Nuke_Troop
PEB Forum Regular Member
A little background. In late 2007, early 2008 I started having terrible fatigue and serious concentration problems. Things that were previously easy for me became impossible. Any sort of writing was nearly impossible. EPRs started taking days to write instead of hours. I kept loosing track of conversations and would forget what I was saying mid sentence. Finally, I started to lose my balance and would fall over several times a day.
After months of telling myself that everything was normal I decided to make an appointment and ask for a referall for a neurologist for the balance problems, I had some balance problems following a mountain bike accident and the neurologist I saw at the time told me to come back if I noticed anything new.
6 months later after seeing 4 different docs and numerous rounds of neurological testing and lab work I was diagnosed with a rare form of encephalopathy.
My MEB will start within the next week or so, I've had a chance to review it and have a question for the forum. My narrative and commander recommendation letter document a significant decrease in abilities, but my MEB narrative contains the statement " FUNCTIONAL IMPAIRMENT: none", which isn't completely accurate. Is it an issue? What typically goes under "functional impairment"?
Text of MEB narrative
Present Illness:
Captain XXXX is seen on a consultation basis for cognitive disturbance and balance difficulty. He is present with his wife at the visit
Captain XXXX reports that he first noticed difficulty with cognition about 2 years ago. [portions removed] In fact, his cognitive trouble appears to be related to difficulty with executive functions such as planning, prioritizing, and organizing. He also notes some possible left-sided weakness and balance difficulty that has been progressive for the last two years. In reviewing his medical records, it is noted that he first described difficulty with balance and dizziness in 2006. He was evaluated at that time, including MRI and ABRs. His cognitive problems were first attributed to a mountain biking accident that occurred two or 3 years prior to his current symptoms. However, his only complaint after the mountain biking accident was lower back pain. In November 2008, he underwent neuropsychological testing in which it was noted that he had deficiencies and psychomotor speed, verbal, working memory, memory, and verbal fluency. Problem solving difficulty was also noted. He began to notice persistent fatigue in 2008 as well as some insomnia. Fatigue continues, but the insomnia was improved with the initiation of Wellbutrin. He was evaluated by his present neurologist, Dr. XXX in January 2009 with an extensive workup including lumbar puncture. The results of this evaluation were largely normal, with the exception of elevated serum thryoperoxidase antibodies.
Final Diagnosis: Chronic, slowly progressive encephalopathy
FUNCTIONAL IMPAIRMENT: none
Commander's Input to Medical Evaluation Board.
1. Does the member’s medical condition allow him/her to perform all primary in-garrison military duties without restrictions, limitations, or work-a-rounds?
Due to ongoing medical issues, Capt XXXX has been performing duties outside of his AFSC for since Aug '08. In addition he was removed from his supervisory/Flight Commander position due to concerns with his decision making abilities.
In his current position as my XXXX he performs repetitive administrative functions with ease, but struggles significantly with new tasks requiring independent critical thinking skills. Overall I would say he performs duties at an acceptable level, but does not compare favorably to other XXXXX I have worked with in the past. He is very hard working, loyal and dedicated and absent his medical issues he would be an outstanding officer.
2. Do you believe the member’s condition(s) will prevent him/her from serving in their primary AFSC in future assignments? If so, how?
Capt XXXX's current condition will prevent him from performing duties in his career field. More importantly his cognitive issues will make it impossible for him to function in stressful, fast paced environment in any other AFSC.
3. Has the member’s duty schedule been modified due to his/her medical condition(s) (i.e., limited duty, half days, no shift work, etc.)? Other than medical appointments, approximately how many days of work has the member missed over the past 90 days due to this condition? How much of this time was physician-directed?
In the last 3 months Capt XXXX has missed a significant amount of time particularly in the morning and occasionally late afternoons due adverse reactions to fluctuations in medical treatment and prescribed medications. He expects this to continue for the foreseeable future until an optimal treatment regiment is found.
I approximate that Capt XXXX has missed a total of between 7 to 10 work days over the period in question, none of which were physician directed.
4. Have you spoken with the Primary Care Manager’s (PCM) regarding the member’s medical condition (including profile recommendation/restrictions, if required? Do you agree with the PCM’s assessment of the member’s condition(s)? If not, why not?
For the past year Capt XXXX has been detailed to me but reports to the XXX squadron commander for OPR purposes, although I have had daily contact with him in this time and in effect have served as his supervisor.
I have not spoken directly to his PCM or any providers, but have had several conversations his squadron commander regarding his condition and associated limitations. In addition, Capt XXXX has kept me abreast of pertinent details following his numerous medical appointments.
I am aware that Capt XXXX has been diagnosed with a serious chronic neurological condition which significant associated cognitive impairment which affects the performance of his duties.
5. Can the member be assigned against an AEF tasking? Do you believe the member could perform his/her primary duties in a OCONUS deployed environment without restrictions, limitations, or work-a-round?
No, Capt XXXX's cognitive problems, continued medical treatment and required medications will preclude future deployment.
6. Does the member’s medical condition impact your ability to perform your in-garrison / deployed mission: If so, how?
Capt XXXX's duties are primarily administrative and have little effect on daily operations. He was previously removed from operational/supervisory duties due to concerns over his cognitive abilities.
7. Is the member pending administrative actions or judicial/non-judicial punishment that could result in his/her demotion/dismissal? Is the member planning to separate/retire or has he/she applied to do so?
Other than his MEB, Capt XXXX has no punishments or administrative actions pending. He has no immediate plans to leave the Air Force and would like to continue to serve, but has reservations about a long-term military career given his medical condition and associated limitations.
8. Commander’s Recommendation: In your opinion, what would be the optimal outcome for the member, your organization, and the needs of the Air Force regarding his/her continued military service? NOTE: Recommending retraining should only be made after the Military Personnel Flight has in fact confirmed the member is eligible to retrain.
The best outcome for the Air Force would be to place Capt XXXX on the Temporary Disability Retired List to allow for continued treatment and a possible return to duty recommendation if his condition stabilizes to an acceptable level.
In his current condition, Capt XXXX's performance does not meet standards commensurate with his rank and years of military experience but if his condition stabilized I would gladly have him serve in any unit I was assigned to and would without reservation recommend him to another commander.
After months of telling myself that everything was normal I decided to make an appointment and ask for a referall for a neurologist for the balance problems, I had some balance problems following a mountain bike accident and the neurologist I saw at the time told me to come back if I noticed anything new.
6 months later after seeing 4 different docs and numerous rounds of neurological testing and lab work I was diagnosed with a rare form of encephalopathy.
My MEB will start within the next week or so, I've had a chance to review it and have a question for the forum. My narrative and commander recommendation letter document a significant decrease in abilities, but my MEB narrative contains the statement " FUNCTIONAL IMPAIRMENT: none", which isn't completely accurate. Is it an issue? What typically goes under "functional impairment"?
Text of MEB narrative
Present Illness:
Captain XXXX is seen on a consultation basis for cognitive disturbance and balance difficulty. He is present with his wife at the visit
Captain XXXX reports that he first noticed difficulty with cognition about 2 years ago. [portions removed] In fact, his cognitive trouble appears to be related to difficulty with executive functions such as planning, prioritizing, and organizing. He also notes some possible left-sided weakness and balance difficulty that has been progressive for the last two years. In reviewing his medical records, it is noted that he first described difficulty with balance and dizziness in 2006. He was evaluated at that time, including MRI and ABRs. His cognitive problems were first attributed to a mountain biking accident that occurred two or 3 years prior to his current symptoms. However, his only complaint after the mountain biking accident was lower back pain. In November 2008, he underwent neuropsychological testing in which it was noted that he had deficiencies and psychomotor speed, verbal, working memory, memory, and verbal fluency. Problem solving difficulty was also noted. He began to notice persistent fatigue in 2008 as well as some insomnia. Fatigue continues, but the insomnia was improved with the initiation of Wellbutrin. He was evaluated by his present neurologist, Dr. XXX in January 2009 with an extensive workup including lumbar puncture. The results of this evaluation were largely normal, with the exception of elevated serum thryoperoxidase antibodies.
Final Diagnosis: Chronic, slowly progressive encephalopathy
FUNCTIONAL IMPAIRMENT: none
Commander's Input to Medical Evaluation Board.
1. Does the member’s medical condition allow him/her to perform all primary in-garrison military duties without restrictions, limitations, or work-a-rounds?
Due to ongoing medical issues, Capt XXXX has been performing duties outside of his AFSC for since Aug '08. In addition he was removed from his supervisory/Flight Commander position due to concerns with his decision making abilities.
In his current position as my XXXX he performs repetitive administrative functions with ease, but struggles significantly with new tasks requiring independent critical thinking skills. Overall I would say he performs duties at an acceptable level, but does not compare favorably to other XXXXX I have worked with in the past. He is very hard working, loyal and dedicated and absent his medical issues he would be an outstanding officer.
2. Do you believe the member’s condition(s) will prevent him/her from serving in their primary AFSC in future assignments? If so, how?
Capt XXXX's current condition will prevent him from performing duties in his career field. More importantly his cognitive issues will make it impossible for him to function in stressful, fast paced environment in any other AFSC.
3. Has the member’s duty schedule been modified due to his/her medical condition(s) (i.e., limited duty, half days, no shift work, etc.)? Other than medical appointments, approximately how many days of work has the member missed over the past 90 days due to this condition? How much of this time was physician-directed?
In the last 3 months Capt XXXX has missed a significant amount of time particularly in the morning and occasionally late afternoons due adverse reactions to fluctuations in medical treatment and prescribed medications. He expects this to continue for the foreseeable future until an optimal treatment regiment is found.
I approximate that Capt XXXX has missed a total of between 7 to 10 work days over the period in question, none of which were physician directed.
4. Have you spoken with the Primary Care Manager’s (PCM) regarding the member’s medical condition (including profile recommendation/restrictions, if required? Do you agree with the PCM’s assessment of the member’s condition(s)? If not, why not?
For the past year Capt XXXX has been detailed to me but reports to the XXX squadron commander for OPR purposes, although I have had daily contact with him in this time and in effect have served as his supervisor.
I have not spoken directly to his PCM or any providers, but have had several conversations his squadron commander regarding his condition and associated limitations. In addition, Capt XXXX has kept me abreast of pertinent details following his numerous medical appointments.
I am aware that Capt XXXX has been diagnosed with a serious chronic neurological condition which significant associated cognitive impairment which affects the performance of his duties.
5. Can the member be assigned against an AEF tasking? Do you believe the member could perform his/her primary duties in a OCONUS deployed environment without restrictions, limitations, or work-a-round?
No, Capt XXXX's cognitive problems, continued medical treatment and required medications will preclude future deployment.
6. Does the member’s medical condition impact your ability to perform your in-garrison / deployed mission: If so, how?
Capt XXXX's duties are primarily administrative and have little effect on daily operations. He was previously removed from operational/supervisory duties due to concerns over his cognitive abilities.
7. Is the member pending administrative actions or judicial/non-judicial punishment that could result in his/her demotion/dismissal? Is the member planning to separate/retire or has he/she applied to do so?
Other than his MEB, Capt XXXX has no punishments or administrative actions pending. He has no immediate plans to leave the Air Force and would like to continue to serve, but has reservations about a long-term military career given his medical condition and associated limitations.
8. Commander’s Recommendation: In your opinion, what would be the optimal outcome for the member, your organization, and the needs of the Air Force regarding his/her continued military service? NOTE: Recommending retraining should only be made after the Military Personnel Flight has in fact confirmed the member is eligible to retrain.
The best outcome for the Air Force would be to place Capt XXXX on the Temporary Disability Retired List to allow for continued treatment and a possible return to duty recommendation if his condition stabilizes to an acceptable level.
In his current condition, Capt XXXX's performance does not meet standards commensurate with his rank and years of military experience but if his condition stabilized I would gladly have him serve in any unit I was assigned to and would without reservation recommend him to another commander.
