First TDRL Reeval for bilateral shoulder instability

S

steve10

PEB Forum Regular Member
I was placed on the TDRL in September 2007 for bilateral multidirectional shoulder instability and was rated at 40% by the Army(active duty)

My history: My MOS was 11b
I was placed on TDRL on 718.81 IAW AR 40-501 chapter 3, paragraph 41(e)
History about the condition: I had left shoulder surgery to fix a torn labrum and tighten the capsule and the surgery held but my instability symptoms remained intact. I never had an operation on my right shoulder. I did physical therapy pre op for about 4 months and post about 8 months on left shoulder (approximately 4 months post op, with both shoulder in PT). When placed on the TDRL, the PEBLO said these type of conditions often get moved to PDRL over time(I took that with a grain of salt but as my appointment nears it makes me wonder)

I would very much like to stay on the TDRL, or be moved to the PDRL and I was wondering the likelyhood of something like this could happen

My history since being on the TDRL is that I haven't been seen by an ortho doctor until recently(about 5-6 months ago). In that time I was given MRI arthograms for both shoulders and found out that I now have a torn labrum in my right shoulder(left shoulder showed the surgery stayed intact). At this time I just started physical therapy(again), 2 weeks ago. I don't know how much of the recent treatment is taken in account for the lack of treatment for the previous 1 1/2 to 2 years. My civilan ortho doctor, wrote on my last appointment, that both shoulders shoulder "global" laxity and that surgery to fix this condition is fraught with difficulties. At the end he said it would require long term care. Now this is coming from one of the best ortho doctors in Chicago(I'm sure the Army really cares
laugh.gif
), and I was wondering if something like this would be sufficient to keep me on the list. I've also been rated by the VA for my shoulders and insomnia related to my shoulder instability at 60%(20% for each shoulder and 30% for insomnia). If you are wondering though, my condition is anything but stable with my shoulders, they sublux almost at will(happens upwards to 8-10 times a week for either shoulder), and I've been in more pain since my surgery on my left shoulder, then I was prior to it. So I'm thinking PDRL might be out of the question...

My TDRL appointment on January 27, 2010 and I will have all this paperwork to back it up and I was just wondering if this was actually going to be enough.

Thank you for your help,

Steve

(I also posted this on the Veteran Benefits Network before I found this community, so if it needs to be deleted, please do so)
 
Steve,

I could see either outcome (TDRL or PDRL). Remember, the standard for "Stability" for TDRL purposes is the likelihood that your condition will improve or worsen over the remainder of the TDRL period to make a difference for rating purposes. Several things you said seem to support instability (discovery of new injury, recent treatment efforts), but I could also see them thinking that your condition won't change for rating purposes over the time remaining until Sept. 2012. Hard to say with confidence which way they will go, much will depend on what your TDRL re-eval exam states. If you get the results of that and care to post it, then that may help in guessing a likely outcome.

Hope all goes well for you!
 
Thanks for replying Jason

I'm just hoping this goes pretty smooth, even though I'm not entirely sure what to expect. I'm sure it would be the same old test for instability. Am I sitting down with the ortho doctor and telling him how I've been effected by my instability while on TDRL(basically a NARSUM while on TDRL?) It doesn't seem like a long process since my one and only appointment tomorrow is with orthopedics.

Steve
 
Just thought I'd give an update on how todays reevaluation went.

I arrived about an hour and a half early(to no fault of my own, miscalculated the time :) ), but good news for me, the PEBLO was already in her office and the orthopedic doctor was already waiting to see people on the TDRL.(I arrived at 8am in the morning), so I was the first one to be seen.

I went to the ortho clinic and was called into see the doctor, we went over my medical history and over the past PEB just to make sure all the information was 100% accurate. We then talked about my condition since being placed on the TDRL. The questions for me were focused around how unstable my shoulders are and what aggrevates my symptoms. He asked if I felt my condition was better or worse, I said worse and I supplied him with my civilian ortho doctors dictations and notes, along with my MRI images and reports. We then ran the standard instability tests for shoulder joints, along with that he took range of motion measurements. After writing down the ROM and instability results, we then talked about current living condition(martial status, work status, if I'm able to enjoy recreational activities such as sports). We also went over any other medical conditions that came about while on TDRL and wrote down the other issues that I've had. We talked a little bit further and he told me that my condition will not likely change in the foreseeable future(due to both his interpertations of the instability tests/prior knowledge, along with my doctors notes stating this is a long term treatment), and that I don't meet retention standards based on my MOS.

Once all the information was organized he sent it for dictation over the phone and allowed me to listen into this to verify everything that was organized in his notes. He said once this was put into print, he would mail me a copy to verify and confirm that it's accurate. I also asked what the turn around rate is for TDRL cases and he said it's about 4-6 weeks from when they receive it.

Overall, it went a lot smoother than I expected, the overall appointment was around 25 minutes. Make sure you come prepared with everything(even if you might think the Army or VA has it, just assume they DO NOT). Both the PEBLO and the Ortho doctor said that it's a pleasant surprise that I came in prepared because many people do not and it makes everyones job or task much more difficult. Thanks to all the information on this website(and VBN), I came prepared and was focused, so appointment was really smooth.

I'll post an update when I receive the reevaluation dictation in the mail.

Steve
 
Steve,

Thanks for the update. Its absolutely a stressor thinking about the TDRL re-eval. If you don't mind...can I ask you-were you notified by mail? And then-where was your re-eval at? At your last base?

I'll be notified soon for my back. I'm thinking about having my doctor here eval me (active duty doc at Peterson-through tricare) rather than flying out of the state-if thats a choice, which I think it will be.

I personally appreciate you updating us-its helpful to have an idea of whats going on. I hear you about PDRL or staying on TDRL...for me-I'm done playing and I'm looking for PDRL. Well, take care-best of luck to you and thanks for keeping us posted.
 
Chinook,

No problem on the update. There seems to be a lot of grey area on TDRL re-evals(from what I've read from other posts) and I thought it might be helpful if I documented my experience with my first re-eval. I definitely was pretty stressed out after reading some troubling stories from other members and I was wondering if I was going to get a fair assessment for myself(which at this time, seems like I did).

As for being notified for my appointment I was mailed twice, one was about two months from my appointment date and the second one was about three weeks out from my appointment date. Both letters had to be signed for when the mail lady brought them to the door. I was also notified prior about an appointment with the VA to have them check out my shoulders from my PEBLO about 4 months ago as well. So I had her email address and contact number if I had any questions regarding TDRL which was very helpful.

My re-eval was at Fort Knox, Kentucky. Which is about 353 miles away from my home address. This was the "nearest" Army facility in my area that would handle TDRL cases.(I was last stationed at Fort Richardson, Alaska). I really wish I would have drove down there the night prior, as it would have saved some discomfort from driving over 10 hours in a single day.

Hopefully for you they will allow your doctor to evaluate you since he/she is already informed on military fitness standards that meet separation/retirement being an active duty doctor. Plus it would be much easier for you due to a back injury and I'm assuming lengthy travel would aggrevate it pretty bad. Not to mention for confidence sake, your doctor knows your condition 100% and knows your limitations and your prognosis would be and you probably will get the best assessment possible.

All we can do is hope for the best,

Steve
 
Hi, I'm back. Just received my NARSUM from my first TDRL re-eval and here is what is says.(I will leave off some personal information though)

Chief complaint: Bilateral shoulder instability.

History of present illness: The 27 year old male relates no significant change in his shoulder symptoms. He feels that the symptoms may have increased in severity. He states he has been having increased instability symptoms in his right shoulder with increased pain in his left shoulder. The patient does not relate any episodes of dislocation in the last 2.5 years. He does relate to increaseing symptoms of instability or subluxation on the right shoulder. He rates the pain in his left shoulder on a daily basis as a 2/10, while aggrevation to his shoulder will increase pain with activities. He states he does not have significant pain his right shoulder unless he subluxates his shoulder with activity. He notices problems with his shoulders with acitivities of daily living such as getting dressed or with any overhead activity. He staes pulling on a heavy door causes him to have sumptoms of subluxation especially with the right shoulder. Lifting greater than 15 pounds causes pain in the left shoulder.

The patient has been followed by a civilian orthopedic surgeon hand his currently going through physical therapy. Surgical discussion has been carried out, but given the diagnosis with poor prognosis, the patient at this time is deferred any surgical intervention.

(skip personal information here)

Physical examination: The male patient is alert and oriented. He is ambulating normally. He is in no acute distress. Examination of his shoulders demonstrates that the left shoulder has well healed surgical scars consistent with previous arthoscopic surgery in the posterior aspect of his shoulder. Range of motion test(my edit: skipping because nothing significant and all readings were normal or above normal). He has a very positive sulcus sign, right greater than left. On exam, I was able to sublux his right shoulder with abduction and external rotation without difficulty. He had a positive apprehension sign on the left shoulder. There was no atrophy. The patient is a right hand dominant male.

Sum of MRI: Right shoulder has anterior and posterior labral tear and left shoulder has subchondral cystic changes

Findings: Bilateral shoulder instability with an anterior and posterior torn labrum to the right shoulder and degenerative changes in the left shoulder

Conclusions and recommendations: This patient's current symptoms preclude him from performing strenous activity required of his rank and MOS. The patient is currently being followed by an orthopedic shoulder specialist. He has continued coservative care with possible discussion of surgical intervention. Evenw tih surgical treatment, the patient has a poor prognosis for significant recovery to a function level that would allow him to return to the rigors of his rank and MOS. He should be considered in accordance with AR 4-501; chapter 3-41(e).

Thanks for reading/helping out.

Steve
 
Steve I just had my re-eval on Monday. Still waiting to get the NARSUM emailed to me, but the doctor I saw already told me he was recommending me fit for duty, which is what I was wanting. Both the doc and PEBLO are pretty convinced the board will agree so my husband and I are anxiously awaiting. Since you're basically a month ahead of me in this process, can you let us know when you receive your outcome. I just have a feeling this is going to be a VERY long 4-6 weeks waiting period! Figured if maybe yours comes back in 4 weeks maybe mine will too, you never know!

Hope you get the PDRL!

Thanks,
Danielle
 
Steve, Thank you so much for the detailed update. The Narsum seems pretty straight forward: chief complaint, hx, , phys eval, reports (mri) , findings, conclusion and recommendation. That was probably due to you being organized in the first place (:

I sure hope that the decision will be the one you are wanting.

I can't thank you enough for taking the time to pass on this info-it really does help others to see how some of these are being processed and how the wording is, etc.

Skellz, Good luck to you! It sounds like you are wanting and will get fit-for-duty. I wish you the best for the rest of your career! Thank you for your continued service!!!

I'll keep you all posted as to when I'm notified. Should be soon. (: Take care.
 
Sorry for the lack of replies in this thread. I've been sitting on my hands(not literally) while I've been waiting for the outcome... and here it is

I'll leave the medical information out (as it's all in previous posts).

Your Condition has not improved to the extent that you are now fit for duty.

Upon re-evaluation, although some change in your medical condition may be anticipated, for the purpose of adjudicating your disability compensation, your condition is considered to have stabilized at a degree of severity that is equal to or greater than 30 percent, as indicated above. Therefore, permanent retirement is recommended.


9. The board finds the soldier is physically unfit and recommends a combined rating of : 40%(initial rating they gave me) and that the soldier's disposition be: Permanent disability retirement.

Good news it looks like! However, I'm not entirely sure what happens on the PDRL(can't seem to find a whole lot of information on it).
 
I would really like to talk to you steve10 if you are still on the forum. I am going through for the same thing currently and they just offered me 20% for bilateral multidirectional shoulder instability w/ chronic pain. They did not connect my insomnia with the shoulders even though I told the doctors it keeps me up at night and is in my med records...let me know if you can help! I think I am going to appeal...
 
macsoldlady,

I am in a very similar situation. I am waiting to hear back from the PEB on my case (bi-lateral shoulder instability, status post, which cause chronic pain). I participated in physical therapy after both of my labrum repairs in 2010, but have not seen an improvement in my condition and the pain has gotten worse. I am currently taking morphine; while it improves my baseline pain level, it is of little help for breakthrough pain when my shoulders dislocate and sublux. I was wondering how big a factor the pain is for you? How much weight did they give to the chronic pain aspect of your case? It's good to find someone who is in a similar situation.
 
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