What's Really in my NARSUM?

StonyAK

PEB Forum Regular Member
#1
First off, this is a great site! I spent a good portion of my 30 days on con leave glued to the pages found within. All the responses have been informative, notably Jason and AFPEBLO.

My story: 15 1/2 year ADAF E-7 had a heart attack. Currently, my case is still circulating the base, I believe it's at the legal office for review before being sent off to Texas.

If I'm not mistaken, one of the main tests for % of disability with the CV systems is your MET score on a stress test. Problem is, the only test I've had was an induced stress test (adenosine, I think). This happened in a Korean civilian hospital, and I have no idea how the results correspond to METs. Regardless, there's no mention of them in the NARSUM that I have seen to date. How is the IPEB going to determine fitness for duty or a % of disability if they're not really given any info by my PCM?

Am I missing something?
 

carnelli53

PEB Forum Veteran
Registered Member
#2
If I'm not mistaken, one of the main tests for % of disability with the CV systems is your MET score on a stress test.
Correct. The main criteria in the VASRD for rating cardiovascular conditions is the METS score, derived from a stress test.

This happened in a Korean civilian hospital, and I have no idea how the results correspond to METs.
Well I would predict they could send your case back and order a nuclear treadmill stress test performed OR the AF PEB can refer to something similar to that found in AR 40-501 Table 3-1 p.47 (in my opinion is the best case as the METS does not usually do one justice). There was a post around here somewhere, I will attempt to find it later when I'm not in a rush out the door, with someone in the Army who had the IPEB conduct a reconsideration under this table.

Here is an 'excerpt' from the table (as it was impossible to copy and paste the whole table, at least for me!):

METS Equivalents (Required for PEB adjudication)
Class I=8 METS or greater
Class II=5–8 METS
Class III=3–5 METS
Class IV=Less than 3 METS
Essentially they are just taking the degree of your cardiovascular condition and crossreferencing it with a METS rating. I am unclear on what criteria the PEB uses to refer to this table instead of just looking at the METS score from a stress test. However, I would imagine that the absence of any METS score would warrant the PEB to reference this table, that is, if there is a similar table in the AFI for Medical Retention. I'll do some more research and get back to this post.

EDIT: I just happened to be speaking with my cardiologist today and slipped in the 'what if...' question in regards to myocardial infarctions and stress tests. More than likely in your case, it is a bit risky to put your on a treadmill for a nuclear stress test in order to ascertain your max heart rate. He told me in his office (could be different for others) that individuals with one or multiple heart attacks in their medical history are usually given induced stress tests as a safety precaution. Again, this is just one opinion from one doctor and I would by no means take it as any kind of material fact. However, this brings up the 'what if...' question of how the PEB will handle your case, I can't imagine they would order a nuclear stress test, however, they may take your induced stress test and weigh that evidence as if it were a nuclear stress test.
 

StonyAK

PEB Forum Regular Member
#3
Thanks for the insight...

I got clarification from my civilian cardiologist today that the test I took did not measure maximal tolerable exercise capacity, so there's no way to infer METs from those test results. Also yesterday, I spoke to my care coordinator at the MTF to voice my concerns. He also agreed that some of sort of Stress Test needs to take place for quantification of my condition by the IPEB.

He suggested that I let the NARSUM go to Randolph as it is, then when I come around for my RILO in a year, there will be further information that would start another MEB process. I don't like the sounds of this and tend to think that if I sign on the dotted line that I have reviewed my NARSUM and say that it's fine, I stand a chance of not being able to dispute what's in the NARSUM further on down the road.

Further, my NARSUM (written by a GP) indicates an Acute MI, with an excellent prognosis. From the standpoint of my health, I wish this were accurate. If it matters, the NARSUM is dated 1 day after I was discharged from the hospital, with no mention of needing follow-ups as directed by my cardiologist at the civilian hospital.

My discharge and follow-up records from the civilian hospital (written by a cardiologist) indicate the Acute MI, plus CVD, plus indefinite pharmaceutical therapy, and oh by the way I will probably require a stent or bypass in the future. Should I let this ride through the IPEB, then dispute it at FPEB, or should I step in now before anything gets sent off base?
 

Jason Perry

Benevolent Leader
Site Founder
Staff Member
PEB Forum Veteran
Registered Member
#4
You have to decide for yourself, based on your desires and circumstances.

That said, the course of action recommended seems better for remaining on duty. However, if you think you are unfit and want that outcome, I would not let anything go forward that I did not agree with (or at least voicing my disagreement).

Best of luck with your MEB/PEB and your treatment.
 

StonyAK

PEB Forum Regular Member
#5
Thanks to everyone for their insights; as always you’ve been very helpful.
BLUF: I am trying to get my NARSUM to accurately describe my condition so that my fate can be decided on the first attempt, instead of getting bogged down and taking forever. I am stationed at an unaccompanied location, and I have a DEROS that is only 5 months away. Even if the eventual outcome is “UNFIT”, I would like the outcome to be speedy so that I don’t have to stay here beyond my DEROS. I do not relish the thought of explaining to my family that I won’t be home when I thought I was going to be because the process is broken! I have made my peace with the fact that I will likely be found “UNFIT” if I pursue this course, I just want to get the process moving!
I have let things simmer for about a month with my MEB, unfortunately it is still on base. I rebutted the first draft that was ready to go to AFPC. The 2 primary reasons:
1.[FONT=&quot] [/FONT]There was incomplete documentation of my diagnosis on the NARSUM and MEB recommendation. (CVD is not referenced, nor are follow up complaints of angina addressed)
2.[FONT=&quot] [/FONT]There has not been a stress test.
My MTF chewed on my rebuttal for 2 weeks and returned the MEB package to my PEBLO for my signature. There were minor clerical changes made, but my primary concerns were not addressed. I have once again indicated that I wish to rebut the findings, and this time I was offered an Independent Medical Review, which I accepted. This happened on 26 May.
According to the 2008 NDAA, the Independent Medical Review must report their opinion of the MEB package to me within 5 calendars days. Today is 30 May, and I was told by my PEBLO yesterday afternoon that the Doc that will perform my review is TDY until 8 Jun!!!! I am furious and am wondering what, if anything, I can do on Monday morning when I go back to work. I have discussed this with my Sq/CC, who will try to speak with the MTF patient advocate on my behalf, but I’m not too hopeful. I feel like at this point I know more about the process than the MTF does. I contacted my local IG office as well as my congressman’s office about a month ago to see what would need to happen to start an inquiry. My Congressman’s office is ready to wade in, but cautioned me to wait until something was obviously broken to ask them to intervene. Is now the right time to get them involved or are there other avenues still at my disposal that I’m just not seeing clearly?
 
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