IPEB and Denied Surgery

In 2008 I fractured my ankle, I continued to have pain well past the healing point and continued to go in to see my PCM's. It took 10 doctors, 2 MRI's, and 2 X-rays until I finally was referred to a specialist at Bethesda, who did one x-ray and knew exactly what was wrong. I was referred for surgery for March 2009, while in surgery my doctor extracted tendons in my foot/ankle that he said were extra and useless; because of this I lost pretty much all ROM in my foot. I then had to be referred for another surgery on my achilles tendon to try and regain some ROM, I had surgery again in Jan 2010. After that surgery I ruptured my achilles tendon and it has been left untreated; therefore my achilles has not healed correctly and I have been told by a new surgeon that I need another surgery for a tendon transfer.

I was put in for an MEB in July (with my narrative still not having been completed), my third surgery was suggested in Sep, but because I am within 6 mo of my ETS I am not allowed to have the surgery without approval from AFPC. When I told my surgeon of this and that he would need to call AFPC to receive the approval, I was told that my surgery was not an urgent matter and that he did not have the time to make the phone call to get approval. Because of this, I can't get this 3rd surgery and I continue to be in extreme pain due to barely being able to walk without limping and still having limited ROM.

Does "being denied" corrective surgery look better to the IPEB board? Since I am not fixed and still unstable I would hope that it would as I am not turning down the suggested surgery, I am being told by my surgeon that he does not have the time to receive the approval. I have 15 yrs in and would love to get either permanent retirement or TDRL.

 

[VAJumper]

I had surgery while awaiting results from the PEB. I have no idea where these policies are coming from that would deny needed surgery--especially when the time to process through the DES could exceed 24 months (as in my case). If nothing else, you should ask for a referral to a pain management specialist who may be able to offer you some pain blocks or other procedures to relieve your pain. It's your right--as per the patients bill of rights as is getting a SECOND opinion. If discharged while still needing another surgery, you would most likely be considered unstable and placed on TDRL, unless it's documented in your record that your disability is permanent. My surgery was to help reduce pain, but my disability was considered permanent which is why I was placed on PDRL. What service are you in? I'd like to research this surgery policy further. I'm working with one prior soldier who was denied surgery, and it took two years for the VA to do it. Complications from delaying the surgery caused him to develop a permanent and progressive painful nerve disorder.

 

[jackey6411]

I am in the Air Force and have an ETS of 31 Mar 2011; according to AFI 41-210, para 10.1.2.4 states that "HQ AFPC/DPAMM is the sole approval authority for non-emergent elective surgery ("Elective" surgery in the AF is non-emergent or non-urgent surgery) during an active duty service member's final 6 mo of service. In order to get approval for non-emergent elective surgery, the physician (either surgeon or PCM) must call AFPC/DPAMM in order to provide all demographics of the member, what type of surgery is being planned,the projected surgery date, and recovery time. AFPC/DPAMM will then either approve or deny the surgical procedure, based off of that information.

I briefed my surgeon of all of this and received a voicemail from him stating "Your surgery is not considered urgent and I do not have the time to make this phone call to get approval." I am hoping that since this condition has not been fixed that I will be able to get a retirement and then still have the procedure after getting retired, I would hope that the board would take this into consideration

 

[VAJumper]

I'm also Air Force. This para should not apply since replacing an archilles tendon is certainly non-emergent but it is not elective. For this para to apply, it must be both. Delaying a surgery of this type could result in complications such as RSD, and you don't want that! This surgery needs to be done and you would be better off getting it before you get out. Your TDRL status should not be affected and you would most certainly not be considered fit for duty with or without this surgery. The Air Force is really bad about documenting symptoms and using the VA checklists. This alone would be grounds for appeal in the event your outcome is not satisfactory. Whether you get the surgery now or not really depends on your desires--not the Air Force. If you think you'd be better off now holding off on the surgery--it seems you are in a position to justify that.

 

[jackey6411]

I agree that I should have the surgery before I get out, but unfortunately they look at any type of surgery if it is to happen within the last 6 mo of TIS and it is not an emergency as "elective" and thus needs approval AFPC approval. Believe me I have been fighting this with the MTF, surgeon, PCM, and AFPC. Along with trying to wrap my head around it, but unfortunately it non-budging by AFPC and although it is dealing with my achilles, I am not ambulatory and therefore according to my surgeon surgery is not a necessity at this time.

 

[resa264]

any updates to this thread? in the same situation now regarding denied surgery.