Should I appeal the MEB findings before signing or after?

Leanest3

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Registered Member
I just got off the phone with legal, whom my PEBLO asked to contact me. Basically, the only thing that I claimed that is being accepted as a reason to get me out is my condition of POTS (postural orthastatic tachycardia syndrome). Army service of the last 8 years has absolutely exacerbated my symptoms, which had not really appeared before I enlisted. They only listed my symptom as getting dizzy whem going from a crouched or sitting position to standing. None of my other symptoms are listed, causing them to deny that the Army exacerbates it. Legal has given estimates of 0% from the Army and 30% from the VA. I was told I can appeal now, or I can sign and wait for the ratings, then appeal if I get 0% military.

My question is, which should I do? I feel like appealing now would be the easier and faster choice. Why would I wait for the ratings when you're estimating nothing due to them not including my other symptoms? On the other hand, waiting gives me a few more paychecks in this hard economic time, and would allow myself and family to remain on Germany for a bit longer.

Any advice is appreciated.
 

chaplaincharlie

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I'd ask the PEBLO for a VARR, it will change your rating if appropriate. Did you attoney not give you specific advice?
 

Leanest3

New Member
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I'd ask the PEBLO for a VARR, it will change your rating if appropriate. Did you attoney not give you specific advice?
She told me what my options were, but did not give an opinion. My PEBLO ended up recommending accepting now and appealing later if I want to. Apparently in order to appeal, I need to get a court date back in the US and with how things are right now, he had no idea how long that might take.
 

KAD

PEB Forum Regular Member
Registered Member
I just got off the phone with legal, whom my PEBLO asked to contact me. Basically, the only thing that I claimed that is being accepted as a reason to get me out is my condition of POTS (postural orthastatic tachycardia syndrome). Army service of the last 8 years has absolutely exacerbated my symptoms, which had not really appeared before I enlisted. They only listed my symptom as getting dizzy whem going from a crouched or sitting position to standing. None of my other symptoms are listed, causing them to deny that the Army exacerbates it. Legal has given estimates of 0% from the Army and 30% from the VA. I was told I can appeal now, or I can sign and wait for the ratings, then appeal if I get 0% military.

My question is, which should I do? I feel like appealing now would be the easier and faster choice. Why would I wait for the ratings when you're estimating nothing due to them not including my other symptoms? On the other hand, waiting gives me a few more paychecks in this hard economic time, and would allow myself and family to remain on Germany for a bit longer.

Any advice is appreciated.
I'm curious about your experience with ratings for POTS and the process in general. After 7 hospitalizations and many ER visits starting in August 2018 my son finally got the diagnosis of POTS in March 2019. The base med staff did not believe and/or accept the specialists diagnosis initially and accused him of "malingering" but eventually started the MEB process in March 2020. He had a NARSUM written in March when the process started but he has a new base doc who said he has to write a NARSUM for him. This is confusing because he recently finished his C and P exams. Is this normal at this point in the process? I Will this replace the one that was written back in March 2020 that stated he was not fit for duty and that his condition would likely not improve? The letter from the commander said the same. I'm also curious, if they are giving you a rating of 0% does this mean that they have determined you are fit for duty even with POTS?? What prevented your other symptoms/conditions from being rated? My son has a long list of things that have been documented in his multiple hospitalizations and for which he is being rated in the VA.
I just got off the phone with legal, whom my PEBLO asked to contact me. Basically, the only thing that I claimed that is being accepted as a reason to get me out is my condition of POTS (postural orthastatic tachycardia syndrome). Army service of the last 8 years has absolutely exacerbated my symptoms, which had not really appeared before I enlisted. They only listed my symptom as getting dizzy whem going from a crouched or sitting position to standing. None of my other symptoms are listed, causing them to deny that the Army exacerbates it. Legal has given estimates of 0% from the Army and 30% from the VA. I was told I can appeal now, or I can sign and wait for the ratings, then appeal if I get 0% military.

My question is, which should I do? I feel like appealing now would be the easier and faster choice. Why would I wait for the ratings when you're estimating nothing due to them not including my other symptoms? On the other hand, waiting gives me a few more paychecks in this hard economic time, and would allow myself and family to remain on Germany for a bit longer.

Any advice is appreciated.
 

KAD

PEB Forum Regular Member
Registered Member
After a multi year battle with the AF med team, my son received 10% DOD and 100% VA as his rating for POTS with the code 7010. I'm trying to understand what this means for his future, particularly around his health insurance. I know that this means he is medically separated w/severance vs medically retired. What exactly will he not have and is it worth the battle now to have the DOD rating reevaluated? They told him that he will have access to his medications (it would cost a fortune if he didn't) and all appointments with his doctors, including specialists through the VA and that the 10% really doesn't mean anything. We have a bit of a distrust for the military so I want to make sure that the information they are giving him is accurate, particularly as the future is unknown. if at any point he is unable to work due to the worsening of his condition. His medical insurance is important as was out of work/hospitalized for 7+ weeks this year which of course is concerning as any worsening of his condition could impact his ability to stay employed.
 

Makarov

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There’s not a lot of information here to guess whether or not it’s worth an appeal. The DoD only assigns a rating for the disability that makes him UNFIT for service. The VA rates on everything that is service-connected, which is why it is usually higher. If he is unable to stay employed due to his health problems, there are plenty of other benefits available to him to help him out. He can:

-Get Individual Unemployability (IU) from the VA. This will pay him out as if he was rated 100% by the VA; a substantial difference in monthly compensation.
-Get his treatments and medications from a VA hospital. This requires being near one but is definitely an option to reduce costs.
-Social Security Disability Insurance (SSDI)
-Medicare Insurance
 

KAD

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Registered Member
Thank you. I'm curious to know what he is not getting and/or what additional benefits he would be eligible for if the DOD rating was increased, particularly if the DOD rating was over 30%. The DOD rated the heart (tachycardia) only component of his POTS but did not rate his diagnosed "non-epileptic seizures" which accompany the POTS, or any other component of POTS which were rated by the VA. Is POTS typically rated as a heart issue only? When he went for his C and Ps he brought documentation with him but she would not look at it and said the info should be in his file. Our confusion was that we really don't know what was provided to the DOD for the rating, other than the letter that his commander wrote (which clearly said he was unfit) and his NARSUM or why they selected just the impact of his heart. His documentation shows that he had more than 7 hospitalizations over the last year and the code shows that more than 5 is a 30% rating but he only rated as 10%. He also has only 6 years of service but I don't think that should impact ratings. He was told that because his VA is 100%, an increased DOD rating would not change his benefits(other than the title of being medically retired) as he is already getting full medical and dental, plus his monthly compensation and his severance (from the 10% DOD), education benefits, etc.

Thanks again for any guidance.
 

Makarov

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To put it bluntly, there may not be enough medical evidence for a 30% rating. The guidance for code 7010 says that the anomalies have to be recorded using ECG or Holter Monitor. It is not based on the number of hospitalizations; it’s based on the number of recorded events. The good news is that you can get a great heart monitor that is pretty discrete from the VA hospital or Military. It’s smaller than the size of your palm and it records all data and it has an app on your phone where you can also report an anomaly you feel and record the symptoms. Then, after a time period, you can send it in for the doctor to review the results. If he wears it for a month and it shows multiple tachycardia events, then the examiners can make an assumption that he has multiple events multiple months of the year, resulting in a 30% rating. I think it would be smart to try to get a monitor and have your son wear it. The data can be recorded on his medical record. I’m not sure if they will accept the data, but Apple Watches have an ECG function that can send the data straight to his doctor. Whether or not he chooses to appeal the findings, at least he will have more data to present.

As for benefits he losing, it’s really only the retirement benefits (base access, MWR access, and Tricare insurance) if he doesn’t get the 30% rating. If I were him, I would apply for P&T TDIU through the VA. He will be making $3k+ a month in tax free compensation for the rest of his life, without fear of a rating decrease. This is also NOT a fixed income so it increases each year when Congress approves fiscal year funding. He will qualify for insurance through SSDI and Medicare and he can get free care through a VA hospital. He can work a small job, if he can, provided he makes less than the annual poverty limit. And then he’ll have all his other benefits like the GI Bill. Many states also waive property taxes for 100% VA rated vets, he can get a VA mortgage with no down payment, and he can use his disability income as regular income for the purposes of getting a mortgage. Not getting the retirement status isn’t the worst thing in the world. Definitely focus on his future and coping with, or reducing, his symptoms. Good luck with whatever he chooses!

DODINST 6130.03, Volume II
MStandards for Military Service: Retention
Section4, Subsection 5.11, Page 18
Line (m.)
“Recurrent syncope or near syncope (including postural orthostatic tachycardia syndrome) that interferes with duty, if no treatable cause is identified or it persists despite conservative therapy.
n. Rheumatic heart disease, if sequelae present.
o. History of spontaneous coronary artery dissection.
p. Surgery of the heart or pericardium with persistent duty limitations.”

VA Code 7010, 38 CFR § 4.104

7010 Supraventricular arrhythmias:
Paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by ECG or Holter monitor30
Permanent atrial fibrillation (lone atrial fibrillation), or; one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor10

This is all just what I would, personally, consider. I am not an attorney. You should definitely consult an experienced veteran attorney for further guidance.
 
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KAD

PEB Forum Regular Member
Registered Member
Thank you for this thorough and thoughtful response. He submitted data to the PCM from multiple ECGs (15ish), an echocardiogram and from 3 different heart monitors that he had during his period of diagnosis from 7/2018-4/2019. He currently has an implanted loop recorder (since 4/19) that sends data of his episodes of tacky/brady directly to his doctor as they occur, 24/7 (used to monitor his safety/treatment/next steps). This was put in after he had an episode while we was driving and lost his license. He submitted all of this data to the PCM as it occurred (as requested) but we didn't see and still don't really know what was seen by the raters or used to evaluate his case as there were thousands of pages of records and he did not specifically select what they looked at. When he had his C and P exams, she did not view the documentation he had as she said it should be in his record.

We had read this description which is what made us think he would have 30% because he has far more than 4 documented episodes a year. How do you know if the information that you present to your PCM has made it to your record or is used by the MEB/PEB?

All of this being said, although we are not sure that all documentation was provided to the raters it appears that he has the max benefits he would get based on his 100%VA (other than retirement title) and will be protected for the future. Unfortunately his route to diagnosis and eventual MEB referral was less than positive or supported by the PCM or SG---that is a whole different nightmare that my son (and our family) need to put behind us--enough said there.

Definitely focus on his future and coping with, or reducing, his symptoms---best suggestion ever. We will be so thankful and grateful to have him safely home.

Thank you for your service to our country and your contributions to support others.
 

Makarov

Active Member
PEB Forum Veteran
Registered Member
Yea it sounds like he got screwed during the C&P exam. There’s an evidence gathering phase they do and he should have been afforded the opportunity to submit things like buddy letters and such. That would have been the time to submit all those records. I found that the military tends to leave out a lot of stuff. For example, my TBI and the emergency room visit shortly after are not documented in my record. By sheer luck, I happened to have my ER discharge paperwork in a box of paperwork from an old command. I think an appeal is definitely a good idea for your son. There’s very little risk of a rating decrease and it sounds like he would definitely get the 30% rating if they had the proper paperwork. Seems worth it to me. Just know that this is going to add time to the IDES process for him.
 
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