IMA QUESTION

D

dkokoszka

PEB Forum Regular Member
PEB Forum Veteran
Can an Independant Medical Review change/downgrade your Narrative Summary
(DA 3947)?

This is where I am at: My narrative summary (to me) looks accurate. It is very detailed and list 6 conditions that do not meet AR 40-501 standards.

I am Over 23 years Active Duty and cocur with an un-fit finding. I bascially have had enough. Commanders statement and NCOER support un-fit finding.

I'm just NOT sure about all the medical language that they are using in the Narrative Summary.

Example: I am being treat for back spasm's. I do NOT see it listed anywhere in the Narrative Summary.

The JAG told me "dont worry" about it that the PEB will look at ALL of your medical documentation.

Now I find it hard to believe (I might be wrong here) that the PEB is going to look at ALL of my individual medical documents.

I do NOT want to ask for an IMR if they are going to DOWNGRADE OR CHANGE what is currently on my Narrative Summary.

I also want included in my narrative summary conditions such as back spasm's.

So is requesting an IMR a good idea in my case?

Thoughts?
 
Dkokoszka,

Go directly to the MEB physician who wrote the summary and tell him or her that you want certain things added to it. Or if your PEBLO is good, have him contact the MEB physician and tell her that you need certain things added.

What are you hoping to gain from an IMR?

JAG should be able to look at the language and say whether it accurately describes your condition for rating purposes.
 
The review does not result in an "automatic" change of anything. The opinion of the reviewer is considered by the MEB approval authority (usually the Deputy Commander for Clinical Services, the Hospital XO) and he decides whether to make changes.

As for "back spasms" not being included in the MEB, I have a few thoughts. That language warrants a 10% award if unfit. So, if your ROM equal or exceeds a 10% finding, then it is probably not so important. I suppose that they could look at it as an additional symptom that supports unfitness, but technically, if you have 10% or higher from another criteria being met, then it should really make no difference.
 
Jason, thank you for your comments.

So IF my ROM is less than 30 forward flexion and have a Lumbar fusion, the back spasm's
wont come into play ?

Also the narrative summary says: Does not meet AR 40-502.

720.0 ankylosing Spondylitis lumbar spine SP multiple fusions

So will the above condition ONLY be rated under 1 condition , 1 VASRD code?

Do you think I should ask for an IMR in my case?

Thank you.
 
Ceilingfan,

What are you hoping to gain from an IMR?

I don't know, maybe I don't need one, maybe the way it's written up is fine, but really how do I know.

The JAG is geeting ready to depart so I am not sure how much time, if any, he really spent looking at my case.

He just asked me what I thought. He seemed not interested in my case. He told me not to woorry about the "minor" details that it would be covered in the PEB process.

I just don't want to agree with the DA 3947 and not submit a rebutal if it hurts me in the future when the PEB hands down their decision.

Thank you for your time.
 
Dkokoszka,

So were you able to speak to the MEB physician who wrote your summary? Also were you there when he or she wrote it?

I think you can get the issue fixed without doing a rebuttal by going to the MEB physician and asking him or her to fix the problem. But if you don't feel comfortable doing that, then have the JAG write up a rebuttal for you.

Did you go to the MEB legal outreach? Just my opinion, but I don't think an attorney should be telling anyone "not to worry about the minor details." You want everything in your packet to be as accurate and as detailed as possible... at least in most cases. I believe that is what you want. At the very least, it sounds like it will give you some peace of mind to get your back spasms added.
 
dkokoszka said:
So IF my ROM is less than 30 forward flexion and have a Lumbar fusion, the back spasm's
wont come into play ?
Click to expand...
I would think that it would not matter; The ROM nets you a 40% rating if unfitting, so from a rating perspective, spasms won't matter.

Also the narrative summary says: Does not meet AR 40-502.

720.0 ankylosing Spondylitis lumbar spine SP multiple fusions

So will the above condition ONLY be rated under 1 condition , 1 VASRD code?
Click to expand...

From what you have said, yes, you will be rated under one code and the criteria will be the same for any of the codes between 5235 to 5243. They will use the General Rating Formula for Diseases and Injuries of the Spine.

Do you think I should ask for an IMR in my case?
Click to expand...

I wouldn't be able to tell you. What you have said does not raise any concerns about your issue, but I don't know what is and isn't in the MEB/NARSUM to give an opinion.
 
Ankylosing Spondylitis is rated under DC 5009-5002. Which rates both the active disease process and the chronic residuals (under various DCs) and applies the higher rating of these two areas. Your limited lumbar flexion should equal at least 40% under DC 5240 but other chronic residual issues could raise the rating or it could potentially be higher under the active disease process criteria of DC 5002.

Mike
 
Good point, Mike. Though, unless he is exhibiting systemic disease (which I would argue includes any involvement of multiple joints), they will more than likely just rate his back under the General Rating Formula...I don't offer an opinion on the correctness of this in his case but as a general matter, the military completely screws up rating AS.
 
Jason,

If mutitple joints are involved, they are all rated and the ratings combined. Other residuals like iritis and psoriasis, common with AS, are supposed to be rated as residuals as well. For psoriasis, a 60% rating is applied if one needs to use an immune suppresive drug such as Enbrel, Humira or Remicade which are often used to treat autoimmune aspectsd of AS. If he is on any of these drugs, he has active disease process as the drugs are only used to treat active disease.

Mike
 
Well, that is how it should go....even in cases like you describe, they don't rate that way. Which is not to say that that failure should not be fought out. Especially troubling to me is that I have never (and I mean NEVER) seen a PEB apply the minimum rating of 10% for otherwise non-compensable joint involvement.

But, in the case of a member with AS who just has a back disability, they would rate it under the specific joint, in this case, back, and apply the General Formula. Not clear from what he posted if he has an active process or not.
 
Yes they do screw it up early and often but both the VA and the Army have clarified that AS ratings involve both the active disease process criteria (5002) and the chronic residual under appropriate codes which includes 5240 for residual damage involving the spine. The best way to prevent rating problems is to make sure the active disease process and all chronic residuals are properly documented in the MEB and then be ready to appeal your IPEB if not properly rated.

Mike
 
You know, Mike, this raises another pet peeve...I have seen PEBs take the position that residuals have to be individually unfitting to be rated. This issue has not been well explored, but it is a big issue, in my opinion. FWIW, I have not seen an appreciable shift in how AS cases are rated, notwithstanding the FAST letter and agency guidance. Have you seen differently? If so, have you had to call them out on it before they accurately applied the standards?
 
Jason, I understand what you are saying, my error, I thought they would rate them separately, anyways it might not matter.

DA 3947: Ankylosing Spondylitis Lumbar Spine S/P Multiple fusions: Does not meet retention AR 40-501.

The supporting documents says: Rheumatologic evaluation revealed that although
The patient has Ankylosing Spondylitis by a positive HLA/27 gene; his symptoms are most current with Rheumatoid arthritis (Early morning stiffness and pain).

Patient started Enbrel in Jan 2010, one injection per week with significant relief in his symptomatolgy.

My rheumatologist never said anything about an Active process.

He best describes my condition as “Undifferentiated Spondyloarthropathy”

This goes back to my original post about understanding the medical terminology that is attached to the DA 3947 as supporting documents from Podiatry, Ortho and the psychologist reports.

Thank you to everyone who has responded to my questions.
 
Jason,

I have seen some done right but not all. I agree, if one is unfit for AS, then all manifestations need to be rated. I have heard of the "each joint must be unfitting issue" but have not run it to it yet. Rating at the sub atomic level is what I call it. Regardless, all joints and other mainfestations needed to be properly documented in the MEB.

Mike
 
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