IMA "review" complete...horrific experience

joelf

PEB Forum Veteran
Registered Member
I just returned from the single worst experience I've ever had with a medical provider. I was scheduled for an Impartial Provider Review, and as I was taken back to her office, the first thing she said was "So you're here because you don't think Dr. ______ (original MEB doctor) knows what he's doing."

I was counseled by the MEB attorney that this was a records review, not an exam; however, she had me remove my shoes/socks and shirt and proceeded to pull, prod, stretch me to the point of intense physical pain. When I questioned this and asked if this wasn't supposed to be pain-free ROM, I was told to "hush." The way my attorney wrote the request memo was to state something to the effect of 'request IPR for all medical conditions, including, but not limited to: _________.' She flat out refused to discuss or consider any condition that wasn't one of the specifically listed items.

I attempted to show her the 40-50 separate notations in my medical record that I had tabbed showing diagnosis/treatment of the conditions I requested the review for, she said she had 'glanced at it briefly' and didn't need my help.'

One of the issues that prompted my request for IPR was that the IVDS and radiculopathy were listed separately on my initial MEB worksheet, but where then combined on the DA3927 & NARSUM. Her response to this was 'you already have enough items listed, you don't need more' and 'everyone that comes in here is just looking for more money.'

When this awful experience was over, she concluded by saying 'that's all I need from you, now get out' The provider was extremely rude, insulting, and unprofessional. I would submit an ICE complaint, but since she has to finish the review, I don't want to throw gas on the flames.

I'm not sure what to do at this point, I'm waiting for my lawyer to call back so I can get his opinion. I guess the best thing to do is see what her review ends up saying and if necessary, appeal it to the DCCS.

Thanks for letting me vent...any thoughts?
 

Jayzdozen

Registered Member
All I can say is that people like this should be held acountable for their actions and it sounds like this individual is very bias. I would report the incident through the proper and official channels I.E. Patiant advocacy.
 

joelf

PEB Forum Veteran
Registered Member
I've contacted both the Patient Advocacy office as well as the hospital Ombudsman. I have no delusions that bringing this to light will help my case in particular, however, I can only pray that it will prevent another Wounded Warrior from experiencing the same disservice.
 

Jason Perry

Benevolent Leader
Site Founder
Staff Member
PEB Forum Veteran
Registered Member
I agree, for this type of unprofessional behavior and treatment, you should complain. At this point, it is not like there is anything to be gained from this "Dr."/provider.

As a side note, though, I think that the impartial medical advice envisioned has hardly been implemented.

This is what the regulations state:

E3.P1.2.6.1.2. Upon request of a Service member referred into the DES, an
impartial physician or other appropriate health care professional (not involved in the
Service member’s MEB process) is assigned to the Service member to offer a review of the
medical evidence presented by the narrative summary or MEB findings. In most cases, this
impartial health professional should be the Service member’s primary care manager
(PCM). The impartial health professional will have no more than 5 calendar days to advise
the Service member on whether the findings of the MEB adequately reflect the complete
spectrum of injuries and illness of the Service member.
E3.P1.2.6.1.3. After review of findings with the assigned impartial health care
professional, a Service member shall be afforded an opportunity to request a rebuttal of
the results of the MEB. A Service member shall be afforded 7 calendar days to prepare a
rebuttal to the convening medical authority. The convening medical board authority shall
be afforded 7 calendar days to consider the rebuttal and return the fully documented
decision to the Service member. In the case of a MEB rebuttal, the MEB shall not be
forwarded to the PEB until the rebuttal is finalized and MEB results indicate the Service
member may be unfit for duty. The fully documented rebuttal will be included with the
MEB information sent to the PEB. Exception to timelines may be granted by an authority
appointed by the Secretary concerned.
E3.P1.2.6.1.4. Medical evaluation participants shall be trained in accordance with this issuance and
existing policy."

What happens way too often is that the "impartial physician" just rubber stamps what was previously found. Now, potentially, it is possible that the MEBs are of such high quality that there is no change warranted. However, I think what is happening is that there is a serious lack of rigorous review and a lot of rubber stamping. I base this on the fact that in many of my cases where we request such a review, no change is recommended or forthcoming by the impartial physician or the MEB- but, then at the PEB I am able to get additional conditions rated. This would seem to indicate error at the MEB level.

I also am seeing some "administrative obstacles" thrown in the servicemembers way. Just yesterday, I had a case out of Fort Knox/Ireland Army Community Hospital, where, at the last minute when my client requested an impartial review, he was told he could not have one unless I submitted a letter requesting it and justifying the request. There is no such requirement in any regulation and it is not something that they have discretion as to granting it or not. They just have to comply (though, for the sake of not making issues where there does not need to be, I did submit a letter, but essentially stated the justification was to provide the advice mandated by the above quoted regulation). My fear is that some MEBs are telling servicemembers that they are not "entitled" to an impartial review.

For what it is worth, I really see two uses for the impartial review as it is presently administered. First, it gives additional time to draft a rebuttal and it requires written response addressing the rebuttal. Both are included in the MEB packet when forwarded to the PEB. This is related to the second use, which is to get the members views and concerns before the IPEB (and later FPEB, if necessary) about the deficiencies or issues with the MEB. This can be important (also, note that the Army, in the DA 3947, block 30, inserts pre-printed language into the form about the member agreeing with the MEB...I find this to be very troubling because it suggests that there are limitations on what can be argued later and because it is pre-printed, it tends to "trick" people into waiving their rights- in contract law, this would be what is called a "contract of adhesion.").
 

joelf

PEB Forum Veteran
Registered Member
received a message from the Ombudsman late this afternoon saying that the hospital commander, DCCS and lead PEBLO had been contacted and for me to expect a response NLT Friday...

really hoping this whole thing doesn't come back to bite me in the a$$
 

Unknown123

Registered Member
With that many eyes on your packet, it would take some serious stones for that reviewer or anyone else who touches it at that level to mess with your packet. It is out of your hands though right now, sit tight and if you don't like the results, then you can take the appropriate action. Me thinks you made the right choice.
 

joelf

PEB Forum Veteran
Registered Member
I definitely had reservations, but agree with Unknown123 that I made the right decision...

On a separate but related note, I think the fact that the "impartial" provider is a doctor that works side by side (their office literally share a wall) with the original MEB doc is asinine. Doctor X is assigned to review Dr Y's findings today, and tomorrow Dr Y is assigned to review Dr X's findings...combine that with the fact that they both report directly to the DCCS who has already signed the original, and will then turn around and sign the impartial review, and you have what I feel is an extremely flawed system.
 

grizz13

PEB Forum Veteran
Registered Member
Dang I don't know anyone there. I would suggest getting with the Chief of Patient Advocacy out there, they can pull bigger strings and do alot of damage to that doc that did that to you. This whole experience you went through is totally uncalled for! Have your told your Chain of Command too??? I am sure your BC will help advocate for you.
 

joelf

PEB Forum Veteran
Registered Member
Received a call from my nurse case manager yesterday to discuss the situation...her resolution is to "redo" the IPR. I will be seeing another MEB doctor Monday morning. I'm not sure if the experience will be tossed out, if the providers review will be included, etc...
 

grizz13

PEB Forum Veteran
Registered Member
Received a call from my nurse case manager yesterday to discuss the situation...her resolution is to "redo" the IPR. I will be seeing another MEB doctor Monday morning. I'm not sure if the experience will be tossed out, if the providers review will be included, etc...
Most likely it will not since it was not an Impartial Review like it was supposed to be (it really wasn't.) If I were you get the MEB JAG highly involved. How about having a senior NCO, officer, or a legal rep. go with you to your appointment just to make sure you are treated fairly? If the MEB doc claims it's a HIPPA violation, laugh at them and tell them the whole MEB/PEB process is a HIPPA violation, that should shut them up...

I did the same and it shut my doc right up!
 

joelf

PEB Forum Veteran
Registered Member
Finished my 'redo' and the new provider agreed (at least verbally) with my assertions...though I won't be too confident until I get the actual paperwork back.
 

grizz13

PEB Forum Veteran
Registered Member
Finished my 'redo' and the new provider agreed (at least verbally) with my assertions...though I won't be too confident until I get the actual paperwork back.
Nice! You should be getting a copy with your new NARSUM.
 

joelf

PEB Forum Veteran
Registered Member
I received my Impartial Provider Review statement back this afternoon. He recommended adding 5 conditions to my 3947…three that meet retention standards, and two that do not. Part of the recommendation was to separate the radiculitis from the lumbar disc rupture.

I was told by both my PEBLO and MEB counsel that the best course of action now is to appeal the original 3947/NARSUM…the goal being to have one complete, accurate set of documents to send to PEB instead of hoping the PEB will put everything together and modify the 3947 at their level.

The only concern I have at this point is that now I have 4 conditions that are specific to my feet. 3 meet retention standards and 1 does not. I understand there's a provision against pyramiding, so I don't know which condition the Army & VA will actually rate.
 

grizz13

PEB Forum Veteran
Registered Member
I received my Impartial Provider Review statement back this afternoon. He recommended adding 5 conditions to my 3947…three that meet retention standards, and two that do not. Part of the recommendation was to separate the radiculitis from the lumbar disc rupture.

I was told by both my PEBLO and MEB counsel that the best course of action now is to appeal the original 3947/NARSUM…the goal being to have one complete, accurate set of documents to send to PEB instead of hoping the PEB will put everything together and modify the 3947 at their level.

The only concern I have at this point is that now I have 4 conditions that are specific to my feet. 3 meet retention standards and 1 does not. I understand there's a provision against pyramiding, so I don't know which condition the Army & VA will actually rate.
The Army will only rate the failing, and may give additional % for the added issues if they deem them to add to the overall pain. The VA will lump some or all and give ratings for them together.

i.e. for me--- Army rated Bi-lateral foot stress fractures 20% (10% each foot rated seperately then added together)

VA rated for--posterior tibial syndrome (same as Army different wording) left foot 10%
posterior tibial syndrome (same as Army different wording) right foot 10%
right foot-chronic strain left ankle with shin splints 20%
left foot-chronic strain right ankle with shin splints 10%
On my va listing i have:
bi-lat shin splints
bi-lat ankle pain
bi-lat foot pain
so on and so forth...

Hope this helps your thought process...
 
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