Need EMG ?
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I don't see where radiculopathy or sciatia nerve damage is even listed in AR 40-501. 3-39 talks about spine. I also don't see anything about it when looking at 3-13 or 3-14, which would be the areas for the legs. They have to go off 40-501 chapter 3 for what they refer you for as being unfit. EMG is usually important into diagnosing why you have the sciatic nerve damage, and that will be what they find unfit. To just say your nerve is shot and it hurts isn't enough of a diagnosis, they need to say if its because of dislocation, herniated disc, spondylolysis, osteoarthropathy etc, and that would be the unfit condition I think.
Now, when it comes to rating, its different. The VASRD does talk about sciatia and radiculopathy and periphal nerve damage, etc. The EMG will be important, but not 100% necessary in rating the damage to your nerve. In my mind its a Good Thing that they kicked it back for further study so that you can be rated properly, either under a VA or DOD rating.
Now, when it comes to rating, its different. The VASRD does talk about sciatia and radiculopathy and periphal nerve damage, etc. The EMG will be important, but not 100% necessary in rating the damage to your nerve. In my mind its a Good Thing that they kicked it back for further study so that you can be rated properly, either under a VA or DOD rating.
MEB/PEB want to see an EMG. The VA C&P evaluation uses the pin prick method for evaluation.
The VA rates your condition, not the MEB. As far as the conditions of sciatica or radiculopathy meting/failing retention standards, AR 40-501 Chapter 3-39 h is where they would find you unfit.
The standard for unfitness is the the condition(s) fail to respond to adequate conservative treatment and necessitates significant limitation of physical activity. e.g. The pain keeps you from performing your duty.
The VA rates your condition, not the MEB. As far as the conditions of sciatica or radiculopathy meting/failing retention standards, AR 40-501 Chapter 3-39 h is where they would find you unfit.
The standard for unfitness is the the condition(s) fail to respond to adequate conservative treatment and necessitates significant limitation of physical activity. e.g. The pain keeps you from performing your duty.
3-39h says nonradicular pain, where his would be radicular I believe. My non-physician reading suggests that he needs a better diagnosis to be found unfit for his condition. Now under 3-13d you could be found unfit if it effects Range Of Motion sufficiently, regardless of cause, since sciatic nerve damage may effect your ability to move your legs or hips, but I know my peripheral nerve damage doesn't effect my ROM. 3-14h if it is causing paralysis of associated muscles, but pretty sure an EMG would be wanted to confirm paralysis.
Is it real and ratable w/o the EMG? Yes. But not sure its unfit w/o the EMG. The EMG was useful for verifying the parathysis or whatever, the tingling and pain, rather than just the loss of sensation associated with the nerve damage. My EMG said moderate damage, the pin prick said mild.
Is it real and ratable w/o the EMG? Yes. But not sure its unfit w/o the EMG. The EMG was useful for verifying the parathysis or whatever, the tingling and pain, rather than just the loss of sensation associated with the nerve damage. My EMG said moderate damage, the pin prick said mild.
scoutcc and gsfowler I appreciate the replies thus far.
I am a AGR Soldier and fall under TRICARE Prime Remote, not a MTF. Most if not all of my medical records have not been scanned into AHLTA. This appears to be the issue with the MEB Doctor not being able to find my conditions unfitting because there are no medical records to confirm my claimed conditions. Also, I had no idea I needed a EMG to confirm sciatica or radiculopathy otherwise I would have asked my civilian doctor to order these tests. Is it too late to request EMG's be done ?
Can the NARSUM be "put on hold" pending the EMG's ?
I am a AGR Soldier and fall under TRICARE Prime Remote, not a MTF. Most if not all of my medical records have not been scanned into AHLTA. This appears to be the issue with the MEB Doctor not being able to find my conditions unfitting because there are no medical records to confirm my claimed conditions. Also, I had no idea I needed a EMG to confirm sciatica or radiculopathy otherwise I would have asked my civilian doctor to order these tests. Is it too late to request EMG's be done ?
Can the NARSUM be "put on hold" pending the EMG's ?
As gsfowler said, a simple pin prick test can be used to confirm sciatica nerve damage. What the MEB is saying, and I'd agree from my reading for AR 40-501, is sciatica nerve damage (radicular pain) doesn't, by itself, fail retention standards. Are they refusing to list it as existing? That's a different problem all together. Do they have any conditions related to the nerve damage that they did list as failing retention standards?
Its important to understand the different steps at this point. MEB is just saying if a condition listed in AR 40-501 applies to you and does not meet retention standards, as well as all other conditions that are rateable. Sciatica nerve damage is ratable, and so should be listed by the MEB and described in the NARSUM. The PEB looks that over and says ok, well, of all these conditions, these are the conditions that are listed which are preventing him from being a Soldier, hence unfit. The MEB and PEB do not have to agree, although the PEB is also guided by AR 40-501, not the VASRD. So I would say its important to get more of a diagnosis, but not 100% necessary, since they can say the condition contributes to being unfit, and hence gets the DOD %. Then the VA rates every condition, fitting or not. So it may not even be important for a condition to be unfit, since for many they receive the VA money not the DOD money.
Do they have any clues as to why your nerve is messed up? You could ask for an IMR to review the NARSUM and submit a rebutall with your own documents to say why it is unfitting. Is the nerve damage just pain without effecting movement? If it effects movement, that should be evidence enough to put it under the correct diagnosis. If its just pain that interferes with the performance of duties, you may be able to get it unfit based off the commander's statement showing how it effects you.
As far as putting it on hold for more diagnostic tests to be performed, my understanding is they throw out the MEB if there is no conditions found that fail retention standards. Once the right tests are done, a new MEB is started. Are they kicked out the MEB all together for meeting retention standards?
I don't know if you can just say wait, hold up until X, Y and Z tests are done. If you have other failing conditions, my understanding is they just proceed with what they have. I think there may be a way for the servicing hospital commander (MEB hospital) to recall a case for additional tests, but its generally rare. Asking for the IMR and then asking to put in rebuttal documents should give you enough time to get an EMG done though.
Its important to understand the different steps at this point. MEB is just saying if a condition listed in AR 40-501 applies to you and does not meet retention standards, as well as all other conditions that are rateable. Sciatica nerve damage is ratable, and so should be listed by the MEB and described in the NARSUM. The PEB looks that over and says ok, well, of all these conditions, these are the conditions that are listed which are preventing him from being a Soldier, hence unfit. The MEB and PEB do not have to agree, although the PEB is also guided by AR 40-501, not the VASRD. So I would say its important to get more of a diagnosis, but not 100% necessary, since they can say the condition contributes to being unfit, and hence gets the DOD %. Then the VA rates every condition, fitting or not. So it may not even be important for a condition to be unfit, since for many they receive the VA money not the DOD money.
Do they have any clues as to why your nerve is messed up? You could ask for an IMR to review the NARSUM and submit a rebutall with your own documents to say why it is unfitting. Is the nerve damage just pain without effecting movement? If it effects movement, that should be evidence enough to put it under the correct diagnosis. If its just pain that interferes with the performance of duties, you may be able to get it unfit based off the commander's statement showing how it effects you.
As far as putting it on hold for more diagnostic tests to be performed, my understanding is they throw out the MEB if there is no conditions found that fail retention standards. Once the right tests are done, a new MEB is started. Are they kicked out the MEB all together for meeting retention standards?
I don't know if you can just say wait, hold up until X, Y and Z tests are done. If you have other failing conditions, my understanding is they just proceed with what they have. I think there may be a way for the servicing hospital commander (MEB hospital) to recall a case for additional tests, but its generally rare. Asking for the IMR and then asking to put in rebuttal documents should give you enough time to get an EMG done though.
The MEB IS listing cervical radiculopathy and sciatica on the NARSUM as VA diagnosed.
They are listing Lumber Degenerative Disc Disease and Cervical Degenerative Joint Disease as failing retention standards.
My civilian MRI's show that a bulging disc with annular tear is causing the sciatica and my cervical radiculopathy is caused by herniated discs also. I went to my civilian orthodo doc less than one week ago and he did strength tests and sensory exams and told me that I have a "pinched nerve" in my neck. The funny thing is the QTC doctor did not do any muscle strength exams, reflex exams, or sensory exams, but listed on my DBQ that these tests were done and they were all normal. The MEB Doctor quoted this in my NARSUM and said because these tests were normal, I meet retention standards for radiculopathy and sciatica.
The sciatica comes and goes depending on the position I am in. Twisting, bending, and lying on my stomach makes the condition worse.
The radiculopathy also comes and goes depending on the position of my neck and left arm. I do have constant pain under my left shoulder blade.
I have a telephonic consult with the MEB JAG (currently no counsel is assigned to the active duty post I have to process through) tomorrow and will definitely inquire about a IMR and the possibility of having my NARSUM re-written with corrections.
They are listing Lumber Degenerative Disc Disease and Cervical Degenerative Joint Disease as failing retention standards.
My civilian MRI's show that a bulging disc with annular tear is causing the sciatica and my cervical radiculopathy is caused by herniated discs also. I went to my civilian orthodo doc less than one week ago and he did strength tests and sensory exams and told me that I have a "pinched nerve" in my neck. The funny thing is the QTC doctor did not do any muscle strength exams, reflex exams, or sensory exams, but listed on my DBQ that these tests were done and they were all normal. The MEB Doctor quoted this in my NARSUM and said because these tests were normal, I meet retention standards for radiculopathy and sciatica.
The sciatica comes and goes depending on the position I am in. Twisting, bending, and lying on my stomach makes the condition worse.
The radiculopathy also comes and goes depending on the position of my neck and left arm. I do have constant pain under my left shoulder blade.
I have a telephonic consult with the MEB JAG (currently no counsel is assigned to the active duty post I have to process through) tomorrow and will definitely inquire about a IMR and the possibility of having my NARSUM re-written with corrections.
The IMR is a shot at a re-write, and its suposed to look at all records, not just C&P. It should be enough to resolve the discrepency between the two tests in your favor. If it doesn't, you can submit the ortho's exam in the rebutal to the NARSUM so the PEB can see the real results. Its making sure the limitations of the condition are accurately expressed to the PEB and how they contribute to your unfitness that's important in the NARSUM. I would focus on AR 40-501 3-12 and show how your ROM of the shoulder is restricted due to the radiculopathy and 3-13 and how the ROM of the hip is restricted due to sciatica, or 3-41e and show how they prevent you from doing any of the 7 basic soldier tasks (evade fire, shoot a weapon, wear body armor, etc). However, does it being uncomfortable or painful to do these things really stop you from doing them? Has someone said stop doing tasks the job require because it will worsen the condition? How severe is it really? There is a different level of severity needed to say unfitting for service and for saying that they effect you and deserve a VA rating. A fit finding may be more appropriate. They are already saying you don't meet standards for the joint degeneration, you need to show how the nerves are also effecting you meeting the standard in a seperate way. Just make sure there is some real information for the PEB to consider besides the C&P exam which wasn't done well.
Mine for example, I have EMG confirmed moderate nerve damage. Therapy showed some loss of strength and sensation. I did fine on the C&P exam tests because it would have to be decently severe with atrophy to fail their tests. Failing their tests would show its severe enough to be slowed down. Its not fun having it around all the time, but at my level I can still perform, so I wouldn't really be able to say its unfitting. So, personally, I am more focused on making sure I have evidence for the VA rating for that condition, rather than worrying about it failing retention standards. I suspect the majority of people that can do the simple C&P tests are going to be fitting.
I think the strength tests on mine were just the finger squeeze and pushing/pulling tests which are garbage IMO compared to what ortho would do. You may need to make sure the VA considers your whole record to get the real rating, not just the C&P, something to keep in mind for the future. Also, I think you can request a new C&P, but generally they seem to be ROM tests and let the rest of the record speak to other problems, so hopefully the rating will be correct even if the C&P didn't talk intelligently about the problem.
Mine for example, I have EMG confirmed moderate nerve damage. Therapy showed some loss of strength and sensation. I did fine on the C&P exam tests because it would have to be decently severe with atrophy to fail their tests. Failing their tests would show its severe enough to be slowed down. Its not fun having it around all the time, but at my level I can still perform, so I wouldn't really be able to say its unfitting. So, personally, I am more focused on making sure I have evidence for the VA rating for that condition, rather than worrying about it failing retention standards. I suspect the majority of people that can do the simple C&P tests are going to be fitting.
I think the strength tests on mine were just the finger squeeze and pushing/pulling tests which are garbage IMO compared to what ortho would do. You may need to make sure the VA considers your whole record to get the real rating, not just the C&P, something to keep in mind for the future. Also, I think you can request a new C&P, but generally they seem to be ROM tests and let the rest of the record speak to other problems, so hopefully the rating will be correct even if the C&P didn't talk intelligently about the problem.
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Just for clarification, radiculopathy would fall under AR 40-501, Para. 3-30,j., :
j. "Any other neurologic conditions, Traumatic Brain Injury (TBI) or other etiology, when after adequate treatment
there remains residual symptoms and impairments such as persistent severe headaches, uncontrolled seizures, weakness,
paralysis, or atrophy of important muscle groups, deformity, uncoordination, tremor, pain, or sensory disturbance,
alteration of consciousness, speech, personality, or mental function of such a degree as to significantly interfere with
performance of duty."
That is the standard you are looking to meet....note that the PEB can find conditions that are not identified as failing retention standards to be unfitting. It is more likely to be found unfit if MEB finds that it fails retention standards, too. With this section, the standards for failing retention standards and being unfit are similar.
j. "Any other neurologic conditions, Traumatic Brain Injury (TBI) or other etiology, when after adequate treatment
there remains residual symptoms and impairments such as persistent severe headaches, uncontrolled seizures, weakness,
paralysis, or atrophy of important muscle groups, deformity, uncoordination, tremor, pain, or sensory disturbance,
alteration of consciousness, speech, personality, or mental function of such a degree as to significantly interfere with
performance of duty."
That is the standard you are looking to meet....note that the PEB can find conditions that are not identified as failing retention standards to be unfitting. It is more likely to be found unfit if MEB finds that it fails retention standards, too. With this section, the standards for failing retention standards and being unfit are similar.
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And, you don't need EMG for MEB, but it helps to confirm the diagnosis.
Since you have now added that the tests were reported as normal by the C&P evaluator, in my opinion you should look for any medical evidence, that supports radiculopathy. EMG results would most certainly help.
I think you may be headed for a formal PEB, since the radiculopathy is not listed as a failing condition.
Thanks scoutcc, gsfowler, and Jason for your replies.
I spoke with my MEB JAG and he suggested that I request a IMR. I will do this tomorrow when I sign the DA FM 3947.
I made a visit to my civilian PCM who did not hesitate to give me a referral for the EMG tests on my left arm and left knee. I'm hoping these test results will be back in time to file my appeal.
I'll update everyone as the process plays out !
I spoke with my MEB JAG and he suggested that I request a IMR. I will do this tomorrow when I sign the DA FM 3947.
I made a visit to my civilian PCM who did not hesitate to give me a referral for the EMG tests on my left arm and left knee. I'm hoping these test results will be back in time to file my appeal.
I'll update everyone as the process plays out !
Well, just returned from my IMR, WHAT A JOKE !!!
Find out via a telephone call from my PEBLO yesterday that the IMR Nurse Practioner told him prior to my meeting with the NP that she said that " I do not see anything in the record to change anything". Sounds like my fate was decided by the NP before I even had a chance to meet her.
We'll, I go into the IMR with another person who just so happens to record the two hour meeting. The NP proceeds to tell me that the only thing she can "look into" are the issues that my JAG attorney mentioned in his Request for IMR MEMO. I thought this was odd, but played along with the game. I told her that I had not seen the letter the JAG attorney sent because he e-mailed it directly to my PEBLO without me reviewing it first ( there is currently no JAG assigned at the instillation I am processing through, so I have to use one assigned to Fort Sam Houston). We debate we'll over a hour on my mental issues and she says" I have to ask you how does your mental health affect you carrying and firing your assigned weapon and how Is your mental health affected by living in a austere environment". I answer her questions and try to bring up other functional activities that are affect by my mental health, but she was having none of it. She said that because the JAG attorney only spelled out carrying/firing assigned weapon and austere environment, she was only going to address those two items. I told her that the JAD attorney also mentioned in his letter that there were also "more issues" making my mental health unfitting, but she would not let me explain them to her. At this point i am upset and tell her this. I told her that "well I guess we're done here". I calm down and continue to try to explain my position to her. After a while, it seems I am getting through to her until she says that at the" MEB appeal you can address these issues". I sort of give up in my mind and decide that I'll fight it at the MEB appeal.
I proceed to show her approx. eight items that were incorrect with my NARSUM and asked her how do I get them corrected. She says " wait a minute, I'll go as the head MEB doctor" and leaves the room. She returns and tells me that she will address my NARSUM issues withe the head MEB doctor. I give her my notes that outlines my issues.
I bring up radiculopathy and sciatica as should be failing retention standards and she says that she knows for a fact that these two conditions do not need a EMG study to have been added by either the MEB or PEB, but the PEB nor MEB WILL NOT, emphasis on WILL NOT add these as unfitting. I recall reading here on the form that these conditions have been found failing retention standards by the MEB and the PEB has also found then unfitting.
Can anyone assist me there story or pointers on how to get these conditions added to my NARSUM as failing retention standards ?
Forgot my ace in the hole; the recording. Did I mention she was rude and difficult !
Find out via a telephone call from my PEBLO yesterday that the IMR Nurse Practioner told him prior to my meeting with the NP that she said that " I do not see anything in the record to change anything". Sounds like my fate was decided by the NP before I even had a chance to meet her.
We'll, I go into the IMR with another person who just so happens to record the two hour meeting. The NP proceeds to tell me that the only thing she can "look into" are the issues that my JAG attorney mentioned in his Request for IMR MEMO. I thought this was odd, but played along with the game. I told her that I had not seen the letter the JAG attorney sent because he e-mailed it directly to my PEBLO without me reviewing it first ( there is currently no JAG assigned at the instillation I am processing through, so I have to use one assigned to Fort Sam Houston). We debate we'll over a hour on my mental issues and she says" I have to ask you how does your mental health affect you carrying and firing your assigned weapon and how Is your mental health affected by living in a austere environment". I answer her questions and try to bring up other functional activities that are affect by my mental health, but she was having none of it. She said that because the JAG attorney only spelled out carrying/firing assigned weapon and austere environment, she was only going to address those two items. I told her that the JAD attorney also mentioned in his letter that there were also "more issues" making my mental health unfitting, but she would not let me explain them to her. At this point i am upset and tell her this. I told her that "well I guess we're done here". I calm down and continue to try to explain my position to her. After a while, it seems I am getting through to her until she says that at the" MEB appeal you can address these issues". I sort of give up in my mind and decide that I'll fight it at the MEB appeal.
I proceed to show her approx. eight items that were incorrect with my NARSUM and asked her how do I get them corrected. She says " wait a minute, I'll go as the head MEB doctor" and leaves the room. She returns and tells me that she will address my NARSUM issues withe the head MEB doctor. I give her my notes that outlines my issues.
I bring up radiculopathy and sciatica as should be failing retention standards and she says that she knows for a fact that these two conditions do not need a EMG study to have been added by either the MEB or PEB, but the PEB nor MEB WILL NOT, emphasis on WILL NOT add these as unfitting. I recall reading here on the form that these conditions have been found failing retention standards by the MEB and the PEB has also found then unfitting.
Can anyone assist me there story or pointers on how to get these conditions added to my NARSUM as failing retention standards ?
Forgot my ace in the hole; the recording. Did I mention she was rude and difficult !