MEB Concerns Psoriatic Arthritis

denmom117

PEB Forum Veteran
Registered Member
#41
I was put up for MEB in April 2014 and I'm still in the appeals process. Today is day 506 (and I'm still counting). All I can say is fight for what you deserve, do as much research as possible in terms of the ratings as well as any other issues you may have, and become knowledgeable about the entire IDES process.
 

cajual

PEB Forum Veteran
Registered Member
#42
Every single person on this board has undergone a variation of the process. It sucks, but the only way to get through it is keep yourself busy. I know I've had very little to do over the past 2 months and I am pulling my hair out.
 

crag83

PEB Forum Veteran
Registered Member
#43
I was given the diagnosis of psoriatic arthritis and started Humira. The pain switches locations but has been really hurting my ankle and feet. Do I need to be going to my PCM? Or since I have diagnosis just press through. I guess I am wondering if I need to go to the doctor for every pain symptom for documentation because we
Already know what the problem is.
 

af-McRob

Registered Member
#44
Crag I was also on immunosupressant and was medically retired. Are you under the care of a specialist? If so just make sure you are getting the paperwork from every visit and don't trust that they will send the paperwork to base to be added to your medical file. You can give all of the documents to your Peblo before submission. I also had a conversation with my Pcm and we agreed we would have follow up appointments every three months corresponding with my required bloodwork to keep my documentation on the military side up to date. I hope sharing my experience helps.
 

crag83

PEB Forum Veteran
Registered Member
#46
Just to add at the quarterly updates my PCM would add any new problems to my file to match my specialist paperwork.
Af-McRob; how long did it take for the medical retirement to roll down. Also, what type of immunosuppressant did you take? So it sounds like as long as the paperwork is flowing from the rheumatologist I should be fine. I will go ahead and meet with my PCM quarterly to update him on my condition. It just sounds redundant to see the PCM for every pain I have when it is related to PsA.
 

af-McRob

Registered Member
#47
Crag, my doc did not trigger the meb until they put me on methotrexate and they determined it was working (6 months). Once the process was officially initiated I had orders in hand in 4 months but your situation may be different. I suffer from dermatitis and can no longer be around my work environment . I think the reason I was retired was because I was no longer fit to deploy due to medicine/bloodwork monitoring required.
 

crag83

PEB Forum Veteran
Registered Member
#48
I received an updated profile putting me on a Code 37 until MEB is complete. PEBLO has not notified me yet. I do meet with my PCM today so I should have some updates. I work in the Medical Group and a lot of medical officers I work with keep telling me I will just get returned to duty. I am fearful they will return me to duty and just put me on a permanent C code rather than medically retiring me which is what I prefer. I'll keep everyone posted. The Humira is starting to work on a positive note.
 

MonsterRod

Registered Member
#49
First, do not worry at all about the military calling it EPTS unless this condition was noted on your entrance physical. I dobt it was. What matters is when the condition manifested, not if it has a genetic factor or not. Even if it was EPTS, the military would still compensate the condition under 10 USC 1207a given the fact you are active duty and have 8+ years of active duty. The VA should service connect/compensate/treat the condition unless they can demonstrate the condition manifested prior to entry which I doubt they can.

Whether it triggers a MEB or not will depend on its severity and the drugs used to treat it. Drugs like Enbrel, Humira, Remicade will usually trigger a MEB. However, the systemic use of these immunosuppressive drugs will trigger at least a 60% rating under the VASRD.

If a MEB is triggered, get back to me as there is a lot you need to know about how to proper document and rate psoriatic arthritis.

Mike
Mike,
I've been going through a similar experience. I'm a E-6/TSgt, AD and I've been in 15 years as of last month. In 2009 after returning from a stressful deployment in a Flightline Maintenance role (comm guy filling in as QA for an airframe because I had systems on the plane). When I returned home I had so many skin splotches I looked like a burn victim. When I took my family home on leave I ended up getting a staph infection, that turned out to be MRSA. That's when the doctors changed their initial eczema/dermatitis diagnosis and changed it to psoriasis. I ended up in the hospital for over a month while they surgically removed the infection and made sure I was okay. I started seeing a dermatologist off base and tried topicals for the next year before I PCS'd to the Pentagon for a special duty assignment. I got better medical treatment and the doctors at walter reed ended up putting me on a biological, Humira. Around this same time I was having joint pain and the X-Rays showed degeneration so my PCM sent me to see a Rheumatologist. I was diagnosed with Psoriatic Arthritis and he was going to put me on Humira when he found out I was already on it from the Dermatologist. Rheum took over meds and ended up upping my dose over the years to a shot every 10 days over the next 5 years. I was put in for a PEBLO and returned to duty and traveled around the world in my Special duty assignment. Each year the PCM would take all the summaries from my doctors and I would be returned fit for duty. (Annual RILO) I ended up hurting my rotator cuff, thinking it was arthritis and it ended up needing its own surgery, but that's another story. After that assignment ended, I was sent to SC and have a Staff Position as a TCF program manager. Things were good until I started have joint problems again. After 5 years of success with Humira, it stopped working. The Rheum here added Methotrexate but it didn't help. Now I get Remicade infusions and they don't seem to be working. I'm having severe joint pain, psoriasis is popping up on my body and scalp slowly and my RILO is coming due in a couple months. I'm worried that since they can't stabilize my conditions something I will be pushed towards medical retirement. Also, I tried to deploy to install a system in Kuwait, but was rejected by the SG, I find this funny because I went to these same countries supporting 4Stars at my last assignment. I haven't done a full fitness test for a couple years. (partly because of the shoulder surgery and further problems, partly due to a back injury. L4-L5 disk compression pushing into the spinal column causing shooting pain down my legs, and the joint pain I'm experiencing now.)
I need help knowing how things should be getting documented since I am probably not going to get the thumbs up to re-enlist in December. Any help would be beneficial from anyone whose gone through similar experiences.
Henry
 

K9 No Bombs

Registered Member
#51
Sorry to jack your thread, but I am in a similar boat. I am supposed to get my P3 profile tomorrow. Psoriasis Arthritis, I've used Humira for bout 6 months, then due to a PCS, I could not anymore. Long story short, I have been prescribed Humira again, and my Rheumatologist told me that initiates a med board...

My question is... I haven't taken 12 months or more worth of Humira, but that is only due to not being able to get it. There was a break in treatment due to PCS'ing, and it takes a while just to get refered to a Rheumatologist at a new base. Will this deny me of a 60% rating?

I appreciate any response.

-Adam
 

crag83

PEB Forum Veteran
Registered Member
#52
Sorry to jack your thread, but I am in a similar boat. I am supposed to get my P3 profile tomorrow. Psoriasis Arthritis, I've used Humira for bout 6 months, then due to a PCS, I could not anymore. Long story short, I have been prescribed Humira again, and my Rheumatologist told me that initiates a med board...

My question is... I haven't taken 12 months or more worth of Humira, but that is only due to not being able to get it. There was a break in treatment due to PCS'ing, and it takes a while just to get refered to a Rheumatologist at a new base. Will this deny me of a 60% rating?

I appreciate any response.

-Adam
The phrasing is **continuous treatment**; the key thing to remember is getting something from the rheumatologist noting you take it on a continuous basis. My doctor typed a letter stating I would take it for the rest of my life to clarify this is a must need medication. Also, @maparker told me to ensure to get annotation that the Humira is for psoriasis and psoriatic arthritis. Hope this helps.
 

K9 No Bombs

Registered Member
#53
That absolutely helps. I really appreciate the info. I dislike how it is sometimes left to the individual raters interpretation. But Tha KS again, that's a really good point.
 

K9 No Bombs

Registered Member
#54
Figured I would ask on here because I have gotten a lot of great information for you all on this topic in this threat already!

I had C&P exam yesterday for PsA. They took x-rays of almost my entire body. My question is...
Service member claims both knees, both elbows and neck for joints that are affected by PsA
At the time of the exam, the x-ray results show no inflammation in the knees. How does this work, because you all knot that when you have PsA, RA or any kind of arthritis, there are periods where there is no inflammation or pain???

I am just worried that a few areas that HAVE been treated over the years for PsA associated joint pain are not going to be compensated.

I hope this question makes sense, and I appreciate any and all help! Thank you.
 

maparker

Staff Member
PEB Forum Veteran
Registered Member
#55
Did they do range of motion measurements? I would not be surprised if there was no inflammation if you are using Humira. The chronic residual rating criteria does not discuss inflammation. Rather it talks about ROM limitation be it from current inflammation or joint damage.

Mike
 

K9 No Bombs

Registered Member
#56
Yes, they did the tested the ROM. It was such a quick "glance" that I guess I get worried. But either way, I appreciate the input, that helps put my mind at ease.
 

K9 No Bombs

Registered Member
#58
Mike,
Yeah, the Doc told me what it was. Apparently when using a goniometer you do not have to worry about precision, because he was flashing it around so quickly. I could be totally wrong here, I have no medical training. I just hope that if the Doc is in favor of a side, it is the veteran.
 

K9 No Bombs

Registered Member
#59
So...
I received my NARSUM back today from my PEBLO. I am really worried about it, and I really am feeling overwhelmed. My PEBLO is very hard to reach, I've only seen him twice in 3 months and he is leaving for the month of July! Anyways, I was hoping @maparker and you guys could shed some clarity in relation to the failing condition of PsA.

"Immunosuppressive retinoids If checked, list medication(s): Humira Specify condition medication used for: psoriatic arthrits/psoriasis Total duration of medication use in past 12 months:  < 6 weeks  6 weeks or more, but not constant  Constant/near-constant"
-6 weeks or more, but not constant is checked.
*I have an issue with that. To give a brief rundown... I was on Humira for approximately 8 months prior to PCS'ing last year. When I arrived on station here at JBLM, it took about 3 months to get a referral to dermatology, then rheumatology etc... Once being seen by a Rheumatologist, he went with a different route first and I did Otezla for about 3 months. Once we deemed that Otezla was not helping, Humira was then perscribed again.

* I have clinical notes, stating that Humira clears up an exacerbation, and without out it, symptoms have gotten worse.

**So my question...
Yes, I had not been taking Humira for more than 6 weeks at the time the NARSUM was written. I was actually literally only on it for 5 weeks at the time!!! However this will be a medication I am on for the rest of my life. The rating per the VASRD is very different from "6 weeks" to "constant/near constant"...

I just feel like the Army is going to get one over on me with this one. My PEBLO instructed me to take this up with JAG, I just have no idea what to expect with them.

Do you all have any insight on this. I know @crag83 said you received a letter stating it will be taken for the rest of you life. I believe I will call my Rheumatologist tomorrow and ask for the same. Is there anything else I can and/or should do???

Thanks guys. I appreciate you taking the time to read through my post. I really value your input at this critical point in time. Thanks again!!!
 

QuebecBravo

Registered Member
#60
Following this thread. I recently completed my C&P exams for Psoriasis and PSA. I hope to see my NARSUM and exam results soon. Have you received the results from your C&P exams K9? Did you get any insight on how they are going to rate your PSA? I haven't been on Humira for a year quite yet, about nine months as of now.
 
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