LOD/MEB/IPEB

[CaptJ]

First let me say this is a great site with a wealth of information!

Not even sure where to start... I'm a Guardsman who has 18 years of service and spent the last 5 on active duty while getting qualified in my airframe. In 2008, I had a LOD injury during training at Fairchild. My injury occurred on day one and the medics assigned to the school felt it was plantafasia and we all thought that it would resolve in the weeks worth of academics prior to field training. Well on day 3 of field training the instructor tells me I need to see the field medic (slowing down the group). He evaluates and pulls me from training to go be evaluated by the base hospital. It takes two days to get off the mountain and back to the base where they take x-rays and determine it is broke. They fill out the LOD paperwork and cancel the rest of my training and send me back to Little Rock where we (the wife) is in the process of packing everything up to PCS back to our home of record.

Back at Little Rock and after some discussion with the Flight Med folks they agree to let me see a Flt Doc (we had already out process medical) and he sends me to the local hospital to get a CT. The CT comes back broken and he then orders x-rays on base... They also come back with a break. They tell me that since I'm PCS'g to see my Flt Doc when I arrive at my next base, give me a post op shoe and wish me luck. In recent discussions, I've been told we never should have been PCS'd with a LOD.

When I get to my HOR the base hospital tells me that I'm Guard and to go see my Med Group at my unit. I'm still on AD orders and inform them that my unit is in the desert. After about a month’s worth of fighting and receiving no care I drive the six hours to my unit to be told ‘nope can't help ya everyone’s deployed’. But go to Scott AFB and see what they say... So I drive to Scott where they take x-rays and a CT and....Yep, it’s still broke. The Flt Doc there tells me it is broken and I need to go see my Med Group at my unit. I wait around the unit for about two or three weeks and the state Ftl Doc comes down. Doesn't look at my records or my foot... Say's hear your foot is broken here is another LOD return to your HOR and report to the local AD base (catchment area) for treatment. We'll we start the whole process over again with them and eventually get in to see the doc who tells me; after a CT and xrays my foot is broken and that I need surgery. He advises that he is going to go discuss it with his Flt Chief and be right back. He returns to advise that we are going to try a few things first.

Those few things were a Cam Boot, Soft Cast, Hard Cast, Wrapped, Post Op Shoe, Crutches, and Bone Stimulator. By the time we rotated through all the "stuff" it had been a year since getting into to see the doc and almost 15 months since the LOD. Not to mention the (3) CT Scans, (2) MRIs, (3) Bone Scans, and (15 sets) of x-rays The doc tells me to go get a second opinion as he was PCSg and he felt I needed care. We went off base and the doctor took a set of x-rays and said we needed surgery. The following week I had surgery to try to resolve the problem.

Since we had an LOD for over 12 months they were pushing for an MEB. However, since I was just days out of surgery they delayed till I was supposedly healed. It’s important to know that being Guard orders were cut for 30 days at a time so everytime orders ended I would drop from TriCare while they worked to get the next set of orders. This caused numerious breaks in care and most importantly Physical Therapy.

The MEB came back and said Return to Duty. While this was the outcome we wanted we were still having problems and were still in PT. That was the units green light to get me back in training and when I said that we didn’t have the required waiver from A3 as per the MEB findings and that I was still under care the unit went nuts. At this point we had been on an LOD for nearly 2 years; however care (surgery) was actually performed six months prior. After all the problems with getting care I requested a transfer to another unit… Maybe, not the best idea at the time… I was told I had three choices: resign my commission, face a Flight Evaluation Board (the unit would take my wings), or voluntarily turn in my wings. I talked with the ADC and decided that the best course was to tell them to re-board the MEB since the issue hadn’t resolved.

Then local base did an MEB last week and it was referred to IPEB. However, due to numerous errors on the 618 they are re-boarding it this afternoon. I spoke to the Flight Doctor who said that he thought there was/is more they can do for pain management and I expressed my desire to stay in even it I was unable to fly.

Found out today that I have an opportunity to fill an IMA non-deployable position but obviously this all hinges on the MEB/IPEB. What can I or should I do? The MEB is local level and while an RTD would keep me in it sends me right back to my unit. An IPEB would allow me to request a non-deployable position but really what are the chances the board grants that. To top it all off I had a doc tell me “if you can’t do the PFT then you’re out”. Since I now have a fused toe and screw… Running is out an doing pushups are questionable since the range on motion on the foot is such that it creates pain when flexing that much.

SORRY for the book… but it captured all the facts and hopefully will help someone else in the future.

 

[CaptJ]

When I talked to the MEB office and asked why none of my other service related injuries were on the 618 they said that the MEB is for my foot only. Is that correct? Also, told I can't see the Commanders letter. I know it's not favorable as he told me in no uncertain terms I was a f&*@# idiot and anyone can do my job. How heavily does this weigh on the MEB and the IPEB and do I have any recourse?

 

[Sgt Williams C. L.]

Sir, do you know how to get the PEB process started? I am trying to research somethings for someone i worl with and i am looking for some answers.

 

[CaptJ]

I don't know they PEB process and hope that those on here can help before we have to add mental health to my package. It's frustrating to watch the guys that want to stay in get put out and those who want out they keep. Whats worse is I would be back to flying if I had lost my foot and had a prostetic but cause my toe is fused here we sit. Ergggg.

 

[maparker]

See the information below. It is from an email from me to a soldier who was also having issues with his MEB. Also see
Reserve Commanders' Guide to the PDES on the USAPDA website. https://www.hrc.army.mil/site/Active/tagd/Pda/pdapage.htm


Mike



Thank you for contacting me in regards to your DES processing. Your concerns are well founded. An improperly adjudicated MEB will lead to an improperly adjudicate PEB and that will likely cheat you and your family out of proper DoD disability benefits you are eligible for by your service to our great Nation. It is ironic that many of these DES problems are perpetuated by Service and DoD civilians who themselves have outstanding disability coverage provided by the Federal Employees Retirement System. You can read about their disability coverage here: FERS Disability

As a wounded warrior advocate, I often hear buzz phrases that indicate DES cases are improperly adjudicated or artificially limited. If you hear these types of phrases, warning bells need to be ringing in your head loud and clear as you are about to get screwed. Here are some examples:

1. “You will only be evaluated for the referred condition(s)”
2. “If you condition meets retention standards, it will not be part of you MEB nor further evaluated”
3. “Go to the VA for those conditions”/ “That’s what the VA is for”
4. “Those “rules” only apply to the new DES Pilot Program” (A good example is the need to include the minimum criteria of the VA’s AMIE worksheets)
5. “There is no way you are getting a retirement that I had to work twenty years to get”
6. “The DES process is different for guard and reserve members. (While there are some differences, all service members, active, guard and reserve on active duty orders for a period of 31 days or more are covered under the same DES eligibility laws and procedures.)
7. “You do not have enough years/rank to qualify for a disability retirement”
8. “TDRL MEBs don’t need to be as comprehensive as your initial MEBs”
9. “PEBs only rate independently unfitting conditions”
10. “If the condition is found within 180 days/30days, it is not eligible for DES coverage.
11. Since you have an ETS date/were stop loss/pending a non punitive discharge, you will not be referred to the DES.
12. Since there is a genetic component to you condition, it is automatically consider to preexist service and therefore non compensable.
13. “You have “adjustment disorder” or “personality disorder””
14. “Deployability cannot be the sole reason for finding a member unfit.”
15. “I am not familiar with that DES law/ regulation/policy. We only follow local/Service DES regulations and policies”
16. “We had someone else look at you MEB so that counts as an independent review.”
17. You did not finish basic/AIT/1st year/1st tour so you are not even a real soldier/sailor/marine/airman and don’t deserve disability benefits.
18. You were not hurt in combat/never deployed and therefore you arenot eligible for and/or deserve disability benefits. (The premium for eligibility for DES coverage is paid in full when you take an oath to defend this great nation. Don’t ever let anyone tell you different.)

Here is the short history. DES laws, regulations and policies over the years have generally been good at protecting the equities of service members who become hurt/sick/injured while serving in the military. However, these provisions were all too often not followed nor enforce by DoD and Service DES officials. The lack of use and enforcement of the rules is sometimes driven by ignorance and sometimes driven by arrogance. Neither is acceptable. It was this ignorance and arrogance that fueled the “Walter Reed” scandal that broke into the public eye in early 2007. (“Walter Reed Scandal” is a misnomer in my mind because the problems were more about DES bureaucracies that are still widespread throughout the military.)

In the wake of the problems identified in the “Walter Reed” press coverage, Congress, DoD and the Services tightened up DES laws regulations and policies. Unfortunately, this does absolutely no good if there is no enforcement. That continues to be the problem. The lack of awareness and enforcement of DES provisions makes it especially critical that you take the time to educate yourself to help ensure your DES case is properly adjudicated. I know this is terrible unfair as a disabled service member should be able to get complete and fair disability evaluation without having to ensure the rules are followed. However it is the reality we are dealing with until the “warrior care ethos” truly becomes a reality.

To begin this process, let me walk you through some key, well established, but often ignored DES provisions. Many of the documents that contain these provisions can be found on the USAPDA website located here: https://www.hrc.army.mil/site/active/tagd/pda/policy_refs_Updated_062207.htm

First is an excerpt from DoDI 1332.38:

E3.P1.2.3. Content. MEBs, TDRL physical examinations, and Reserve component physical examinations shall document the full clinical information of all medical conditions the Service member has and state whether each condition is cause for referral into the DES. (See enclosure 4 of this Instruction.) Clinical information shall include a medical history, appropriate physical examination, medical tests and their results, medical and surgical consultations as necessary or indicated, diagnoses, treatment, and prognosis. MEBs shall not state a conclusion of unfitness because of physical disability, assignment of disability percentage rating, or the appropriate disposition under Chapter 61 of 10 U.S.C. (reference (b)).

DODI 1332.38 also has attachment 1 of Enclosure 4 that delineates the minimum data requirements required for MEBs. Make sure your MEB is compliant with these requirements. It begins on page 66 of DoDI 1332.38.
As a result of the Walter Reed scandal, several new laws and policies were put into place. Unfortunately, again either by ignorance or arrogance, the Service DES officials continue to do business as usual. If you MEB officials are ignorant of these provisions, educate them. If they arrogantly refuse to follow them, just let me know. I am current engaging DoD, the Services, Congress and the press on these issues.

One of the key Post Walter Reed DES MEB provisions states that MEB documentation must include the minimum criteria from the VA general exam and AMIE worksheets. These documents are specifically designed to ensure the information required to properly rate the condition is included. Without this information, you are at high risk of being improperly rated for any condition that is unfitting or that contributes to unfitness. Insist your MEB includes the required information from the VA general exam worksheets and the applicable AMIE worksheets. The Army has a policy dated 24 July 2009 that implements this requirement. I have attached a copy of this policy. Below is the DoD requirement:

DTM 14 October 2008

E3.P1.2.6.1. The Military Departments shall publish policies that ensure:
E3.P1.2.6.1.1. Service disability medical examinations for the DES meet the
minimum criteria outlined in the VA General Medical Exam, and the applicable Compensation and Pension Automated Medical Information Exchange (AMIE) worksheets.

These worksheets can be found here:

Index of Disability Examination Worksheets (U.S. Department of Veterans Affairs)

The same 14 October 2008 DTM includes a requirement to provide an impartial medical review of your MEB. Once your MEB is complete you need to request such a review. If your MEB is incomplete, you need to bring those issues out in your rebuttal. This is your best chance to get the MEB right so exercise these rights. If your MEB goes to the PEB broken, you will likely get a bad PEB adjudication as well and this will affect the health and welfare of you and your family. This requirement is below:

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.

Another relevant provision from the 14 October DTM states all independently unfitting conditions and conditions that contribute to unfitness must be rated per the VASRD. This provision states:

E7.1.2. The Department of Veterans Affairs Schedule for Rating Disabilities
(VASRD) shall be used in making ratings determinations for each of the medical conditions determined to be unfitting independently or due to combined effect, to include in combination with an independently unfitting condition. If more than 1 military unfitting condition exists, the VASRD will be used to determine a combined disability rating for each unfitting condition. For purposes of establishing a rating, the VASRD will be used in
relation to the Service member's physical disability at the time of the evaluation. If use of convalescent ratings and/or other interim ratings (i.e prestabilization ratings) applies, the Service member may be placed on the Temporary Disability Retired List (TDRL) for reevaluation purposes.

E7.1.3. Use of the VASRD is statutorily required, “to the extent feasible.” In
applying the VASRD, any determination of infeasibility would have to be based on statutory differences between the DoD and VA disability systems, compelling differences in mission grounded in statute, or some other major difference in the 2 systems. A policy disagreement or different medical opinion would not constitute infeasibility.

This is but another reason why it is important to have all you medical conditions covered in your MEB. Again, insist they do and use your impartial medical review and rebuttal to highlight missing requirements. Your DA Form 3947 must list all diagnoses. Make sure it does.

Below are some counseling and PEBLO requirements from the 14 October DTM. Please do what you can to educate your MEB staff on any areas where they are not meeting the standards.



E3.P1.4. Counseling
E3.P1.4.1. Purpose. The counseling element of DES shall afford Service members undergoing evaluation by the DES the opportunity to be advised of the significance and consequences of the determinations made and the associated rights, benefits, and entitlements. The Military Departments will publish and provide (or make available) standard information booklets in hardcopy and electronic form that provide general and specific information on the MEB and PEB processes. These publications will include the rights and responsibilities of the Service member while navigating through the DES. The information will be made available at the servicing medical treatment facilities (MTFs) and Physical Evaluation Board (PEB).

E6.1.1. Physical Evaluation Board Liaison Officer (PEBLO). The PEBLO is a DoD employee assigned to serve as the Service member’s case management specialist throughout the DoD DES process. The PEBLO informs and notifies the Service member of the Medical Evaluation Board (MEB) and the Physical Evaluation Board (PEB) process and results. The PEBLO also coordinates with the assigned VA MSC on all issues requiring the VA’s action. The PEBLO is trained and qualified on uniform DoD standards of practice.

E6.4. PEBLO DUTIES. Immediately after the DES case is referred to the MEB, the MTF Patient Administration assigns a PEBLO to the case. The PEBLO provides the coordination among the Service member, the member’s command, the MSC and the DoD DES. PEBLOS are an integral part of the process from the point of MEB referral to the Service member’s return to duty or to separation from military service. Specific duties of the PEBLO are found in Military Department regulations and instructions, but minimally the PEBLO shall:

E6.4.1. Explain the process of the DES and the VA Claims process (VA Physical Disability Evaluation Board Claim -VA Form 21-0819) to the Service member and /or family or representative. The PEBLO must maintain brochures and other approved products for the Service member to read and take home to family members.
E6.4.2. Explain the statutory, DoD requirements and respective Military Department policies to the Service member to include process steps on dispute resolution.
E6.4.3. Explain the methodologies for decisions and the ramifications of findings to the Service member and his/her family or representative.
E6.4.4. Explain and assist in the processing of requests for formal boards and appeals. Assist in referring the Service member to legal counsel, as appropriate.
E6.4.5. Explain the payment calculations for severance pay or retirement pay, or refer the member to the appropriate DFAS or finance representative.
E6.4.6. Refer the Service member to the MSC to explain the potential VA benefits and VA-specific appeal process.
E6.4.7. Refer the Service member to the Social Security Administration for any benefits that the Service member could receive while on active duty and after transition to veteran status.
E6.4.8. Counsel the Service member on potential transition insurance and Survivor Benefit and Transition programs and benefits or refer the member to the appropriate base level support agencies to include trained Survivor Benefit Plan (SBP) counselors and the Transition Assistance Program (TAP) staff. This information is also provided by the Services’ TAP.
E6.4.9. Construct the DES case file and ensure that the MSC is aware that a new case has been initiated. Provide the MSC a hard copy or electronic copy of the file.
E6.4.10. Obtain the line of duty determination and good conduct determination when required by notifying the Service member’s command.
E6.4.11. Ensure the Service member is scheduled for all general and specialty medical examinations required for their DES case through the best source (MTF, contractor, Veterans Health Administration, or TRICARE provider).
E6.4.12. Monitor the completion of scheduled examinations and resolve scheduling issues to ensure completeness of the DES case file.
E6.4.13. Maintain program effectiveness data (to include the administration of survey and customer satisfaction data) as required by DoD issuances.
E6.4.14. Act as a conduit for information and DES decisions to the Service member’s parent command and to the VA.
E6.4.15. Provide the Service member or his designated representative with a copy of the member’s medical evaluation board results or the narrative summary, the Informal Physical Evaluation Board findings, rating(s) and decision, and line of duty determinations upon election of Formal Physical Evaluation Board and ensure medical records are available for review as well.
E6.6.4. Online Resources. There are several resources available to the PEBLO that provide training, Service member referral, and general information on the DES, including the MEB and PEB processes.
E6.6.4.1. Military One Source is a clearing-house of information and
referrals on a variety of subjects from health care to housing, pay, and personnel benefits useful to Service members and those responsible for their care located at:
Military OneSource. Also available is a 24-hour hotline at 1-800-342-9647.

This is not everything you need to be aware of as you go through the DES but it does contain the key provisions for the MEB phase. Please keep in touch as you proceed through your MEB and PEB.
Regards,

Michael A. Parker
LTC, USA (Retired)
Wounded Warrior Advocate

 

[CaptJ]

Thank you! I see I'll already have to challenge the MEB process... Reading through the information you sent raised another question; should I be on orders while this is going through the MEB process? I was told by the NGB that I would remain on orders till resolved but my unit canceled the orders in July and the MEB process restarted in October of 2010.

 

[CaptJ]

<<Bump>>

As a reservist/guardsman going through an MEB should I be on orders? My unit took me off orders after the first MEB said RTD. However, I was still undergoing treatment and was told that if I wasn't able to get back in the airplan then I would have to go back for a second MEB. From June 2010 till now I have been in the MEB/DES process without orders... My MEB came back as a refer to IPEB. Been waiting on the PEBLO to send me the package so I can sign; it for the last week. She originally, said she the board was done and she was sending it to AFPC! Only after I said that I'm supposed to review the package and request independant review did she say she would send it after the MDG signed it. We'll see...
Any help on the orders question is greatly appreciated.