Military Psychiatrist's findings of fit or unfit

Chief

PEB Forum Veteran
#1
Does anyone know where the military psychiatrist gets their data for fit or unfit? AR 40-501 only addresses the requirement to refer an SM to the MEB.

If my psych says my condition is "medically acceptable", where does she draw that conclusion from? Is there another reg out there? Is it based solely on her opinion? If so, would I benefit by getting another objective opinion from a civilian psych?

It's a bit confusing to me.. she mentioned that she may want to hospitalize me for awhile, but yet I am fit for duty??? Makes no sense to me.

Thanks.
 

Jason Perry

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#2
Chief,

"Medically Acceptable" refers to meeting retention standards. The PEBs rate for fitness, with the standard being the members ability to reasonably perform the duties expected of someone of their grade, rank, rate, or office.

The important thing to remember is that this is not necessarily only how you can perform your current job. It is against the normal jobs held by someone in your grade and career field.
 

Chief

PEB Forum Veteran
#3
Chief,

"Medically Acceptable" refers to meeting retention standards. The PEBs rate for fitness, with the standard being the members ability to reasonably perform the duties expected of someone of their grade, rank, rate, or office.

The important thing to remember is that this is not necessarily only how you can perform your current job. It is against the normal jobs held by someone in your grade and career field.
So the fact that she put "medically acceptable" does not have much to do with whether or not the PEB will find me fit or unfit, but rather it is the written findings from the psych that will let them know whether or not I can perform the duties expected of someone of my grade, rank, rate, or office. ????

If that is the case, the all of the "medically acceptables" on my DA 3749 (9 of them), could still be found as unfit. ??
 

Jason Perry

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#4
So the fact that she put "medically acceptable" does not have much to do with whether or not the PEB will find me fit or unfit, but rather it is the written findings from the psych that will let them know whether or not I can perform the duties expected of someone of my grade, rank, rate, or office. ????
No. Medically acceptable has nothing to do with your job. The standard is the same for all jobs at whatever grade. Failing retention standards (having a condition that is not "medically accpetable") means your case will be forwarded to the PEB. Without a finding of medically unacceptable for a condition by the MEB, it is unlikely that you will be found unfit for that condition.

If that is the case, the all of the "medically acceptables" on my DA 3749 (9 of them), could still be found as unfit. ??
This works both ways. The PEB is not bound by the MEBs findings, though they often follow them. You can be found unfit for conditions not listed as medically unacceptable on the DA 3749. You can be found fit for conditions that are listed as unacceptable.

This is not to say that it is not important to get proper documentation and findings from the MEB. If the MEB Report, the Commander's input, and your profile all match up, it is highly likely that the PEB will agree.
 

Chief

PEB Forum Veteran
#5
Without a finding of medically unacceptable for a condition by the MEB, it is unlikely that you will be found unfit for that condition.
Jason,
I kind of assumed this. That's why I am trying so hard to get the docs to change my conditions to "medically unacceptable".

My understanding is that medically acceptable or unacceptable is determined by AR 40-501. For instance, if the ROM on my knee shows that my knee can't exceed flexion to 90 degrees or extension to 15 degrees. If this is the case, then this would be found as medically unacceptable. Correct?


 

Jason Perry

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#6
That would be the basis for your knee condition being medically unacceptable.
 

Chief

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#7
Jason,
That's what I thought. And as far as mood disorders, the criteria is:

a.
Persistence or recurrence of symptoms sufficient to require extended or recurrent hospitalization; or
b.


Persistence or recurrence of symptoms necessitating limitations of duty or duty in protected environment; or
c. Persistence or recurrence of symptoms resulting in interference with effective military performance.

Therefore, I need to convince my psych that my symptoms at the very least interfere with my effective military performance. It blows my mind that she doesn't see that.

I'm concerned that the military doctors may be too close to the "system" to provide a proper assesment of effective military performance. Should I seek an outside psych eval? Does the PEB typically default to military docs over civilians?



 

Jason Perry

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#8
I'm concerned that the military doctors may be too close to the "system" to provide a proper assesment of effective military performance. Should I seek an outside psych eval? Does the PEB typically default to military docs over civilians?
This is a decision you should make with your attorney's advice.

My own thoughts on this matter are that the weight given to an outside medical opinion depends on many factors. To start, yes, the military docs are given deference and weight to their decisions.

However, in some cases, a civilian doctor's opinion will be given greater weight. The factors include, whether this is an independent medical opinion in the absence of a previous therapeutic relationship. If you are only seen one time for the purpose of the getting an opinion, then this may be seen as a "paid" opinion and, thus, not objective. Other factors include the education, professional qualifications, scholarly writings, basis for opinion and experience of the doctor. The opinion of a newly minted psychiatrist, from little known State U., who only reviewed the patient's mental health records will obviously not be given as much weight as the opinion of the Dean of Psychiatry from Harvard University Medical School, who has seen the patient over a course of time.

Another factor to consider is the purpose of the opinion. If it is to sway the PEB, most times the member will have no luck with an outside opinion, in the absence of profile limitations or evidence of duty limitations. And if you have the preceding, the military doctors will have normally given a favorable opinion in the first place. If, however, the idea is that the member is looking to fight the case on appeal, very often the PEB and/or the approving authority will not respond in a meaningful way, which will give a basis for appeal. However, many times, you can accomplish the same through other means.

It is hard to think that, in the absence of a profile or evidence that your condition has impacted your duty performance, an outside opinion would have much success at the PEB. The corollary is that if you can get evidence of significant duty limitation, the profile and the supportive Narrative Summary will likely follow (and obviating the need for the outside opinion). The point is, the former will be required in almost all cases to get a fit finding anyway. Developing that kind of evidence is what I normally advocate.

TDRL members have some different considerations as they are usually seen by a civilian after they are retired. Also, as I posted elsewhere earlier today, the analysis is completely different at the VA (though many of the same considerations as to weight of opinion are still operative). As in every case, you must look at the actual circumstances of the case when deciding how to proceed.
 

Chief

PEB Forum Veteran
#9
Jason, thank you. That makes a lot of sense. I do have a permanent profile of S4 on my PULHES. Is that the kind of profile they are looking for? Or do I need a temp profile?

I'm not sure if I can get my commander to sign anything for me. He's pretty new and doesn't really know my status. I guess I could ask him anyway.

I have been seeing a civilian psych for over a year. very very nice CV. However, I think I should focus my efforts on trying to persuade my military psych by use of convincing evidence that my military duties have been impaired. She is supposed to call me tomorrow.

This forum rocks!!! I plan on keeping everyone updated as I go along and hopefully my process will help others.
 

Jason Perry

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#10
A permanent S4 is as good as it gets for showing unfitness. Only thing that can improve on that is very restrictive limitations, such as "No weapons, no exposure to explosions or loud noises, No stressful duty, Duty day limited to 8 hours, should not be deployed due to risk of decompensation," etc. But, I think with the S4, you would likely not have a hard time getting an unfit finding. No guarantees there, but a different finding would be very unusual.

If the diagnosis is PTSD, if unfit, you should get a minimum of a 50% Temp rating (which means TDRL). However, they can find PDRL if your condition is stable at 50% or higher.

Commanders are good sources for letters, but another superior or supervisor can also suffice.

Good luck!
 

Chief

PEB Forum Veteran
#11
Jason,
Thank you again. PTSD is one of the diagnosis. The other is major depressive disorder. I currently have a PULHES of 213214. I'm fiarly confident that this will change to 233214 (at a minimum). I'm shooting for a 344214. I should know by the end of this week. I may even raise my H to a 3 depending on what EENT finds during their evaluation of me and my recent MRI. I have problems with vertigo, balance, dizziness, etc... Have yet to find this in the AR. Still looking.

I'm not sure what raises the P? But I already had migraines added to my list of complaints and diagnosed by a neurologist. I have supporting docs for migraines and cluster headaches dating back to 1990. I also have Hep C which I believe should fall under the P.

Hopefully, by the end of the week, I'll have the profile I'm shooting for.
 

Jason Perry

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#12
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