Is my off-post Neurosurgeons statement enough for a PA to initiate a meb?

[France9488]

Hey everyone,

Unfortunately, this year has been particularly tough for me, filled with a variety of medical challenges. After enduring a painful snapping hip for a year and a half, and despite multiple rotations and a PCS, I finally received a referral to orthopedics. Surgery was performed two months ago, but it did not resolve the issue.

Additionally, this past summer brought on severe neck and back pain. Despite multiple evaluations—by a PT, a PA, and a neurosurgeon on post—they all said that there is no clear reasons for why there is pain radiating down my arms and legs. The MRIs did reveal disc herniations and bulges at every level of my cervical spine and spinal stenosis in my lumbar spine, but my thoracic spine appeared normal. The on-post neurosurgeon, based on the imaging, acknowledged the degenerative disc disease and herniations in my cervical spine but claimed my thoracic and lumbar spines looked great, despite the evidence of lumbar spinal stenosis noted in my MRI. He said he does not give recommendations for MEB and said I needed to go to yoga, message therapy or do more PT.

Unable to accept this dismissal of my symptoms, my new PA (who has been amazing since we met) was able to get me an off-post referral for a second opinion from a neurosurgeon. This surgeon ordered more MRI scans of my C & T spine from an off-post facility. These scans confirmed disc herniations at every level of my cervical spine, with two levels compressing the spinal cord. Though no T spine MRI was ordered, the cervical spine MRI indicated herniations extending from C-7 to T-3. I plan to request a T spine MRI in my next visit. The lumbar spine MRI also showed herniations at every level as well.

The off-post neurosurgeon documented how these conditions are severely affecting my daily activities, making it impossible for me to participate in any ACFT events. He even recommended undergoing fusion surgery for both my neck and lower back.

Given this detailed and concerning diagnosis, isn't this sufficient for a PA to initiate an MEB, or at least acknowledge that I may be unfit for service? This journey has been extremely challenging, especially proving to the medical system that my symptoms are real and significant. Any advice or support from this community would be greatly appreciated.

 

[Provis]

Hey everyone,

Unfortunately, this year has been particularly tough for me, filled with a variety of medical challenges. After enduring a painful snapping hip for a year and a half, and despite multiple rotations and a PCS, I finally received a referral to orthopedics. Surgery was performed two months ago, but it did not resolve the issue.

Additionally, this past summer brought on severe neck and back pain. Despite multiple evaluations—by a PT, a PA, and a neurosurgeon on post—they all said that there is no clear reasons for why there is pain radiating down my arms and legs. The MRIs did reveal disc herniations and bulges at every level of my cervical spine and spinal stenosis in my lumbar spine, but my thoracic spine appeared normal. The on-post neurosurgeon, based on the imaging, acknowledged the degenerative disc disease and herniations in my cervical spine but claimed my thoracic and lumbar spines looked great, despite the evidence of lumbar spinal stenosis noted in my MRI. He said he does not give recommendations for MEB and said I needed to go to yoga, message therapy or do more PT.

Unable to accept this dismissal of my symptoms, my new PA (who has been amazing since we met) was able to get me an off-post referral for a second opinion from a neurosurgeon. This surgeon ordered more MRI scans of my C & T spine from an off-post facility. These scans confirmed disc herniations at every level of my cervical spine, with two levels compressing the spinal cord. Though no T spine MRI was ordered, the cervical spine MRI indicated herniations extending from C-7 to T-3. I plan to request a T spine MRI in my next visit. The lumbar spine MRI also showed herniations at every level as well.

The off-post neurosurgeon documented how these conditions are severely affecting my daily activities, making it impossible for me to participate in any ACFT events. He even recommended undergoing fusion surgery for both my neck and lower back.

Given this detailed and concerning diagnosis, isn't this sufficient for a PA to initiate an MEB, or at least acknowledge that I may be unfit for service? This journey has been extremely challenging, especially proving to the medical system that my symptoms are real and significant. Any advice or support from this community would be greatly appreciated.

MEB is for when you are unfit and all treatment has been exhausted. More than likely it will end with a MEB but it sounds like you need surgery to treat your condition. Then rehab and if that doesn't fix it then they would refer you to a MEB.

 

[France9488]

MEB is for when you are unfit and all treatment has been exhausted. More than likely it will end with a MEB but it sounds like you need surgery to treat your condition. Then rehab and if that doesn't fix it then they would refer you to a MEB.

Yes a few months ago I had accepted the fact that I would need surgery and I was on board to do it when the time came. However after receiving my C spine epidural I had a change of heart because of how painful the procedure was. Basically I’m not ready to have just anyone work on my back nor am I ready to open up a pandora box where I’ll have to receive multiple surgeries to correct my issue. I guess what I’m saying is that I’d rather wait until I begin having red flag symptoms before I have to do surgery or find a reputable surgeon that’s experienced with doing extensive procedures such as mine would be.

 

[Provis]

Yes a few months ago I had accepted the fact that I would need surgery and I was on board to do it when the time came. However after receiving my C spine epidural I had a change of heart because of how painful the procedure was. Basically I’m not ready to have just anyone work on my back nor am I ready to open up a pandora box where I’ll have to receive multiple surgeries to correct my issue. I guess what I’m saying is that I’d rather wait until I begin having red flag symptoms before I have to do surgery or find a reputable surgeon that’s experienced with doing extensive procedures such as mine would be.

Just know that if you don't get those surgeries at the advice of the PCM or in house specialist its possible you get non compensational. So even if MEB you don't get any severance or medical retirement. I am not an expert in this part but I have known people that had the fusion surgery and it went well. I have known some where it didn't. So i get your reluctance but it would suck to be kicked out without anything to show for it and then later on get the procedure. Delaying only harms you and if you can medically retire you get Tricare for life. My wife is disabled and has Medicare through SSDI + Tricare + VA healthcare. She has a lot of health issues and its nice that she can go in different directions if she isn't happy with her primary medical care. She gets everything through the VA but when there is a deficiency she can go to pretty much any other doctor and get treatment.

I know the decision is important. However, even with the best docs in the world there is no guarantee you get to 100%. I would hate for you to be broken and not have the full array of options available to you after your time in the military is done.

 

[France9488]

Just know that if you don't get those surgeries at the advice of the PCM or in house specialist its possible you get non compensational. So even if MEB you don't get any severance or medical retirement. I am not an expert in this part but I have known people that had the fusion surgery and it went well. I have known some where it didn't. So i get your reluctance but it would suck to be kicked out without anything to show for it and then later on get the procedure. Delaying only harms you and if you can medically retire you get Tricare for life. My wife is disabled and has Medicare through SSDI + Tricare + VA healthcare. She has a lot of health issues and its nice that she can go in different directions if she isn't happy with her primary medical care. She gets everything through the VA but when there is a deficiency she can go to pretty much any other doctor and get treatment.

I know the decision is important. However, even with the best docs in the world there is no guarantee you get to 100%. I would hate for you to be broken and not have the full array of options available to you after your time in the military is done.

Ok wow I didn’t know any of that so I am glad I sought out advice. Yeah looks like I got a lot more thinking to do. Alright thanks for that. I’ll look more into this.

 

[MSG_Raven2-3]

I had similar situation. Went to PT, neurosurgeon etc. Bottom line Neuro said “you’re done”. Surgery was an option, but I didn’t want to give any more. Gave the Army 28 years reserve (6 active). Once I made the decision, I provided medical with my MEB request package. It’s a standard forms. DA 7809 summary of care from whatever doctors are willing to fill it out and the ACFT limitations forms. That basically started the profiles. Then it’s a matter of time pressure and keep getting medical documentation. The process is riddled with twists and turns but chance favors the prepared. All said and done, Army took care of me on the way out.

So if you think you’re done, you think it IS service related. Then start digging the fox hole and preparing.

 

[PolloxTroy08]

Sounds like you're at a place where a MEB could be initiated, if now, at least eventually. A MEB is initiated when the MDRP has been reached and generally your PCM will initiate it. Your PCM was probably reluctant to do it previously based on the on-post specialists comments, but due to the off-post specialist's opinion, may now have the ammo to initiate it. It may depend on how long you've been non-deployable, generally they like a year to have passed. If you don't currently have a dead man's profile, I'd talk to your PCM about giving you one. Talk to your PCM about your unwillingness to have surgery and the path/timeline to a MEB in your case. Your willingness to have surgery or not shouldn't factor into whether a MEB is initiated, I've seen others choose not to have surgery and then get MEB'd; the Army can't force you to have surgery and they can't keep you in for more than a year when you're not deployable (at least they're not supposed to). Now whether that affects your ratings or not that I don't know, but I wouldn't think so in this case due to the complexity of your issue and the risk of spinal surgery. However, you may want to consult with IDES/PEB attorney.

 

[France9488]

Unfortunately it wasn't enough. I was told that I should go see other Neurosurgeons and the Off-post Surgeon's notes was completely overlooked. So I have appts with 2 other Neurosurgeons which will make 4 in total. Is this normal for a patient to have to go through this much length for a diagnosis to be accepted. I feel like they don't believe me and that the on post diagnosis is the only thing that matters. This is crazy, how much more evidence do they need?

 

[S3Mi]

Unfortunately it wasn't enough. I was told that I should go see other Neurosurgeons and the Off-post Surgeon's notes was completely overlooked. So I have appts with 2 other Neurosurgeons which will make 4 in total. Is this normal for a patient to have to go through this much length for a diagnosis to be accepted. I feel like they don't believe me and that the on post diagnosis is the only thing that matters. This is crazy, how much more evidence do they need?

Please make sure the documentation is actually being shared with your on post provider. What I mean by that is when you see someone off post, they should be putting in their notes/professional opinions, and that is SUPPOSED to be shared with the military health system (I forget the name). Does that happen? Sometimes. I was being seen by off-post medical professionals for 7 months... and then they told me that they had no records of the visits LOL so, I filled out the release of information form for the 100th+ time and then they got all the records a few days later... shortly after that, Med Board was started. Start figuring out what documentation they have because if they don't have much, or any, then you'll continue to spin your wheels.

In a perfect world, you'd be referred to a medical professional off-post, they would see you, put in their notes, send it to the system so ALL people can see it. Does it happen that way, of course not.

 

[France9488]

Please make sure the documentation is actually being shared with your on post provider. What I mean by that is when you see someone off post, they should be putting in their notes/professional opinions, and that is SUPPOSED to be shared with the military health system (I forget the name). Does that happen? Sometimes. I was being seen by off-post medical professionals for 7 months... and then they told me that they had no records of the visits LOL so, I filled out the release of information form for the 100th+ time and then they got all the records a few days later... shortly after that, Med Board was started. Start figuring out what documentation they have because if they don't have much, or any, then you'll continue to spin your wheels.

In a perfect world, you'd be referred to a medical professional off-post, they would see you, put in their notes, send it to the system so ALL people can see it. Does it happen that way, of course not.

It's in there and I only know this because the Physical Therapist and I looked at the notes together before I had my appt with the PA. So I know the PA seen it and I made sure to inform him that's its in there during the appt. The only weird thing is that I still can't see it on my end in MHS Genesis. Basically I was told that I should go see another Neurosurgeon on post.