Upcoming MEB; (2)Pulmonary embolisms and DVT

ANGCapt111

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#1
I'm new to this site and I need some guidance. I'm a Capt in the Air National Guard (AGR Title 10 status) and I PCS'ed to Buckley AFB CO in Aug 2010. Long story short... I had problems running during my PT tests and I failed twice (never failed a PT test in 20 years in the Guard). On 20 Jan 12, while performing the run during my PT test, I pasted out and spent 6 days in the hospital. Come to find out I have 2 pulmonary embolism (PE) in my lungs and a deep venous thrombosis (DVT) in my right calve. My doctor said I would be on Coumadin for the rest of my life and I will meet a MEB in July. I have 21 satisfactory years in the Guard and 13 years active duty. I was planning on staying on Title 10 status to finish out my active duty time, but now I don't know what's going to happen and no one can give me straight answers.

Will I get the boot come July or does the AF let members stay in on limited duty status with this condition?
And, if i do get the boot what rating will I most likely get if i do get form the AF/VA?

Any help/advice/comments would be welcome.
 

GI Joe

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#2
Do they know what caused your PE/DVTs? I also developed clots in my legs and lungs. The first time was in 2003 following a long flight (Germany to California). I was put on coumadin for about a year while they did all kinds of tests to see if they could find a reason for the clots to form. I had a non-deployable profile during this time but there never was a word spoken about a med board. These tests all came back negative and I was taken off coumadin. Fast forward to 2011 and I once again developed clots in my legs and lungs. Since this was my second episode of developing clots, I will be on coumadin for life. So this triggered a MEB/PEB.

So I would think the doctors would follow the same protocol for you. If this was your first time developing clots and they find no under laying conditions to cause clots then I don't see why they would put you on coumadin for life. I would ask my doctor why he you need to be on coumadin for life and the doctor should, if he/she has not done already, be referring you to hemotology for testing.

And just so you know, the PEB normally only awards 0% for blood clots. I was lucky enough to drag my Med Board out so I will be over 20 years AD when I am forced out this July.
 

ANGCapt111

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#3
Thanks for the reply.

I went to see a hemotologist and he said basically it's in my blood and recommends "indifinite anti-coagalation".

Why does the PEB award 0% for blood clots if it's enough to get you kick out? The VA schedule of rating rates it at 60% (VA Code 6817 Chronic pulmonary thromboembolism requiring anticoagulant therapy)? I've read some of the post on this site and it seem DOD and VA give different rating for various issues. Will the AF kick me out for this or is it a limiting duty issue?

Again, thanks for the info...
 

GI Joe

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#4
If I were you I would be talking to the hemotologist and find out if he discovered a reason for the clots. There are several reasons for clotting to include Protein C problems, Protein S problems, Factor V Leiden and other causes for clotting. And getting all the tests done while you are receiving anit-coagulation therapy could result in false test results. At least this is what my hemotologist explained to me.

I was also confused about my 0% rating but the informal reconsideration and the formal board would not change it. Now, I was under the legacy system so you might have better results when the VA does it's evaluation. Basically, the Army's position is that the condition makes me non-deployable but does not present a disability per se. I disagree with this because for me it does limit my able to be employed in my career field as a police officer. My military training and my BS degree in Criminal Justice are pretty job specific. No police agency will hire me with a blood clotting problem despite my military training and education.

I know that I can't serve on AD with the risk of bleeding that accompanies being on coumadin. I know I am a liability and would not want to be a burden on my fellow Soldiers if I were to become injured. As you know, even minor injuries can be life threatening due to the bleeding risks.

I don't know what the AF's guidelines are but I would assume that they are similar to the Army's policies and being non-deployable is a big NO-GO. The Army would not even consider any limited duty assignments due to this. Maybe a few years ago this would have been an option, but with the current down-sizing, I am out of luck.
 

Chief Jake

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#5
In August of 2004 my 14 year Navy career ended when I developed a pulmonary embolism. (It was discovered at that time that I have factor V Leiden.) Long story short, a PEB awarded me 0% from the Navy. I then filed an appeal with the PDBR and they agreed (2 of 3 votes) that my original award from the Navy was correct. I am 0% disabled by the Navy but 30% disabled by the VA. A navy doctor told me I should take Coumadin for life and the navy threw me out for taking his advice! The VASRD clearly indicates a 60% rating for my condition.
 

devildog4321

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#6
Im going through the same deal except i have not had a PE, just chronic dvt's in my lower extremeties. From what I know, yes a PE will rate a higher percentage unless they determine that its not service connected.... I think the reason for the 0% rating may have been because they did not consider it service connected due to the pre-disposition for factor V. Thats just my two cents... dont take that in any way that i agree with them. I think its crap that indefinite anticoagulation rates nothing even though it limits job prospects etc.
 

Will76

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#7
Being new to this website, I hope I can get some answers to the MEB process and lifetime coumadin. Recently I was placed on coumadin for life, but no doctor has uttered MEB to me, as of yet.
I am a O-4 in the Air Force. Back in 2006, I had masco-facial surgery, paid for by DoD. During the conclusion of the surgery, I aspirated and was sent to the ICU. Apparently the "junk" inside one of the tubes was transfered to my lungs. My oxygen level went below 90%, therefore they woke me up early from the surgery, forcing me to cough.
The surgery was 10+ hours, therefore I had compression socks and a pnuematic pad on both of my legs. While in the ICU the socks and pad were left on, but not turned on. After about 24hrs in the ICU, I was sent home. 2 or 3 days later, my left calf began to feel like I pulled a muscle. The surgeon told me to immediately go to the emergency room for a potential blood clot.
At the emergency room, the conducted an echo and immediately sent me to the ICU. The DVT had formed from just below my knee to my ankle. I was given a 20% chance of survival at that point. The next several hours would be crucial. Following the echo, my leg really began to hurt, worse pain I ever felt. I was given lovenox, blood thinners, and demerol. For three days I remained in the ICU and eventually sent home. I remained on warfarin for the next year. A genentic test was conducted with negative results, no heriditary mutation.
Since then, I have deployed to Iraq, flown countless hours to Europe and back, with no problems. Upon my PCS from Northern California to Colorado, I had a small clot, form just below my knee. The doctor said I would remain on coumadin for life since this is my second clot. I guess chances increase to 60% reoccurance if you get a second clot.
Fast forward to today. I get my INR checked weekly/monthly. I am on 22mg of coumadin, apparently I have a strong liver...I tribute it to my alcohol drinking ancestors in Germany :) Anyway, I asked the medical tech whether or not I would be found unfit and placed through an MEB. She stated that usually that is the case, but since my PCM (doctor) is a civilian, that they do not typically start the process.
If and once I do begin the MEB process, what can I expect? My initial DVT/clot, was due to my surgery...malpractice? I know I cannot sue the hospital because it was DoD funded, but was told at the time that I would be compensated upon retirement. I did have a pulmonary embolism and once again a second clot. Now that I am on coumadin for life, I know I am not deployable. So, the MEB is inevitable, I am just trying to get a leg up and be ready for whats to come. I have nearly 13 years in the Air Force. I hear things about VA and retirment percentages, but whats the difference? Do you receive both or just one? Regarding severance packages, I am assuming you have to pay those back? I am not in severe pain, but do feel tightness in my calf every once and awhile. I still conduct myself as normal, I have no physical limitations. Occasionally I do get palpitations in my heart, but was told that this is a normal occurance. Other than not being able to play rugby or football...due to bleeding, I live life as normal. Not sure if altitude is the full contributing factor, but when I due try to run faster than my normal pace, I cannot seem to get that extra breath of air...lung damage from the pulmanary embolism?
Anyway, any advise or information would be helpful.
Thanks much!
 

ANGCapt111

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#8
Will76, I was placed on Coumadin for life, did all the blood test you could possibly have done and went through an MEB. I was just returned to duty 2 weeks ago.

"If and once I do begin the MEB process, what can I expect?"- My MEB started in Jul 12 after all my testing and the recommendation to be on Coumadin for life.

Check out the uploaded documents that i was given during my process, they should answer some questions. The VA Schedule of rating for DVT/pulmonary embolism is 6817. Also, check out AFI48-123, 5.3.7.2.5 (page 37-38 Vascular Disease)

 

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Will76

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#9
Will76, I was placed on Coumadin for life, did all the blood test you could possibly have done and went through an MEB. I was just returned to duty 2 weeks ago.

"If and once I do begin the MEB process, what can I expect?"- My MEB started in Jul 12 after all my testing and the recommendation to be on Coumadin for life.

Check out the uploaded documents that i was given during my process, they should answer some questions. The VA Schedule of rating for DVT/pulmonary embolism is 6817. Also, check out AFI48-123, 5.3.7.2.5 (page 37-38 Vascular Disease)

ANGCapt111,

Great to hear about being returned to duty, but are you still deployable? Don't know if AD and NG have different standards in regards to be fit or unfit for duty?

Thanks for the info, I appreciate it.

Will76
 

ANGCapt111

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#10
I am but the MAJCOM has to buy off on it and have the facilities to check my blood every 2 to 4 weeks. My Doc told me "good luck on getting that approved by anyone".
 

MRT555

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#11
I just got done with my formal board last month. I have Factor V leiden, 1 DVT in left leg, and 1 superficial clot in left calf. They only rate you for what problems the condition caused, not the condition itself. Because of my DVT I have permanante edema (swelling) in my left calf which gives my 20%. I found out later that the rash on my foot is ezcema and I am doing a 1 time VA reconsideration. With the ezcema added in my rating should be getting increased to 40%.

Originally I was 20% and severance. I wanted to fight to stay in, but my lawyer told me the chances are slim to none with me being on coumadin. :( So instead I fought to have one of my other fitting conditions to be identified as unfitting. I was rated 20% for my lower back, and I am in a lot of pain because of it. I told the board how it causes problems in my daily life, I explained to them that because of the fact that I am on coumadin I am not able to take any medications that really help with the pain(NSAIDs, steroids, cortizone shots, traction therapy). I am forced to only be able to take narcotics, I am on a pain contract, and about a month before the board my narcotic dosage was increased.

My back is not as severe at some other people going through an MEB, but because of the reasons I stated above the board agreed with me, and moved my back to an unfitting condition. I am now at 40% and permanent retirement. Hopefully after my VA reconsideration I will be at either 50% or 60% DOD, and I think 60-70% VA.

Long story short, look at what issues the DVT/PE caused, does not being able to take certain medications cause problems for you. Everything needs to be documented, the more the better. Take a good look at the VASRD, try to see if any items apply to you, (stasis pigmentation, ulcers, edema, ect), and once again document, document, document!
 

MRT555

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#12
Also, I was rated under VASRD 7121 for my DVT issues:

7121 Post-phlebitic syndrome of any etiology:

With the following findings attributed to venous disease:
Massive board-like edema with constant pain at rest....................................... 100
Persistent edema or subcutaneous induration, stasis pigmentation or
eczema, and persistent ulceration................................................................. 60
Persistent edema and stasis pigmentation or eczema, with or without
intermittent ulceration................................................................................... 40
Persistent edema, incompletely relieved by elevation of extremity,
with or without beginning stasis pigmentation or eczema............................ 20
Intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by
elevation of extremity or compression hosiery............................................. 10
Asymptomatic palpable or visible varicose veins.................................................. 0

but you will probably be rated under 6817 for the PE. I don't know if they will rate you seperatly for both the DVT and PE.

6817 Pulmonary Vascular Disease:

Primary pulmonary hypertension, or; chronic pulmonary thrombo-
embolism with evidence of pulmonary hypertension, right
ventricular hypertrophy, or cor pulmonale, or; pulmonary
hypertension secondary to other obstructive disease of pulmonary
arteries or veins with evidence of right ventricular hypertrophy or
cor pulmonale.................................................................................................... 100
Chronic pulmonary thromboembolism requiring anticoagulant therapy,
or; following inferior vena cava surgery without evidence of
pulmonary hypertension or right ventricular dysfunction................................... 60
Symptomatic, following resolution of acute pulmonary embolism.......................... 30
Asymptomatic, following resolution of pulmonary thromboembolism...................... 0

Note: Evaluate other residuals following pulmonary embolism under the most appropriate diagnostic code, such as chronic bronchitis (DC 6600) or chronic pleural effusion or fibrosis (DC 6844), but do not combine that evaluation with any of the above evaluations.
 

Rudeboi

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#13
I am new to this site and just been sent to medboard for DVT in my left calf and PE in 3 parts of my lungs. I returned from deployment in August and it was discovered in Oct. They dont know what caused it because i havent had any surgeries but they are saying it is not related to the deployment. I am on xeralto and will be switched to coumadin and they want me on that indefinitely. Also my left calf continues to swell with prolong standing or sitting and i still have shortness of breath with let exercise. I have severe dry skin that has developed on my left ankel where the clot was. I was put on medhold because of my shoulders but was sent to medboard because of dvt/pe but my shoulders was never operated on because i was on blood thinners. Does anyone know if i can get my shoulders added to the medboard package? I am a reservist on active duty and i get a lot of push back because of being a reservist.
 

scoutCC

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#14
As part of the MEB process you will fill out a claim with the VA. With the VA you will note everything you believe is connected with your service. The VA will conduct an exam to determine severity and service connection for ratings.

The MEB uses that exam and the rest of your medical records to determine what conditions meet or fail retention standards. They must consider every condition. You can request an IMR so another doc will look at it if you feel they didn't do things right. You can also submit a rebuttal to provide evidence and/or arguments, generally if you feel additional conditions fail retention standards.

Then the PEB considers the medical and non-medical evidence (commanders statement, etc) to determine what is unfit for service and hence part of the DoD compensation. Every service connected condition will be part of VA compensation.
 

SFSzo

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#15
Thanks you all for the information. II just suffered a PE and I'm currently on xlerto.I will have a meb once I finish all treatments. Also I am AGR 15 years TS and 13 years AD. IfIf anyone has more information it will be greatly valued.
 

Kazhmone

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#16
Thanks you all for the information. II just suffered a PE and I'm currently on xlerto.I will have a meb once I finish all treatments. Also I am AGR 15 years TS and 13 years AD. IfIf anyone has more information it will be greatly valued.
I to am an AGR Soldier going through the MEB, over 20 years active duty, who developed Blood Clots in both legs upper and lower,pulmonary embolism in both lungs and in the abdomen Dec 2014. This is my 2nd reoccurrence getting blood clots in my legs so now I have been ordered by my Dr to remain on Coumadin the rest of my life. I have not returned back to work full time because my legs become so swollen even with the compression garments on in uniform, wearing my boots; sitting or standing. I am still out of breath walking up stairs and distances at work. My legs are sometimes in pain. It has not been easy dealing with getting back into shape again. I have been very depressed and my Unit has not been supportive with my medical conditions or with having to go to the Drs (missing work or not being able to work at all from pain). I have been reading the post concerning the ratings for dvt's, pe and blood disorders ( my referred conditions for MEB board) that people have received 0% or have had to do appeals for these conditions and even found fit. Because of my other medical conditions submitted for rating with the VA (PTSD, anxiety, panic attacks, severe major depression, headaches, sleep apnea, herniated disk, degenerative disk disease, fibromalygia, chronic fatigue syndrome, arthritis from lymes disease) I am still worried about my ratings from DOD and VA, although I'm entitled to my 50% from being over 20 years AD. My question to you SFSzo, is were you not already given a P3 from the Nurse Case MNGR at the RSC to start being medically boarded? I was given a P3 immediately within 1 month of being released out of hospital in Dec. that initiated the MED board? I am in the stage of waiting on VA ratings and the NARSUM. When will you be starting the MEB process?
 
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Kazhmone

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#17
Recieved 0% from VA & DOD for 6817 Pulmonary Vascular Disease (Pulmonary Embolism-PE)

I am writing an update in reference to my ratings concerning my Pulmonary Embolism in both lungs and being on life long Coumadin. Under the VARSD code 7121 for Post phlebitic syndrome, I did receive 20% for each leg that I had the DVTs in.
As you see from my previous post I have numerous other medical conditions listed in my previous post that gave me 100% from the VA and 60% DOD. I just wanted to post this information for others searching for info on PE and DVTs.
 

Allan0320

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#18
I have dvt also mines was just sent up for va rating and army rating. I hoping I get 60 percent on army and 100 on va will keep hall posted
 

Kazhmone

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#19
I have dvt also mines was just sent up for va rating and army rating. I hoping I get 60 percent on army and 100 on va will keep hall posted
Hello Allan0320,
Please keep me posted. I went back through this forum trying to find more people that had this condition as we do. I did not see alot. I am having complications still with my legs swelling. I guess that is why they gave the 20% for each leg under 7121. I feel the rating should have been more for life long anticoagulant condition especially when I'm having to take thinners (6817) for life since this is my second time developing clots within 2 years. Certain jobs will not hire you when you are taking this medication because of the risk. Make sure you got everything documented for that condition.
 

Allan0320

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#20
Roger will do and I will keep you posted am praying for at least 60 percent and 100 on va then am applying for ssdi

Thanks