Help!! Questions

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CatLady

PEB Forum Regular Member
Registered Member
I hope I picked the correct forum. I'm asking help on behalf of my husband. My husband has shin splints/stress fractures. Most likely stress fractures in both lower legs. We have been fortunate to get help on this matter from his co workers and new PCM. My husband and I are overseas and he's been in for almost three years. He started with shin splints near the tail end of tech school and has had them since. Tech school killed his legs because they always had to run. He did show improvement in his legs health, but that changed when he had to start running on pavement. Which is horrible on the feet and legs. He had physical therapy at tech school and here at our current. He's been on a couple of waivers/profiles for legs at tech school and about the same amount here. He's at the point right now to go with out a waiver again for his legs, so he doesn't get noticed by the higher ups or DAWG. His legs are way better now than how they were at tech school, but he's always in pain after his PT run and it lasts a couple of days.

This is from the Fitness AFI 36-2905: 11. The UFPM will identify Airmen who have been exempted from one or more of the four components of the fitness test for a continuous 12-month period or have four component exemptions in a 24-month period. The UFPM will notify the Unit Commander, who will, in turn, request the EP/Wing Fitness Program Manager (FPM) review the case at the Deployment Availability Working Group (DAWG). The DAWG will review and evaluate the member’s medical history and determine the best course of action IAW AFI 10-203. This guidance supplements guidelines established in AFI 36-2905 (dated 1 July 2010), paragraph 4.2.

His new PCM has been very informative on this matter and seems willing to work with us. The only reason he took physical therapy here is that Orthopedic wouldn't "look at him" to be seen for possible surgery. My husband has scheduled an appointment next month with his PCM if he can get started on surgery for his legs or one leg(his right leg is the problematic one) or the next course of action (waivers, ?). We are concerned he won't get his surgery because of the AF furlough or sequestration going on. What kind of surgery would he get? Fasciotomy or one with rods and screws? We were told that he is allowed (not sure correct word) to be seen and treated. We were told to go to Patient Advocacy if he were to be turned down for surgery. We were also told that going to Med Board they could give him permanent yearly waivers or they could simply medically discharge him. If we were to go to Med board or DAWG either way good or bad he's noticed and seen. We are aware that either path we choose he might be medical discharged. He wants to stay as long as possible or until his enlistment is up. Does having a top security clearance job help to stay in longer?

Any thoughts and answers would be greatly appreciated!!
Thanks
 
maam, with all respect. if he was to get meb'd out, he would get the benefits to accomodate such injuries. if he simply waits until his enlistment is up, then he would have to deal with your own benefits and bills for it. if they give him surgery that will covered as well under the current benefits.
 
Thank you for the response. I'm concerned for his health, and we are in our low 20's and don't really have much experience in the civilian world since we come from military families. We feel uncertainty when we think he if he does end up med board. We hear good things and bad things about the med board. That's why I came to the forum to get some answers from those who have gone through. We want to be prepared as much as we can, so we know his rights and options.
 
The fasciotomy is if he is identified as having compartment syndrome vs shin splints, the rods are for stability etc. Shin splints is not a true "diagnosis" per so just a symptom of somethign else going on. IF he has compartment releases in both legs (4 compartments) then he will be MEB'd but his condition will be bi-lateral and he will likely wind up with retirement vs severance BUT either way atleast he will have VA benefits for hisself. DO NOT ignore an issue until seperation etc. if he did not have issues before his service, then the service caused the injuries etc.
 
Thank TSgt Twitch. Yes, I am aware of shin splints not being an actual diagnosis. Early in his "shin splints" when we came to our new base; my husband did have some pain in his arch and one time he was conversing with a co worker about it and his co worker had the same pains and symptoms as my husband, but he had plantar fascial fibromatosis. My husband went to his old PCM if he had it and his PCM said no without even looking at him or treating him, but at the end of the appointment he was sent to get new orthotics. My husband has been wearing Superfeet orthotics since tech school and they help him a lot. He never experienced or had pains in either of legs before joining. At his tech school they had them run on hard surfaces and not on a track, so that's when the pain began. We're young and before joining he was a fast runner. He wants the pain gone, so he can run again.
I attached a picture of where he feels the pain. The picture has the pain marked in red.

Thank you.
 

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Your #1 concern should be addressing the health issue. Research the civilian ortho specialists in your area and find the best. Then, call their office and talk to the doc or his/her nurse about your situation. Get names and contact numbers. Then, when your husband meets with his PCM, ask for a referral out to see that particular doctor. Let the PCM know that you have consulted with the doctor and they are ready to see you and fix the issue. "No" is an easy answer to give, so your goal is to make it easy for the PCM to say "yes" to the referral.;)
As for waivers, he can be sure that he will get one if surgery enters the picture- and for many months or years after the surgery, as physical therapy and wound healing take time. My wife had a fasciotomy over four months ago, and she is still healing/rehabbing. However, waivers trigger MEB's, and (ultimately) he could end up in the process. Keep in mind that (if not found fit) he will be severed/separated or retired, and both options have pros and cons. Personally, I think that every sm that receives a rating below 30% should appeal until they exhaust every avenue, but that is just my opinion- and you know what they say about opinions.:D
You mention being in your early 20's in re to not being used to civilian life....imagine some of us that have known nothing but the military for 16, 17, 18+ years. If he ends up MEB'd and you end up as civilians, being young is surely to your advantage.
In re to having a TS clearance/job- it has no bearing on the MEB. There are many here (myself included) that have TS-SCI clearances/jobs, and you see where we ended up. Will your husbands job and clearance be calculated into the decision- yes, but it only bears fractional weight in the big picture. The main determining factors are how his condition affects his job performance, deployability, PT, for Army- "soldering skills", and prognosis (are his conditions likely to get better or worse)- and, ultimately, how his condition impacts the mission.
I know this is a lot of info- but it is just the tip of the iceberg. Like I opened with, concentrate on your husband getting repaired first, then go from there.
 
Thank usafaviator. That's a lot information, but very much appreciated. I'll look into some civilian specialists. I hope it isn't too hard because we don't live in the states. I didn't know we could contact other doctors especially civilian. This is new to me. Is it better to see a civilian ortho than getting a referral to a military ortho?

Thank you!
 
TSgt Twitch said:
The fasciotomy is if he is identified as having compartment syndrome vs shin splints, the rods are for stability etc. Shin splints is not a true "diagnosis" per so just a symptom of somethign else going on. IF he has compartment releases in both legs (4 compartments) then he will be MEB'd but his condition will be bi-lateral and he will likely wind up with retirement vs severance BUT either way atleast he will have VA benefits for hisself. DO NOT ignore an issue until seperation etc. if he did not have issues before his service, then the service caused the injuries etc.
Click to expand...
I was found unfit for, for shin splints. Separate for each leg not bilateral.
 
Sicotic said:
I was found unfit for, for shin splints. Separate for each leg not bilateral.
Click to expand...
I may be wrong, its happened before, but I believe it should be/have been bi-lat. I will have to look at the code again sorry if i gave wrong information thanks for the correction.
 
I don't see why it would be bilateral. They are seperate legs. It's possible to have shin splint in one leg.
 
Sicotic said:
I don't see why it would be bilateral. They are seperate legs. It's possible to have shin splint in one leg.
Click to expand...
She stated his right was worse than his left, if the condition excists in both legs it should count as bilateral ont he computation of ratings and the bi-lateral factor applied. it can mage a fairly large difference in percentages if there are multiple things wrong.
 
§ 4.26 Bilateral factor.​

When a partial disability results from disease or injury of both arms, or of both legs, or of paired skeletal muscles, the ratings for the disabilities of the right and left sides will be combined as usual, and 10 percent of this value will be added ( i.e. , not combined) before proceeding with further combinations, or converting to degree of disability. The bilateral factor will be applied to such bilateral disabilities before other combinations are carried out and the rating for such disabilities including the bilateral factor in this section will be treated as 1 disability for the purpose of arranging in order of severity and for all further combinations. For example, with disabilities evaluated at 60 percent, 20 percent, 10 percent and 10 percent (the two 10's representing bilateral disabilities), the order of severity would be 60, 21 and 20. The 60 and 21 combine to 68 percent and the 68 and 20 to 74 percent, converted to 70 percent as the final degree of disability.
(a) The use of the terms “arms” and “legs” is not intended to distinguish between the arm, forearm and hand, or the thigh, leg, and foot, but relates to the upper extremities and lower extremities as a whole. Thus with a compensable disability of the right thigh, for example, amputation, and one of the left foot, for example, pes planus, the bilateral factor applies, and similarly whenever there are compensable disabilities affecting use of paired extremities regardless of location or specified type of impairment.
(b) The correct procedure when applying the bilateral factor to disabilities affecting both upper extremities and both lower extremities is to combine the ratings of the disabilities affecting the 4 extremities in the order of their individual severity and apply the bilateral factor by adding, not combining, 10 percent of the combined value thus attained.
(c) The bilateral factor is not applicable unless there is partial disability of compensable degree in each of 2 paired extremities, or paired skeletal muscles.

http://www.ecfr.gov/cgi-bin/text-id...ode=38:1.0.1.1.5&idno=38#38:1.0.1.1.5.1.98.22
 
Yes, my husband has "shin splints" or more accurately stress fractures in both legs. His right leg is more severe than the left.
Sicotic, are you still in the process of being med boarded? I don't know too much about it and I can't tell from your timeline. Are you CONUS or OCONUS? Would you know if being CONUS or OCONUS if one of the med board processing out is faster than the other?
These of about being med board may be too early for us, but I like to have my bases covered.
Thanks for the new information and link, usafaviator.
 
TSgt Twitch said:
The fasciotomy is if he is identified as having compartment syndrome vs shin splints, the rods are for stability etc. Shin splints is not a true "diagnosis" per so just a symptom of somethign else going on. IF he has compartment releases in both legs (4 compartments) then he will be MEB'd but his condition will be bi-lateral and he will likely wind up with retirement vs severance BUT either way atleast he will have VA benefits for hisself. DO NOT ignore an issue until seperation etc. if he did not have issues before his service, then the service caused the injuries etc.
Click to expand...

TSgt Twitch identified a serious issue with many military cases. The military (both at the MEB and PEB levels, but more often at the MEB level) gets wrapped around the axle about "diagnoses." The correct issue is whether the member has a "disability" (that is, generally, a loss of function of anatomy or system).

That issue aside, the thrust of TSgt Twitch's post is correct.
 
TSgt Twitch said:
I may be wrong, its happened before, but I believe it should be/have been bi-lat. I will have to look at the code again sorry if i gave wrong information thanks for the correction.
Click to expand...


Somewhat confused about the question...if there are conditions that the conditions are eligible for bilateral ratings, here is the regulation:


§4.26 Bilateral factor.

When a partial disability results from disease or injury of both arms, or of both legs, or of paired skeletal muscles, the ratings for the disabilities of the right and left sides will be combined as usual, and 10 percent of this value will be added (i.e., not combined) before proceeding with further combinations, or converting to degree of disability.
 
Oops, ninja'd by usafaviator.
 
Hello! He's been diagnosed with bilateral shin splints.
Here's an update on what's going on. Sorry about the long post I posted this in another thread.

My husband is active duty in the Air Force (he's been in for almost four years) and ever since 2011 he's been dealing with bilateral shin splints or stress reaction shin splints ever since. He's gone through physical therapy multiple times, been prescribed NSAIDs, being on crutches to help being off his legs (which ultimately didn't help), orthopedics, and now rheumatology (because he now has knee pain, patella tendonitis and the doctors over here wanted to make sure it wasn't something else). Surgery is out of the question since there are no fractures or breaks just "stress reactions" from tech school (2011). My husband and I are really considering MEB because we rather start it then wait for the military to.
The point of this post is to find out anything and everything on the MEB.
We are currently overseas and our PCS date is this summer, if we start the MEB are we stuck here until the process is done? The PCM has also been helpful that she said if we want to start it that she will write up and have us go over it.
Has anyone on here gotten out of the military with shin splints? And can tell me an approximate time frame of the process?
It seems likely my husband will get medical discharged because we've been told by his PCM and the other specialists that if we go that route (MEB) the military will med discharge him.
He probably made it this far because his security clearance.
What do we need to do to make sure my husband gets every help and full percentage?
We have documentation proof that he got shin splints and such from the military. We also have proof that early on he had feet problem probably from the shin splints and now the knee problems.
How do we factor the percentages of those problem areas?
Can anyone give answers on how the process is?
We live on base, will they let us live on base until the MEB is done?
If med boarded will my husband get money from the military or any benefits?
Also, will he be able to be seen at the VA?
Also, will my husband be given an military ID to be seen at the VA since it's military?
I'm sorry for the long post and I hope you guys can point me in the right direction and let me know something that I need to know.
 
Well you put a lot of questions in one post, please please please do some research on here, there is a wealth of information. but lemme help where I can.

yes he can be discharged for shin splints
Yes he will recieve care for any service connected conditions from the va(the va is not military)
it is very unlikely that he will be rated at greater than 30% for shin splints, so if found unfit, he will be discharged with severance, you will have tricare prime for 6mos after separation, then nothing.
The process can take upwards of 1-1.5 years current time frame
It can be accomplished at some overseas locations, or they can PCS you stateside depending on current assignment, he will be active duty until its completion so housing and such is not a concern during the long and to be honest non-transparent high anxiety, low information process.

now for the long stuff, I see you pretty much ignored the advice given previously, so i hesitate to go into detail on anything and waste time again.

Shin splints is a symptom of something, not a disability, there has to be something causing the shin splints, and your husband should push for a proper diagnosis via bone scans, compartment pressure measurements, running clinics, checking for patella femorral syndrome, bone spurs, hallux valgus, plantar fasciaitis, etc. additionally if he is havign pain spread into the knees/feet and has not been performing high impact cardio, then something else is wrong and needs to be identified. I am sensing your Husband is very passive in his quest for information.

Percentages:
If your husband is referred into the IDES/MEB system with SHIN SPLINTS as an unfitting condition and no other conditions are found as unfitting. then using the VASRD (efcr located here http://www.ecfr.gov/cgi-bin/text-id...&rgn=div5&view=text&node=38:1.0.1.1.5&idno=38)

Shin splints will be rated analgous to malunion of the tibula fibula (based on a quick search of prior cases) under VASRD code 5262, the language reads like this:

5262 Tibia and fibula, impairment of:
Nonunion of, with loose motion, requiring brace40
Malunion of:
With marked knee or ankle disability
30
With moderate knee or ankle disability
20
With slight knee or ankle disability10


Without any marked degeneration evidenced by MRI's/CT scans, or loss of range of motion of the ankle or knee, 10% will be awarded to each leg and then a bi lateral factor applied, this will result in a 22% DoD disability rating and discharge with severance pay, and no future benefits (you would maintain VA home loan gurantee and GI bill of course, and entitlement to VA voc rehab etc., but no commissary/BX/base access/tricare for life etc.)

since the slight knee impairment is rated under the above code, unless there is clear evidence of another problem, it would not be rated due to the pyramiding rule(cannot rate the same thing twice). Same for the Ankle.

If he has any other issues, even if they have not been diagnosed yet, he needs to get them tested/checked out etc. as with just the 22% (which would round down to 20% btw), he would get a small check from the VA and nothign from the DoD, (regardless of dependents at the 20% rate) of $260 a month, and it would be zero for a long time until the severance is paid back. (18-20,000 dollars severance if e-4 at over 4 years), but this is taxed at 28% initially, you will likely get some back at tax time however.

I strongly strongly urge you to push yor husband to request second and third opinions on what is causing his shin splints, it could be something simple as fat kid running syndrome (not an insult, its how I lost my hip), or it could be serious like compartment syndrome, bone density issues, early arthritis issues ranging from RA to psoriasis etc. Just because he is a younger (time in service wise) Airmen, do not let him, let hisself be mistreated, which is all to common I am afraid.

Please excuse my tone at the beginning of this post, I intentionally wanted to get you angry to emphasize the points I am trying to make and to hopefully get you motivated to get him motivated to take care of hisself, NOONE IN THE AF WILL BE HIS ADVOCATE, even those who it is there job to protect him etc, they are only doing their job, few if any ever go above and beyond to truly be an asset, and most fall short by the ET. He has to go into every appt and meeting with his defenses up, and his mind in the game in order to achieve what ever his desired outcome is, He needs to tell his chain of command what his desires are so they can write his NMA (commanders letter) properly, he needs to get the doctors to recognize he is in pain, and he needs to exercise his rights under the patient act. good luck.
 
Thank you, thank you, thank you for the information, Tsgt Twitch. I've been going to every appointment with my husband to ask questions and make sure everything gets done, but they can never tell us what else is causing it. My husband is not very pushy, so that's why I go with him. I will see about other opinions, but I thought all the specialists were great and informative because they ran tests for him. But, no one could say why he has shin splints or what is causing it. They all agree that it was military PT and such. I have been doing some research, but a lot of the terms are confusing for me to understand.

Since my original post we made more headway in getting treated or seen. We first saw orthopedics and they did xrays and MRIs and the conclusion was that there was no fractures or breaks in either of the shins, but the MRI showed activity and cortical thickening in the right leg, but the orthopedic doctor said that isn't normal and he said that is stress from the beginning, called stress reactions.
From that the orthopedic doctor put my husband on another profile and had my husband on crutches. (Last spring/summer to the fall). Crutches did not help because they aggravated both his legs more, so they took him off them.

Around last November my husband started experiencing knee pain in both knees and the orthopedic doctor diagnosed him with patella tendonitis. From that appointment the PCM referred him to rheumatology to see if there is something serious going on like arthritis or autoimmune. In between that time my husband started experiencing horrible lower back pain, so when he went to see the rheumatolgist he did some flexibility stretches (not that flexible in the back) and ran blood/urine results for any autoimmune and arthritis diseases and they came back negative. They did xrays on his side joints and they came back negative, but we are now scheduling an MRI for the side joints to see if there is anything inside the tissues and such. Our PCM did refer my husband to the Pain clinic or the physical medicine and rehabilitation service, but when my husband went to make the appointment last month they deferred him back to orthopedics, saying that they can't help him. So, now we have an appointment with orthopedics this week. We were told by the rheumatologist that should push for an MRI of his knees when we go back to orthopedics.

My husband enrolled into that tricareonline site and it shows past appointments, radiology results, and etc and one of the MRIs that happened last summer said things that the orthopedic doctor didn't mention.
"Three hours after the radiotracer injection bone phase images in multiple projections over the lower legs were obtained and show markedly increased radiotracer activity along the posteromedial periosteum of the tibiae, with an area of focalization in the right tibia, at the junction between the proximal 1/3 and the distal 2/3, consistent with a grade I stress fracture and associated tibial stress changes. There is increased activity in the knees (early DJD) and in the left >right tibiial tuberosities, correlate clincally for tendinitis. There is mild activity in the ankles and moderate scattered activity in the mid-feet/1st toes (L>R), which likely represents post-traumatic/early degenerative changes. There is increased activity in the bilateral inferior calcanei,, correlate clinically for symptoms of plantar fasciitis."

Now, does this mean that my husband has the diagnoses? This was back last June and my husband didn't get knee problems til the fall. We plan to show this the orthopedic this week and ask what all of this means. If/when MEB happens can he use this so they can compensate him? The reason we are considering MEB is because my husband might get caught in the retention board and if he becomes eligible they won't compensate him at all.
I really appreciate your advice. My husband is also going to talk to his MSgt this week and we were advised to go speak with someone at the PEB on our base. His PCM also said that if these referrals don't help him then she would submit his case to the MEB..... Wow, 1-1.5years. I guess more time in Germany.
 
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