What to do, where to go?

H0713

PEB Forum Regular Member
Registered Member
Greetings all. I hope this is a place that can help. I came across it after doing some research. The past year and half, I have had some issues, as well as some diagnosed issues. Current, my Primary Care Provider has me on a profile of 333111, and for some reason, she was unable to select Needs MEB. Let me provide a brief history. I have a permanent profile for Chronic Plantar Arch Pain, no worries there, it originally had me at a 112111. Last year around summer time, I had my knees and neck Xray as I was scheduling my hernia surgery (second one). The knees came back with degenerative arthritis, and my neck is a whole other issue. Neuro has not done surgery yet, I have done therapy to no avail, and they tried one pain blocking shot to no effect and I have one more before they determine if surgery will fix it or not, which it appears as if they will have to do surgery. I also start therapy this month for my knees and finally got an appointment with Ortho, hopefully they can give a better idea that my PCM who is a NP. Because of Neuro, and my foot, and now my knees, I cannot carry a weapon (which in my MOS I have to carry daily), and my profile has me limited to absolutely nothing, No all the way down. I guess my question is this. I have been in four services, reserve and active, and am hitting my 18year mark this year. What are the odds they are going to medically retire me. I guess I am concerned because its only been the last couple of years that things started breaking down. I would hate to leave with no retirement and no benefits. That has a pretty high suck factor. As of now, I can only move certain ways, and besides dropping things randomly, I can't move my neck for a prone position, and because of my knees and neck together, often times during the day, I have to move around and kind of stretch or find different positions. Any thoughts or insights would be greatly appreciated. Neuro stated it is Cervical Spondylosis, Cervical Radiculopathy. But like I said, they are putting off surgery as a last resort. Personally...Im tired of living with a "5" every day I wake up. If anyone has an expertise or an insight, I can gladly provide more details.
 
Which branch are you in, Reserves or Active Duty? and I'm guessing you're Combat Arms.

The short answer is you have to be referred to an MEB.

Then the MEB sends you off for VA C&P exams and has a NARSUM done.

Then the MEB decides which of your conditions does not meet retention standards.

Then it's sent off to the PEB, who sends it back to the VA for ratings.

Then the PEB decides which of your conditions are Unfitting, and those and only those are factored into what the DOD ratings are, and they are separate from the VA as the VA counts all your ratable conditions for benefits.

If your DOD ratings are BELOW 30% you're Medically Separated, if they are 30% OR HIGHER you are Medically Retired.

Medical Separation is a one time lump sum severance check, with NO Military Retirement or Benefits (including NO Tricare).

Medical Retirement means no large lump sum, but Military Retirement Benefits including Tricare. If your injury is Combat Related, including instrumentalities of war, or simulations of war, then you should be eligible to draw BOTH your VA benefits as well as a calculated portion of your military retirement and CRSC benefit.

In any case, the VA ratings and benefits paid are separate and don't count for or against what the military may give you, BUT if your injury is NOT combat related, it will be recouped over time from the VA benefits.

Hope this helps...

There's plenty more information on when and how to fight and appeal. but that's for another time.

Welcome to the forum
 
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I'm sorry, I was trying to keep it somewhat short. Yes, I am currently active and yes Combat Arms. My PCM has stated I need a MEB, bless her heart, but I'm not quite sure she knows what to do. I'll have to look up the rest of the process, C&P and NARSUM. Im just trying to get my head around it right now. I did not know off hand there was a difference between the two, interesting. Well, I would hope like hell I get Medically Retired. Permanenet for my foot, degenerative arthritis in both knees, and the neck surgery alone will be two plates front and back.... I know it runs counter, but I would think since most of it appears to be service related (Not necessarily combat related (no injuries), I would think medical retirement would be it. I don't know. Can I be Medically separated with a lump sum, and still receive benefits from VA?

I have to say..after years in the military....this alone....this process is so unreal and complicated. I had even thought about trying a TERA, simply because I can't make e-7 before retirement (but can't because I have no bad papers)...FML...can't win for losing sometimes....

Thanks for all the help !
 
VA C&P exams is where you will get examined in person and the VA examiner will report on your condition and limitations, such as your range of motion (ROM) and any episodes of being bedridden, etc... The C&P reports will play a key part in how the VA rates you later on. Hopefully they will be accurate, but if not, there's things you can do to effectively counter by showing other medical evidence that shows your conditions to be worse than shown on the C&P's. A DBQ (Disability Benefits Questionarie) roughly the same questions as the C&P, but performed by an outside doctor of your choice is probably the best counter to a falsely minimizing C&P exam.

NARSUM, Narrative Summary, is an interview with a military physician. It will play a key part in the MEB's decision as to what they consider are limitations and conditions that would NOT meet retention standards. It's important that you explain your conditions and limitations fully. They are looking at IF you can perform you MOS at the position and rank you hold, so if you're an Infantry Staff Sergeant, your inability to perform such activities what they should be comparing your limitations to.

At the MEB stage, they will give you a list of all your stated conditions, and a decision on which they consider do not meet retention standards. You will have 10 days to review, talk to JAG attorney (free of charge) or a lawyer of your choice (at your expense) and file an appeal to the MEB if needed. It's key at this step to have ALL the conditions that prevent you from doing your military job listed as NOT meeting retention standards. This can get technically complicated, there are conditions that are ratable but might not be on the MEB findings, in my case getting bilateral (both legs) radiculopathy added by appeal was crucial to success later on during the PEB stage. This is where researching all your conditions and the medical basis for what is and isn't meeting retention standards is key. Do your homework, look them up in AR 40-501.

http://www.apd.army.mil/pdffiles/r40_501.pdf

After MEB the VA will decide based on your medical records, the C&P exams, and the NARSUM what each condition warrants for a rating based on the severity. This usually takes several months for the VA to process, it's the quiet before the final storm.

When the PEB gets the VA's ratings back they decide which conditions are "Unfitting", they base this mostly on what the MEB has found as Not meeting retention standards, hence the reason why getting the MEB findings right is crucial. Then the PEB will send you their findings along with the VA's ratings. Again you'll have 10 days to review and appeal if needed.

If your VA ratings are lower than they should be, at the PEB stage you can file a VARR (Veterans Administration Ratings Reconsideration), which the JAG lawyer will help you with. A great weapon to show your actual limitations and conditions is a DBQ for that particular area of injury, as explained above. When two sources of reliable evidence (C&P and DBQ) that disagree for a ratable condition, the VA is supposed to default to the higher rating.

The Military Severance is a shining carrot on a stick to those like the idea of a big lump sum check, but keep in mind that's a one time deal and the VA will get every penny of it back over time if you can't prove it's combat related. Worse you'll be out of the military with NO Tricare coverage (in the long run worth more than any severance check), and as far as the Army's concerned you're not their problem anymore and you have NO retiree benefits such as base privileges, life insurance, SBP (Survivor Benefit Plan) which allows your wife to draw up to 55% of your military retirement check AFTER you die for the rest of her life. That said in most every case getting to 30% or higher on the Army PEB finding and being Medically Retired is a much better deal for financial security and healthcare coverage.

No matter what rating the Army gives you, the VA ratings (for all your ratable conditions) is separate and paid from the VA not the Army. Lump sum you pay back to the VA over time, and the Army retirement money you have to waive to draw the full VA amount, IF you don't qualify for either CRSC or CRDP.

CRSC and CRDP are the two ways you can draw BOTH the VA disability and Army Retirement benefits, basically CRSC applies to Combat Related injuries (including getting injured by military specific gear, or during field training for combat), and CRDP applies to those who have at least a 50% rating AND have 20 good years of service. I believe TERA after 15 years also counts if you can swing it, but double check.

http://www.dfas.mil/dfas/retiredmilitary/disability/comparison.html

Lastly the hardest part of the IDES process is you have to learn much of it on your own, and messing up one step can have severe repercussions at later steps. So you're doing the right thing to ask, learn, explore and know beforehand. This forum is a great source of both information and experience. Still it's up to you to do the research and legwork to get the best outcome possible.

Hope this helps...
 
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Wow, first, thanks for all the info. It does sound like a hell of a process. Nope, I'll fight for retirement, no lump sum if I can avoid it. I think it is going to be very interesting and more than likely frustrating at times as well. I was pushing the whole early out thing, which apparently I can't do, then fight the fight with VA later. But since I can't, I'll go through the process. I'll have to take a look through the forums. I still have my upcoming appointment for my knees with Ortho, and the follow up with Nuero. Nuero alone has said MED, period. Si I guess the wait begins. Thank you so much. Hopefully I can contribute to the forums in some way as I am beginning to understand what a nightmare process this is.
 
I talked to my PCM, after a discussion, she has changed my profile to a 333111. She also sent it up for MEB, and the person she sent it to has sent it to the IDES chief at Fort Meade, since I am at Fort Myer. I started Physical Therapy for my knees, still no MRI. Physical therapist seemed nice enough, prior I had met with Sports Medicine, complete waste of time. She was half an hour late, walked in, no apologies, no nothing, sat down and said "Tell me what's wrong". I did, she recommended I purchase an over the counter herbal supplement out of pocket and there wasn't much more discussion. I told her everything I tired and she said to get with therapy and see how it goes. Awesome. Anyways, we will see what happens.
 
I talked to my PCM, after a discussion, she has changed my profile to a 333111. She also sent it up for MEB, and the person she sent it to has sent it to the IDES chief at Fort Meade, since I am at Fort Myer. I started Physical Therapy for my knees, still no MRI. Physical therapist seemed nice enough, prior I had met with Sports Medicine, complete waste of time. She was half an hour late, walked in, no apologies, no nothing, sat down and said "Tell me what's wrong". I did, she recommended I purchase an over the counter herbal supplement out of pocket and there wasn't much more discussion. I told her everything I tired and she said to get with therapy and see how it goes. Awesome. Anyways, we will see what happens.
Sounds like you're on track for the IDES/MEB/PEB. Unfortunate that the Sports Medicine doctor wasn't more helpful, but that the way it goes, some are good and some are bad. Either way keep moving forward.

If you haven't already, look over AR 40-501 and the VASRD's for your particular condition(s) to have a decent idea of how the Army judges meeting retention standards and how the VA rates conditions based on severity. If you do this BEFORE the C&P exams and NARSUM it will give you a better idea of what kinds of things they are looking for and what they might rate them.

http://www.apd.army.mil/pdffiles/r40_501.pdf

http://www.benefits.va.gov/warms/bookc.asp

Good luck and keep proactive about both your treatment and your working through the IDES process.

Hope this helps...
 
Sounds like you're on track for the IDES/MEB/PEB. Unfortunate that the Sports Medicine doctor wasn't more helpful, but that the way it goes, some are good and some are bad. Either way keep moving forward.

If you haven't already, look over AR 40-501 and the VASRD's for your particular condition(s) to have a decent idea of how the Army judges meeting retention standards and how the VA rates conditions based on severity. If you do this BEFORE the C&P exams and NARSUM it will give you a better idea of what kinds of things they are looking for and what they might rate them.

http://www.apd.army.mil/pdffiles/r40_501.pdf

http://www.benefits.va.gov/warms/bookc.asp

Good luck and keep proactive about both your treatment and your working through the IDES process.

Hope this helps...
I just got off the phone with the MEB doc. He was pretty polite. He told me pretty much my neck alone (I believe) will be a 60% disability payment from VA. He said he doesn't believe my knees and foot would count towards the disability. He did recommend i do a sleep study for whatever reason. He said if I go through the board now, that is what I will receiv. around 1600-1800 a month. He also said if the Army awards me 30% I would keep my id card and benefits (but no payment). He also explained that I could take a lump sum of somewhere around 30,000 and after about 18 months, i would receive my VA payments. He also said if i could stick it out another 20 months, i would double in pay because of retirement and benefits. Interesting. Although I have an open job offer, I really don't know what to do. The doc did state, there is nothing they are going to do to be able to fix my neck, Nuero has pretty much said it as well. The pain shots are only diagnostic (that would take way to long to explain). I am going to look over what you have sent, Florida..I really appreciate it. I really need to give it some discussion with my wife and see what best suits us.
 
Obstructive Sleep Apnea is often caused by your neck structure. The theory about being overweight causing it is due to the extra weight at the neck being enough to distort the neck and cause an obstruction. Its probably wise for anyone with a serious neck problem to get it checked. Most of the complaints about OSA ratings isn't because OSA isn't a serious problem that leads to shortened life spans and complications, its just that once treated those serious problems are most likely no longer a factor.

He also said if i could stick it out another 20 months, i would double in pay because of retirement and benefits. Interesting. Although I have an open job offer, I really don't know what to do.

Research CRDP and CRSC. If you have injuries that are combat related, CRSC may be able to justify not worrying about CRDP. Being at 18 years, finding a way to delay the MEB so that you can get CRDP is likely a worthwhile strategy.
 
On the subject of Obstructive Sleep Apnea (OSA) Benjamin Krause posted an article on his site today regarding a study that was done connecting stronger symptoms of OSA to those suffering from PTSD. May or may not apply in your case, and just because a study supports such a link, it doesn't mean the VA will.

http://www.disabledveterans.org/201...e0a7bcf72bea5d85c062e1ed3f15be550201b7e5c4557

BTW, if you're planning on using the VA's Voc-Rehab program, Benjamin Krause wrote a good guide on the intricacies of it. It's available for sale and downloading on his site. Beyond that I also bought the book "Veterans Guide for Dummies" 2009 edition, and it is also helpful on a wider range of Veteran related topics.

Hope this helps...
 
Obstructive Sleep Apnea is often caused by your neck structure. The theory about being overweight causing it is due to the extra weight at the neck being enough to distort the neck and cause an obstruction. Its probably wise for anyone with a serious neck problem to get it checked. Most of the complaints about OSA ratings isn't because OSA isn't a serious problem that leads to shortened life spans and complications, its just that once treated those serious problems are most likely no longer a factor.



Research CRDP and CRSC. If you have injuries that are combat related, CRSC may be able to justify not worrying about CRDP. Being at 18 years, finding a way to delay the MEB so that you can get CRDP is likely a worthwhile strategy.
No, they are not combat injuries..just old fashioned wear and tear....
 
Although the process seems simple, it seems complicated at the same time. I have spoken to "someone" from the MEB, and yet I have no idea of what is going on or what is going forward. I did send that person a couple of emails about considering what he had told me and I told him what path I was likely to go down. I called yesterday and he was hesitant because I mentioned the word offer. Interesting? Anyways, he said he would be sending whatever forward for the MEB....
 
Well, I just found out the Dr. I had been talking to was simply letting me know there is a possibility of a MEB Board. The issue, my PCM did not list it as a permanent profile and this doctor was only letting me know what my options are and the likely outcome. I guess that was pretty nice of him, after he explained it. So, I have to get my sleep study done, get back with my PCM, and let her know to make my profile permanent with the 333111 and go go forward.....been wasting time, i guess in a way....but atleast this will give me a few more weeks to get the sleep test done ( I don't see anythjing coming from it) and to get further documentation on my knees. That may work out.
 
Which branch are you in, Reserves or Active Duty? and I'm guessing you're Combat Arms.

The short answer is you have to be referred to an MEB.

Then the MEB sends you off for VA C&P exams and has a NARSUM done.

Then the MEB decides which of your conditions does not meet retention standards.


Then it's sent off to the PEB, who sends it back to the VA for ratings.

Then the PEB decides which of your conditions are Unfitting, and those and only those are factored into what the DOD ratings are, and they are separate from the VA as the VA counts all your ratable conditions for benefits.

If your DOD ratings are BELOW 30% you're Medically Separated, if they are 30% OR HIGHER you are Medically Retired.

Medical Separation is a one time lump sum severance check, with NO Military Retirement or Benefits (including NO Tricare).

Medical Retirement means no large lump sum, but Military Retirement Benefits including Tricare. If your injury is Combat Related, including instrumentalities of war, or simulations of war, then you should be eligible to draw BOTH your VA benefits as well as a calculated portion of your military retirement and CRSC benefit.

In any case, the VA ratings and benefits paid are separate and don't count for or against what the military may give you, BUT if your injury is NOT combat related, it will be recouped over time from the VA benefits.

Hope this helps...

There's plenty more information on when and how to fight and appeal. but that's for another time.

Welcome to the forum

Is this only an Army process, or DoD-wide process. I ask because I have heard nothing about a C&P exam taking place either at that point of my MEB, or soon after. And is the C&P ONLY done following an MEB's findings that you have conditions that do not meet retention standards, or will I go through a C&P if they decide I'm to go on LIMDU.

Also had a question regarding one of your other posts--the DBQ exam. Is this something I set up for a civilian physician? If so, is it a specific TYPE of physician? And is this something I get a referral from my military PCM for?

A lot of good info you posted, so I appreciate that, but has also raised more questions for myself that I need to research, I guess. Thanks in advance!
 
DoD requires the VA to provide a C&P exam and ratings for everyone in the IDES process, so AF, Army, Navy, Marines (coast guard is homeland security). The C&P exam then becomes the exam of record and part of the MEB. So the C&P is done after LIMDU and after LIMDU decides MEB is necessary, but before MEB is complete.
 
Is this only an Army process, or DoD-wide process. I ask because I have heard nothing about a C&P exam taking place either at that point of my MEB, or soon after. And is the C&P ONLY done following an MEB's findings that you have conditions that do not meet retention standards, or will I go through a C&P if they decide I'm to go on LIMDU.

Also had a question regarding one of your other posts--the DBQ exam. Is this something I set up for a civilian physician? If so, is it a specific TYPE of physician? And is this something I get a referral from my military PCM for?

A lot of good info you posted, so I appreciate that, but has also raised more questions for myself that I need to research, I guess. Thanks in advance!
I believe the VA C&P are across the board for all the branches. Not sure about the NARSUM, but the NAVY might have something similar.

The DBQ is something that any qualified physician can fill out, it mirrors the VA C&P exam for questions and content. It should be applicable to whatever condition(s) that are being addressed, especially those that are the main focus of your MEB.

In my case, the VA C&P exam was all jacked up, I have a severe spinal injury but the VA examiner put down "No Pain, No Flare Ups, No work limitations". Not just lies, but damned lies. So upon advice from Jason Perry (the founder of this forum) I went to my civilian orthopedic surgeon, the one who had performed two surgeries already on my spine.

It's important that you pick a physician who has experience in the area you're having examined. If you neck and knee are the issues, then an orthopedic surgeon trumps a general practitioner. One who has prior history of treating you is a plus as well, but not a deal breaker.

Go to the VA website and download the DBQ(s) that apply to your condition(s). Then take them to the physician of your choice. If it were me, I doubt I would go through my military PCM for it, only because I would rather get the physician I want to use, even if it means a higher out of network cost. Worst case scenario, the PCM says it's unwarranted, and then Tricare refuses to cover it at all. I don't know exactly how that would work, but better to beg forgiveness than ask (and be denied) permission.

Download and hand a hard copy to the doctor, and when completed have the doctor hand it back to you, NOT submit it directly to the VA. That way you have a chance to look it over for accuracy and to see it helps your case. If there's something that works against you on it, and the doctor submits it to the VA directly, that would now be forever in the VA files and may jam you. Again, why take the chance when you can have an opportunity to QA it?

Hope this helps...
 
I believe the VA C&P are across the board for all the branches. Not sure about the NARSUM, but the NAVY might have something similar.

The DBQ is something that any qualified physician can fill out, it mirrors the VA C&P exam for questions and content. It should be applicable to whatever condition(s) that are being addressed, especially those that are the main focus of your MEB.

In my case, the VA C&P exam was all jacked up, I have a severe spinal injury but the VA examiner put down "No Pain, No Flare Ups, No work limitations". Not just lies, but damned lies. So upon advice from Jason Perry (the founder of this forum) I went to my civilian orthopedic surgeon, the one who had performed two surgeries already on my spine.

It's important that you pick a physician who has experience in the area you're having examined. If you neck and knee are the issues, then an orthopedic surgeon trumps a general practitioner. One who has prior history of treating you is a plus as well, but not a deal breaker.

Go to the VA website and download the DBQ(s) that apply to your condition(s). Then take them to the physician of your choice. If it were me, I doubt I would go through my military PCM for it, only because I would rather get the physician I want to use, even if it means a higher out of network cost. Worst case scenario, the PCM says it's unwarranted, and then Tricare refuses to cover it at all. I don't know exactly how that would work, but better to beg forgiveness than ask (and be denied) permission.

Download and hand a hard copy to the doctor, and when completed have the doctor hand it back to you, NOT submit it directly to the VA. That way you have a chance to look it over for accuracy and to see it helps your case. If there's something that works against you on it, and the doctor submits it to the VA directly, that would now be forever in the VA files and may jam you. Again, why take the chance when you can have an opportunity to QA it?

Hope this helps...
Absolutely! Thanks. I'm actually seeing a civilian specialist the day following my MEB, so I'll look on the VA site to find the DBQ and request he fill it out and get it back to me. For my other condition (back), I could probably get my Pain Mgmt specialist to fill it out; while he's not an orthopedic surgeon, he's been treating that condition and actually has expertise in dealing with back pain, plus, he's a Doctor of Osteopathy, which from my understanding, means he's better suited to treat patients with musculoskeletal system issues. Thanks, again.
 
Well, gang, after finally getting a bit vocal, I found out my PCM did in fact submit my permanent profile and it was still pending. I emailed the Doc (that is mysteriously related to the board somehow), and he told me


"Got your message...

I have not forgotten about your case and was looking at it yesterday as we are looking at having you come on the 4th of August to start the process. You will need to be available for 80 days with exclusive priority to the MEB process. I am going to email your PCM and have her submit another U-3 permanent profile for your neck condition only. There is not enough recent good evidence to board you for your knee and foot conditions. She can give you an L-2 for those items on the same profile. You should get a call from one of our Contact Reps either this week or next week. If you have plans, ie leave, tdy etc for the 80 days after the 4th of August then we would have to wait till you get back to start the process."

I haven't seen my profile go permanent yet, although I did speak to my PCM, there was some email traffic between her and one of the approving officials for my profile. Keep in mind, my plantar fasciitis has been my permanent foot profile for almost 5 years now, and as far as my knees, I started that right at a year ago. By the way, I just did my sleep study, didn't think much about it. According to them, my prelim results show I am waking up on the average of every ten seconds. I have another appointment with them to determine the correct airflow for my new mask they gave me. Never bothered with it before because i thought it was the aching in my knees that kept me up. Haven't heard anything back from whoever was supposed to contact me, although I guess I have another week. Is it odd that they want to meet with me on the 4th for the board?
 
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