2008). I have complete LODs on all conditions, and they're included. My wife, boss, and coworker are all writing letters to the board reinforcing my disability over time.


What else should I do?


Thanks,
Click to expand...
 
No idea on unfitting conditions being rated by PEB. I think they'll be rated by VA. However, if I hit 30% w/ PEB, I'd have to be more than 90% VA to get more money from the VA, based on my base salary.

Also, Here are the ROMS: All are sequentially across ALTHA notes: active Pain Begins/end range Passive/ After 3 reps pain/end range
Thoracolumbar spine
as a unit. T1-L5
Forward Flexion, 20/50 pain begins, end range, with passive being 50 and after 3 reps 30/50 pain begins/end range
Extension: 20/20/20 active/passive/after 3 reps
Left lateral flexion: 20/25, active pain begins/end range, 30 pasive, 22/27 after 3 reps pain/end range
Right lateral flexion: 15/20/25/17/22 active pain/end range/passive/after 3 reps pain begins/end range
Left rotation: 20/25/30/25/30
Right rotation: 20/30/35/30/35

Cervical Spine:
Forward Flexion 0/30/n/t wnl 0/45
extension: 17/27/40/27/40
left lateral flexion: 12/22/25/20/22
right lateral flexion: 10/20/25/20/22
left rotation: 52/55/58/50/57
right rotation: 66/75/72

Right ankle: ranges expressed as above:
dorsi flexion: 3/3/5/2/2
plantar flexion: 40/40/40/40/40

Left ankle:
Dorsi Flexion: 5/5/7/5
plantar flexion: 60/NT/WNL/60
 
The Veterans Benefits Administration (VBA) of the Department of Veterans Affairs (VA) has developed Automated Medical Information Exchange (AMIE) worksheets to help focus C&P examinations.

Still looking.
 
DoDI 1332.38 States:

E3.P3.4.4. Overall Effect. A member may be determined unfit as a result of the overall effect of two or more impairments even though each of them, standing alone, would not cause the member to be referred into the DES or be found unfit because of physical disability.

So PEBs are allowed to rate conditions that are not independently unfitting nor even required to be referred to the DES (the condition meets retention standards). However, PEB often ignore this provision. Further, the 14 October 2008 DoD DTM (which modifies DoDI 1332.38) states:

E7.1.2. The Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) shall be used in making ratings determinations for each of the medical conditions determined to be unfitting independently or due to combined effect, to include in combination with an independently unfitting condition. If more than 1 military unfitting condition exists, the VASRD will be used to determine a combined disability rating for each unfitting condition. For purposes of establishing a rating, the VASRD will be used in relation to the Service member's physical disability at the time of the evaluation. If use of convalescent ratings and/or other interim ratings (i.e prestabilization ratings) applies, the Service member may be placed on the Temporary Disability Retired List (TDRL) for reevaluation purposes.

The use of the VA AMIE (AKA VA Physician Worksheets) by MEBs to properly document MEB information is found in two places. First is the 14 October 2008 DoD DTM which applies to all DES cases and the second is the 21 Nov 2007 DTM which implements the Pilot (Integrated) DES. The 14 October 2008 DTM states:

E3.P1.2.6. Additional instructions for Disability Medical Evaluation.

E3.P1.2.6.1. The Military Departments shall publish policies that ensure:

E3.P1.2.6.1.1. Service disability medical examinations for the DES meet the
minimum criteria outlined in the VA General Medical Exam, and the applicable
Compensation and Pension Automated Medical Information Exchange (AMIE)
worksheets.

The 21 Nov 2007 DTM states:

5.3. The Assistant Secretary of Defense for Health Affairs [ASD (HA)], under the USD (P&R), shall:

5.3.1. In coordination with the Military Departments and the DVA, ensure the conduct of a single, comprehensive, standardized medical examination, which will include the protocol-based General Medical Exam and Specialty Exams (based upon DVA examination worksheets and templates) for referred and claimed conditions. The Military Department MEB will use the medical examination results to identify conditions that are potentially unfitting for military service. The DVA will use the medical examination results to determine the disability rating(s) for the referred and claimed condition(s). The exam will also serve as the separation physical should separation from the military service occur. The exam will include an electrocardiogram (EKG) if the member is over 40 years old and a Human Immunodeficiency Virus (HIV) test to meet military separation physical requirements.

Bear in mind the MEB does not have to use the worksheet per se, but the information from the worksheets needs to be included in the MEB someway, somehow.

Mike
 
Sooooooo,
Can I just go "down the line" in the SRD based on ROM and SWAG my own PEB percentage???

Thanks,
 
I never found anything to say that they needed to use those worksheets and I think that is why they don't care what is in my package. I even used the "common sense" arguement and it didn't work, should have know the "military intelligence" arguement would win.
 
Mike,
I guess that I hadn't considered that PEB might find unfitting conditions fitting. I believe there's ample evidence in ROM/ALTHA/and NARSUM to show the impact of my issues. I guess I'll ask for a formal PEB if iPEB doesn't come back as I like it, or as my MEB Outreach Counsel believes it shoud.

Thoughts, advice?

Thanks,

Jeff
 
To Mike,

From this excerpt you state, "So PEBs are allowed to rate conditions that are not independently unfitting nor even required to be referred to the DES (the condition meets retention standards). However, PEB often ignore this provision."

My question is, would it be better to do an Impartial Review, if the SM believes a condition that falls in the "Conditions that meet retention standards"; should in fact be in the " Conditions that fail to meet retention standards"?

or would this be a waste of time?

Also I did have one question that's sort of related to ROM, from what I noticed on crsdsabers.

Can an unfitting spinal injury be sent to the IPEB, with just a "Flexion" ROM? and be rated appropriately? and does it have to show average or can it just be one number? example: forward flexion limited to 30 degrees due to pain? end statement.

thanks.
 
You don't have any unfitting conditions until the PEB states it is unfitting. This happens all the time where conditions that don't meet retention standards sre found to be fitting. This a great technique used by PEB's to keep ratings, and benefits, low. They simply cherry pick which conditions to deem unfitting. The MEB states if the condition meets retention standards or not and this is not the saame as unfitting. I was found fit by my PEB only to be rated 80% by the VA upon separation. In many cases, logic does not apply - only dollars.

Absolutely do an impartial review if you believe the condition does not meet retention standards. First, read up on the standards found in DoDI 1332.38 as well as your service fitness standard reg. For the Army, it is AR 40-501, Chapter 3. Bottom line is that you want your MEB to document the truth well and completely. Trash in = Trash out. A bad MEB will lead to a bad PEB.

Make your case as to why it does not meet retention standards and specifically ask the impartial review to address your point.

Sounds like your ROM was not done completely. If that was lumbar flexion, expect the PEB to send it back as a 30% ROM on lumbar flexion = 40% if found unfit. They will not accept this without it being done right and in detail.

Mike
 
Thanks Mike,

For the good information. Sounds like I need more for my ROM, otherwise my package will get kicked back from the IPEB from what your stating. And yes I do understand what your saying about the concept of the PEB more clearer now, as they can pretty much do as they choose "cherry pick" possibilities. But what your saying is it'd probably get more attention if the MEB had the correct condition in the right category and not the other way around.

I did have one other question that I have asked a couple people on this site. Can Radiculopathy of the left leg be rated with just an MRI showing nerve impingement or protrusion in the nerve canal?

I know from what I've read here people have received EMG tests to confirm actual nerve damage to appropriate limb.

Reason I'm asking is, this is what the PCM stated, the one writing my NARSUM.

thanks.
 
PAcket sent to JBLM today. Letter of input from spouse, Commander, and co worker. On leave. Headed to Manchester, TN for BONNAROO!!!

Thanks for all the great guidance. Will keep the forum informed.

JEC
 
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