NARSUM Rebuttal/IMR

I received my NARSUM last Friday, and had some issues with it, so I sent back a rebuttal. Basically, the characterizations of some of my conditions were incomplete, changed, or wrong. The Dr. provided a surrebuttal stating that he wasn't changing anything. It stands as is. So I requested an IMR, thinking that this might 'change' the NARSUM somehow, but according to my MEBLO, no, the NARSUM is finished, as is. So what's the point of the IMR? What outcome will I get from this? My MEBLO stated that my rebuttal will be seen by the IPEB, so I needn't worry, but I can't help but feel worried. I did forward my concerns to the JAG, and he responded and stated that yes, my rebuttal information was important to bring to light, so I guess as long as the PEB sees my rebuttal (and the fact that it actually is reflective of what's in my medical record) should be enough, right?

Also, just for informational purposes, does it matter what % the DoD comes back with, if they find me unfit, since I'm over 20 years? Am I only concerned with what the VA rates me as? I guess that if the DoD rates me at like 10%, but the VA comes back with 50%, I'm then eligible for concurrent receipt, right? And if it's 40% or lower, than that VA % amount is simply deducted from my retirement pay and basically 'reapplied' as tax free? Just wondering if what I'm thinking is correct?

Any answers would be greatly appreciated.

 

[gsfowler]

I had the same shit happen to me, my PEBLO was able to send my NARSUM to a QA team and it got corrected. It took a few months but eventually they got it close enough for me to proceed with my PEB.

Ask your PEBLO if this is an option.

It may make a difference what the DoD comes back with for tax purposes.

Since you are over 20 years, you will get your length of service retirement no matter what.

 

[NAV LDO]

I had the same shit happen to me, my PEBLO was able to send my NARSUM to a QA team and it got corrected. It took a few months but eventually they got it close enough for me to proceed with my PEB.

Ask your PEBLO if this is an option.

It may make a difference what the DoD comes back with for tax purposes.

Since you are over 20 years, you will get your length of service retirement no matter what.

Thanks for the advice. I did speak with my MEBLO, and he stated that my rebuttal AND IMR will be seen by the board, which is all I really want from this, is to make sure they understand the 'true' characterization of my conditions, and that the NARSUM is NOT accurate as is.

A JAG also stated the same and said that if the PEB feels things were not addressed that should have been, then that will be on the Dr., not the service member, so I needn't worry about an repercussions of inaccurate data being sent up. And as was mentioned, my Rebuttal reflects my medical record, and the IMR, I suspect, will as well.

On the retirement piece, that is good to know that I'll get my 22+ credited years. I wanted to know that if VA comes back with 50% or higher, I am eligible for Concurrent Receipt, correct?

Thanks again, for the input!

 

[scoutCC]

Yes you should be eligible for concurrent receipt, CRDP depends on only two factors, 20+ years of service and a 50% rating from the VA. Should be automatically applied, no application process or anything. FMR volume 7b chapter 64 provides the rules DFAS uses.

 

[NAV LDO]

Thanks scout. Was informed that my package was sent off today, so hope to hear something by December. I really have no idea how the board will decide. My NMA was pretty basically worded that I'm GTG, so long as I don't have to deploy or go overseas. With the veritable medicine cabinet full of prescriptions I take, I doubt they keep this stuff in stock on the ship, or in an isolated overseas duty station. My NMA states that I miss about a half a day of work every week for medical appointments, which is true, but says that I'm a good Officer, but cannot deploy, and should be placed in a Permanent Limited Duty (PLD) status to allow me to finish my 3 or so years left of commissioned time to get to my 10 years, then allow me to retire at that point. So I wonder if with the PLD recommendation (and the fact that I can't deploy), along with my neurostimulator implant, that I'm already at my 22 year mark, take about 8 different medications, have had 6 surgeries in the past 6 years and am still in chronic pain. So all that, and my 3 conditions I'm being referred for are...well, here it is, directly from the NARSUM--hopefully it's ok to post this--my name is not attached in anyway, but here is the Doctor's Assessment:

"ASSESSMENT:
1. INGUINAL NEUROPATHY as a complication of right inguinal hernia repair.
2. S/P SPINAL CORD NERVE STIMULATOR PLACEMENT due to #1
3. CHRONIC LBP
4. CLASSIC MIGRAINE

RECOMMENDATION: The board agrees to the above diagnosis. It is the opinion of the board that this member has a CHRONIC PAIN CONDITION that prevents him from performing the duties in his rank and inability to perform the required physical readiness test. His condition is chronic and given the duration of his symptoms, is expected to continue. This case is therefore referred to central physical evaluation board for further adjudication.

A personal appearance before the PEB would not be deleterious to this member’s physical or/ nor mental health."

I'm not sure what that last sentence is supposed to "state", really? That I'm 'ok' to go to a formal PEB is needed?

Also, a little more info about the conditions:

"CT of the LS spine showed mild L5-S1 spondylosis. He saw pain specialist who performed facets injection x2, RFA x2 right L5, ESI x2 with temporary relief of his back pain. He continues to experience pain in the right inguinal region, pain in the right medial proximal thigh region and LBP. His PRT has been waived since 2011 due to inability to run or perform stationary bike test."

Migraine headaches: He has headaches for the past 20 yrs. Intermittent. For the past year, he has 10 migraines preceded by aura (seeing squiggly lines in his visual field) followed by headaches. No associated neurologic symptoms related to this headache."

If the board 'digs' a little deeper, they'll see I've had to go in for Toradol shots and Valium a few times during working hours in the past 3-4 years.

Anyway, what do you all think, based on this limited information. I did add some stuff in my rebuttal--some mischaracterizations of conditions and treatments, and added about 3 medications he didn't list for some reason, and the fact that my back pain does actually have 'radicular symptoms' to my right buttock and hip.

Any thoughts on which way you think the board will decide?

 

[Camp P Marine]

S/P SPINAL CORD NERVE SIMULATOR PLACEMENT---May I ask how long did it take for your body to heal at the incision site?
How was this implant looked at by the VA C&P?

 

[NAV LDO]

S/P SPINAL CORD NERVE SIMULATOR PLACEMENT---May I ask how long did it take for your body to heal at the incision site?
How was this implant looked at by the VA C&P?

It was actually the most painful surgery recovery I've ever had; I feel horrible for anyone who has ever had to go through back surgery. the only reason they 'cut open' my back was for the lead placement/attachment to my vertebrae.

Anyway, I was given 30 days convalescent leave, and I needed very single day of it. I was hurting for quite some time following. The area where they made a 'pocket' of sorts, to house the battery/control unit--that only took about 7-10 days to recover from, it was the lead placement that hurt like the dickens.

As far as my C&P Report, it didn't really address having the unit implanted it self, just the scars associated with the surgery. They didn't 'rate' anything for having the implant, if that is what you were wondering. Not sure why, other than the fact that I have it helps provide some pain relief.

 

[Camp P Marine]

Thank you. I just had one installed about 3 weeks ago and it is very painful. 30 days convalescent leave, hopefully will be enough, but at this point more would be great. Also the limitations for 6-8 weeks make getting dressed and driving alone very difficult if not impossible.

It was actually the most painful surgery recovery I've ever had; I feel horrible for anyone who has ever had to go through back surgery. the only reason they 'cut open' my back was for the lead placement/attachment to my vertebrae.

Anyway, I was given 30 days convalescent leave, and I needed very single day of it. I was hurting for quite some time following. The area where they made a 'pocket' of sorts, to house the battery/control unit--that only took about 7-10 days to recover from, it was the lead placement that hurt like the dickens.

As far as my C&P Report, it didn't really address having the unit implanted it self, just the scars associated with the surgery. They didn't 'rate' anything for having the implant, if that is what you were wondering. Not sure why, other than the fact that I have it helps provide some pain relief.

 

[NAV LDO]

Thank you. I just had one installed about 3 weeks ago and it is very painful. 30 days convalescent leave, hopefully will be enough, but at this point more would be great. Also the limitations for 6-8 weeks make getting dressed and driving alone very difficult if not impossible.

Yeah, hurts like a b!tch! But actually, you'll see how 'quickly' you are able to do stuff most likely within a week. I felt like you--that no way was 30 days going to be enough--but that last week I made vast improvements. Everyone is different, of course, but at least wanted to give you a little hope. And as far as the limitations, just take it slow. But I drove after 4 weeks and was fine.

Hopefully it works for you--mine was for groin pain, and it does pretty well. What you need to understand though, is that it's just one of many 'treatments' for the pain, not a cure all. You aren't supposed to drive with it on, so any long trips can be rough. And there is only so much you can turn it up--mine sends the 'signal' down both legs, so if I turn it up too much, my legs turn to jelly, so I can only 'crank' it if I know I'm sitting for a long period, and even then, it can get 'uncomfortable' for the other areas that aren't in pain when it's turned up high.

Anyway, best of luck to you...

And for anyone else, I'd really appreciate any opinions about my case, whether with what limited information I provided, you think I'll come back as FIT or UNFIT...just curious while I'm in the 'waiting' phase...thank you!

 

[Camp P Marine]

Doesn't the device alone disqualify you for "worldwide deployable" making a strong case for unfit?

I know what you mean with the cranked up = jelly statement. When you turn it off after that it feels like you just got off a moving train or something.

Best of luck as your case moves forward. If you are fit you could still apply for LOS retirement?

 

[NAV LDO]

Doesn't the device alone disqualify you for "worldwide deployable" making a strong case for unfit?

I know what you mean with the cranked up = jelly statement. When you turn it off after that it feels like you just got off a moving train or something.

Best of luck as your case moves forward. If you are fit you could still apply for LOS retirement?

No, actually, I don't have the requisite commissioned service time, which is fine--I'm not really in a hurry to retire. My 'preferred' outcome would be FIT with PLD, so I can finish my last 3+ years on active, but feel a bit 'guilty' about taking up a commissioned 'slot' and not being able to deploy--doesn't make me much of a 'military member' if I can't deploy; basically doing a desk job that a civilian could do. But it's outside of my hands now, so I'll do whatever is dictated by the board. If they want to let me continue serving in a PLD role for 3 years, then that is more than fine with me. If they determine it's time for me to transition out of the service and retire from the Navy, then I'm preparing for that eventuality as well.