IRILO questions??

J

jr0718

PEB Forum Regular Member
Registered Member
I'm new to this group so forgive me if this is a recurring theme/question. June 2020 I injured my back and hip while on orders for COVID response (Air National Guard member). Since I have been diagnosed with herniated disc, piriformis syndrome, radiculopathy, sciatica, degenerative disc disease, torn hip labrum, and osteoarthritis has now formed in the hip. I have been through PT with no improvements. I'm prescribed a slew of meds aimed at calming muscle spasms and dialing back the radiating pain from the nerves. I have also been getting epidural spinal injections over the last year. These injections have began to not work as well. My latest MRI showed canal narrowing where the nerves travel through. I met with our medical squadron yesterday and IRILO was mentioned. I am unsure what this actually means. I have also been told by my PCM that I will most likely be referred to a PEB. I am not sure of the processes moving forward or if I should be doing anything to strengthen my case on my injuries or what. Could someone please offer some insight into this process and if the process is different for the guard side?

Also at one point they removed me from MEDCON orders just short of 365 days to keep from a mandatory MEB. Since then I was put on orders to support another mission on base and all of these injuries have been aggravated during the performance of my duties. I have began the process for a new LOD for this but seem to be getting push back and mixed information on the processes moving forward. I have also been diagnosed with a hiatal hernia, chronic gastritis, and tenitis since being on orders.

Thanks in advance for any help.
 
Hi J,

I might be able to offer some insight if you could answer a few questions.

1. Do you have a completed LOD for the back and hip?

2. If you were put taken off MEDCON and put on another set of orders, were you told you were officially returned to duty? Specifically, did the clear you from your profile (AF 469)?

3. Were you still in treatment when you were taken off MEDCON?

4. What was the timeframe from when you came off MEDCON to when you started your new set of orders?


An IRILO stands for In Review In Lieu Of....this is essentially a "triage" point for the Guard and Reserves. What this means is that the medical unit reviews your case and determines if you may need an MEB, based on your medical conditions, treatment and current status/prognosis. If they determine you are not meeting retention standards (in accordance with 48-123 and the MSD) they will put an IRILO package together and send it to NGB/SG. Headquarters medical staff will review your case and if they agree (again, in accordance with the same guidance) they will recommend your case move forward for an actual MEB.

When you PCM told you, you would most likely be sent for a PEB, he is referring to the IPEB (Informal Physical Evaluation Board). He is nicely telling you he does not feel you meet retention standards and he will be supporting/recommending your case to an MEB.

The MEB falls under the IDES...the Integrated Disability Evaluation System. This consists of two processes...on the MEB and the VA ratings. When someone goes through an MEB, the VA will also do their process to ensure the whole process is done when the person is medically retired.

Once you answer the above questions I may be able to offer some guidance on what to ask and who to talk to...hope this helps.
 
Thanks for the reply.

Timeline:

June 24th, 2020: injured back/hip while on active duty orders in response to COVID-19. Back completely locked up as well as hip. Was unable to walk or stand up without assistance. Taken by ambulance to the ER. ER doctor stated he believed it was a bulging disc compressed into the nerve column but needed to follow up with an ortho spine doc for back and someone for the hip.

July 2020: Placed on pre-medcon orders while waiting for medcon orders to come through. Began treatment through orthopedic doc for my hip. Diagnosed with piriformis syndrome, herniated disc, radiculopathy. Referred to physical therapy. MRI for hip and back ordered.

July 28th 2020: Medcon goes into affect. LOD approved.

June 30th, 2021: After physical therapy and pain management getting involved, doctor believes we have plateaued and we have done all we can do for now. Basically told my condition would continue to deteriorate with my discs. Also informed that the VA was an option to file for a rating and let them begin treating any reoccurring problems.

July 1st 2021: I was "cleared" for duty. AF 469 was pulled in relation to my back and told I was ready to go back to full duties.

July 8th 2021: Began orders for mission support.

September 20th 2021: Back injury reaggravated as well as the hip. Reported to my supervisor and he told me to go see the military doctor at the local Naval base. LOD was not filed yet due to hesitancy from supervisor and myself in regards to how serious the injury actually was. Doctor began referring me to spine specialist as well as a new ortho doc for my hip. Pain management was also restarted at this point (epidural spinal injections).

November 15, 2021: Ortho doc reviewed prior MRI with hip and found torn labrum and DJD. Also stated the hip most likely had bone spurs that needed attention. Reported this back to Naval doc and we began the LOD process. Surgery is inevitable but waiting on spine specialist to determine plan of treatment on back.

November 16th 2021: Received push back from on base medical clinic about it (back injury) not being their responsibility because it was a prior injury. I informed them per AFI it was an aggravation to an injury and required an LOD. This was also the point I was informed they never processed an LOD for the hip when the injuries originally occurred.

December 23rd 2021: Meeting with commanders to discuss the issues the medical clinic listed as "not their problem". After meeting these issues were resolved and new LODs were sent up for the back aggravation and hip injury.

January 20, 2021: Medical group stated my file would sent to IRILO to determine a med board. Still waiting for LOD approval on both.

February 2nd 2022: AF 469 put into the system with box 37 (MEB) checked. Placed on restrictive duty with nothing physical allowed.

Side note: since being prescribed a myriad of medications I have stomach issues that I have been getting treatment for. Should I push for an LOD for this or will having it documented in my file by the Naval doctor be good enough?
 
Hi J

Great timeline.

Okay, the main issue I see here is them clearing your 469 when the doctor said there was nothing that would improve the situation. At that moment, they should have determined if this did or did not meet retention standards...and if not, started your IRILO. It does not sound like your 469 should have been cleared, and good chance you should have stayed on MEDCON orders.

And right as rain, you injury was aggravated. Fortunately, the re-aggravation occurred while you were on orders. For future knowledge...NEVER EVER hesitate to have an LOD completed. It is not the LOD that disqualifies you...it is the profile that disqualifies you. An LOD is just the proof that an injury/illness/disease occurred in a duty status.

The Navy medical, as a collective...for whatever reason...does not seem to have a huge interest in taking care of the service members. They seem to work harder to find no, than to find yes. Wish I understood why. No matter, you have the LOD and they are starting the IRILO package together. NGB will not process the IRILO until all the LODs are completed. Currently, from my understanding the Guard is still sending their LODs to NGB versus the Wing/CC to make the final decision. Something to do with the system they use for LODs. (Feel free to validate this with your medical unit.)

Can you tell me specifically the diagnosis on your first LOD and what the diagnosis is on the most current LOD? I am concerned if there is no LOD for your hip.

As far as the stomach issues go...I would push for the LOD. Yes, it may be a result of medications for your other conditions. However, it is still a separate condition that is being treated. If there is resistance, I would see if the medical unit can reach out to NGB or PEB to clarify if an LOD is warranted. (And I would ensure you had their guidance in an email as proof.)
 
The LOD for the back and hip hasn't been approved and sent back down for me to see what was listed as diagnosis. The doctor diagnosed my hip with torn labrum, hip impingement syndrome, and bone spurs. He also stated I have DJD at this point which if I understand correctly is basically osteoarthritis. He also mention that it is likely I will need a full hip replacement at some point in the future because of the DJD.

The back LOD should have been sent up as an aggravation to the previous injury. My commander stated she saw it was listed as an aggravation and not a new injury. The LOD should have radiculopathy, sciatica (which I thought was the same thing), and herniated disc.

I will go this week to have a nerve conduction study. Based on those results, we will determine how quickly we move forward with the hip surgery.

I'm not really sure what to expect moving forward or what to do or not to do as far as IRILO/MED Board stuff goes. Keep trucking along and wait on them? I've also been keeping up with all the doctor's notes and making copies for myself just in case.
 
Update.

March 1st: Spine specialist stated there is no surgical intervention they could proceed with that they could say would alleviate any pain. Any surgery at this point would be more risk than reward. They believe discs will continue to deteriorate. They added chronic pain syndrome and chronic radiculopathy to my growing lists of diagnosis for my back. Referred me back to pain management with a recommendation of pain stimulator implant.

March 3rd: Orthopedic doctor for hip is moving forward with surgery for March 26th.

At this moment my LODs are still not processed through the system. Commanders along with military doctor have told me to move forward with surgery and not wait around on the LODs. Moving forward I know I have an extensive recovery. Is there anything I need to be doing at this point besides documenting and collecting records? I still have not heard from IRILO and if I am getting sent to MEB.

Any help would be great!
 
jr0718 said:
Update.

March 1st: Spine specialist stated there is no surgical intervention they could proceed with that they could say would alleviate any pain. Any surgery at this point would be more risk than reward. They believe discs will continue to deteriorate. They added chronic pain syndrome and chronic radiculopathy to my growing lists of diagnosis for my back. Referred me back to pain management with a recommendation of pain stimulator implant.

March 3rd: Orthopedic doctor for hip is moving forward with surgery for March 26th.

At this moment my LODs are still not processed through the system. Commanders along with military doctor have told me to move forward with surgery and not wait around on the LODs. Moving forward I know I have an extensive recovery. Is there anything I need to be doing at this point besides documenting and collecting records? I still have not heard from IRILO and if I am getting sent to MEB.

Any help would be great!
Click to expand...
No advice on the IRILO as I was not Air Force but feel free to message me if you have any questions about hip impingement. I was medically retired for it.
 
X5379 said:
No advice on the IRILO as I was not Air Force but feel free to message me if you have any questions about hip impingement. I was medically retired for it.
Click to expand...
Could you shoot me some information based on your experience with hip impingement?

Thanks in advance
 
Update.

March 25th: The day before I was scheduled for surgery I was contacted and advised not to go ahead with my hip surgery because the hip LOD had not been signed completed yet. After notifying my commanders of the issue, we were able to find out the LOD is sitting at NGB and has been for 47 days at this point. I was directed to postpone my surgery until this LOD matter is resolved. Lengthy conversation through e-mail with active duty medical officers stated my likelihood to return to service is not likely and an IRILO should have already been in process.

April 3rd: Advised by my POC at on base medical squadron that the LOD system has been down and it is the root of the delay with getting my LOD signed. Not sure I buy this reasoning but maybe it's plausible. Also stated she did not gather my notes from the one doctor I see most often in regards to my back to have placed in my medical file. She said I need to hand deliver them to her even though I signed a release form for her to gather them after each visit.

April 5th: Nerve block procedure in my lower back to attempt to alleviate some of the nerve pain. Now being told arthritis has spread through the lower parts of my back and should expect more pain to ensue.

April 6th: Follow-up with military physician. During visit diagnosed with anxiety and high blood pressure (stress related according to him). Also diagnosed tinnitus. He state the amount of time it has taken to get my injuries attended to is "unprecedented" and it reeks of inability to provide needed medical care to service members (not that I haven't already figured this out).

Sorry if these updates are lengthy. Just need somewhere to vent and offload all of this.

Thanks again for any information and support.
 
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