Not sure if this is the best place to post first or not, but I have some questions and after reading around everyone seems so helpful and knowledgeable.
Background: Army AD with 18yrs and 2 months, jump status for last 10 years, 2 Irq, 3 Afg deployments.
DX info:
I had a posteior and anterior anal fissure while deployed to Afg, that they did surgery at BAF for after it wasn't healing. Ant fissures are 95% IBD dx, but my colo was negative at the time. Fissure recurred at school the next year. Fast forward to next deployment 2-3 yrs later, had symptoms start in deployment, sucked it up, came home diagnosed with Crohn's (this spring). I've had a recurrence of my fissure since then and now a draining fistula. Thanks to the fistula i know have to wear liners.
My GI doc, Command, and PCM are super supportive as I wanted to stay on active service and keep doing all functions of my job. There was no profiling, but proper documentation is in my ALHTA. My goal was to do 23-24 years, and everyone was willing to help me find a way to meet that goal and not just MEB me out. But now I've failed mesalamine and have been determined to be steroid resistant. Because of that GI is having to place me on Remicade and probably Imuran. Both place me in CENTCOMs non-deployable, but 40-501 doesn't actually require MEB for use of biologics. It only states does not meet the standard "if not controlled". SO my GI and PCM are basically NOT starting an MEB because they feel I haven't been given the opportunity to be "controlled" as I have not had a medication response yet, so we are effectively still in the first step of finding treatment. Since my diagnosis is less than a year old and I've never been profiled I don't have an MRDP to "force" their hand I'm told. So basically they are goign to let me stay until we find out if Remicade and Imuran get me controlled, then they will take me off Imuran and see if Im stable. If so, they plan to let me stay and just apply for CENTCOM waiver if I we ever go back there. As I said my Command is supportive and since I can do my daily job without profile and we are not pending a deployment they are happy to leave me alone as long as I keep them up to date.
So now my questions...
Am I screwing myself later by doing this? I want to finish my intended goal. But I am worried that if this all works out and I can meet my goal when it comes ready to retire I'll be found "Fit for Duty" since I'd have dealt with it for another 4-5 years. (Even though I suspect I'm only "getting away with it" because of supportive Cmd and Med staff).
How does VA deal with things that have since improved? I.e. VSARD(sp?) For fissure or fistula is 30% if you wear a pad. If my fistula resolves with the Remicade, is that still included in my rating? Same for the disease itself, Crohn's is rated under UC (which is bu**sh** by the way apple and oranges). This summer I would have been 100% as I lost 20lb was malnourished had anemia from blood loss and admitted to hosp. But if I respond well to treatment, my symptoms may be as low as the 10% mark. I don't understand if VA uses symptoms at their worse when not treated to calculate, or if they use symptoms at the time of eval ignoring that I could be on significant medications just to reach that point.
Same info for the Army PEB - do they set my disability rate at time of eval or a time of worse or "average" symptoms?
I have no intention of PCSing and will likely ask for MEB directly and Profile if I come on orders as I worry that a new command or new post would not support me staying, as well as might not be as supportive in the MEB process as my current location appears to be (even though Im not actually in the MEB process).
Sorry for super long post, but thought it would be easier to try and give you info instead of asking me to fill gaps. Let me know if I missed something in order to get some advice. Thanks for anything you have to offer.
Background: Army AD with 18yrs and 2 months, jump status for last 10 years, 2 Irq, 3 Afg deployments.
DX info:
I had a posteior and anterior anal fissure while deployed to Afg, that they did surgery at BAF for after it wasn't healing. Ant fissures are 95% IBD dx, but my colo was negative at the time. Fissure recurred at school the next year. Fast forward to next deployment 2-3 yrs later, had symptoms start in deployment, sucked it up, came home diagnosed with Crohn's (this spring). I've had a recurrence of my fissure since then and now a draining fistula. Thanks to the fistula i know have to wear liners.
My GI doc, Command, and PCM are super supportive as I wanted to stay on active service and keep doing all functions of my job. There was no profiling, but proper documentation is in my ALHTA. My goal was to do 23-24 years, and everyone was willing to help me find a way to meet that goal and not just MEB me out. But now I've failed mesalamine and have been determined to be steroid resistant. Because of that GI is having to place me on Remicade and probably Imuran. Both place me in CENTCOMs non-deployable, but 40-501 doesn't actually require MEB for use of biologics. It only states does not meet the standard "if not controlled". SO my GI and PCM are basically NOT starting an MEB because they feel I haven't been given the opportunity to be "controlled" as I have not had a medication response yet, so we are effectively still in the first step of finding treatment. Since my diagnosis is less than a year old and I've never been profiled I don't have an MRDP to "force" their hand I'm told. So basically they are goign to let me stay until we find out if Remicade and Imuran get me controlled, then they will take me off Imuran and see if Im stable. If so, they plan to let me stay and just apply for CENTCOM waiver if I we ever go back there. As I said my Command is supportive and since I can do my daily job without profile and we are not pending a deployment they are happy to leave me alone as long as I keep them up to date.
So now my questions...
Am I screwing myself later by doing this? I want to finish my intended goal. But I am worried that if this all works out and I can meet my goal when it comes ready to retire I'll be found "Fit for Duty" since I'd have dealt with it for another 4-5 years. (Even though I suspect I'm only "getting away with it" because of supportive Cmd and Med staff).
How does VA deal with things that have since improved? I.e. VSARD(sp?) For fissure or fistula is 30% if you wear a pad. If my fistula resolves with the Remicade, is that still included in my rating? Same for the disease itself, Crohn's is rated under UC (which is bu**sh** by the way apple and oranges). This summer I would have been 100% as I lost 20lb was malnourished had anemia from blood loss and admitted to hosp. But if I respond well to treatment, my symptoms may be as low as the 10% mark. I don't understand if VA uses symptoms at their worse when not treated to calculate, or if they use symptoms at the time of eval ignoring that I could be on significant medications just to reach that point.
Same info for the Army PEB - do they set my disability rate at time of eval or a time of worse or "average" symptoms?
I have no intention of PCSing and will likely ask for MEB directly and Profile if I come on orders as I worry that a new command or new post would not support me staying, as well as might not be as supportive in the MEB process as my current location appears to be (even though Im not actually in the MEB process).
Sorry for super long post, but thought it would be easier to try and give you info instead of asking me to fill gaps. Let me know if I missed something in order to get some advice. Thanks for anything you have to offer.